News 5/20/16

Top News

Theranos cancels or corrects the results of tens of thousands of lab tests it ran in 2014-2015 on its proprietary Edison analyzer. Basically, the company says none of those results can be trusted even though the medical decisions made from them have long since happened.

One doctor who sent a patient to the ED in 2014 because of abnormal lab results recently received a revised report in which the corrected results were actually normal. In addition, an insider says Theranos regularly reported inaccurate coagulation results because it incorrectly programmed its Siemens analyzer.

This admission by Theranos is ample cause for the company’s doors to close even before CMS metes out its likely punishment. The privately held (and therefore minimally transparent) company hyped its technology without medical evidence; claimed as its niche a questionably advantageous (except in pretending to be a high-multiple technology company) finger-stick sampling method that turned out not to work; loaded its board and management team with people who know nothing about healthcare; expended extraordinary effort to avoid participating in the mainstream medical community; advocated that consumers order their own lab tests even though the clinical and financial impact of that practice has not been studied; and now admits to a remarkable level of incompetence in not even being able to correctly program another company’s analyzer. Selling cheaper lab tests isn’t much of a draw (no pun intended) if the results are untrustworthy. Theranos needs to give back the tiny bit of volume it took from Quest and LabCorp and find something less critical for its college dropout founder to pursue while waiting for the inevitable patient class action lawsuits to gather steam.

Reader Comments

From Damascus Sword: “Re: MD Anderson. Encore did the selection, Santa Rosa did the go-live, but whoever ran the implementation (Deloitte, I think) would have been paid fees far exceeding the other two.” Unverified.

HIStalk Announcements and Requests

I’ve figured out how to filter out the 99 percent of political “news” (especially of the emotional Facebook and Twitter variety) that is really just zealots spewing intolerant invective: skip anything that uses a carefully chosen unflattering photo of a political figure or that refers to that person by last name only. I apply similar criteria for scientific or technical articles in which the author pretends to be informative while actually editorializing – I move on immediately if I see the words “fortunately” or “unfortunately.”

Mrs. Boyd says students in her North Carolina class have “taken ownership of their learning and celebrate each other’s success” by using the two Osmo gaming systems we provided in funding her DonorsChoose grant request. Most interesting to me is that she reports — as have other teachers for whom we have provided group learning technology – that it has brought some shy students out of their comfort zone as they participate more actively, which will probably benefit them long after they’ve forgotten the specific lessons.

This week on HIStalk Practice: Keizer Solutions acquires Colonial Valley Software. PatientPop raises a $20 million Series A. The Midwest Independent Physicians Practice Association gets into telemedicine. The Center for Rheumatology’s expansion strategy highlights the tough choices physicians must make to remain independent. Medical Association of Georgia plans to launch private HIE. Consortium of Independent Physician Associations opens for business in Ohio. CityMD CMO David Shih, MD shares the challenges urgent care facilities face when it comes to adopting healthcare IT.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

EHR hosting and support vendor ITelagen acquires competitor Planet Logic.

Onex Corp. again places medical imaging vendor Carestream Health on the market, considering separating its medical imaging and dental imaging business in raising up to $3 billion. The buyout firm acquired Eastman Kodak’s healthcare business for $2.35 billion in 2007 and failed to attract a buyer in 2013 at the $3.5 billion price it sought. The company made $360 million EBIDTA on revenue of $2.1 billion in 2015.

Quality Systems (NextGen) reports Q4 results: revenue flat, adjusted EPS $0.19 vs. $0.21, meeting revenue expectations and beating on earnings. 

Sales

England’s Sandwell and West Birmingham Hospitals NHS Trust chooses Cerner pending financial approval.

Lake Health (OH) chooses Cerner Millennium and HealthIntent, replacing Soarian.

Houston Methodist (TX) selects Phynd to manage and share the data of its 21,000 providers.

Decatur Morgan Hospital (AL) chooses InfoPartners for its Meditech 6.0 to 6.1 upgrade.

People

Stratus Video hires Brad Blakey (CareCloud) as VP of sales and marketing.

Announcements and Implementations

SAP announces its Connected Health ecosystem and its most recently announced partners CancerLinQ, Castlight Health, and Dharma Platform.

Health IT startup Vericred announces availability of API-driven drug formulary datasets for health plans in all 50 states. The API returns information on drug formulary tiers, prior authorization, step therapies, and quantity limits.

InterSystems releases its TrakCare Enterprise laboratory business management system, with initial implementation in two NHS trusts.

Government and Politics

CHIME and the Association for Executives in Healthcare Information Security send comments to a Senate hearing on ransomware, suggesting that Congress remove the HHS restriction on pursuing a national patient identifier (which it says will make health records less attractive to hackers since they won’t have otherwise identifiable information such as SSN) and to “encourage investment through positive incentives for those who demonstrate a minimum level of cyberattack readiness and mature information risk management programs.” I can’t imagine any industry other than healthcare that could keep a straight face while asking Congress to pay its members for keeping their own business information secure.

Privacy and Security

A hacker claiming to be part of the Anonymous group leaks a database from two hospitals in Turkey in retaliation for a previously rumored Turkish hacker’s attack on two US hospitals. Anonymous denies any involvement.

The hackers behind the TeslaCrypt ransomware sunset their product and post the master decryption key on their support site.

Technology

UC Irvine’s medical school posts a video showing the use of smartphone-powered digital health technologies. 

Other

FHIR architect Grahame Grieve says FHIR is being hyped as the solution for interoperability, adding that groups like HL7 can’t impose prescriptive information models or force vendors and providers to standardize processes – it can only provide a common way for them to do it if they’re so inclined. He adds that conforming to FHIR doesn’t accomplish anything unless it’s supported by cultural changes. 

A prenatal imaging clinic in Canada blames a computer virus after it gives a dozen parents-to-be identical ultrasound images that also match the sample image featured on the company’s website.

Australian Computer Society profiles the year-old, non-profit CancerLinQ, an American Society of Clinical Oncology project that is analyzing the information of 1 million US cancer patients to identify treatment patterns and to allow doctors to search symptoms and treatments. Its CEO says that only three percent of cancer patients qualify for clinical trials, but the automated collection of EHR information for the other 97 percent creates a rapid learning system in which any doctor who contributes de-identified information can use the entire database.

Weird News Andy sings happily along to his just-created TV jingle, “Cleaner, Fresher, Softer Arteries!” Scientists find that a sugar that’s the active ingredient in the Febreze air freshener can remove plaque from hardened arteries. WNA cynically notes that the article’s last line should really be its first – the sugar can’t be patented, so drug companies aren’t interested in sponsoring the clinical trials that would allow it to reach the human market.

Sponsor Updates

• Valence Health opens registration for its Further 2016 value-based care conference September 14-16 in Chicago. 
• HDS will exhibit at the Cerner Great Lakes RUG May 31 – June 2 in Chicago.
• Influence Health will exhibit at the Healthcare Marketing & Physician Strategies Summit May 23-25 in Chicago.
• InterSystems will exhibit at the Midas+/Xerox Annual Symposium May 23-25 in Tucson, AZ.
• National Decision Support Company adds support for ACR’s Radiology-TEACHES and R-SCAN initiatives to its platform.
• Frost & Sullivan recognizes Intelligent Medical Object’s medical terminology platform for enabling the clearest patient narrative.
• LiveProcess will exhibit at the Mississippi Preparedness Summit May 24-26 in Biloxi, MS.
• Obix Perinatal Data System will exhibit at the HIMSS Northern Ohio Trade Faire & Conference May 26 in Cleveland.

Blog posts

• Training your affiliate partners: 3 best practices (Nordic)
• How to deal with ransomware attacks—before and after clicking (The Advisory Board Company)
• May 2016-The Healthcare World Shifted on Its Axis and Almost No One Noticed…Yet (PatientSafe Solutions)
• The Top 5 Things You Need to Know about MIPS/MACRA RIGHT NOW! (Impact Advisors)
• Change in Paradigm: Sharing Healthcare Information Outside the Hospital Walls (Hayes Management Consulting)
• Pagers: Fact or Fiction (Spok)
• Ransomware in Healthcare: Where the Stakes are Higher (ID Experts)
• The Top 5 Things You Need to Know About MIPS/MACRA RIGHT NOW! (Impact Advisors)
• What is Integration and How can Providers Benefit? (InstaMed)
• How Does MedData Create a Better Experience for Our Clients’ Patients? (MedData)
• Population Health: a Community Approach (Medecision)
• Financial Metrics Your Routine Should Always Include (Navicure)
• Building stability, breaking the cycle of poverty [Habitat for Humanity] (Nordic)
• Training your affiliate partners: 3 best practices (Nordic)
• SayIt supports Gastroenterologists by capturing the patient narrative (NVoq)
• Medication Failures: the Real Cost (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.

Paging Dr. Facebook

HIStalk looks at how healthcare use of social networks is changing in light of consumer expectations and provider comfort levels.
By @JennHIStalk

The rise of social media usage in healthcare settings has increased over the last several years as the entire industry has moved to a more digital-centric way of doing business. Whether it’s patient portals, online bill pay, way-finding apps, or online appoint check-in, patients — and providers, to some degree — have become used to conducting the business of healthcare via convenient, easily accessible, Web-based tools.

While patients in the US may never log in to patient portals with Facebook credentials, their providers are inching their way ever closer to incorporating social networking tools into relationship-building aspects of care.

Twitter Consults Take Off

Will social networks ever be used as bona fide care tools? With HIPAA’s tight hold on patient data and the love/hate relationship consumers have with privacy, the role of said networks as diagnostic tools remains a pipe dream at best. Not so in India, however, where Practo has added Twitter-based healthcare consults to its ecosystem of digital tools for providers and patients.

The startup, which claims to be Asia’s number one physician search engine, launched the @AskPracto Twitter account in early April, giving users in India, the Philippines, and Singapore the ability to tweet their health questions to the handle and receive responses back from Practo-affiliated physicians in near real time.

“We are excited about our partnership with Practo, as this addresses a fundamental need for users and opens up the benefit of real-time healthcare information access to millions of users,” said Ravi Bhaskaran, Twitter’s head of business development for India and South Asia, leading up to the launch.

Bhaskaran’s comment highlights the need for Web-based tools that make it easier for people to access care. With a population of over 1.25 billion, India has more Internet users than the US has people. Healthcare access, especially in rural areas, is — at the risk of understating a nationwide problem — a challenge for those looking to connect with physicians at brick-and-mortar facilities. Thus, mobile, Web-based communication tools seem like the go-to answer for issues of access and provider availability.

“We believe that healthcare issues can be addressed and awareness can be raised by social networks like Twitter,” says Practo Assistant Vice President of Marketing Varun Dubey. “With this partnership, we are making it super easy for people to get access to healthcare information right from Twitter. This collaboration will enable millions of consumers to get quick access to relevant healthcare information and make better, more informed decisions about their health.”

Response to the collaboration has been overwhelmingly positive. “We saw impressive traction on the first day of the campaign,” says Dubey, “with over 5,000 questions being tweeted by consumers with answers sent from @AskPracto. More than 8 million people have participated so far on the social media platform, and this number is growing every day. We’ve actually received questions from many more countries including the US, Australia, and even parts of Africa and Latin America.”

Such collaborations may offer citizens in less developed countries an easy, albeit extremely high-level, answer to issues of access. Their ability to succeed in the US remains doubtful, especially when it comes to the inevitable questions of privacy and physician reimbursement. Dubey is quick to note that Practo takes patient privacy “extremely seriously. Consumers can always come straight to Practo Consult and ask their questions anonymously.”

He is slightly more evasive when it comes to how Practo physicians are reimbursed for their time on Twitter, moving the conversation back to the company’s proprietary physician-patient consulting platform. “All healthcare specialists on the Practo Consult platform respond to questions in order to generate more awareness and enable consumers to make more informed decisions about their health,” he explains. “This in turn helps them build their value as a qualified, experienced, and trusted doctor. If you think about it, a patient who gets the right answer on Practo Consult from a verified doctor will trust that doctor and is likely to visit him or her in the future for any healthcare problem that needs to be assessed in person.”

While the @AskPracto handle is likely part of a larger marketing push to drive users to the company’s private consulting platform, it can’t be denied that opening up healthcare expertise by way of social media will likely offer underserved patients an easy, affordable way to have their high-level healthcare questions answered.

Messaging Apps Make Provider Wish Lists

The concept of healthcare diagnoses via social media seems to be taking a different turn here in the US, with secure messaging apps piquing the most provider interest and vendors responding accordingly. Remote consulting startup HealthTap launched its service via Facebook’s Messenger app last month, offering users the ability to submit questions and receive answers from the company’s physicians covering 141 specialties.

“HealthTap is a really cool platform,” says Piedmont Healthcare (GA) Chief Consumer Officer Matt Gove, “and them getting into Messenger makes all the sense in the world. But when you’re a healthcare provider, you have a different cost structure. We have a different way of interacting with people. We have a different goal in terms of increasing the health of our communities and building long-term relationships with individuals. It’s a bit different than the app that allows you to quickly ask a question and keep moving.”

“We’re certainly interested in how to use digital technology to provide alternative models of care,” he adds, “but I haven’t seen the use of social networks to diagnose people. Where I am most excited is not doing it inside social networks, but doing it inside messaging apps. That’s what has the most potential – inside Facebook Messenger where you can have a secure conversation with people about their medical issues.”

“We occasionally use messenger apps to engage with folks about their specific experience with us,” Gove continues. “It’s not as much about the clinical side as it is about the experience side. To be fair, in many ways, I think the customer’s perception of quality is really about the experience they have with us. The average person doesn’t understand clinical quality, but they do understand if you smile and say hello and ask them if they need something. Did you provide them with an easy to understand bill? That’s where the experience breaks down for most people. It’s not in the direct interaction with the caregiver. That’s where we’ve been focusing on — how to better use secure messaging apps to have conversations with people.”

Gove adds that a HealthTap-type messenger app would be nice to have, but it’s not likely to happen until the service is seen as more than a novelty, a sentiment based on Piedmont’s rollout of virtual visits. “We’re getting extraordinarily good reception for it,” he explains. “There’s a hurdle to get people over the novelty piece and see this as just as good as what they’re used to. I would put HealthTap getting into Messenger into that same category. I think messenger apps are an important part of the future. We are not there yet, and if Piedmont isn’t there yet, there won’t be many systems that are.”

The Future Role of Social

Gove, who has gained a well-earned reputation for pushing the boundaries of social media marketing within healthcare organizations like Piedmont and Grady Health System (GA), continues to look for innovative ways to use social media within the healthcare setting. Looking ahead, he hopes to get a better handle on using the social networks that have the most user traction and growth.

“I’ve yet to meet a health system that does Snapchat very well,” he says. “Most of my colleagues describe it as a cesspool. That may or may not be correct. It certainly made me laugh when they said it. It reinforces the fact that Facebook will always be a very powerful place for us to be. Twitter isn’t there and isn’t going to get there. Instagram is okay, but I don’t see it evolving to something that becomes a great tool for engagement. I think you’ve got to look at where people are aggregating and excited and engaged right now and figure out how to best leverage that.”

For now and the foreseeable future, provider use of social media seems to be about building relationships with patients and prospective customers. Gove believes that health systems are just getting to the point where they can use social media in an effective way to have conversations and build those relationships. Making the leap to using Twitter as a clinical tool is not in their near futures.

“I think most providers are looking at social as a way to maintain relationships, which again gets into the messenger space,” he says. “Facebook is their mobile strategy. There’s no denying that as everybody continues to get on Facebook, and as the average age of the Facebook user trends older, that something else takes its place on the young end. Don’t forget that so many of the patients that we need to maintain relationships with everyday are older. Them getting on Facebook is a wonderful thing.”

News 5/18/16

Top News

The VA says it will have its Enterprise Health Management Platform (EHMP) running by the end of summer. It’s a graphical front end for VistA that I’m guessing is the Facebook- and Google-like “prototype” that was mentioned a couple of months ago.

VA Chief Information Strategy Officer David Waltman said during a demonstration that, “The interoperability between the VA and the [DOD] record system exceeds any electronic health record systems that are anywhere in the non-government environment.” EHMP builds on previous development work for the VA-DoD Joint Legacy Viewer and will replace CPRS as part of the VistA Evolution program.

The VA has released a software development kit for the open source EHMP, hoping that companies will extend or commercialize it.

Reader Comments

From Dutch Loaf: “Re: ransomware webinar. That had to be the best-attended of those you have had and it was very useful.” John Gomez’s ransomware webinar was indeed excellent, and while it did very well with 115 live attendees and 700 YouTube views afterward so far, the leader is still Vince and Frank’s November 2014 “Cerner Takeover of Siemens, Are You Ready?,” the YouTube recording of which has been viewed an astounding 7,750 times.

From Boots on the Ground: “Re: MD Anderson’s Epic project. The reader comment referring to Encore Health Resources should have noted that Santa Rosa Consulting ran the successful  go-live, providing 1,100 associates in the largest, single-sourced go-live.” Verified. Encore got a $50 million contract for selection and other services, as the reader pointed out, but Santa Rosa ran the go-live.

HIStalk Announcements and Requests

I was interviewing Hayes Management Consulting President and CEO Pete Butler the other day when he mentioned how long he has been reading HIStalk, going back to his days as the company’s western region director when he recommend to founder Paul Hayes that they sponsor. I checked my old emails and can thank Hayes Management Consulting for supporting my work for 10 years – they signed up in July 2006. Which also reminds me that HIStalk itself turns 13 years old on June 3, entering that awkward, insufferable teenager phase.

Ms. Stuckeman from Texas reports that her after-school science and math club “embarked on a journey of exploration and invention” when they received the machine-building kits we provided in funding her DonorsChoose grant request. She adds, “They were so excited to have these shiny new building materials. Students came across problems and had to solve them. This made them stronger as it challenged them to think critically through trial and error. Team members rejoiced with confidence as they were proud of what they had accomplished.”

Listening: hard horror punk rock from Wednesday 13, which sounds like Alice Cooper mixed with Iron Maiden and Dixie Dead. The band is really just Joseph Poole from North Carolina’s barbeque capital of Lexington along with some backing musicians in tribute to 1980s horror films.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Financial Times has fun with the rock concert / party rally launch of the Siemens Healthineers name, calling it “a writhing, Spandex-clad horror” and noting that at the end, “A few arms were raised bearing phones to capture what was possibly the most embarrassing corporate rebranding event ever.” The article notes that the launch violated three rules:

• Don’t try to put your corporate values to music since that always creates mass humiliation.
• Don’t create eye-rolling names by cutting and pasting parts of other words.
• Claiming to be one team with one dream doesn’t make it so. It just makes you look stupid.

Healthcare-only technology and consulting firm CitiusTech will hire up to 1,200 new employees this fiscal year, increasing its headcount by nearly 50 percent. CEO Rizwan Koita says the company is hunting for acquisitions.

Decisio Health launches its FDA-cleared Decisio Clinical Intelligence Platform, which formats patient monitor information into an electronic triage system, and closes a $4.5 million second round of funding.

Pharmacy software vendor Rx30 acquires competitor Lagniappe Pharmacy Services.

Experian Health signs 276 new deals and 479 existing client contracts in Q4.

People

The Indiana HIE hires Valita Fredland, JD (Indiana University Health) as VP, general counsel, and privacy officer.

Jason Griffin (Encore, A Quintiles Company) joins Orchestrate Healthcare as AVP South.

Parallon Technology Solutions names Charles Bell, DO, RPh (HCA) as chief medical officer.

Mercy Health (OH) hires Jeff Carr (Cintrifuse) as its first chief innovation officer.

Announcements and Implementations

PokitDok releases its Pharmacy Benefits Solution, a set of three APIs (pharmacy plan, pharmacy formulary, and in-net work pharmacy) that allow EHR users to check a member’s prescription insurance and send prescriptions to in-network pharmacies.

American Well creates an online marketplace that will allow its customers to exchange services, such as providers who can create and market condition-specific telehealth programs to insurance companies and employers. Consumers seeking telehealth services can choose doctors from provider organizations that market their services.

DSS will incorporate First Databank’s medication reconciliation and e-prescribing solutions in its open source EHR.

Government and Politics

The Missouri Health Connection HIE supports the governor’s veto of funding that would have helped the state’s Department of Social Services connect to it. MHC says unnamed special interests (Cerner?) “are working to hinder and fragment the adoption of HIE in Missouri.” MHC claims the proposed budget would have prevented hospitals from freely choosing an HIE and would have forced MHC to share patient information with competitors without having privacy and cost structures in place. The counterpoint might be that federally funded MHC wanted to connect with DSS and then charge competing HIEs for connecting to it. The governor said he vetoed the line item funding because it would have allowed some providers to participate without paying. Missouri HIEs have been fighting for control for years. Perhaps ONC should launch its data blocking investigations in Missouri, starting with organizations that have received HHS/CMS/ONC grant funding specifically to facilitate data exchange.

FTC Chair Edith Ramirez says she’s worried about hospital mergers that are creating expensive health system monopolies, adding that competition is also vital for maintaining hospital quality. The president of the American Hospital Association disagrees, saying the creation of a modern healthcare system requires such mergers.

The state of Arizona spent millions (it isn’t sure exactly how many) to develop a tissue and organ specimen database that has been abandoned. The system was used by only three hospitals and did not have a sustainable business model, leading to its shutdown in September 2014. Hospitals are trying to resurrect the system, hoping to rebuild it using a different contractor since the original one has since left the state. That company’s founder says the real challenge is that hospitals don’t necessarily want to share their research information in a competitive environment. It’s a lot like hospitals not willing to financially support HIEs or share their information on them.

The National Cancer Institute solicits research ideas for the National Cancer Moonshot Initiative, with already-submitted ideas being publicly visible on the site. 

Privacy and Security

Dekalb Health (IN) says a ransomware attack last week forced it to take its systems down, transfer patients out, and initiate ambulance diversion. The health system did not say in the announcement whether it paid the ransom demanded.

The government of Kuwait will require all citizens and visitors to undergo DNA testing to create a national database for use in criminal cases and paternity claims. Visitor samples will be taken upon arrival at Kuwait International Airport.

Technology

A Florida business paper profiles Medical Tracking Solutions, which offers medical device companies a supply chain system for tracking the devices they stock on consignment in hospitals. The COO says the system replaces “really old school” hospital methods that involve forms that are hand-filled and faxed.

Other

Cerner help desk employees file a class action lawsuit against the company, claiming they were expected to work at least 48 hours per week without being paid overtime because their positions were misclassified as exempt. Four other overtime lawsuits are pending against Cerner.

A Navicure survey of 300 provider executives finds that the most significant patient payment challenges are patients who can’t pay, the need to educate patients about their financial responsibility, and patients who don’t pay on time. Patient payments make up a significant portion of revenue for most organizations, with one-fourth of respondents saying it’s 31 percent or greater. The majority of respondents acknowledge that they don’t store patient credit card information, send electronic statements, or offer automated payment plans.

Patients of a Virginia lab company that was acquired by a competitor following its bankruptcy filing to settle kickback charges are being sent bills for tests done as far back as 2009. Bankruptcy lawyers for former high-flyer Health Diagnostic Laboratory, which had $375 million in revenue in 2013, were ordered by the court to try to collect its $50 million in unpaid bills to pay off its remaining debt. The competitor who bought the company is receiving complaints and threats about the collection practices even though it didn’t buy the overdue accounts along with the business and thus isn’t involved with the collection efforts. 

The Boston Globe reports EHR employee complaints at Partners Healthcare (MA), whose $1.2 billion Epic project is the largest ever undertaken by Partners. A maternity nurse says she speaks for others like her in complaining that the system has come between her and her patients, calling it “tedious, labor intensive, and you feel like you can’t do what you want to do.” One doctor, annoyed at having to work at a wall-attached monitor with her back to her patients, retired early. On the other hand, the article is hardly a shining example of thorough investigative reporting, with the newspaper chatting with just 24 of 68,000 Partners employees. One might also note that the “you can’t do what you want to do” comment is exactly why hospitals implement EHRs.

Weird News Andy says a man was “saved by the pizza.” Employees of a Domino’s Pizza in Oregon become concerned when a customer who has ordered delivery almost every day for seven years fails to place an order for 11 days. They sent a delivery driver to check on him, but the man didn’t answer the door or answer his phone. The driver called 911 and deputies found him on the floor suffering from an apparent stroke. He’s in stable condition.

Sponsor Updates

• Impact Advisors posts a white paper, “The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways.”
• LogicStream posts a recording of its webinar, “Reduce CAUTI Through Clinical Process Measurement.”
• AirStrip CEO Alan Portela will speak at the Medical World Americas conference May 19 in Houston.
• Nordic kicks off its Community Giveback Week.
• CultofMac.com highlights AirWatch BYOD technology.
• NCQA awards Aprima with PCMH Pre-Validation status.
• Clockwise.MD will exhibit at the Pediatric Urgent Care Conference June 1-3 in New York City.
• RN FM Radio will feature Bernoulli CNO Jeanne Venella, RN May 18 at 3pm ET.
• The Boston Globe features BIDMC’s use of Clockwise.MD’s online appointment reservation service. 
• Divurgent donates $5,000 to Dell Children’s Medical Center of Central Texas during its annual retreat.
• Bloomberg profiles GE Healthcare CEO John Flannery.
• ClinicalWorks will exhibit at the 2016 annual meeting of the California Orthopedic Association May 19-21 in Dana Point, CA.
• Extension Healthcare will exhibit at the AAMI Conference & Expo June 3-6 in Tampa, FL.
• Healthwise will exhibit at the Cognizant / Trizetto User Group Meeting May 22-25 in Palm Desert, CA.

Blog Posts

• How Will Your Organization See the Value of Patient-Generated Health Data? (Iatric Systems)
• Data Re-Use – Usability, Patient Safety, and Organizational Policy (AdvancedMD)
• Empowering Your Care Team (Arcadia Healthcare Solutions)
• Persistent Data Stewardship (Forward Health Group)
• Joint Commission Allows Secure Texting (Catalyze)
• What you should know about United States House of Representatives v. Burwell (Besler Consulting)
• Encore for National Nurses Week: Second generation RN shares her story (CapsuleTech)
• From Disbelief to Dawning Reality: The Four-Stage Journey Providers Took Toward Embracing Code 99490 (CareSync)
• Early Synopsis for MACRA Proposed Final Rule (CitiusTech)
• Gen Z in HIT Part II (Direct Consulting Associates)
• Transforming Your Care Model? Don’t Forget the Physicians (ECG Management Consultants)
• MACRA Proposed Ruling: Medicare Quality Payment Program (Galen Healthcare Solutions)
• Why You Need a Data Analytics Plan and How to Get Started (Hayes Management Consultants)
• Plagued by Performance Problems? (HCTec Partners)
• Epic EMR Training: A Guide for the Epic Training Director (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.

Monday Morning Update 5/16/16

Top News

John Halamka revisits his criticism of the proposed MACRA requirements, specifically suggesting that HHS focus on rewarding three specialty-specific outcomes at a time, allowing each specialty to choose those three outcomes and giving doctors free rein to use whatever technology they need to achieve them.

Halamka also suggests limiting EHR certification to basic care coordination interoperability functions:

• Sending a summary of care to a recipient listed in a national provider directory.
• Querying a record locator service and retrieving a common data set.
• Sending a care summary to a patient-provided address.
• Populating a relevant registry.
• Interacting with a prescription drug monitoring program.

Reader Comments

From Mister F: “Re: MD Anderson / Encore’s $50 million contract. Trace the relationships of current MDACC leadership > Encore leadership > Healthlink. It’s fraternity-based procurement behavior. If someone had the time to create the map of Healthlink alums in provider leadership roles, those in services (vendor) roles, and the subsequent contract awards, it would look pretty interesting.”

From Mark: “Re: Qardio’s real-time blood pressure and scale monitor that was just launched. Do MDs really want this ‘continuous’ information? Is this a billable service? How will MDs replace lost income with fewer patient visits?” Technology companies anxious to get a foothold in the lucrative healthcare market often confuse their limited sensor and analytics capabilities with what will work in real life to improve oucomes. Doctors don’t have the time or interest to monitor a patient’s self-measured vital signs, which have minimal diagnostic or therapeutic value (ask any nurse how often they ignore inpatient vital signs monitors without clinical consequence). It’s a situation similar to companies convinced that the biggest problem in medicine is lack of accurate diagnosis and offer technology to assist where assistance usually isn’t needed, not to mention that diagnosing from data alone ignores that art of medicine. It’s rarely healthcare professionals that come up with these ideas, and when it is, they’re usually ignoring the practical practice of medicine hoping nobody will notice and buy their product anyway.

HIStalk Announcements and Requests

Poll respondents say it’s the federal government and doctors themselves who are most responsible for physician dissatisfaction. Some respondent thoughts:

• Ann Farrell says MACRA is crazily complex, but adds that doctors have been self-centered for decades in denying their quality statistics and failing to lead the charge on patient safety. She welcomes income-focused doctors to the world in which RNs and other employed professionals live — KPI games, stagnant wages, job loss, unrealistic productivity goals, and dwindling respect.
• Frank Poggio says doctors have been their own worse enemy since the start of Medicare, first fighting the concept but then jumping on the bandwagon when Part B was introduced, making many specialty doctors millionaires but not helping PCP who found that, “When you go to the bed with the devil, you wake up in hell.” He adds that doctors have an image problem both with patients and with payers because of the way they practice.
• Meltoots (who is a doctor) says the profession may be seen as whiny, but physicians are being beaten senseless with constantly changing regulations, fighting with insurance companies, patients who can’t pay their large deductibles, board certification headaches, and RAC audits. He says everybody should be paying attention if it’s so bad that John Halamka is on the ropes. He or she adds, “It takes 14 years of training just to make a fresh new me and another 17 of practice experience that is truly invaluable to my abilities as a surgeon. With my low costs and my quality numbers, CMS and ONC should be begging me to stay on board and not be penalizing me 2 percent because I cannot do MU. And with MACRA, it looks like they want to ratchet me down 9 percent. Look at my costs per patient, co-morbidities, and readmit rate and tell me I’m a bad deal for CMS. No chance.”

New poll to your right or here: would you recommend the hospital or medical practice where you had your most recent medical experience as a patient? Overachievers are welcome to click the Comments link on the poll after voting to explain.

I’m annoyed that Yelp, Tripadvisor, and LinkedIn are forcing website readers on mobile devices to open their proprietary app to continue reading. Not only do I resent being forced into their walled gardens, they often launch the App Store instead of handing off smoothly to their app that I’ve already installed.

Ms. Hardy and her Pennsylvania class of 18 elementary school students are “incredibly grateful” for the document camera, dry erase lapboards, and computer speakers we provided in funding her DonorsChoose grant request. She has students show their math answers on the whiteboard so she can easily see which ones need extra help. She reports that the document camera makes the students more eager to share their work  and allows the visual learners to see lessons and materials modeled for them in their preferred learning style.

Last Week’s Most Interesting News

• Theranos shuffles its board and its president steps down.
• MD Anderson attributes its $160 million year-over-year drop in net income to its Epic implementation.
• NantHealth files for an initial public offering.
• McKesson loses a Horizon hospital to Cerner and a 14-hospital Star and Horizon group to Epic.
• HHS Secretary Burwell acknowledges to the ACP that Meaningful Use has been “burdensome” and “inflexible” for doctors and reinforces HHS’s interoperability agenda.
• ProPublic’s online narcotics prescribing database that was intended to call out questionable prescribers has the unintended consequence of being used to identify those prescribers by drug-seekers.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Sales

Doctors Community Hospital (MD) chooses the Summit Express Connect interface engine to manage all EHR connections.

Lincoln Surgical Hospital (NE) selects Access Passport for Web-based electronic forms integrated with Meditech.

Announcements and Implementations

ZeOmega releases Clinical Assessment Protocols for its Jiva population health management platform.

Penn State Health (PA) signs up for virtual ICU monitoring from Mercy Virtual.

Privacy and Security

The creator of the Tor anonymous Web browser (which powers the “dark Web” hacker haven) warns that medical identity theft is fast becoming the primary form of identity theft. He mentions that an unnamed healthcare organization is developing anonymous online drug tests, health services, health chat, and research questionnaires. He defends anonymous browsing as being similar to encryption in initially being used by people trying to hide something, but eventually becoming mandatory for secure, Web-powered commerce.

Children’s National Health System (DC) warns that its outsourced transcription provider, Ascend Healthcare Systems, misconfigured a server and thus allowed access by FTP to the information of 4,000 patients over a one-week period in February 2016. The health system stopped doing business with Ascend in mid-2014 and notes that Ascend failed to meet its contractual obligation to delete its data.

New Scientist magazine, which exposed England’s NHS data sharing agreement with Google two weeks ago, finds that neither Google nor the Royal Free London NHS Foundation Trust have requested ethical approval. It also notes that Google’s recently acquired DeepMind app has not been registered as a medical device. Royal Free defends sending Google the fully identifiable information of 1.6 million patients each year, saying that patients give their implied consent when their information is used by IT companies related to direct patient care.

Technology

Entrepreneur profiles India-based ICliniq, which offers an online doctor consultation app that uses a bot running on the WhatsApp-like messaging program Telegram. The company also offers a standard Android version.

A LinkedIn article by Cyrus Maaghul describes out-of-hospital use cases for blockchain technology that include tracking drug development, clinical credentialing, population heath data analysis, insurance risk pooling, telemedicine, and remote device monitoring. He’s head of product and technology for Phoenix-based PointNurse, which offers virtual visits with nurses for patient navigation, referral, consultations, disease management, and remote monitoring.

A Memphis man’s LifeVest wearable heart monitor and defibrillator saves his life when his heart stops beating in his sleep. The device has a 98 percent first-shock success rate for patients at risk for sudden cardiac arrest. The device first earned FDA approval in 2001, although I don’t recall hearing about it until now.

Other

Scripps Health’s Q2 financial report shows that its Epic project will cost $309 million in capital and $361 million in 10-year operating cost, although it expects to save $211 million of that by retiring applications that Epic will replace.

The New York Times notes that people who buy medical insurance via Healthcare.gov or state exchanges are often treated as second-class citizens even though their policies are issued by the same big insurers as employer-provided plans. Many providers don’t accept exchange-issued policies, provider networks are narrower and geographically limited, and some policies offer no out-of-network coverage at any price. The article notes that exchange-issued policies often omit high-priced providers that have local clout to set high prices, such as Memorial Sloan Kettering being left out of every exchange-sold plan even though New York employers would not find that acceptable for their employees. The article also observes that many of the doctors listed in insurance company directories aren’t accepting new patients even though federal law requires insurance companies to keep their provider directories current.

Direct-to-consumer teledermatology websites made a lot of mistakes when diagnosing and treating fake patients. In 62 encounters with 16 websites:

• None of the doctors asked for the patient’s ID.
• Two-thirds of the sites assigned a doctor without giving the patient a choice, mostly without disclosing the doctor’s licensure status. Some of them used offshore doctors who aren’t licensed in California where the study was performed.
• Only one-fourth of the doctors asked who the patient’s PCP was, and only 10 percent offered to send them records.
• Patients were rarely offered warnings about the risks of the drugs prescribed during the encounter.
• Clinicians diagnosed correctly most of the time when shown a photo in which the condition was obvious, but failed to ask good questions otherwise.
• The doctors missed significant diagnoses such as secondary syphilis and gram-negative folliculitis.
• The treatments ordered didn’t always follow guidelines.

The study’s authors note, however, that those same doctors might have performed equally poorly during in-person sessions, so maybe it’s not teledermatology itself that’s the problem. They suggest that while direct-to-consumer medicine can be be effective, the clinicians should be part of the practice or health system the patient already uses rather than randomly selected contractors of third-party sites.

UPMC reports that it paid six of its executives at least $2 million in its most recent fiscal year, including $6.43 million to President and CEO Jeffrey Romoff. CIO Dan Drawbaugh made $1.57 million.

TV consumer reporter John Stossel complained about poor customer service while he was hospitalized for lung cancer, but now he offers his solution: high-deductible insurance that forces consumers to shop carefully. Maybe he missed the recent research that found that what actually happens is that people just skip getting care rather than shopping more carefully for it. He also takes a logical leap in assuming that people paying more out of their own pockets will create an environment he describes as: “When patients shop, doctors strive to please patients rather than distant bureaucrats. More doctors give out their email addresses and cellphone numbers, and shorten waiting times. Their bills are easier to read because the providers want customers to pay them!” A lot of Americans now have high-deductible plans, so he as an investigative reporter should be able to fund examples where his idea has actually worked.

Sixteen VPs/SVPs of Wheaton Franciscan Healthcare will lose their jobs in its merger with Ascension Health, among them SVP/CIO Greg Smith.

The family of comedian Joan Rivers settles the medical malpractice lawsuit they brought against the New York city clinic where she died during a routine endoscopy. The suit claimed that the gastroenterologist performed a laryngoscopy despite the concerns of the anesthesiologist, while a CMS investigation found that the clinic failed to keep proper medication records, didn’t record the patient’s weight, failed to obtain informed consent, and allowed staff to take selfies with Rivers before she died.

Vince and Susan move along with their 2016 vendor review, covering small vendors in Part 4.

Weird News Andy says this man’s heart’s in the right place, even if it’s the wrong place. A patient’s complaint of right-side chest pain radiating to his right shoulder is found to have situs inversus, a rare condition in which all of the major visceral organs are on the opposite side of normal.

Sponsor Updates

• Huron Consulting Group employees lead nearly 100 events during its annual day of service.
• ESD offers a discount on automated testing solutions to CHIME members.
• T-System will exhibit at the MIHIMA 2016 Annual Meeting May 18-20 Bay City, MI.
• Talksoft is chosen as Greenway’s Intergy Partner of the Month.
• Visage Imaging will exhibit at ACR 2016 May 16-17 in Washington, DC.
• Zynx Health announces the winners of its 2016 Clinical Improvement Through Evidence Award.
• Experian Health and PatientMatters will exhibit at the HFMA Florida Spring Conference May 15-18 in St. Petersburg, FL.
• Red Hat announces the agenda and keynote speakers for Red Hat Summit 2016, June 27-30 in San Francisco.
• The SSI Group will exhibit at the Rural Hospital Alliance of Mississippi meeting May 18-20 in Orange Beach, AL.
• Streamline Health will exhibit at the 2016 Michigan HIMA Annual Meeting May 18-20 in Bay City, MI.

Blog Posts

• National Nurses Week 2016 (TeleTracking)
• Adding a mobile ultrasound program … but how? (UltraLinq)
• The Financial Impact of 2017 Medicare Advantage Payment Rules (Verisk Health)
• The Sweetest Match: Clinical and Coding Professionals (VitalWare)
• Patient safety requires close collaboration. (Voalte)
• On Death’s Door: My Patient Experience (Xerox Healthcare)
• GPS for Corporate Wellbeing ROI (West Corp.)
• Don’t Just Manage Denials; Prevent Them (ZirMed)
• 2016 Nurses Week – Culture of Safety: It starts with You (PatientSafe Solutions)
• Change Management: the Secret Ingredient in Successful Implementations (Sagacious Consultants)
• Say Thank You to a Labor Nurse (PeriGen)
• Survey Finds Healthcare Executives Credit IT with Improving Care (Phynd Technologies)
• The Beat Goes On: Medicare’s Newest Acronyms, MACRA, QPP, MIPS, and APMS (PMD)
• Combating Medical Errors with Interoperability (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.

News 5/13/16

Top News

Theranos President and COO Sunny Balwani will retire, which Theranos says is part of a broader reorganization that involves creating three new positions – chief medical officer, head of research, and COO. The company has also added three board members, two of whom were already on the board until Theranos replaced them in a hasty October 2015 reaction to media coverage questioning its technology claims and a CMS investigation of its clinical practices.

Balwani was a technology executive with no medical or science experience when he was put in charge of the company’s California lab in 2009, which CMS later cited as posing “immediate jeopardy” to patients.

Reader Comments

From Frank Poggio: “Re: HHS challenge to design a simpler patient bill. This is the height of hypocrisy. Does CMS think providers on their own created the insane billing requirements and processes? It started with Medicare Part A, then B, then D. Co-payments, deductibles, out of network, referral approvals, contractual allowances, UC charges, and on and on. Next, billing systems will have to deal with VBP, P4P, bundled payments, MACRs, and more. Providers never asked or suggested any of these — they just have to figure out how to carve up charges /costs and services and put it all on a one-page bill. A 1995 analysis found that the Federal Register contains 11,000 pages dealing with an IRS 1040 submission, but hospital billing required 55,000 pages to describe. If CMS really wants to simplify the patient bill, they need to go to a single-payer system. Until they do that (not likely), the patient bill will continue to be the mess it has been for the last 50 years. Who do I call to collect my $5k?” I had the same reaction. Not only is billing too complicated for even providers and payers (much less patients) to understand, the bill is constantly amended over months as the parties involved negotiate who will pay what. It’s absurd to think that patients will assume financial responsibility when nobody can tell them what they owe at the time they owe it, not even accounting for the fact that bills are full of errors and questionable practices that patients aren’t equipped to analyze and report no matter how well presented the information might be. In comparison, IRS forms and tax policies are a consumer-friendly delight.

From Wonky Warrior: “Re: George Washington Medical. Appears to be switching back to Allscripts from Epic at six of their sites.” Unverified, although a recruiter’s email sent my way says that six recently acquired sites (four urgent care centers and two OB/GYN practices) were on different EHRs, they moved to Epic, and now they’re going back to Allscripts EMR, which is what the medical faculty plan uses. 

From Jenson: “Re: MD Anderson. Encore did indeed run the selection process. It’s a great business model – Encore runs the procurement, chooses the vendor that requires the most third-party integration support (Epic), and then gets nearly $50 million to support the Epic project. I would pick Epic every time.” The internal document is here. The same regent’s meeting agenda from late 2013 also included a nearly $5 million contract with Cognizant for ICD-10 implementation services.

From Pithy Patti: “Re: MACRA. HHS is out of touch if it expects providers to understand 962 pages of legislation.” Here’s an important point that a lot of self-proclaimed experts are missing: nobody expects providers to individually read and understand those 962 pages. We all follow a lot of laws and rules that are mired in endless pages of legalese somewhere in the government, but that doesn’t mean we’re expected to read and interpret those documents on our own. The government’s job is to pass laws that pass legal muster and convey legislative intent, not to create breezy, easily digested summaries of what they mean so that laypeople can use the Congressional Record as their personal policy manual. That’s a job for non-government experts (consultants and associations, for example) who turn those dense documents into rules their constituencies can follow, just like they do for payment rules that providers follow. The Affordable Care Act had a couple of thousand pages that nobody read (including the politicians who voted for or against it), but it has spawned dozens of thousands of pages of regulations that spell out the specifics.

From Kellan Ashby: “Re: Siemens Healthineers video on YouTube. It’s been pulled. Siemens Embarrassedineers?” Fear not – someone reposted a copy of the corporate atrocity-filled video. Sing and air-guitar with me, “Oho, oho …” Just in case it accidentally gets removed from YouTube again, I’ve downloaded a copy.

HIStalk Announcements and Requests

Ms. Mills from Texas says the electric circuit kits we provided in funding her DonorsChoose grant request have had a great impact on her fifth graders, who have gained confidence in progressing from the easy projects to those that required all the kit’s parts.

I had an appointment with a new doctor this week, having taken the first available slot (mid-May) when I made the appointment (early January). I was encouraged when the practice sent me a link to its Practice Fusion portal to provide basic information. I arrived 30 minutes early to complete the inevitable pile of paperwork, which was just as I expected (entering my name and date of birth maybe a dozen times on a clipboard full of forms for medical history, insurance, notice of privacy practices, release of information, and so on). I returned the forms and waited for 15 minutes before I was called to the desk, only to be told that the doctor was out sick for the day (which they didn’t mention when I checked in) and that I should have received a call the previous to reschedule (they had transposed the digits of my phone number). The next available appointment was three more weeks out. I’m not sure which worries me more, the inefficiency of the staff or the fact that they use a free EHR and lots of paper to run the practice. We’ll see how it turns out.

This Week on HIStalk Practice: St. Thomas East End Medical Center goes live on Greenway. ReGroup Therapy raises $1.8 million for virtual mental health consults. Pediatric Medical Associates makes the leap to electronic records. British researchers take the first steps in developing a diagnostic video game. Retailers rate their top challenges when it comes to jumping into healthcare. Healthix President and CEO Tom Check offers insight into the challenges of bringing physician practices into the HIE fold.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Teladoc reports Q1 results: revenue up 63 percent, EPS –$0.40 vs. –$5.87, meeting revenue expectations but falling short on earnings. The company reported big increases in telemedicine visits and membership and touted high satisfaction rates, with President and CEO Jason Gorevic saying in the earnings call that telehealth has a higher barrier to entry than many people believe and that its competitors are stumbling in trying to achieve scale. The company spent an unbudgeted $1 million in legal expenses, including $700,000 in its fight with the Texas Medical Board, and will spend another $4 million in legal fees in the remainder of 2016. Teladoc expects to lose around $42 million in the fiscal year. TDOC shares are down 40 percent since their June 2015 IPO, valuing the company at $440 million.

The 14-year-old CEO of a company that sells first-aid vending machines claims he turned down a $30 million acquisition offer from an unnamed healthcare company. He started the company last year after winning a business plan contest in his high school’s entrepreneurship class. The Six Flags theme park has ordered 100 of the machines, which dispense kits of Band-Aids and other supplies for up to $20. One of the four revenue sources he offers is “selling opt-out data.” The machine also requires the purchaser to acknowledge a form that releases the organization that installs it from liability. I’m not sure I’m really buying the success story since the alleged acquisition offer and product sales are hearsay and since then he has raised his unsubstantiated asking price to $50 million, but I’ll try to suppress my cynicism that the world doesn’t really need a Redbox stuffed with overpriced Band-Aids.

Sales

Freeman Health System (MO) chooses the Empower patient portal from Influence Health.

British Columbia’s Interior Health Authority chooses FormFast for enterprise forms standardization and automation in its 22 facilities, integrating with Meditech.

Hospital for Special Surgery (NY) chooses Strata Decision’s StrataJazz for cost accounting and continuous improvement.

People

The NIH names Patti Brennan, RN, PhD (University of Wisconsin – Madison) as director of the National Library of Medicine.

Lee Horner (CareCloud) is named president of telemedicine at remote interpretation services vendor Stratus Video.

Announcements and Implementations

Health Catalyst eliminates its non-compete agreements, no longer restricting for whom employees can work after leaving the company.

ZocDoc will integrate its appointment-finding and patient self-scheduling marketplace with Epic using APIs.

Sunquest announces GA of Laboratory v8.0.

Government and Politics

CMS, responding to small medical practice concerns about MACRA, publishes a fact sheet and reminds that it will accept comments about the proposed legislation through June 27. I’m not sure that “flexibilities” is an actual word (sort of like “implementations”), but it does seem that CMS is listening and they (along with ONC) have been pretty good about soliciting and using stakeholder feedback.

A federal judge rules that the US government can’t subsidize the cost of health insurance for lower-income Americans by reimbursing insurance companies for income-based premium reduction, saying that the administration overstepped its bounds since Congress did not approve that expense. Insurers were reimbursed for more than half of the exchange-issued policies, and if appeals fail and the payments are stopped, insurance companies will be stuck with paying several billion dollars per year themselves, giving them strong incentive to stop selling policies on the exchanges. It’s a complex issue that is beyond my understanding, but Tim Jost at Health Affairs provides expert opinion.

Privacy and Security

Allen Hospital (IA) notifies 1,600 patients that their information was accessed by a former employee whose EHR login credentials had not been deactivated despite having apparently left the organization seven years ago.

Ponemon Institutes’s annual healthcare privacy and security study, sponsored by ID Experts, finds that 90 percent of the 91 covered entities have had a breach in the past two years, although most involved fewer than 500 records. It calculates the cost of a provider breach as $2.2 million. Half of the reported breaches involved criminal activity, with an additional 13 percent caused by a malicious insider. Providers continue to worry most about careless employees, but a significant number also worry about cyberattacks and the use of unsecured mobile devices. One-third of providers say they’ve bought cybersecurity insurance.

Technology

@drnic1 tweeted about Luxe, an Uber-like service that will meet you wherever you are, park your car securely, and return it to wherever you want for $5 per hour or a flat rate of around $15 per day (the price varies by city, but that includes both the parking car and the service). They’ll even wash your car or fill it up with gas for a bit extra. It’s available now in San Francisco, LA, Chicago, Seattle, Austin, and New York. That would be cool when you’re driving into the city for meeting, heading off to the airport, or attending an event that might charge $20 or more to park in an uncovered and unsecured lot. I would enjoy not only the cost savings, but the lack of stress and time required to find a spot and then hunt down the car afterward.

Other

Doctors in England are told to review patients for whom they had prescribed statins after experts find a seven-year-old error in the QRISK calculator provided in the SystmOne EHR sold by UK-based TPP. QRISK is a short questionnaire that determines the disk of cardiovascular disease.

ProPublica notices from Web traffic to its 2013 Prescriber Checkup — a database that shows heavy opioid prescribers based on Medicare Part D data – that drug seekers are apparently using it to find doctors who are most likely to write them narcotics prescriptions.

Minnesota’s health department cites a nursing home operator for two deaths involving mistakes in transcribing medication orders, one involving a blood thinner transcribed to the wrong resident’s chart and the second due to a 10-fold morphine dose transcription error.

US Army Sgt. Elizabeth Marks, the combat medic who won four swimming events this week at the Invictus Games — for injured military personnel and veterans — and received her medals from the competition’s organizer Prince Harry asks him to instead take her medal to the medical team at England’s Papworth Hospital that saved her life from respiratory distress in 2014. The 25-year-old Arizona swimmer joined the Army at 17 and suffered a serious hip injury while deployed to Iraq in 2010 that left her with no sensation in her left leg.

The ratings agency of Gulfport, MS downgrades the city’s bonds issued on behalf of Memorial Hospital at Gulfport, noting a sharp decline in liquidity that the agency partially attributes to an increase in AR days following the hospital’s Cerner implementation.

This is a great graphic making the social media rounds, although like most graphics, it’s nearly impossible to determine the source.

A Washington Post reporter touring a hospital in North Korea with government handlers is ushered out for asking too many questions in the staged situations that tried to put the country in a positive light. She apparently insulted her hosts in noting ancient diagnostic equipment, staff who aren’t allowed to access the Internet, supposedly frequently used PCs for which nobody knew the password, and a photo op with a perfectly made up patient who strangely had no personal effects or chart in her room. I assume “The Interview” wasn’t available on the patient entertainment system.

Weird News Andy has Hollywood gold in mind with his script for “Snakes in the Ceiling,” inspired by the story of a live python falling from the ceiling at Tacoma General Hospital (WA). WNA wonders if the reptile subsisted on hospital food during its stay. A visitor brought the snake into the hospital a month ago in a cat carrier filled with stuffed animals (any one of those elements might suggest a need for mandatory psychiatric observation), then called the hospital to report that he had lost his slithery friend. The hospital, to its credit, called him back so he could take his wayward pet back home to do whatever it is that people do with pet reptiles in the privacy of their homes. I’ll stand by my long-held assertion that hospitals are the one place where you see a random and often disturbing cross-section of the citizenry that you would ordinarily avoid.

Sponsor Updates

• Medicity CEO Nancy Ham is named one of the most powerful women in healthcare IT. Also named is Vyne President and CEO Lindy Benton.
• Bernoulli will present a poster on alarm reduction during the 18th Annual NPSF Patient Safety Congress, May 23-26 in Scottsdale, AZ.
• ID Experts sponsors the Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data.
• Influence Health announces the 2016 eHealth Excellence Award Winners.
• Orion Health announces that its software manages 102 million patient health records globally.
• AdvancedMD launches patient-centric solutions for independent OB/GYN practices with a limited-time promotion at the ACOG conference.
• GetWellNetwork will host its user conference May 23-25 in Philadelphia.
• InterSystems will exhibit at VA Healthcare 2016 May 16-18 in Arlington, VA.
• Early bird registration for Health Catalyst’s September 6-8 HAS16 ends May 27. 
• Nordic releases a white paper titled “Value-based care: How’d we get here and how do we go forward?”
• LifeImage and National Decision Support Co. will exhibit at ACR 2016 May 16-17 in Washington, DC.
• LiveProcess will exhibit at the 2016 Virginia Public Health & Healthcare Preparedness Academy May 17-18 in Portsmouth, VA.
• Bernoulli will exhibit at the at the Association for the Advancement of Medical Instrumentation (AAMI) 2016 Conference & Expo, June 3-6 in Tampa, FL.
• MedData will exhibit at the ASCA Annual Meeting May 19-21 in Grapevine, TX.
• Obix Perinatal Data System will exhibit at the CSO HIMSS Spring Conference May 20 in Dublin, OH.
• Direct Consulting Associates will exhibit at the Central & Southern Ohio Spring HIMSS Conference May 20 in Dublin.
• Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
• ECG Management Consultants will co-host the first annual Behavioral Health Business Summit May 12-13 in Chicago.
• EClinicalWorks will exhibit at the American Telemedicine Annual Meeting and Trade Show May 14-17 in Minneapolis.
• Hayes Management Consulting will exhibit at CHUG and GE Centricity Live 2016 May 17-20 in Phoenix.
• HCS will exhibit at the HealthTech Conference 2016 May 19 in Newark, NJ.

Blog Posts

• Connecting to an HIE – The Good, the Bad, and What it Means to You (Iatric Systems)
• Preparing Your Team for Go Live (Impact Advisors)
• Making Goals Reality (Ingenious Med)
• Liaison Technologies is happy to take a pass on the iPaaS Magic Quadrant (Liaison Technologies)
• 4 Things You Should Know About Florida’s New Price Transparency Law (Navicure)
• Rolling out to an owned site versus via Community Connect: Nordic’s take (Nordic)
• National Nurses Week: Celebrating the Role Nurses Play in Healthcare (Spok)
• FHIR is Sparking Innovation in Health Information Sharing (Orion Health)
• Data Re-Use: Usability, Patient Safety, and Organizational Policy (E-MDs)
• Yes, nurses do research and it’s improving patient care (Elsevier Clinical Solutions)
• Secure Texting for Healthcare – More Than Just Messaging (Part 2)
• It is Always About the Patient … Always (Galen Healthcare Solutions)
• 7 Months in: Where do we stand with ICD-10? (HCTec Partners)
• Epic Go-Live: Maximizing Your Support Program (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.

EPtalk by Dr. Jayne 5/12/16

I spend a lot of time hearing physician complaints about EHR usability. It’s certainly sensitized me to the issue of usability in general.

Let’s face it – there is some pretty poor software out there, in all spaces. There are some websites I visit that just want to make me scream, especially ones that use technology reminiscent of Geocities circa 1990-something. No matter what industry one works in, if you have to use something day-in and day-out that makes your life harder, you’re not going to be happy.

I was grateful today that I only have to renew my state controlled substance number once every couple of years. It’s bad enough that I have to register with both the federal Drug Enforcement Agency and also with my state, but their website put me over the edge.

I knew it was going to be a pain when the login screen told you to make sure you had enough time to finish the renewal because the system might time out on you. Then, it told me to turn off my pop-up blocker, but not until I had been through multiple screens that had to be resubmitted when I arrived at the pop-up step. They also introduced new fields that had to be completed for each practice location — fields detailing the number of hours per week spent in various activities such as patient care, ambulatory administration, inpatient administration, research, etc. Since I work a varied schedule at more than a dozen sites, this meant pulling numbers out of the air to populate more than 72 fields.

Additionally, when you save each location, it fires a popup that tells you that you need to complete the fax number for the location if it has one, despite it not being a required field. That was another 12 clicks and 12 screen refreshes that I didn’t need to do.

The final usability flaw was when I arrived at the credit card payment screen. Although it leaves the card number and CVV fields blank, it pre-populates the expiration date. If you’re like me and either multitasking or simply get distracted, you look back and the expiration field has numbers in it, so you move on. Unfortunately it then pops up that your card is expired, and sends you back three screens for you to re-key the information.

It felt like an exercise in futility, but what’s a girl to do? Complaining to the board that regulates your ability to prescribe certain drugs feels like you’re just asking for an audit. There’s no competition and no choice, so you just have to pay your fee (which feels like a cash grab, since we’re already regulated by the DEA) and be happy about it. Or if not happy, at least resigned.

On the opposite side of the usability chasm, there are plenty of vendors who are actually getting it done. One of the things I enjoy most about HIMSS is checking out emerging solutions and looking at vendors that are trying to break into the market with something novel. It doesn’t always have to be a “gee whiz” product. but it might be just someone who is doing things better or slightly different than the people who are already in the market.

I recently had a chance to look at iScribeHealth and learn about their journey to market. Their mobile app solution is an adjunct for EHR documentation. It allows providers to enter key data elements such as medications, problem list updates, histories, and more without using the EHR. It also supports dictation and charge entry.

They recently took their first batch of clients live. It’s quite different moving from the development phase to the real world and I’ll be interested to see how things go over the coming months. They’ve got some good hooks in their marketing material – encouraging users to “free yourself from late nights spent updating patient charts and wishing you had chosen a different career path.”

They’re also pushing the patient engagement aspect, allowing physicians to focus on the patient at the point of care and not on the technology. They also have automated reminders and surveys to connect with patients outside of the visit. Personally, they had me with their martini glass icon. Who doesn’t like a cosmopolitan in their daily workflow?

Just when you thought you had recovered from HIMSS16, it’s time to start planning your submissions for HIMSS17. The call for proposals opened last week and runs through June 13. They’re also looking for reviewers to take a look at all the content submissions during the summer months. I’ll let you do the math on how many months it is from the time the submissions are due until the actual presentation and determine for yourself whether it’s easy to keep things fresh with that kind of lead time.

I’ve previously been somewhat down on the American Academy of Family Physicians and other organizations for enabling some of the negative forces impacting physicians today. They have posted some introductory modules covering MACRA and the shift to value-based care. I appreciate their taking it down to the basic level that many physicians need to try to understand what’s about to happen to them.

In people news, today the National Institutes of Health announced the appointment of Patricia Flatley Brennan, RN, PhD as the new director of the National Library of Medicine. She has a long history in the informatics community. I find it most interesting that her doctorate is in industrial engineering and she has worked to leverage that knowledge in health care. The best implementation director I ever worked with was a ceramics engineer by training, so I appreciate what that background and mindset can bring to the table.

Email Dr. Jayne.

News 5/11/16

Top News

NantHealth announces plans to launch the IPO it postponed in November 2015 when it cited poor market conditions, hoping to raise $92 million. The company lost $72 million on $58 million in revenue last year, at the end of which Patrick Soon-Shiong, MD announced a $200 million investment by Allscripts that valued the company at $2 billion. 

Soon-Shiong, worth around $10 billion, earned $150 million in compensation when his NantKwest cancer research firm went public last year.

Reader Comments

From Ricardo: “Re: MD Anderson. Reported a $160.5 million adjusted decrease in income due to Epic. Not surprising given that there were 1,000+ contracted for go-live support. Encore made a killing on this project, although I can’t recall if they ran the selection process, too. I’m surprised this hasn’t received more widespread coverage.” Internal UT documents from a meeting being held later this week indicate that MD Anderson blames Epic-related costs and revenue reduction for its nearly 60 percent year-over-year income decrease, but adds that it had assumed some degree of impact to both from the beginning. 

From Doozy: “Re: trying to get electronic copies of your hospital medical records. Reminds me of this clip from ‘Seinfield’ that aired in October 1996, just after HIPAA was enacted.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor HBI Solutions. The Palo Alto, CA-based company offers predictive analytics and performance analysis solutions to providers, payers, HIEs, and technology vendors. Its Spotlight Data Solution uses real-time (not historical) clinical, billing, and claims data to provide risk models, dashboards, reports, and scorecards to support population health management, risk management, readmission management, and quality improvement. Its work has been vetted both in peer-reviewed research articles and by providers in the field. The system fits into any BI, EDW, EHR, or interoperability environment, using HL7 and 837 feeds, CCLF files from ACOs, EMPI, and natural language processing to extract data from non-discrete data types such as care summaries. According to customer Todd Rogow, SVP/CIO of the New York’s Healthix HIE, “HBI’s comprehensive suite of predictive analytics solutions enable Healthix to be responsive to the needs of doctors and nurses in an environment of shifting models of care. Real-time patient risk stratification and population and event based predictions will give healthcare organizations real-time, actionable information to help them deliver preventive, proactive care and reduce unnecessary utilization.” You probably know some of the company’s executives from their experience with Stanford and Eclipsys: Bruce Ling, Eric Widen, Frank Stearns, and Karl Sylvester, MD. Thanks to HBI Solutions for supporting HIStalk.  

Here’s a just-published video I found on YouTube in which St. Joseph Healthcare (ME) talks about its use of real-time population health alerts from HBI Solutions.

Ms. H from New Jersey says the two iPad Minis and accessories we provided in funding her DonorsChoose grant request have been valuable not just for research, but also because students are getting to work with technology they’ve seen that their families can’t afford. She also adds that her inner city male students are more likely to be kinesthetic leaners and she can meet their needs by assigning them hands-on iPad exercises.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Humana makes an unspecified investment in Glen Tullman’s chronic disease management technology company Livongo Health, closing its Series C round at $49.5 million and increasing its total to $82.5 million.

Patient satisfaction technology vendor Lumin Medical acquires patient feedback technology from Implementing Technologies, which it will add to its PatientTrak patient experience solution. The system steers patients to sites where they are urged to leave four- and five-star reviews.

Sales

Southeast Health (MO) and Missouri Delta Medical Center (MO) choose Cerner Millennium, replacing Siemens Soarian at both. Searching the HIStalk archive turns up a March 2015 mention that Southeast Health was getting hammered by high costs and erratic billing from Soarian and planned to move to Cerner. I also wrote in 2012 that these two competing organizations were sharing the data center and Siemens licensing costs in forming a new company called Servir. Sometimes I forget how valuable the information in old HIStalk posts can be.

Boca Raton Regional Hospital (FL) selects Cerner Millennium. I believe it was a McKesson Horizon shop. 

For-profit Ardent Health chooses Epic for its 14 hospitals in Texas, Oklahoma, and New Mexico (including Lovelace Health System), replacing McKesson Star and Horizon.

UCHealth (CO) chooses LeanTaaS for predictive analytics to improve OR utilization.

Greater Oregon Behavioral Health (OR) will use data aggregation and analytics technology from Arcadia Healthcare Solutions.

People

UTHealth’s School of Biomedical Informatics names Ivo Nelson as the first recipient of its John P. Glaser Health Informatics Innovator Award.

Announcements and Implementations

Walgreens collaborates with Mental Health America to add mental health resources to its website, offer access to MDLive’s behavior telehealth solution, and provide mental health training programs to its pharmacists, nurse practitioners, and physician assistants.

The IT department of Children’s Hospital of Philadelphia (PA) wins a local award for developing an app that tracks patients and employees to reduce wait times, alerts staff when a patient hasn’t been seen for a long period, and identifies occupied treatment rooms.

Government and Politics

ONC offers $1.5 million in interoperability standards grants.

HHS calls for entries for a challenge to simplify patient bills, with $5,000 prizes for the winners.

The government of China orders search engine company Baidu to change its search results presentation following the death of a student who used it to seek questionable cancer treatment from a paid hospital advertisement. The government’s Internet regulator has given the search engine three weeks to display results based on credibility, to limit the size of the ads it presents, and to filter unauthorized providers from the search results. Baidu says it will comply and claims it has already removed 126 million ads from its site. The hospital is being investigated separately for illegally outsourcing its services and for running false advertisements. The Chinese government blocks access to Google via its so-called “Great Firewall,” but the student asked a US friend to do a Google search for him right before he died, only to find out that the treatment he had received had fallen out of favor years ago due to poor results in clinical trials.

CMS Acting Administrator Andy Slavitt says in his remarks to his final Health Datapalooza conference (his job, along with many in HHS, is a political appointment) that, “Physicians are baffled by what feels like the physician data paradox. They are overloaded on data entry and yet rampantly under-informed. Physicians don’t understand why their computer at work doesn’t allow them to track what happens when they refer a patient to a specialist when their computer at home connects them everywhere.” He observes that people got distracted by the Healthcare.gov debacle and missed the successful implementation of real-time insurance sign-up, a marketplace that has reduced insurance prices, and matching consumers to health plans that meet their needs. He cites HHS’s user-centered policies as:

1. Releasing of CMS databases.
2. Changing provider payment incentives to emphasize quality and care coordination.
3. Rolling out a single set of core quality measures.
4. Requiring open APIs and exposing data blocking practices.
5. Proposing the replacement of Meaningful Use with quality measures that “put the needs of the users – clinicians and patients – back in the center.”

Other comments from Slavitt:

Physicians don’t need to get pushed into using technology with incentives to show they’re clicking. They are pulled in because they need collaboration tools. The purpose of new payment models is to give care providers the freedom to do what they think is right. Your opportunity is to allow it to happen. Go find them and talk to them– design for them … If you want to lead the way with innovations that help consumers, great. If you want to follow by using established standards for data and measurement and technology, also great. If you have a business model which relies on siloing data, not using standards, or not allowing data to follow the needs of patients, pick a new business model or pick a new business. What Vice President Biden said should stick with us– as taxpayers, we did not spend $35 billion so companies could build their own silos.

Slavitt specifically listed practices that everyone should follow:

• Eliminate contract language that prevents systems from being plug and play.
• Put machine-readable data on edge servers so it can be used to answer questions.
• Give physicians real-time data inside their work flows, not through a vendor’s portal.
• Use APIs.

Privacy and Security

Mental health provider Bay Area Children’s Association (CA) reports that hackers loaded malware onto its EHR via credential theft and acquired an unknown number of patient records. BACA uses the PrognoCIS EHR from Bizmatics, which announced a breach of its systems last month, so I assume BACA is just one more Bizmatics customer that was affected.

The UK information commissioner fines an NHS trust $260,000 after its HIV clinic sends its 800-patient email newsletter using CC: instead of BCC:, thereby disclosing the identities of the recipients to each other.

The Atlantic says ransomware was first distributed in 1989, when a biology researcher sent 20,000 copies of an AIDS survey to researchers around the world whose computers would be seized the 90th time they were booted afterward. The ransomware demanded that a cashier’s check for $189 be sent to a PO box in Panama. The biologist was arrested and charged with blackmail, but claimed he was planning to donate the money to AIDS research (despite speculation that he was upset about being passed over for a job with the World Health Organization). The UK jury found him mentally unfit to stand trial and instead deported him to the US, where he died nearly 20 years later after creating a New York butterfly conservatory and naming it after himself.

Technology

The team that developed Siri demonstrates Viv, which adds artificial intelligence to speech recognition in discerning the user’s intent and in integrating with apps via an open ecosystem. The demonstration involved placing a complicated pizza delivery order by voice alone, without scripting. Experts note that mobile device users have lost their enthusiasm for apps that use up cell plan data, require logon credential maintenance, and send useless notifications, with most of them settling on just a handful that they use regularly.

Other

A Time article says Apple created the Apple Watch because Steve Jobs, who was dying of pancreatic cancer, wanted to empower patients and improve the healthcare system. It’s not especially convincing speculation, but it’s a convenient excuse to reflect fondly on Steve Jobs.

Insurers are sharing information gleaned from past medical malpractice cases to help providers develop new protocols and strategies, such as requiring doctors to examine every wound treated in the ED to make sure  no foreign bodies or tendon injuries are present.

I’m surprised at the poorly worded, error-filled writing I see on the websites of newspapers all over the country that should know better, although maybe they’re losing so much money they can’t afford decent writers. For example, you might expect the Richmond paper’s headline writer to have noticed the 10 correct spellings of “Novant” in the article he or she was summarizing that were not in concordance with his or her version.

Weird News Andy notes that the Panama Papers have a medical connection, naming New York University School of Medicine and at least one of its doctors (neurosurgery professor Patrick Kelly, MD) as having offshore accounts. I found a searchable database of the information online, which lists several US doctors as well as some medical companies suspiciously headquartered in the Caribbean.

Sponsor Updates

• Clockwise.MD will exhibit at the NAHAM patient experience conference from May 24-27 in New Orleans.
• AirStrip releases a video on how it helped an academic medical center improve early detection of potential hemodynamic instability.
• Aprima will exhibit at the American College of Obstetricians & Gynecologists Annual Meeting May 15-16 in Washington, DC.
• Advanced Data Systems will offer its EHR customers Chronic Care Management technology and services from CareSync.
• Besler Consulting releases a new podcast, “Common Mistakes Associated with Physician Documentation.”
• Boston Software Systems launches a Podcast Resource Center.
• CoverMyMeds will exhibit at the American Psychiatric Association Annual Meeting May 14-18 in Atlanta.

Blog Posts

• Using Telemedicine in Your Independent Practice (AdvancedMD)
• CMO Challenge: Multiple Payors, Multiple Quality Measures (Arcadia Healthcare Solutions)
• 4 PHI Marketing Special Cases (Catalyze)
• National Nurses Week: RN shares her nursing career from detective to designer (CapsuleTech)
• Healthcare’s Cybersecurity Mandate (Caradigm)
• Using Technology to Promote Shared-Decision Making for Neoadjuvant Breast Cancer Therapy (Carevive Systems)
• What’s Next for Meaningful Use (CTG)
• Empowering Patients (Culbert Healthcare Solutions)

Contacts

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

Diagnosing Primary Care’s Identity Crisis

Faced with increasing pressures related to government mandates, decreasing reimbursement, workforce shortages, and keeping up with the technology Joneses, primary care and family medicine physicians look for relief in new business models.
By @JennHIStalk

It’s a tough time to be in primary care. PCPs and their family medicine counterparts are faced with a barrage of competing interests that, at first glance, would seem to leave little time for face-to-face patient care. Meaningful Use, MACRA, MIPS, ACOs, PCMHs … the list of acronyms and the public and private payer programs they stem from seem to get longer by the day.

As Dr. Jayne mentioned in a recent post, “In the provider space, there is a tremendous amount of chatter about [the proposed rule for MACRA] being the last straw for small or independent practices. The requirements are daunting, especially for practices that haven’t been at the forefront of payment reform efforts. Just trying to read and understand all the rules and keep track of all the FAQs we’ll undoubtedly see could be a full-time job.”

Even Beth Israel Deaconess Medical Center CIO John Halamka, MD, in his analysis of the proposed rule, seems to have finally thrown in his usually optimistic towel, concluding that physicians at this point really have only two choices – take a hospital job or become employed. “As a practicing clinician for 30 years,” he adds, “I can honestly say it’s time to leave the profession if we stay on the current trajectory.”

It’s a trajectory that, while filled with good governmental intent, has become bloated with oversized expectations and expense related to technology and resources. While Halamka’s list of options is certainly short, it leaves off one route that has become increasingly attractive to fiercely independent physicians – direct primary care.

Understanding Direct Primary Care

The DPC model, though still in its infancy, has grown exponentially in popularity over the last several years as PCPs and family medicine practitioners look for creative ways to stay in business without being shackled to fee-for-service care models and third-party administrative burdens. As the Direct Primary Care Coalition stresses, DPC is “an innovative alternative payment model in primary care …. In DPC, unwanted fee-for-service incentives are replaced with a simple flat monthly fee. This empowers the doctor-patient relationship and is the key to achieving superior health outcomes, lower costs, and an enhanced patient experience.”

“DPC is very popular among a small percentage of our members who practice it, less than two percent, although many want to learn more,” says American Academy of Family Physicians President Wanda Filer, MD, a family physician in York, PA. “Those who are in it love it and are very enthusiastic. They cite not being torn away from patient care to do non value-added tasks such as checking boxes, answering prior authorizations, or other administrivia. They are able to get off the hamster wheel driven by fee-for-service and inadequate payment from payers. They have more time to spend with patients and morale across the office staff seems to be very high, as well as quality metrics.”

Jack Forbush, DO, who practices DPC at the Osteopathic Center for Family Medicine in Hampden, ME, believes the interest in DPC is the result of the de-specialization of family medicine. “Until recently, family medicine was the end-all and be-all of medicine,” he says. “It encompassed obstetrics, pediatrics, internal medicine, gynecology, and hospital medicine. Family medicine physicians aren’t even called physicians any more, but rather providers or practitioners. Do you have heart issue? Go see a cardiologist. Do you have a concerning mole? Go see a dermatologist. National organizations have dropped the ball at maintaining the identity of family medicine. Those physicians in practice have allowed it to happen.”

Forbush also attributes the identity crisis to attempts by non-medical entities like public health officials, administrators, and policy makers to formalize and quantify medicine through programs like Meaningful Use and patient-centered medical homes. “Family medicine has always done what PCMH programs now demand practices do, but now they have to do it and prove it through metrics,” he explains. “Meaningful Use has been a colossal failure and cost practices millions of dollars. One such example is a colleague of mine who, despite complying with the MU mandates, has been fined $18,000. Payment is, of course, expected immediately. MU bonuses were potential bonuses issued after a year of doing the work. What other industry would tolerate this? Decreasing reimbursement rates for primary care in addition to the increasing financial demands placed upon family physicians via technology mandates and  MU mandates continue to squeeze the lifeblood out of primary care.”

Maribel Aviles, MD faced similar frustrations in July 2014 when she decided to leave the Medicare HMO clinic where she was working to open Orlando’s first DPC practice. “When I entered medical school back in 1985, I did it with the mission of being a team member in the patient-doctor relationship,” she explains. “Little did I expect that 20-plus years later I would be subjected to heavy administrative and regulatory burdens. Now we are called providers instead of doctors. These days, family docs can be replaced by almost any PA to decrease medical costs. To top it all off, we’re expected to address the needs of our patients within an allotted time and at a set fee, which we’re often not immediately privy to as it varies by insurance. In a nutshell, I have seen my profession as a family medicine physician shift towards this new image of a servant to government regulations and insurance administrators instead of to our patients. I’ve even been compared to Dr. Google.”

Staying in Control

In moving to a DPC model, Aviles and Forbush have attempted to retain their identities as physicians and seem to be enjoying a renewed sense of independence. “Without a doubt, models like DPC definitely help physicians retain their sense of identity and control,” Forbush says. “The more popular model of being a network physician for an insurance company is essentially allowing yourself to be a slave to someone else’s ever-changing rules, regulations, and expectations. The DPC model frees the physician from unnecessary administrative burdens and decreases the financial expenditures associated with running a practice. For example, you save perhaps eight percent by getting rid of the billing company and your RCM timeframe becomes much closer. Rather than waiting 30, 60, or 90 days to be paid for a service provided today, patients in a DPC model either pay you the day of or via a membership model.”

Aviles expresses similar administrative sentiments, adding that she enjoys no longer having to wrangle with third-party administrators over what tests to order for her patients. “I also don’t have to hire additional personnel to deal with extra administrative burdens, and as a result, can pass along those savings to my patients. I have a renewed sense of control over the treatment of my patients. I feel I am a doctor again, able to contribute significantly to someone’s life and to the system in general.”

“I want to see my colleagues enjoying their profession again,” she adds. “We must continue looking for ways to accomplish this goal. Happier doctors will definitely make happier patients.”

The Other Side of the Coin

While Filer and the AAFP recognize the value DPC models have, especially when it comes to relieving physician burnout, she is focused on helping those physicians who have decided to stick with Medicare and Medicaid programs. “I really do not see an identity crisis. Quite the opposite,” she says. “Family medicine has been asking for some time to be recognized for the cognitive work that we do. We know that the work that we do has immense value that is currently under-recognized and dramatically undervalued. Worldwide and in the US, locations with a higher percentage of healthcare dollars spent on primary care have significantly better patient outcomes at a lower total spend. The reverse is not true for specialty care. Policymakers have finally come to recognize this. The shift to value-based care is aiming to strengthen primary care at last.”

“For the first time in my 25-plus year career,” Filer adds, “I think we have a shot at getting US healthcare where it needs to be – meeting the Triple Aim of lower healthcare costs, improved population health outcomes, and better patient experiences. Stronger primary care is the only proven path. We are working to invert the current pyramid of healthcare spend. Many PCPs are caught in the midst of this immense, chaotic change, but understand that the previous system was unsustainable. It will be critical to give family physicians new resources very quickly. They need time with patients, staff to delegate tasks to and to support patient needs, and better EHRs.”

The Effect of MACRA

Filer believes MACRA to be a step in the right direction, albeit one that will require additional resources (a notion seemingly at odds with the love Aviles and Forbush have for the DPC model, which requires fewer resources). “We are launching a large campaign for members called MACRA Ready to get their questions answered and to position them for success in the new value-based payment models,” she says. “Interestingly, one member survey suggests that 40 percent are already doing some value-based contracting.”

Filer doesn’t shy away from the fact that physicians who move to value-based contracting are appropriately cynical about new government programs like MACRA and the Comprehensive Primary Care Plus program. Given their cynicism and Halamka’s gloomy analysis of attempts to replace Meaningful Use, one has to ask if physicians aren’t simply trading one hamster wheel for another.

“Meaningful Use in its old iteration was destructive to morale, patient-physician face-to-face time, and trust that government could get it right,” Filer says. “Under MACRA, it is my understanding that MU will be retained as the name, but that many programs will be streamlined into one set of requirements. Done correctly, the new MU should use the Core Collaborative Measures that CMS, AAFP, AHIP, and others worked diligently to define for primary care. This is a much shorter set of measures. They are focused on patient care and evidence-based. They can be culled from the EHR and, over the next couple of years, can be adopted by most if not all payers in the US, thereby letting everyone compare apples to apples. These streamlined measures should help family physicians feel more like physicians who care for people rather than box-checkers.”

Optimism Despite Shifting Identity

No matter the label physicians give themselves, Filer believes joy can be put back into the practice of primary care and family medicine. “It is my belief that eliminating administrivia, substantially improving payment, getting them off the hamster wheel of volume, and giving them more time and resources to spend on patient needs can make family medicine the first choice of at least 40 percent of students, which is what the US requires for a patient-centered, efficient healthcare system.”

“I think the future of primary care/family medicine is incredibly bright,” she adds, “but fundamental US system changes and graduate medical education reform are critical. Frankly, this country can no longer afford to do business as usual. We are long overdue for this shakeup.”

Monday Morning Update 5/9/16

Top News

HHS Secretary Sylvia Burwell tells the American College of Physicians that not only do some EHRs lack interoperability, but health systems sometimes don’t want to share information and providers aren’t paid in a way that rewards information sharing. She acknowledges that Meaningful Use has been hard on doctors with its “burdensome reporting and inflexible requirements.”

Burwell says HHS will set common interoperability standards, chane the culture in hospitals and practices regarding the right of patients to access their own information, and make sure its rules and regulations support the smooth movement of healthcare data.

Reader Comments

From Frank Poggio: “Re: MACRA. Dr. Halamka’s assessment isn’t surprising. The federal government’s objective is to control healthcare costs even though most of the escalation is due to societal failings like obesity and smoking. The provider is stuck in the middle and the middle gets squeezed every time. Providers play ball with payers and government trying to keep impending regulations from going off the track, and when the changes don’t meet the cost savings goal the feds sold to Congress, the bureaucrats have no choice but to go off track, blaming it on providers and promulgating even more onerous rules (remember that HITECH was supposed to pay back $800 billion over 10 years). This bureaucratic insanity will continue as the government continues to ignore the basic issues that drive healthcare costs. Unfortunately, that guarantees there will be many versions of the good Dr. Halamka over succeeding decades.”

From Skitch Henderson: “Re: medical error deaths. How many of those were IT-related, I wonder?” We in healthcare unfortunately kill some patients with the best of intentions but the worst of execution, but nobody really knows how many, much less how those deaths break out by individual cause. Keep in mind that the widely-quoted recent study (with obligatory clickbait headlines, including that of the Washington Post above that inserts the incorrect “now” in falsely suggesting a fresh trend) doesn’t represent new information or signify a rising trend – the authors merely used a different calculation method to create a new estimate from old data using massive extrapolation. Even the authors seem embarrassed that their results have been so overblown in trying to put a new number on an old problem using questionably useful methods. We simply don’t know when medical treatment causes a patient’s death – you can bet that a lot of death certificates say “heart attack” only because nobody knows for sure.

HIStalk Announcements and Requests

Two-thirds of poll respondents think MACRA’s Advancing Care Information is better than Meaningful Use. Meltoots says it’s just more of the same for physicians who are already burned out, adding new measures that haven’t been proven to improve care, cost, efficiency, safety, or interoperability. New poll to your right or here: who is most responsible for physician dissatisfaction? Like those dissatisfied physicians, I am interested in your personal narrative and not just your check-the-box answer, so click the poll’s Comments link after voting to document your story.

It occurs to me that the acronym-obsessed healthcare industry hasn’t yet abbreviated the new program, so I hereby dub it MACI (MACRA Advancing Care Information). You are welcome.

Mrs. R from Ohio says her third graders ask every day if it’s a tablet day, referring to the iPad Mini and case we provided in funding her DonorsChoose grant request. Her students are using it to practice their math skills, perform research, and teach each other to use the iPad.

Also checking in is Mr. Willet from North Carolina, who says the faces of his elementary school students light up with pure joy when he brings out the programmable robot kit for his digital lab program, which he says enhances not only their math skills, but their communication and critical thinking. A surprising 15 percent of the students in his school are homeless, so the only technology access many of them have is at school, and quite a few students go home on Friday with donations from the local food bank in their backpacks. It’s interesting that schools are better than hospitals at identifying social determinants of health and connecting those in need with resources.

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

Last Week’s Most Interesting News

• BIDMC CIO John Halamka criticizes proposed MACRA rules, saying that nobody can understand them and that it’s time for physicians to consider leaving their profession if the government’s trajectory doesn’t change.
• Siemens Healthcare renames itself to Siemens Healthineers.
• IMS Health and Quintiles announce plans to merge in creating a pharma services business with $7 billion in annual revenue.
• Joint Commission reverses its 2011 decision that prohibits sending orders by text messaging, provided that the messaging platform meets specific technical requirements.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Here’s the recording of a recent Webinar, “Provider-Led Care Management: Trends and Opportunities in a Growing Market.” Our presenter had audio problems during the live Webinar, so we recorded a new version.

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call:

• President Richard Poulton says the Netsmart transaction will allow patients to be managed across acute and chronic illness to health maintenance.
• CEO Paul Black says the company is building a precision medicine knowledge hub.
• Allscripts offers 135 certified solutions in its application store and developers are using its APIs to work on 1,550 applications.
• Black quoted a recent study that found that 87 percent of financially challenged hospitals regret changing IT systems, 90 percent of nurses say EHRs impede their ability to deliver care, 63 percent of executives say their jobs or those of their peers were threatened by an EHR replacement, and 78 of physicians say replacement EHRs didn’t deliver the expected clinical buy-in.
• Responding to an analyst’s question about rumored loss of market share in the independent physician segment, Black said that every vendor has churn but that of Allscripts is within expectations.
• Black expects MACRA to cause some of the nearly 500 certified EHR vendors to leave the market, creating replacement opportunity.
• Asked about the NantHealth partnership, Black says that two or three Sunrise customers will be going live on integrated Eviti protocols soon and that he expects to gain EHR business from the partnership.
• Black says the physician complaints in South Australia got more press than either the client or Allscripts wanted, but haven’t damaged the relationship.

From the Cerner earnings call:

• The company says its win rate against Epic is at an all-time high, which it attributes to product improvements, predictable delivery, lower cost of ownership, population health capabilities, and an open platform.
• Cerner says the number of hospitals moving from the former Siemens products to Millennium is ahead of expectations, while the overall financial and operational objectives of the acquisition are on track.
• The company says its HealthIntent population health management product is a differentiator when competing for new EHR business, with most new customers choosing it.
• Cerner’s go-forward product for patient accounting remains Millennium, but the company will continue to offer the Soarian product to the 25 percent of the market that wants a standalone patient accounting product.

I checked the five-day share price performance of a few companies that recently announced earnings: Cerner (down 4.5 percent), Allscripts (down 1.7 percent), Athenahealth (down 2.8 percent), McKesson (up 0.2 percent), CPSI (down 12.4 percent), and Imprivata (up 0.4 percent).

I’m enjoying the savagely clever commentary about Siemens changing the name of Siemens Healthcare to Siemens Healthineers, as the company apparently intends to spin it off (Siemens says the “eers” part refers to “pioneers” rather than “engineers” like you might expect). Much of the scorn involves an employee-posted video (with 450,000 YouTube views) of the obviously expensive yet hilariously awful employee kickoff event that Siemens held in its home town in Germany, which to many typifies everything that’s wrong with big companies — cluelessness, mandatory employee attendance at morale-boosting events that actually kill morale, spending money on frivolity while laying people off, and inadvertently emphasizing the multi-faceted chasm between the richly compensated executives and the trudging masses who do the actual work. Some of my favorite comments from a Reddit topic titled “Siemens embarrasses 44,000 employees with new ‘Healthineer’ mandatory dance concert”:

• Can confirm – this killed all productivity at our newly-christened Healthineers office today. It was hard to get any work done in between the fits of laughter and moments of dumbfounded shock that anyone, anywhere, thought this was going to be a step in the right direction.
• Siemens made ovens at Auschwitz. I think they will regret this more.
• Hawaiian Shirt Friday.
• Siemens: we’ll lay off 12,000 employees to keep profits up. Now show us how much you love your job! Dance, puppets, dance!
• First, do no harmineering.
• This event was probably a huge success. Nothing brings people together quite like hating something together.
• Look at all those people watching this " concert" in dead silence. That pretty much tells they were forced to attend this s&^%. Besides, this reeks of brainwashing and reminiscent of propaganda videos that dictators release un-ironically.
• When the camera pans across the crowd … wow. It’s like a bunch of KISS fans who accidentally showed up at a gospel festival, or vice-versa.
• After this presentation, Hermann von Siemens was exhumed and charged with war crimes for a second time.
• The balding, middle-aged engineers in the audience seem to be as horrified and bewildered as we are, so we can at least have some faith that the people who do the actual work at Siemens have their s&^% together despite upper management’s cluelessness.
• I was waiting for one of the blue morph suit guys to tear their mask off, revealing a Michael Scott glowing with so much pride it hurt to look at.
• It really pains me to know that this is what our healthcare dollars are being spent on.
• I think the world is finally getting over giggling at the pronunciation of our company’s name. We need to up the ante with something else embarrassing.
• This is great marketing material … for GE and Phillips. How can a company be taken seriously if they are so out of touch to think this was a good idea?
• I feel like there must be some elderly Germans left around who would be more than willing to tell you that this is, in fact, a very clear sign of things about to go very, very wrong.
• It is cringingly awesome how they have the lyrics highlighted as if they thought everyone would want to sing along.
• Suffering through that pap is one thing, but having to tell people who ask that you work for Siemens Healthineers? That’s torture.

Sales

Grace Health System (TX) selects Patientco for its patient-focused payments solution.

People

Imprivata hires Aaron Miri (Walnut Hill Medical Center) as CIO and VP of government relations.

Allscripts hires Tess Coody-Anders (Resolute Health) as SVP/GM of consumer health.

Announcements and Implementations

Centura Health (CO) went live on Epic at five hospitals and their clinics on May 1.

Privacy and Security

A hacker steals the W2s of all 2,800 employees of Saint Agnes Medical Center (CA) when one of them falls for a phishing email.

Other

The Irish government gives initial approval to a nine-year, $1 billion plan to provide all patients with a digital health record. The one-year product selection will start at the end of 2016. The first go-live will be the new National Children’s Hospital in Dublin.

Allegheny Health Network (PA) blames an unexpected operating loss on the one-time costs of implementing Epic.

The local paper notes that St. Charles Health System (OR) will implement Epic, creating 100 jobs in reversing their late-2014 decision to stick with McKesson Paragon. This will be the health system’s fourth EHR, having previously chosen to move from McKesson Horizon to Paragon.

Kaiser Family Foundation tweets out a timely graphic showing the primary role mothers have in keeping their children healthy.

This interesting video shows how Cedars-Sinai is using virtual reality to reduce the boredom of hospitalized patients. I would be happy just to get fast WiFi since my one and only night in a hospital for observation was like spending a night in jail – I didn’t get dinner because they didn’t find me a bed in time and all they had was fruit juice, there was no WiFi, my bed was missing the TV remote/call button combo, and I was in the dreaded “semi-private” room (meaning separated by only a paper-thin curtain that allowed every sound, smell, and silhouetted image to pass freely) with a guy who was a lot worse off than me. I was also awakened frequently by the nurse charged with writing down what the gadgets around me displayed, which must have required a lot of her focus because she didn’t notice that my IV ran dry and didn’t give me the meds that were ordered. This was the hospital that refused to give me an electronic copy of my medical records with the excuse that “we only do that for doctors.”

Here’s Part 3 of Vince and Susan’s vendor review. It’s fact-filled and entertaining as always.

Sponsor Updates

• TeleTracking will host an executive forum on transforming patient access May 10 in Long Island.
• Midmark closes its acquisition of Versus Technology.
• WeiserMazars #BestAdvice campaign wins the Association for Accounting Marketing’s National Social Media Campaign of the Year.
• Optimum Healthcare IT is ranked among the top two Epic consulting vendors for overall broad performance by KLAS.
• ZirMed will exhibit at the Zoll Data Summit May 17-20 in Denver.
• Experian Health will exhibit at the HFMA/MO Joint Conference May 11-13 in St. Louis.
• PeriGen offers a National (OB!) Nurses Week Appreciation Toolkit.
• Streamline Health will exhibit at the 2016 National Rural Health Association Innovation Summit May 10-13 in Minneapolis.

Blog Posts

• Five Ways to Make IT More Strategic (TierPoint)
• What’s Next for Meaningful Use (CTG)
• This May, We’re All About the Historicals (UltraLinq)
• Connecting to an HIE — The Good, the Bad, and What it Means to You (Iatric Systems)
• Time for National Access to a Prescription Drug Repository in the EHR Workflow (First Databank)
• 8 Tips for a Seamless Risk Adjustment Program (Verisk Health)
• ICD-10-PCS Has a Starring Role in the FFY 2017 IPPS Proposed Rule (VitalWare)
• Bots are red-hot. (Voalte)
• Leverage SMS Messaging for Fiesta-Worthy Communication (West Corp.)
• Healthcare’s Strategic Asset: Customer Service (Xerox)
• The Future of Enterprise Mobility is Here: What’s Your Strategy? (PatientSafe Solutions)
• Will Physicians Say #Don’tMACRAme”? (PatientKeeper)
• A nurse’s intuition: Filling the gaps technology can’t (PerfectServe)
• Looking Past the Cherry on Top (PMD)

Contacts

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

News 5/6/16

Top News

BIDMC CIO John Halamka, MD dissects the nearly 1,000-page MACRA NPRM and makes interesting points:

• It’s a zero-sum redistribution rather than a stimulus program –  some clinicians will be paid more while others will be paid less based on performance.
• MACRA doesn’t impact hospitals or Medicaid EHR incentive participants. For them, Meaningful Use and quality reporting continue.
• ONC in March gave itself more authority over how EHRs are used in the field, with the proposed MACRA wording requiring clinicians to sign off that they have cooperated with ONC and that they haven’t disabled the interoperability capabilities of their EHRs. He says a lot of people are going to see ONC’s self-proposed surveillance role as overly intrusive.
• Clinicians can meet the secure messaging and view-download-transmit measures by having a single patient participate.
• Clinicians must participate for the full 2017 year, use a 2014 or 2015 certified EHR, and report to either eight Stage 2 or six Stage 3 measures in the Advancing Care Information objectives that replace Meaningful Use.
• Halamka also dryly notes a requirement that clinicians “continue to practice medicine” and that “listening to each patient’s story, being empathetic, and healing are optional.”
• He concludes that “sometimes when you remodel a house, there is a point where additional improvements are impossible” and says that nobody can understand the 962-page MACRA document, concluding that clinicians probably only have two choices – become a salaried employee or take a hospital job to avoid the complexity.
• The usually-optimistic Halamka summarizes darkly, “As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.” That’s a significant development since he called for rolling Meaningful Use into a less-prescriptive quality measurement program, but he’s not happy with how it turned out.

Reader Comments

From EMR Expert: "Re: King Khaled Eye Specialist Hospital in Saudi Arabia. It will become the first hospital in the Middle East to reach HIMSS EMRAM Stage 7.  That’s very good news for InterSystems, hard luck for Cerner and Epic.” Unverified. The InterSystems TrakCare-using hospital, a Johns Hopkins partner, reached Stage 6 in December 2014.

From Compressed Coal: “Re: Quintiles-IMS Health merger. Quintiles acquired Envoy in 1998 to create a competitor to IMS. It didn’t work and Quintiles eventually sold the business to Healtheon / WebMD. Envoy is one of the core assets of Emdeon, which is now Change Healthcare. I guess Quintiles finally got what it wanted all those years ago.” I wince remembering those irrational dot-com days of 2000, when Quintiles sold Envoy to Healtheon / WebMD for $2.7 billion after acquiring it in a $1.4 billion stock swap just a year earlier.

From Chili Dog: “Re: SPARC. CMS has notified the winners of its 10-year, $24 billion Strategic Partners Acquisition Resource Contract (SPARC). Here’s the small business winner list that CMS hasn’t announced yet.” I wasn’t familiar with SPARC, but the RFP description says it’s a multiple award, indefinite delivery / indefinite quantity contract divided into two pools – small business and unrestricted – with a $25 billion ceiling. It is described as, “This contract will provide strategic, technical, and program management advice, guidance, and support services to CMS to facilitate the modernization of business processes and supporting systems and their operations. These systems will include the Federal Healthcare Exchange and Medicare / Medicaid information technology systems. Other Department of Health and Human  Services Operating Divisions (HHS OPDIVs) may place orders under this contract as well.”

HIStalk Announcements and Requests

Mrs. M from Pennsylvania is using the three iPad Minis, cases, and document camera we provided in funding her DonorsChoose grant request to challenge her second graders with STEM skill exercises and games. She adds that the students who don’t have access to technology at home are especially excited about learning and working hard.

Listening: new from reader-recommended Purson, an inexplicably obscure female-led British psychedelic band that sounds like all the best musical parts of the trippy early 1970s (Deep Purple, Jefferson Airplane, and The Doors come to mind). The female lead singer-songwriter, Rosalie Cunningham, can and does shred it on guitar. They just started a small-venue US tour. They are outstanding, including their choice of name.

This week on HIStalk Practice: CMS, AMA offer resources for physicians struggling with MACRA. Jonathan Bush sounds off on Athenahealth’s trajectory, gives thanks for Obamacare. DAS Health acquires EHR/PM assets of Jackson Key Practice Solutions. "HIPPA" loses its luster thanks to a fraudulent letter to patients. Tandigm Health rolls out virtual visits courtesy of TouchCare. Warburg Pincus acquires DocuTap. Dr. Gregg channels Prince in his ode to MACRA.

You can rekindle your (hopefully) fond memories of HIStalkapalooza in Las Vegas by checking out Elsevier’s great video. Thanks to Elsevier for creating the video, sponsoring the event, and sponsoring HIStalk for several years. I guess I need to decide soon whether to do it again in Orlando since venue booking is always the first step, but it’s also the scary one where I sign on the line which is dotted an agreement to pay many dozens of thousands of dollars in hopes that sponsors will step up to keep me financially solvent.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

DocuTap, which offers an urgent care PM/EHR, is acquired by private equity firm Warburg Pincus.

Envero Health, which offers care management and analytics systems, raises $14 million. CEO Dan Neuwirth was previously president and CEO of MedCPU Americas. The company’s website is irritatingly vague and artsy in failing to explain exactly what they’re selling, but a news search turns up its recent acquisition of two other Richmond, VA firms owned by local health systems, one that offers an HIE and another selling call center services. 

McKesson reports Q4 results: revenue up 7 percent, EPS $1.97 vs. $1.69, meeting revenue expectations but falling short on earnings. Technology Solutions wasn’t mentioned much in the earnings call except to say that margins are improving and hospital revenue is decreasing. Stock analysts didn’t even ask any technology questions as they focused exclusively on McKesson’s core drug business.

CPSI announces Q1 results: revenue up 51 percent, EPS –$0.07 vs. $0.49, missing expectations for both with the company blaming the timing of its $250 million January Healthland acquisition closing. From the earnings call, Healthland CEO Chris Bauleke has left CPSI well before the 12 months he agreed to stay on to help with the transition.

Cerner reports Q1 numbers: revenue up 14 percent, adjusted EPS $0.53 vs. $0.45, meeting earnings expectations but falling short on revenue.

Allscripts reports Q1 results: revenue up 3 percent, adjusted EPS $0.13 vs. $0.08, beating earnings expectations but falling short on revenue.

The Advisory Board Company reports Q1 results: revenue up 12 percent, adjusted EPS $0.46 vs. $0.30, beating earnings expectations but falling short on revenue.

The dour German engineers that run the gray metal conglomerate Siemens inexplicably turn their marketing people loose to justify their existence in creating a forcibly fun new identity for the healthcare business, with the end result being that Siemens Healthcare will now be known as – it’s making me retch as I type it – Siemens Healthineers, which sounds overly cheery for a company best known for supporting the Third Reich and bribing government officials. Feel free to sing along with the video above that celebrates the “innovators and family of friends” who mostly seem embarrassed by the corporate misstep that is exploding with mandated joviality around them, with the Disney-esque song running way too long before it finally ends to stunned, half-hearted applause. The only people who seem to be actively engaged in the white-bread proceedings are two on-stage suits, who I assume were in charge since their beaming faces and stiff dancing are the exceptions among an otherwise borderline hostile crowd who would clearly rather be anywhere else. They should have passed out the faux Blue Man Group costumes at the door to prevent the friends and families of employees from recognizing them. Surely the out-of-touch executives that approved the name without thinking it through are horrified by the scorn it is generating, leading to my prediction that it will be quietly retired within a few weeks and everybody who was involved will claim they didn’t know anything about it or were just following orders.

Startup Ns1ghter offers free, unlimited online access to its board-certified doctors. It boasts of a machine learning platform whose contribution is not described, but that appears to be intended for developing care algorithms. The “free” part is made possible by “funding and marketing partnerships.” The choice of name is bizarre without being memorable (they apparently pronounce it “insighter” without acknowledging the presence of the numeral) and the company’s address on its privacy policy page is a residence in Austin, TX.

Sales

Salem Regional Medical Center (OH) selects Meditech 6.1 to replace McKesson Horizon.

People

Rock Health Founder and Managing Director Halle Tecco announces via Twitter that she is leaving the venture capital firm for unstated reasons and destination.

Kaleida Health (NY) hires Cletis Earle (St. Luke’s Cornwall Hospital) as VP/CIO.

David Chou (University of Mississippi Medical Center) joins Children’s Mercy Hospital (MO) as VP/CIO.

Announcements and Implementations

Optum, Medecision, and TriZetto launch a set of software and service offerings for state Medicaid Management Information Systems, taking advantage of a CMS change that provides federal funds for states to modernize their Medicaid enrollment, eligibility, and claims systems incrementally.

Government and Politics

Farzad Mostashari tweets out this CMS actuary’s graphic that shows the expected impact of MACRA on physician payments, which he describes as “financial suicide” for small practices. It suggests that 87 percent of solo practices will be paid $300 million less, or about $3,400 less per doctor. It’s interesting that the bigger the practice, the lower the expected rate of negative adjustment (dropping to just 18.3 percent for practices of 100 or more clinicians). The inevitable consolidation might sound like a good thing economically, but note that hospital consolidation has raised rather than reduced prices and patients are dealing with an even larger indifferent bureaucracy.

Privacy and Security

A hacker called “The Collector” offers 1.7 billion email passwords for sale, stolen from all of the most popular online email services. The hacker is selling the entire package for $1, asking only that positive reviews be posted on a hacker forum. Experts recommend changing passwords for email as well as any other sites where the same password was used.

Privacy advocates question Sharp Grossmont Hospital’s (CA) use of OR video surveillance in trying to determine which team members were stealing drugs. The hospital hid motion-activated cameras inside the computer monitors of anesthesia machines, thereby capturing video of every delivery and tubal ligation over a year without patient consent. The hospital says the videos show the doctor they suspected pocketing drugs, but the doctor says he was just keeping them handy and other videos show the doses being used on patients. The hospital doesn’t want to give the doctor’s lawyers access to the videos, saying they would invade the privacy of Sharp HealthCare, employees, and physicians.

Other

The mainstream press picks up an FDA MAUDE database adverse event report filed by Merge Healthcare in which an unnamed hospital customer ignored the company’s antivirus configuration instructions for its Merge Hemo cath lab documentation system, failing to exclude huge medical imaging and data files. The hourly scans caused an incident described as, “A customer reported to Merge Healthcare that, in the middle of a heart catheterization procedure, the hemo monitor PC lost communication with the hemo client and the hemo monitor went black … there was a delay of about five minutes while the patient was sedated so that the application could be rebooted.”

A TransUnion Healthcare survey finds that three-quarters of consumers are worried about increasing healthcare costs as they watch their premiums, co-pays, and deductibles increase even before the 2017 rate increases. I have to assume that the 25 percent who don’t care about healthcare costs are funded in some way by taxpayers who do.

Study authors determine that medical mistakes kill more Americans than all other causes except heart disease and cancer. The study involves quite a few assumptions since death certificates don’t include codes for medical errors and BMJ seems awfully promotional in touting the article, but regardless of methodology, all of us working in healthcare know that patients die because of our screw-ups. Still, it’s hard to say definitively that a given medical error killed a patient, just like it’s hard to say that a given patient died of cancer rather than of chemotherapy complications.

An LA Times investigative report finds that Purdue Pharma, which has sold $31 billion worth of the narcotic OxyContin, knew that the drug didn’t really offer 12-hour relief as its packing claims, but it  stuck to those claims because the 12-hour dose was the only advantage the patented drug had over older, cheaper alternatives. The company instructed sales reps to tell doctors to increase the dose rather giving it more often, causing many patients to be ordered dangerously high doses and to go into withdrawal even while failing to achieve pain relief, feeding a cycle of addiction in which seven million Americans have abused the drug. Meanwhile, the company’s owners (the Sackler family whose name adorns several art museums) have amassed a $14 billion fortune.

Sponsor Updates

• Ingenious Med launches a year-long bus tour to offer guidance to providers on how to lower costs through improved care.
• Influence Health announces the 2016 EHealth Excellence Award winners.
• Cumberland Consulting Group is rated by KLAS as the top-performing targeted Epic consulting firm.
• InstaMed sponsors the 21st annual Taste for a Cure at UCLA Health.
• PokitDok joins CommonWell Health Alliance.
• Visage Imaging will exhibit at ACR 2016 May 16-17 in Washington, DC.
• Netsmart will exhibit at the Decision Coordinated Health Care Summit May 9 in Baltimore.
• Obix Perinatal Data System will exhibit at the Philadelphia Pregnancy Center Prenatal Summit May 5-7 in Philadelphia.

Blog Posts

• Trading in Fear: the Anatomy of Ransomware (ID Experts)
• Moving Forward with Interoperability: the Behavioral Health Perspective (InterSystems)
• 7 Months in: Where do we stand with ICD-10? (HCTec)
• Limiting the Hidden Costs of Data Security and Compliance (Liaison Technologies)
• Direct Consulting Associates interviews former CIO and now consultant Sue Schade.
• Joint Commission allows texting of orders (DrFirst)
• Client Outlook and LifeImage: Unified Access to All Imaging Content (LifeImage)
• Partners in Time (MedData)
• What Today’s Patients are Borrowing From the World of Money Management (Navicure)
• The Joint Commission Recognizes the Value of Secure Text Messaging (Spok)
• Capturing Patient Stories (NVoq)
• What are your concerns about interoperability, in your healthcare organization? (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.

News 5/4/16

Top News

Pharma services firm Quintiles – which acquired Encore Health Resources in 2014 – will merge with drug data and marketing firm IMS Health, creating a drug data behemoth with 50,000 employees and $7 billion in annual revenue.

Quintiles founder Dennis Gillings, PhD was a biostatistics professor at University of North Carolina at Chapel Hill when he founded Quintiles in 1982, eventually making him a billionaire.  IMS Health is mostly known for selling drug prescribing and dispensing information to drug manufacturers to allow their salespeople to aggressively market their products to physicians.

Reader Comments

From Spiffy Duds: “Re: [vendor name omitted]. Glassdoor reviews say the place is imploding, running scared about Epic threat, losing customers and employees, late on software, new platform released with huge issues. The new president runs a fear-based shop and can’t stick to a strategic decision. The owner knows nothing about healthcare and is an incurable narcissist who believes the company is saving lives and doing things that no one else can do.” Unverified. I’ve omitted the company name since anyone can say anything on Glassdoor, plus Glassdoor now allows full viewing of comments only to those who write a review or submit a salary, of which I’ve done neither.  

From Publius: “Re: Coast Guard and Epic. It’s quite the coincidence that Leidos deleted the Coast Guard’s Epic SAN while working with Cerner on the DoD project.”

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mr. S from New Mexico, who asked for electronic circuitry to help Zack, a student in his high school class who has set his sights on obtaining a Harvard math and engineering PhD. Zack reports, “I thank you for empowering me to use electronic circuitry components to create Arduino circuits that I code and assemble. This is most exciting because I can use circuitry components that I previously was unable to access. Thank you for allowing me to do this.”

Also checking in is Ms. W from Arizona, whose preschoolers are learning “sight words” in the 10 minutes per day she has set aside for using them. She reports, “These tools may be small to some, but to my students who do not have the opportunity to have these things, it is a great essential. I can’t wait to continue using these tools for the years to come in my classroom and see the great learning that happens.”

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Healthcare managed services vendor MedData acquires patient engagement software vendor Duet Health.

Behavioral health telemedicine software vendor WeCounsel closes its $3.5 million Series A funding round. The company offers practices unlimited use of its platform for $15 per month.

NIH awards ID Genomics a three-year, $3 million grant to continue development of its 30-minute test that identifies the bacteria causing an infection and matches it against a profile of antibiotic resistance to help doctors choose the right antibiotic.

Cotivity, which sells payment accuracy solutions to payers in healthcare and retail, announces plans to launch an IPO.

Investor Warren Buffett, asked a question about board member diversity at Berkshire Hathaway’s annual meeting, uses Theranos as an example of what not do do when choosing a board:

You know, one organization recently, the one that did the blood samples with small pricks, they’ve got some very big names on their board. Theranos. I mean, the names are great, but we’re not interested in people that want to be on the board because they want to make two or three hundred thousand dollars a year for 10 percent of their time. And we’re not interested in the ones for whom it’s a prestige item and who want to go and check boxes, or that sort of thing.

Imprivata announces Q1 results: revenue up 23 percent, adjusted EPS –$0.21 vs. $-.24, beating analyst expectations for both. 

Announcements and Implementations

England’s West Suffolk NHS Foundation Trust goes live on Cerner.

CommonWell and NATE (the National Association for Trusted Exchange) will join each other’s organization as members.

Government and Politics

A study finds that citizens of states that spend more on social and public health services vs. healthcare services have better outcomes for several chronic and debilitating conditions.

The federal government will require the DoD’s Defense Health Agency to issue IT contracts through the General Services Administration.

Innovation and Research

A study finds that the most profitable hospitals (based strictly on operating income) are for-profit, have higher markups, have regional prestige that allows them to dictate terms to insurers, and are located in states (interestingly enough) with price regulation. The most profitable hospitals in the 2013 data studied were 268-bed Gundersen Lutheran Medical Center (which made $300 million in profit from patient care), Sutter Medical Center, and Stanford Hospital. I checked Gundersen’s federal tax forms, which show 2014 profit of $95 million, down from $312 million in 2013. To its credit, the hospital paid its executives comparatively modestly, with the CEO earning $910K and the CIO $385K.

Half of surveyed teens say they are addicted to their smartphones, with 78 percent of them checking their devices at least hourly and 72 percent believing they must respond immediately to texts and social networking messages. More parents than teens (56 percent) check their devices while driving, while a big chunk of both groups think the other ignores them and plays with their phones when they’re together. 

Technology

Microsoft’s SQL Server 2016 will launch on June 1, with speed and security enhancements, support for the R analytics tool, the ability to query both structured and unstructured data, and the ability to query encrypted data without decrypting it first.

Google donates $250,000 toward Flint, MI’s water problems, of which $150,000 will fund a University of Michigan data project to identify homes with likely high levels of lead. UM will also develop a mobile app and website that will allow residents to visualize data and communicate with the city.

Other

As reported here earlier in quoting Shriners CMIO Richard Paula, MD, the Joint Commission confirms in an emailed newsletter Monday that it has reversed its 2011 policy that prohibited sending orders via text message, effective immediately. Joint Commission says it changed its mind because messaging platforms have improved.

The only rural hospital in Massachusetts — 19-bed, Partners-owned Nantucket Cottage Hospital – may cause all state hospitals to lose $160 million in Medicare funding in the next year after consultants make mistakes in calculating the hospital’s labor costs. The hospital’s high-cost location makes it the state’s most expensive and Medicare sets the labor payments to all other hospitals based on its costs. Some hospitals could lose 10 percent of their Medicare payments due to the mistake.

An interesting article describes Mid-Atlantic Permanente Medical Group’s hepatitis C screening protocol, which has these components:

• An EHR alert recommends to providers that patients born between 1945 and 1965 undergo hepatitis C screening if they haven’t already had it.
• Patients who test positive for the hepatitis C antibody are automatically ordered confirmatory testing.
• An assigned hepatitis C coordinator manages the follow-up activities and educates the patient.
• A liver damage assessment is automatically ordered.
• Patients are connected to physicians to make sure ongoing care occurs.

A Kaiser Health News article concludes that hospitals are not good at coordinating post-discharge care with home health agencies and nursing homes, particularly when it comes to medications. The article notes that none of the $30 billion in HITECH EHR bribes went to nursing homes, rehab facilities, or home care providers. The article failed to note equally sobering problems in coordinating the care of patients with behavioral problems, which have a similar genesis.

The Chinese government will investigate search engine company Baidu following the death of a student who searched online for a treatment for his rare form of cancer. The student claimed that his search turned up a hospital that lied about a high rate of success with an experimental treatment he was given. Before he died, the student accused Baidu of promoting false medical information and called out the hospital for false advertising.

Two large employers who offered a healthcare price transparency tool found that only small percentage of employees used it and healthcare costs actually increased slightly.

A study finds that the price of oncology drugs is steadily and illogically increasing, as drugs whose initial high price was justified by expected narrow usage get more expensive even when new indications are discovered.

Sponsor Updates

• KLAS recognizes Sagacious Consultants (now part of Accenture) as a top-performing Epic consulting firm.
• AdvancedMD releases a new ebook, “Advanced Practice Training: Changing the Game in Financial Reporting.”
• Extension Healthcare releases a video showing how its Engage Mobile solution integrates with AirStrip One live waveforms.
• AirWatch launches the Echo One Podcast.
• Aprima will exhibit at the ACP Internal Medicine Meeting 2016 May 5-7 in Washington, DC.
• KLAS recognizes Nordic’s Epic implementation support and staffing services, also ranking the company for the first time in the IT Advisory segment with a 92.6 score.
• Besler Consulting releases a new podcast, “What Hospitals Should Do Regardless of Who is Elected President.”
• DrFirst’s Rcopia e-prescribing platform wins the Surescripts White Coat of Quality Award for the fourth time.
• CapsuleTech celebrates National Nurses Week May 6-12.
• The Advisory Board Company features Carevive Systems in a presentation during its Oncology Roundtable series May 5-6 in Washington, DC.
• CompuGroup Medical will exhibit at the Rural Health Care Conference May 10-13 in Minneapolis.
• CoverMyMeds will exhibit at the 2016 New England Regional MGMA Conference May 5-6 in Bretton Woods, NH.
• Wellcentive develops a free tool to calculate the cost of delaying the shift from payer volume to value-based care and reimbursement.
• Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
• ECG Management Consultants will present at the MGMA New England Regional Practice Management Conference May 5 in Bretton Woods, NH.
• EClinicalWorks will exhibit at the IMGMA Spring Conference May 5-6 in Indianapolis.
• Healthwise will exhibit at the EClinicalWorks 2016 Health Center Summit May 11-13 in Boston.

Blog Posts

• Provider How-To: Minimizing Gaps in HCC Data Capture (Arcadia Healthcare Solutions)
• Data-Enabled ≠ Data-Driven (Catalyze)
• Protecting Against Ransomware with Layered Security (Impact Advisors)
• Gen Z in HIT (Direct Consulting Associates)
• Revenue Management: Pay Attention to Your No-Show Rates (E-MDs)
• 4 quick tips for your next cybersecurity conversation (The Advisory Board Company)
• The New Architecture of Healthcare Delivery (Part 1) (Extension Healthcare)
• Top 6 Reasons Healthcare Organizations Should Automate the Informed Consent Process (FormFast)
• The Death of an Electronic Note (Galen Healthcare Solutions)
• Tale of Two Systems: Making the Right IT Choice Following a Merger or Acquisition (Hayes Management Consulting)
• Healthcare Cybersecurity: Prevention, Detection, and Training (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.
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ResearchKit Unlocks the Power of Real-Time Clinical Research

New studies at Boston Children’s and RWJF highlight the evolving role of Apple’s mobile research technology.
By @JennHIStalk

It’s been just over a year since Apple introduced ResearchKit, an open source framework that enables researchers and developers to design apps for healthcare research. In that time, participation has soared. The platform now boasts 100,000 users who are submitting data to studies sponsored by hospitals and non-profits, including ones focused on asthma, breast cancer, diabetes, heart disease, hepatitis C, melanoma, Parkinson’s, post-partum depression, prostate cancer, and sleep apnea.

Even the NFL Players Association has gotten in on the act, partnering with Harvard University researchers to use ResearchKit in a joint investigation into the long-term effects of football injuries on 3,000 former NFL players.

The platform has also made accommodations for personal genomics via integration with 23andMe’s module. Researchers can enable 23andMe customers to contribute their genetic data to a study or offer genotyping services from the company to study participants. It’s a timely move given the industry’s White House-driven focus on precision medicine and cancer moonshots.

Apple, having realized the escalating potential of its own creation, decided earlier this year to start collecting ResearchKit data for its own internal purposes. Study participants who submit data to the Mole Mapper Study app and Parkinson’s mPower study app now have the option of also submitting that data directly to Apple. The company no doubt plans to use the data to further refine the platform and to impact future iterations of HealthKit and the new CareKit, corresponding apps that help power and further ResearchKit’s capabilities.

Real-World, Real-Time Research

Studies leveraging ResearchKit continue to be introduced, evidence that the platform is well on its way to changing the face of medical research. “It’s the most evolved mobile platform to run studies,” says Paul Tarini, senior program officer at the Robert Wood Johnson Foundation, which has taken an interest in ResearchKit from the beginning. “We’ve been interested in what we call real-world, real-time data for a number of years now, especially what that data can tell us about our health, how it can be used for research, and how it can be used to improve care. ResearchKit was the first formal platform developed to conduct research by taking advantage of the IPhone’s native capabilities to collect real-world, real-time data.”

Tarini and his team began talking about what kinds of apps might be useful within the ResearchKit library not long after its debut. “In discussions with Apple staff and industry experts, we ended up settling on mood and what helps influence mood,” Tarini explains. The result of that decision – RWJF’s Mood Challenge – launched earlier this month.

“We’re hoping the winning app could be used in part or in whole by another study that’s interested in including some aspect of mood or variable in its focus – something that other researchers can pick up, use, and plug in as they build their own apps,” Tarini adds. “We’re also interested in apps that use a mash-up of data, such as data from the phone and other sources, to shed light on mood. In this case, we’re particularly interested in data on social context. What are the graduation rates in your neighborhood? The income rates, family structures, crime rates, weather patterns? How do these influence health, if at all? We’re really focusing on building a culture of health in this country, and social context is certainly a reflection of culture.”

Uncovering the New Normal

Researchers at Boston Children’s Hospital have also been ResearchKit fans from the beginning. “We are proud to be the first academic institution to launch our second ResearchKit app,” says Jared Hawkins, director of informatics and innovation and of the hospital’s digital health accelerator. The hospital launched its C-Tracker app last year to collect data on the effects of hepatitis C and debuted the Feverprints app last month.

“One of the major lessons we learned from C-Tracker was how best to link anonymized data from ResearchKit to our servers at the hospital, securely and at scale,” Hawkins explains. “There are a number of commercial solutions for this, but none of them offered the flexibility that we needed. Fortunately, the C-Tracker team developed open-source software, C3-PRO, to accomplish this, which we have leveraged for Feverprints.”

The Feverprints study and ResearchKit-powered app will help Boston Children’s researchers better understand what a “normal” temperature looks like, how fever patterns can be used effectively to diagnose disease, and how fever-reducing medications affect the course of an illness.

“The standard notion that a normal temperature is 98.6 and a fever is anything above 100.4 is based on questionable research from a few hundred years ago,” says Hawkins. “This study seeks to leverage modern technology, including smartphones and continuous temperature monitoring, to revisit this historical research and collect temperature from tens of thousands of participants to reassess what is normal.”

Form Factor Makes the Difference

The enthusiasm Hawkins has for Feverprints can be largely attributed to ResearchKit’s form factor. “It transforms how we can do clinical research by addressing some of the biggest hurdles we face as researchers – recruitment and long-term engagement,” he explains. “ResearchKit allows us to consent exponentially more users than would be possible traditionally, at minimal cost. These users have the power to enroll themselves, giving them a more direct role in the study and increasing engagement.

“Overall user experience is improved because ResearchKit makes it easier to share health data,” Hawkins adds. “If the user allows it, data from any connected smart thermometer can automatically be loaded from HealthKit. Even if data is entered manually, the whole process takes less than a minute. We hope that the data collected will allow us to identify distinct ‘feverprints’ that may aid clinicians in patient diagnosis in the future. For this, continuous data from a wearable device may prove to be the richest, although temperature data captured at any granularity will be helpful.”

Hawkins add that Feverprints app developers plan to add additional engagement features in the near future that will, for example, allow users to see how their data has specifically helped researchers better understand normal and elevated temperatures, and how they compare to the population as a whole. “We don’t have to wait until the study is over to begin to feed our results back to the user,” he says, “which really drives home the power of participatory real-time research.”

Tarini and his colleagues at RWJF also see immense value in ResearchKit’s data delivery methods. “We like the creativity, the flexibility, and the democratization,” he notes. “More people can enroll in the studies. We also like the fact that the platform is able to turn more results around more frequently to participants.”

Changing the Research Game

While there’s general consensus on ResearchKit’s ability to transform the way clinical studies are conducted, the verdict is still out on it being a bona fide “game changer.” It is, after all, available only to Apple users, which leaves the much larger Android user base without the means to participate. (an Android alternative called ResearchStack became available earlier this month.)

“I wouldn’t call ResearchKit a game-changer,” Tarini says, “because that means we’ve done it. I would say changing. ResearchKit is changing perspective on the importance of returning results to people. It’s producing greater engagement from the people who are participating.”

“We’re also excited about CareKit and the opportunity for more seamless integration of research data with regular care,” he adds. “You can repurpose the data that was collected by the research study and inject it into the processes of care so that a provider can see the data that’s coming in from the study. Previously, that was really hard to do, if not impossible. ResearchKit is changing the relationship between research studies and their participants, and the relationship between the research enterprise and the care delivery enterprise.”

Hawkins is more optimistic about the role ResearchKit has thus far played in the evolution of clinical research. “It’s absolutely a game-changer for health research because it addresses some of the biggest hurdles we face as researchers – recruitment and long-term engagement. We are looking for other projects at the hospital that would benefit from ResearchKit as well as the newly announced CareKit. Apple has built some truly exceptional platforms to enable health research.”

Monday Morning Update 5/2/16

Top News

Meditech releases Q1 results: revenue up 4.3 percent, EPS $0.51 vs. $0.53. Product revenue rose 3.2 percent, with 78 percent of that coming from services. The company generated $23.1 million in total cash flow, all of which was paid to shareholders as dividends.

Meditech Director Dan Valente, 85, has resigned as director and was replaced by CFO Barbara Manzolillo.

Reader Comments

From Dixie Chicken: “Re: Epic. Verona, WI will collect taxes based on an Epic campus value of $393 million, but Epic has spent billions on it. If that’s the basis of property taxes, is Verona celebrating when they should feel ripped off?” Verona will close the special tax district it created to get Epic to relocate there from Madison 14 years ago when the company had only 550 employees, cashing in the district’s financial surplus and making Epic’s campus taxable. The property’s value is established at the time the tax district is created, meaning Epic’s massive campus growth (from 550 employees to nearly 10,000) returns only a partial benefit as companies pay only lower, construction-related taxes when they expand.

HIStalk Announcements and Requests

Forty percent of poll respondents think that EHR redesign offers the best hope for reducing the time physicians spend entering data into EHRs, while 25 percent say the capture of non-clinical information is the real problem that should be addressed. Tech MD wonders if those readers who chose EHR redesign or reduced data capture burdens believe the other choice is a lost cause, while Mobile Man says it’s futile to expect EHRs to be redesigned because they are intended to be big filing cabinets. Curious (along with a least one person per poll I run) expresses an unrequited lust for surveys that allow shades-of gray answers, which of course means that he or she must also prefer capturing EHR narrative rather than easily interpreted check-boxes for precisely the same reason  — I would rather force respondents to choose the “best answer” rather than leaving me to wade through 431 free-text comments and abstract their thoughts into a collective opinion.

New poll to your right or here: is the proposed replacement of Meaningful Use with MACRA positive or negative?

Ms. Ahrstrom says the math books we provided to her South Bronx, NY third graders in funding her DonorsChoose grant request have eliminated the boredom using the limited selection of books available in the school’s library, as students can’t wait to finish each book and start the next one.

Also checking in is Ms. B from Minnesota, whose students are still talking about the field trip we provided to the Wildlife Science Center even though it was weeks ago.

Listening: Nico Yaryan, of whom I know basically nothing except he’s a newcomer and I like his music. He sounds like he could make it big. Here’s another of his songs.

Last Week’s Most Interesting News

• HHS issues a Notice of Proposed Rulemaking that spells out details of MACRA, the value-based payment model for providers who accept Medicare. MACRA will replace the Meaningful Use program with less-prescriptive measures called Advancing Care Information.
• Joint Commission announces that it will permit clinicians to send orders via secure messaging, provided that the system they use supports specific message management and EHR integration standards.
• Epic gives its side of the story on why the Coast Guard cancelled its EHR implementation plan.
• NextGen confirms employee layoffs, immediate cessation of development on its NextGen Now cloud-based PM/EHR, and a strong focus on the HealthFusion PM/EHR it acquired for $165 million in January.
• Apple releases the CareKit developer’s framework and announces availability of the first four apps that will use it.
• The FDA rejects the “digital pill” drug application that would have used technology from Proteus Digital Health.
• Nokia acquires consumer health device vendor Withings for $192 million to create Nokia Digital Health.
• CMS releases the minimally redacted warning letter it sent to Theranos last month in which it accused the lab processing company with a lack of knowledge of CLIA standards and diluting finger-stick samples so they could be run on standard Siemens analyzers.
• Verisk Analytics announces that it will sell its Verisk Health services business to Veritas Capital for $820 million.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

A small reference in Caradigm’s announcement of a new CEO last week says that Microsoft has sold its 50 percent interest in Caradigm the holder of the other 50 percent, GE Healthcare. The company didn’t explain why the change wasn’t otherwise announced.

From the Athenahealth earnings call:

• The company has partnered with Intacct to offer its hospital customers an ERP solution and says it will seek additional partnerships to expand its service capabilities.
• Jonathan Bush said in answering a stock analyst’s question, “In the small-hospital market, there is a borderline collapse of the established technologies, so there is a huge demand … with the exception of Epic and Cerner, most of the HIT companies appear to be just not able to make a go of it.”
• Bush added that Athenahealth won population health management system deals at Dignity and Providence because those health systems trialed products from their existing vendors and found them unacceptable (Dignity is a Cerner shop, while Providence uses Epic).
• Bush said of the company’s efforts to move users of systems from the acquired RazorInsights to those of Athenahealth, “It’s very hard … in order to be that fast, the architecture was more client-centric than network-centric. Every single table — the drug list, the provider directory, the pharmacy supply, the medical supplies — every single one of them is a separate table that only works for each individual customer. That is not the point of Athenahealth … we are taking back those tables, taking back the administration of them and connecting them to great little Web services that connect to national tables that are always current, always correct because they’re maintained by us. That work involves moving the cheese of people that have worked very hard on their tables for years. So, it’s painful.”
• Bush replied to an analyst’s question about an unnamed competitor moving to a cloud-based product, “You need to double-check on the idea that anybody that you’re thinking about is cloud-based. That somebody will host your data center and run backups does not make them cloud-based. I just described the agony we’re going through centralizing the remaining tables that are being maintained by clients. These are companies where 100 percent of tables are maintained by clients. This is just rental software and 99 percent of the code is running on the servers in the client side. So let’s be clear — those guys are not cloud-based.”
• When asked about the credit-worthiness of hospital prospects, Bush said, “We used to joke in selling to doctors in the early days that we restrict our sales team to doctors that have a pulse. That was an interesting comment at the time because a lot of the doctors’ pulses that we originally signed were quite thready at best … not only are the HIT companies dying, but a lot of the hospitals are dying … . You have very, very low bed occupancy in this segment, a need to dramatically change strategy from kind of end provider of inpatient and acute care to front-end of the larger health system for the ill … if you took the imaging margins out of every hospital right now, more than half the hospitals in the country would close. Some of the best names in healthcare with the best institutions in healthcare have the majority of their profits coming just from an anomaly where the cost of the imaging equipment is going down because of digital equipment faster than Medicare can figure it out and chase them down.”
• Bush explained the company’s More Disruption Please program as, “It’s too bad that Epic and Cerner and Meditech and all these guys can’t build open enough platforms, because we don’t really want to do Athena dietary management systems. But if it doesn’t come out of MDP and if Epic and Cerner and Meditech don’t open up their API so that they could be used by responsible developers, what can you do?“
• Bush replied when asked about adding billing capabilities to the former RazorInsights product, “The front desk for the hospital is the front desk for AthenaNet. It’s the same front desk, same work flow, same insurance capture, same portal registration … one of the big arbitrage opportunities for AthenaOne for the inpatient is, we get all the doctors around the hospital. We don’t have to register them when they show up at the hospital. We already know what their deductible utilization is, we already know their eligibility, we know their medical records, et cetera, et cetera  … there has been a product we’ve been dying to release for years, for a decade, called AthenaController, which basically takes on the same approach to the cost cycle as we have to the revenue cycle. We are now pregnant with that baby. We have to do it.”

People

Ryan Nellis (Optum) joins Stanson Health as SVP of sales and marketing.

Announcements and Implementations

Clinical Architecture launches its SIFT Services product line, which uses natural language processing to extract coded data from free-text documents for specific data targets. The company offers a free trial of the first offering, SIFT for Meds. 

Nordic hires its 600th consultant.

Government and Politics

Political differences aside, President Obama might offer Ronald Reagan a challenge for the title of funniest American president ever. Above is the video, “Couch Commander,” released by the White House and presented at the White House Correspondents’ Association Dinner. The Obamacare references at 1:33 are interesting.

Privacy and Security

A science magazine analysis finds that the agreement between the UK’s NHS and Google’s artificial intelligence company DeepMind gives the company full electronic information on 1.6 million patients treated annually by three hospitals of Royal Free NHS Trust. Google says it needs complete information on all patients because NHS can’t provide a subset just for the kidney patients who will be monitored by Google’s Streams system. The agreement also calls for Google to develop a clinical decision support and surveillance system called Patient Rescue that will use real-time data streams from the hospitals. Critics are not only worried about Google keeping the patient information secure, but also that Google is the only company with access to the data.

The American Dental Association notifies subscribers to its Dental Procedure Codes that some of its thumb drive updates contain malware. The ADA speculates that one of the duplicating machines used by ADA’s China-based manufacturer were infected with data from a previous customer, meaning that only the drives produced by that specific machine contain malware.

Other

Here’s a nice quote from Farzad Mostashari, MD in responding to a tweet saying that non-profit Minnesota HIMOs (like most health systems everywhere) insist that what’s left when income exceeds expenses is a “surplus” rather than a “profit,.” although they seem to love the word “loss” when things aren’t so rosy. Perhaps Farzad can weigh in on “payment” vs. “reimbursement” and “invested” vs. “spent.”

Dear Health Data Management, please spell company names correctly, not like the actual word is spelled. Thank you.  While I’m quibbling journalistically, I would to ask newspapers to stop saying that someone “checked himself in” to a hospital since that just doesn’t happen.

Here’s the next HIS Vendor Review from Vince and Susan, which this time looks at high-end vendors.

Sponsor Updates

• T-System will exhibit at the CHIMA Annual Meeting May 5-6 in Denver.
• The local news interviews TeleTracking President Michael Gallup about the company’s sponsorship of the Walk MS Pittsburgh 2016 event.
• Fortune profiles Validic.
• Vital Images will exhibit at the McKesson User Group May 2-4 in Atlantic City, NJ.
• Huron Consulting Group will exhibit at the MAGI Clinical Research Conference 2016 East May 1-4 in Boston.
• Wellsoft will exhibit at Emergency Medicine Update 2016 May 3-5 in Toronto.
• ZeOmega offers the Jiva Consultant Certification Program.
• PatientPay extends the $10,000 healthcare billing challenge.
• Streamline Health will exhibit at the 2016 DCHIMA/MDHIMA Annual Meeting May 6 in Hanover, MD.

  Blog Posts

Blog Posts

• Doctor’s Orders: The Joint Commission allows texting. (Voalte)
• Healthcare’s Moving Into the 21st Century, but Many Users are Holding on to 20th Century-Style Expectations (West Corp.)
• Why Partner with an RCM Clearinghouse? (ZirMed)
• The Future of Enterprise Mobility is Here: What’s Your Strategy? (PatientSafe Solutions)
• Lessons From Our Recent Provider Survey (Patientco)
• A Prescription for Physician Applications (PatientKeeper)
• Preventing readmissions through enhanced care team collaboration (PerfectServe)
• Mary Greeley Medical Center Weighs In (PeriGen)
• Predictions of Apple Q2 Earnings from Medical Charge Capture and Secure Messaging Users (PMD)
• Biosimilar Legislative Trend Means Big Changes for EHRs (Point-of-Care Partners)
• Providers, EHR Vendors Weigh-In on the Importance of Electronic Prior Authorization (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.

News 4/29/16

Top News

HHS issues a Notice of Proposed Rulemaking for the long-awaited Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will replace the Meaningful Use program in moving clinicians to payment based on value starting in 2017. The Merit-Based Incentive Payment System (MIPS) sets Medicare payments based on quality, use of technology, clinical practice improvement, and cost. Physicians participating in alternate payment models such as CPC+ and the Next-Generation ACO will be eligible to receive bonuses without participating in MIPS.

A CMS blog entry from CMS Administrator Andy Slavitt and National Coordinator Karen DeSalvo says Meaningful Use boosted EHR usage, but adds, “We remain a long way from fully realizing the potential of these important tools to improve care and health.” HHS says incorporating Meaningful Use in the MIPS program in a program called Advancing Care Information will “make it more patient-centric, practice-driven, and focused on connectivity.”

Slavitt and DeSalvo’s article says Advancing Care Information will:

• Simplify physician reporting by eliminated all-or-nothing measures.
• Provide flexibility for doctors to choose the most applicable measures.
• Emphasize interoperability and the right for patients to access their own information through APIs.
• Reduce the number of measures from 18 to 11.
• Exempt doctors from reporting if EHR technology isn’t applicable to their practice.

The article sheds light on the technology focus going forward:

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

The proposed HHS changes would affect only Medicare payments to practices. Nothing will change for hospitals and Medicaid program participants.

The full text of the 962-page proposed legislation is here. The Advisory Board Company posts a good summary.

Here’s a new three-minute HHS video for consumers that describes delivery system reform.

Reader Comments

From Richard Paula: “Re: texting of orders. The May 2016 Joint Commission Perspectives will contain a revised statement on texting orders, ending the ban enacted in 2011. It reinforces the fact that texting can be an expedient method of patient care. The secure texting platform must have:

• A secure sign-on process
• Encrypted messaging
• Delivery and read receipts
• Date and time stamp
• Customized message retention time frames
• Specified contact list for individuals authorized to receive and record orders

It requires text orders to be complete, dated. timed, confirmed, authenticated, and documented in the medical record.” Rich is CMIO of Shriners Hospitals for Children. This is a pretty big deal as companies whose messaging product can’t integrate with EHRs to complete the order loop now find themselves at a significant competitive disadvantage.

From Marshal: “Re: Meditech. Delta Regional in MS has signed to replace Cerner with Meditech. Salem Regional Medical Center in OH has signed with Meditech to replace their McKesson Horizon system. Cerner was the other finalist in that bid.” Unverified. 

From Graham: “Re: Coast Guard EHR. I saw that Politico just replayed your coverage from last October. The Coast Guard won’t say if a particular provider’s software caused the issues. What’s your take on where accountability resides? Sounds like mismanagement at a project level by USCG themselves, but Epic paying back $2.2 million on a $14 million award isn’t immaterial, either. It gets even fuzzier with the InterSystems component coming in later and then Leidos / Apprio / Lockheed.” The Coast Guard cited unstated problems with the implementation, seemingly blaming itself for a lack of consistent workflows and ongoing scope expansion, while outsiders speculate that it handled the product selection poorly and that Epic and Leidos may have bid too low to  meet the Coast Guard’s expectations.

Meanwhile, Epic uncharacteristically posts its side of the Coast Guard story, saying its software was originally ready for go-live in 2011, but Coast Guard changes such as hardware procurement delays, vendor changes, data center changes, and a government accounting investigation of the Coast Guard’s method of payment threw the schedule off. The Coast Guard’s storage area network was also lost twice, once from corruption and once after someone from Leidos deleted it. Epic says the go-live was rescheduled for October 2015 and was on track until the Coast Guard cancelled it the month before for unstated reasons. Epic says it was paid in full and the Coast Guard did not ask for a refund.

HIStalk Announcements and Requests

I’m interested to learn what sort of EHR prototype the VA is creating in exploring the idea of replacing VistA with what sounds like another self-developed product. Let me know if you can provide information, on or off the record.

The vast majority of 514 poll respondents (92 percent overall, including 90 percent of the females and 93 percent of the males) think it’s a bad idea for HIMSS to publish a separate website and newsletter for women in healthcare IT. Sandra says the goal is to be separate but equal rather than separate but separate, while NoHorseInThisRace says its a disservice for HIMSS to be “peddling its clickbait drivel” specifically at women. Lisa says she might take an occasional look but since the issues and concerns are the same for everyone, the choice of content the site will promote will be interesting. Long Disappointed by HIMSS adds that, “The comment made on HIStalk is appropriate – look no further than the board.” The women’s interest stories so far is lame – it’s anything related to Karen DeSalvo, third-party stories on gender pay gap, and mentions of people who have been promoted who happen to also be female.

Ms. Anderson’s Arizona fourth graders, especially her special education students, have used the electricity and magnetism kits we provided in funding her DonorsChoose project to complete her standards-based assignments while having fun.

Also checking in is Ms. Isaacs, whose Indiana second graders are using the 16 sets of headphones we provided to participate in an online literacy program, which she saves “gives our class the opportunity to focus on what we are learning rather than the other students around us.”

This week on HIStalk Practice: Thirty-six practices sign up for CancerLinq’s oncology analytics. Raleigh Orthopaedic Clinic settles with OCR to the tune of $750,000. AMA partners with IDEA Labs to support student entrepreneurship in healthcare IT. The American Telemedicine Association aims to broaden the Rural Health Care Connectivity Act. Reliance ACO COO Gene Farber highlights the role of CCM in coordinated care. UniVision gets into telemedicine. Vice President Joe Biden set to spice up Health Datapalooza. CDW’s Jonathan Karl offers advice on how to promote positive outcomes with communication and technology.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

A RBC Capital Markets analysis says Quality Systems / NextGen issued investor updates Wednesday indicating that it will focus on streamlining management, building up the business of the HealthFusion PM/EHR it acquired in January for $165 million, and cutting costs furthers. Analyst Dave Frances expresses skepticism on the downbeat business changes announcement given a shrinking market share in QSI’s core business, adding that, “We remain unconvinced that HealthFusion and Mirth are the answer.” Quality Systems says it will stop development on its NextGen Now product immediately, taking a $32 million charge and confirming that it will reduce headcount by 150 as I previously reported from reader rumor reports. The cloud-based NextGen Now PM/EHR was announced in November 2014 and was supposed to be launched in 2015.

A New York Times op-ed piece says Theranos wasn’t a product of Silicon Valley hype – the company pitched to top life sciences venture capital firms whose doctorate-heavy investment teams were put off by Theranos trying to appear cool while keeping the technical details intentionally vague. Those VCs also noted that Theranos hadn’t published in peer-reviewed journals and that the company’s board was made up of mostly old politicians with zero healthcare experience. The company’s investors were non-Silicon Valley types who were apparently less discerning.

Leidos announces Q1 results: revenue up 5 percent, adjusted EPS $0.72 vs. $0.67. Chairman and CEO Roger Krone says in the earnings call it’s on track to bring the DoD’s MHS Genesis Cerner project live at two facilities in the Northwest by the end of the year, but Leidos will also continue making money supporting the old system for another 8-10 years until the Cerner rollout is finished.

Athenahealth announces Q1 results: revenue up 24 percent, EPS $0.34 vs. $0.24, beating analyst expectations for both. ATHN shares are up 13.3 percent on the year.

Spok reports Q1 results: revenue down 6 percent, EPS $0.17 vs. $0.18. The SPOK share price is down 12.9 percent compared to a year ago.

Vocera announces Q1 results: revenue up 12 percent, EPS – $0.14 vs. –$0.17, beating analyst expectations for both. VCRA shares are up 7.8 percent in the past year.

Sales

MedStar Health (MD) chooses provider data management and scheduling software from Kyruus.

UK Healthcare selects Voalte for caregiver secure messaging.

People

Medfusion hires John Juzaitis (ZirMed) as chief revenue officer and Michelle Murray (EDM Americas) as VP of marketing.

Brigham and Women’s Health Care (MA) promotes Adam Landman, MD to CIO.

Caradigm promotes Neal Singh to CEO. He replaces founder Michael Simpson, who has left the company.

Anita Pramoda (Owned Outcomes and former Epic CFO) joins the board of Health Catalyst, replacing EVP/Co-Founder Steve Barlow, who remains on the executive team.

Announcements and Implementations

The first four apps that use Apple’s CareKit developer’s framework are released to the Apple Store as the open source CareKit itself is also released to GitHub. The apps are Glow Nurture (fertility tracking), Glow Baby (maternity), One Drop (diabetes monitoring), and Start (depression medication tracking).

Other

Here’s a cute “Take Our Daughters and Sons to Work Day” photo from Karen DeSalvo’s office from @Commanda4aCure.

The FDA rejects the application for a drug-device combination, or so-called “digital pill,” to monitor drug adherence. FDA had already cleared the use of Proteus Digital Health’s technology in existing drugs, but wants to see more data before allowing Otsuka Pharmaceutical manufacture it as part of its Abilify antipsychotic medication. Proteus has raised $334 million in 10 rounds of funding, adding $50 million earlier this month.

A man sues Snapchat and the 18-year-old driver who rear-ended his car at 107 miles per hour while taking a selfie, leaving him with brain damage. The teen admitted that she was speeding while posting to earn a Snapchat “speed filter” trophy icon for recording her speed with her photo. After the crash, the teen took a photo of her bloodied face and labeled it “lucky to be alive.” Snapchat says it gives users a warning not to use its speed filter option while driving.

This TV screen grab will resonate with everyone annoyed by poorly timed Windows 10 update nagware messages.

Sponsor Updates

• Employees of Impact Advisors attending the company’s annual meeting in Orlando delivered 150 teddy bears to patients at Florida Hospital for Children.
• Florida Hospital (FL) reports decreased mortality and a $72.5 million increase in appropriate reimbursement after rolling out Nuance’s Clinical Documentation Improvement embedded, with the next step being to embed Nuance Clintegrity CDI within Cerner Millennium.
• Bernoulli will exhibit at the at the American Association of Critical-Care Nurses’ 2016 National Teaching Institute & Critical Care Exposition (NTI), May 16-19 in New Orleans.
• Intelligent Medical Objects will exhibit at the IHealth 2016 Clinical Informatics Conference May 4-7 in Minneapolis.
• MedData will exhibit at the Louisiana Chapter HFMA Annual Institute May 1-3 in Lafayette.
• Orchestrate Healthcare will help Pertexa integrate its Radekal physician productivity tool for hospital use. The tablet-based product expedites the clinical encounter, reducing visit time by up to 30 percent.

Blog posts

• Improve your revenue cycle: Make your providers more accessible [podcast] (Nordic)
• Information Sharing is Caring – If You Do It Right (ID Experts)
• Local SEO & Listings Management are Essential in Healthcare Marketing (Influence Health)
• Our Top 10 Favorite Moments from the InstaMed 2016 User Conference (InstaMed)
• Have We Created Connected Value for the Healthcare Community? (InterSystems)
• Discover the 5 Hidden Costs of Data Security and Compliance (Part 1) (Liaison Technologies)
• Health Data Interoperability or Bust (LifeImage)
• Introducing the Vyne Brand (Vyne, formerly MEA I NEA)
• The Role of Continuity in the Acute Care Setting (MedAptus)
• 6 tips for rocking Nordic’s best* maxim: Listen. (Nordic)
• By the Numbers: The Secure Text Messaging Market (Spok)

Contacts

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

How Providers Are Addressing Ransomware

Providers share their methods for staying one step ahead of healthcare’s latest foe.
By @JennHIStalk

While national headlines related to ransomware attacks on hospitals seem to have abated – for now – the healthcare industry’s interest in the latest cyberattack trend has only intensified. Research related to provider preparedness seems to come out weekly, highlighting what has by now become common knowledge: healthcare has a lot of work to do.

A HIMSS study released in early April found that 75 percent of surveyed hospitals were or could have been hit with a ransomware attack in the last year, with a significant number or respondents saying they aren’t sure or have no way to tell. Statistics like these make IBM’s data on industry-wide breaches in 2015 that much more believable, where the global company’s Cyber Security Intelligence Index found that healthcare was the most-attacked industry in 2015 with over 100 million patient records compromised.

The industry is working to handle what seems like a non-stop assault. HHS has created a Cyber Security Task Force to develop recommendations and best practices that could eventually impact legislation. Intermountain Healthcare (UT) has partnered with the University of Utah to establish a joint security center to help providers keep up with the latest cybersecurity threats, while providers in the trenches seem focused more than ever on assessing their cybersecurity vulnerabilities.

Taking a Proactive Approach

Northwell Health, a New York-based IDN with 21 hospitals and 450 ambulatory sites, has taken a proactive approach to cybersecurity, according to Mark Jarrett, MD, senior vice president, chief quality officer, and associate CMO. (Jarrett also serves on the new HHS task force.) “Recent events have only supported our enterprise-wide efforts to secure our network,” he explains. “We are performing hazard vulnerability assessments on a regular basis. As news becomes public of new events, we adapt our defenses. Maintaining all current security patches on our multiple systems is also key. To prevent ransomware attacks, we are employing all standard intrusion techniques from technical, such as firewalls, to staff education and testing so that they understand social phishing and the risks of non-certified thumb drives. We remain concerned as the sophistication of intruders to introduce malware has been increasing.”

Across the country, Texas Health Resources, a health system with 25 hospitals and 69 outpatient facilities serving the Dallas-Fort Worth area, has taken a similar approach. “In the last couple of years, we started to take aggressive action to defend against threats such as ransomware,” says Luis Saldana, MD, CMIO and medical director for clinical decision support. “This action included targeted reduction of direct user access to certain forms of unstructured data such as DICOM images and PDF files. We also have a robust anti-phishing program to reduce the possibilities of a user receiving or being lured into clicking on potentially malicious email links. We’ve also validated our backup and restoration strategies and have fine-tuned our incident response when we detect a ransomware attack.”

In terms of keeping up with emerging security threats, Saldana adds that Texas Health’s cybersecurity program is designed to continuously evolve and adapt. “We do this through a continuous risk-management philosophy that is linked to operations.”

Size Matters

Northwell and Texas Health are capable of taking such proactive approaches thanks to their internal resources – a luxury that smaller hospitals and physician practices are not typically afforded. “I believe small- to medium-sized health systems of stand-alone hospitals and practices that hadn’t had the opportunity to invest in a robust infrastructure to defend against this kind of threat, or that are unable to attract cybersecurity professional talent might be more vulnerable to the impact of such an attack,” says Saldana. “We are fortunate to have a fairly sophisticated cybersecurity program.”

Jarrett points out that with greater resources comes greater vulnerabilities. “Although our size allows us to have more resources than a small hospital or group of hospitals, it also means that there are many more potential sites for failure of our defenses,” he explains. “With 61,000 employees, the task of maintaining a high level of awareness around social phishing is monumental.”

Culture and Consultants Do, Too

Both Jarrett and Saldana are quick to point out that their organizations see cybersecurity threats like ransomware as more than just a problem for the IT department to solve. “Our organizational culture is really what makes this work,” says Saldana. “Our C-suite is very educated on the issues and very supportive, and the programs have been broad in scope – beyond just IT.”

“The C-suite recognizes this is not just an IT issue,” Jarrett adds. “They have supported IT in its efforts to ensure network security.”

For both organizations, support also comes in the form of outside expertise. Northwell engages third-party consultants to evaluate its cybersecurity and provide an outsider approach to vulnerabilities. Texas Health Resources has multiple partners that perform periodic testing of its internal and external defenses, as well as monitor its cyber defenses. “We have selected these vendors through proof-of-concept testing and self-defined cybersecurity capability needs,” Saldana explains.

Prevention Boils Down to Awareness

Saldana believes that cybersecurity prevention and preparation begins with awareness. “The first step is to acknowledge that you are constantly being targeted by threats,” he explains. “Then, backups, backups, backups. Know your recovery time requirements and build backup restoration capabilities to match those requirements. Ensure you have an effective and tested business continuity plan for scenarios when data might be unavailable.”

Saldana also suggested that providers keep their tools up to date and conduct frequent phishing training and testing to prepare employees. “Have an incident response plan in place and prepare your employees to have a heightened awareness,” he adds. “Carefully manage access and be prepared to respond and practice your plan. And don’t forget to keep up with industry intelligence. It’s important to see and learn from other organizations in many areas and to support other organizations who are targets for these types of threats.”

Learning from Hospital Peers

The Intermountain / University of Utah shared Security Operations Center will play a big part in helping providers share industry intelligence around cybersecurity threats in real time. “It will be an opportunity for partner organizations to share learnings and intellectual property around security,” says Intermountain CIO Marc Probst. “There is also the opportunity to share some technical solutions and security intelligence. For example, the ability to immediately understand threats that other organizations are experiencing and to take action to prevent these at your own organization. To the extent organizations are members of the shared SOC, they could inherit these benefits.”

Probst adds that organizers hope to see the center up and running before the end of this year. “There are many details to work out.” he explains, “It’s possible that the participants could change and/or increase. There’s still a lot of work to do, but we are convinced that this is a good idea and we are actively pursuing it.”

Probst’s words reflect the learning curve the healthcare industry is still experiencing when it comes to cybersecurity and more targeted ransomware attacks. There is still – and will likely always be – a lot of work to do. Culture, collaboration, and vigilance will be key to ensuring that ransomware-related headlines soon become a thing of the past.

News 4/27/16

Top News

Nokia will acquire France-based consumer digital health device vendor Withings for $192 million to create Nokia Digital Health.

Finland-based Nokia, which sold its mobile phone business to Microsoft in 2013, sells telecommunications infrastructure and licenses its brand name and patents.

Microsoft announced last year that it would write down $7.6 billion on its Nokia phone business (for which it paid only $7.2 billion) and would cut 7,800 related jobs as it refocused on the Windows Phone, sales of which were announced last week to be continuing their steady descent into market share rounding error territory.

Reader Comments

From Day1Date: “Re: NextGen. The ongoing restructuring continues with a layoff of around 5 percent focused on corporate, RCM, and ambulatory. This is to further the goal of focusing the company on being the best PM/EHR vendor in the market.” Several  readers report that NextGen has let 150 people go.

From Femdom: “Re: the HIMSS HIT rag. They’re creating a ‘room of one’s own’ with a separate section of their website and a newsletter for women only. I’m not sure that’s a good idea or even necessary.” That sounds like an awkward, paternalistic grab for feel-good advertising eyeballs to me. I doubt that whatever gender disparity exists in healthcare IT was caused by lack of vapid, gender-specific faux news; retweeted links to generic articles under the guise of “awareness” of which everyone is already amply aware; and running feel-good profiles of women whose accomplishments they devalue in spreading the recognition collectively over all women and not just the achiever. Creating what is in essence a special interest group for any demographic group seems like a step backwards to me no matter how well intentioned. Perhaps the publication could start by launching a hard-hitting investigative report as to why six of the seven executives of its parent organization HIMSS are white males.

Disregarding my own cynicism for a moment, I will defer to HIStalk readers – take my poll as to whether a separate HIMSS-published site and newsletter for women is a good idea. Click the poll’s Comments link after voting to make your case.

HIStalk Announcements and Requests

Mrs. Lee says her Arizona kindergarten students are using the math puzzles and magnetic wands we provided in funding her DonorsChoose grant to further their STEM knowledge.

Here’s a reminder to prevent the appearance of cluelessness: do not refer to times as “EST” since we’re on “EDT” until November 6. I’m surprised at how many seemingly otherwise competent people can’t keep this straight, and additionally surprised at how much it annoys me when they don’t. Under the premise that it’s better to mumble than shout when you aren’t sure, you can simply say “ET” and be correct all year.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Augmedix, which offers a Google Glass-powered remote scribe service, raises $17 million from five large health systems that include Sutter Health and Dignity Health, increasing its total to $40 million. Google’s development of an enterprise version of Glass – which never graduated from beta status and has largely disappeared even within Google’s hierarchy — has not been announced, leading Augmedix to suggest that it may explore other technologies. The company has a few hundred California doctors using its services.

CMS releases the 45-page warning letter it sent to lab testing vendor Theranos last month, in which it individually addresses the company’s responses to dozens of problems at the California lab of Theranos with, “The laboratory’s allegation of compliance is not credible and evidence of correction is not acceptable.” The letter adds that the company’s responses “show a lack of understanding of the CLIA requirements.” CMS notes that Theranos diluted finger-stick samples so they could be processed on a standard Siemens lab machine, a practice that CEO Elizabeth Holmes had previously denied.

Verisk Analytics will sell its Verisk Health services business to Veritas Capital for $820 million. I ran a rumor of the sale in early October 2015 and the company announced later that month that it was exploring strategic alternatives for the business. Veritas has no other healthcare holdings, but the private equity firm cashed in big in selling the Truven Health Analytics business it bought from Thomson Reuters for $1.25 billion in mid-2012 to IBM, which paid $2.6 billion to acquire the company in February 2016.

Medical communications transaction platform vendor MEA-NEA-TWSG renames itself Vyne. Its newly created Vyne Medical business unit includes the former Medical Electronic Attachment (claims attachments) and The White Stone Group (healthcare communications management), while its National Electronic Attachment business unit offers electronic attachment management for dental practices.

Blockchain technology vendor Gem launches Gem Health, which is partnering with Philips to build a healthcare blockchain ecosystem.

Roper Technologies – whose healthcare IT holdings include Sunquest and Strata Decision – reports Q1 results: revenue up 4 percent, EPS $1.48 vs. $1.54, missing expectations for revenue and non-adjusted earnings but beating on adjusted earnings. CEO Brian Jellison said in the earnings call that Strata’s growth is “really exceptional” and that Roper will make more acquisitions.

Patient payments and check-in software vendor Inbox Health acquires the consumer health expense management technology of CakeHealth, which seems to have accomplished little beyond spending its tiny 2011 funding ($150K) despite aspirations of becoming “the Mint for healthcare.”

Apple reports Q2 results: revenue down 13 percent, EPS $1.90 vs. $2.33, missing expectations for both and guiding down as the company records its first revenue decline since 2003. It was also the first quarter in which iPhone sales dropped as Apple produced little innovation beyond offering bigger iPhone screens. AAPL shares dropped sharply in after-hours trading following the announcement. They’re down 20 percent in the past year.

Also turning in crappy quarterly numbers is Twitter, shares of which are tanking in after-hours trading Tuesday as the company misses revenue and earnings expectations wildly and reports slowing user growth despite its desperation-smelling rollout of Periscope and Moments.

Sales

Baylor Scott & White Health (TX) will implement the Pieces surveillance and population health management system and will make an unspecified investment in the company. Pieces raised a $21.6 million Series A round last month.

People

Switzerland-based healthcare wireless and security technology vendor Ascom names Holger Cordes (Cerner) as CEO.

John Driscoll (Care Centrix) and John Glaser (Cerner) join the board of Press Ganey.

Announcements and Implementations

InterSystems will interface its TrakCare information system to the blood ordering and inventory management system of the Australian National Blood Authority to allow its users to automate blood ordering and distribution.

CareOne LTAC Hospitals (NJ) completes its implementation of NTT Data’s Optimum Clinicals.

Government and Politics

India passes a law requiring cell phone manufacturers to add a panic button and satellite-based locating technology to their smartphones, hoping to improve the country’s widely publicized rape problem. India doesn’t have a 911-type emergency number but hopes to introduce one soon. Companies sell several personal safety apps (such as My Safetipin, above) to India-based customers, most of which notify an emergency contact and share the user’s location.

In Australia, the state of Victoria will spend $23 million to develop a real-time database to help doctors and pharmacies identify patients who overuse prescription drugs. Victoria recorded 330 deaths from prescription drug overdoses last year, more than the number of people killed in car accidents or from overdoses of illegal drugs.

Parents of children with muscular dystrophy testify to the FDA about the benefits their children receive from taking a drug with questionable proven effectiveness. Afterward, the FDA declared that the drug company’s poorly designed, 12-patient study was not sufficient to prove the drug’s value, but three of the 10 panel members abstained from voting after being moved by the comments of the parents. Following the “no” vote, some of the audience members shouted at the advisory panel. The FDA says it will “take the views of the community into account.” I can’t decide if that’s an admirable move toward patient empowerment that shows the value of “little data” or an uncomfortable vaccine-like abandonment of science in allowing laypeople to argue with emotion rather than documented facts.

The FDA warns drug companies that it won’t accept clinical studies that use data prepared by India-based Semler Research Center after an FDA inspection turns up evidence of intentional data tampering.

New York Mayor Bill de Blasio will propose big changes and $2 billion in subsidies to bail out money-hemorrhaging NYC Health + Hospitals that include reducing ED visits, turning inpatient space into ambulatory facilities, and developing vacant property, all while closing no facilities or laying off any employees to avoid $6 billion in losses over the next five years. The consultant’s report is here.

Innovation and Research

A study of the 46,000 Maryland residents who had a least five ED visits in 2014 finds that 70 percent of them used more than one hospital, meaning that most hospitals won’t be able to identify those high ED users or coordinate their care using their own data alone.

Other

An op-ed article in a British newspaper says idealistic young Americans should work on domestic problems instead of trying to save the world in addressing overly simplified issues in exotic locations. It explains the “reductive seduction of other people’s problems” as being no different than if an idealistic, naive student in Uganda traveled to America for the first time, confidently expecting to win fame and maybe an award for fixing our gun violence problem. In a related item, a new book questions whether healthcare volunteers who trek off to developing countries for short stints help or hurt those communities, with the author concluding after analyzing the available data that the net effect is probably slightly positive if the volunteer has the right attitude. The problems with medical volunteers include that they may be tempted to perform tasks that exceed their skill level, they may try to impose unrealistic US standards,  and that they could hurt local doctors by undermining confidence or offering free services that put them out of business.

Western Australia’s health department, which hasn’t had a permanent CIO since 2010, gives up after finding no suitable candidates and instead creates a support services organization led by a procurement specialist who will oversee IT. WA Health’s troubled IT implementation delayed the opening of newly built 783-bed Fiona Stanley Hospital in 2013.

Sponsor Updates

• AirStrip announces that 4 million US births have been monitored using its system over the past 10 years.
• Interactive patient TV vendor PDi will provide patient education videos from Elsevier.
• Aprima will exhibit at the American College of Physicians Internal Medicine Meeting May 5-7 in Washington, DC.
• Audacious Inquiry’s Team Ai took first and second place at the Port to Fort 6k.
• Team EcoBase from First Databank and Zynx Health wins second place at the FHIR Connectathon in Indianapolis.
• Besler Consulting releases a new podcast, “Comprehensive Care for Joint Replacement (CJR) Target Pricing & Episode Spending Calculations.”
• CenterX will exhibit at the NCPDP May Work Group Meetings May 1-2 in Scottsdale, AZ.
• Obix posts a video covering the use of its perinatal data system at Norman Regional Hospital (OK).
• CitiusTech will exhibit at the LHC Executive Briefing with Milton Johnson, chairman and CEO, HCA, May 4 in Nashville.
• Crossings Healthcare Solutions releases its Spring 2016 e-letter.
• Direct Consulting Associates will exhibit at iHealth 2016 May 5-6 in Minneapolis.
• EClinicalWorks will exhibit at the American College of Physicians Internal Medicine Meeting May 5-7 in Washington, DC.
• Extension Healthcare will exhibit at the IONL Mid-Year Conference April 29 in Bloomington-Normal, IL.
• HCS will exhibit at the NALTH 2016 Spring Clinical Education & Annual Meeting April 28-29 in Memphis, TN.
• Healthwise will exhibit at the ZeOmega Client Conference May 2-4 in Plano, TX.

Blog posts

• Solving Notification Overload in Healthcare (TelmedIQ)
• Raise Your Patient Satisfaction Scores, 2 Planning Tips (Part 1 of 2) (AdvancedMD)
• Adapting to the New Wave of Nursing (AirStrip)
• Why Your Business’ Mobile App Strategy will Probably Fail (If It Hasn’t Already) (AirWatch)
• What in the Health IT is a Hierarchical Condition Category (HCC)? (Arcadia Healthcare Solutions)
• Filling Your Prescription for Desktop Security: 7 Levels of Access Management (Aventura)
• 4 Essentials to Establishing Clinical Integration (Catalyze)
• The Future of Enterprise Mobility is Here: What’s your strategy? (PatientSafe Solutions)
• Nine Notes from NAACOS16 (Caradigm)
• Things to Consider Before Starting a CCM Program: Requirements, Compliance, Buying vs. Building, and Integration (Caresync)
• Florida Joins Legislative Movement Toward Uniformity in Prior Authorization (CoverMyMeds)
• 50 Years and Counting (CTG)
• Placing a Premium on AMC Performance (ECG Management Consultants)
• Securing Your Practice (E-MDs)
• Maximizing Your Conversion Through Assessment (Galen Healthcare Solutions)
• Caring for the Clinician: The Key to Improving Patient Experience, Enhancing Health Outcomes, and Reducing Cost (Hayes Management Consulting)
• Epic Upgrade: Single vs. Double Upgrade (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.

Curbside Consult with Dr. Jayne 4/25/16

I wrote last week about my experience with a client who had been swindled by a practice administrator who had promised far more than he could deliver. A reader commented: “I would have loved to hear a few more specifics on what a practice might do to avoid hiring such an administrator or office manager. It has also been my experience that too many independent practices don’t seem to know what to really look for and consequently suffer down the road.”

I’ve certainly done more than my share of hiring and firing over the last decade. On my own, I’ve employed medical assistants, office managers, and partners. I also had to terminate at least one of each. As part of the corporate world, I’ve had to deal with vetting a host of positions including clinical staff, IT staff, managers, and operations execs. As a consultant, I’ve been asked to deal with errant members of the C-suite and upper management and also to assist in finding their replacements.

The best tip I can offer anyone in a hiring position is an old adage: trust your gut. Nearly every time I’ve gone against my gut, there’s been a poor outcome. Sometimes you can’t avoid it, especially if you’re in an employed capacity or part of a larger corporate entity.

For example, I once had to hire an analyst to run some lab interface work. The health system’s HR department (which usually left something to be desired) was only able to find two candidates who were remotely qualified. Although their resumes were decent, both of them interviewed somewhat poorly. I felt the first one didn’t understand the job we were offering, despite our attempts to explain it and talk about the work she would be doing. She kept going back to what she had done in the past and how good she was at it, even though we were trying to assess whether she’d be a good fit going forward.

The second one was too folksy right off the bat. Don’t get me wrong, I’m a folksy girl myself, but there’s a time and place for familiarity and it’s not in a job interview. I don’t want to hear about your children and your weekend plans – not because I don’t care, but because it’s too easy to get close to discussion topics that are normally a bad idea during the interview process. She seemed to be much more eager than the other candidate, but I didn’t really feel that she would be able to get the job done.

I wanted to go back to HR and ask them to look for other candidates, but was under pressure to fill the open posting immediately to ensure we could get someone in the position before a series of budget cuts that might force us to pull the opening off the board.

Although her interface skills were decent, it turned out that her overly casual demeanor was reflective of casual regard which she paid to all her work. When asked for status reports, it always felt like she was on the cusp of getting to the tasks that needed to be done, rather than actually doing them. She also liked to spend a lot of time chatting with other team members, which impacted not only her productivity, but that of others. It felt like she spent a lot of time doing nothing and then sprinted towards the deadline, which was a poor fit for our company culture.

Although I was involved in the hiring, I wasn’t her direct manager. He didn’t seem to have the wherewithal to deal with her because she interpreted every element of constructive criticism as “being mean.” Needless to say, she didn’t last very long. My failure to fight for my gut feeling in that situation bothered me for a long time.

Besides following your instinct, it’s important to watch out for people that seem too good to be true. Maybe they have a seemingly stellar record of accomplishments, but are willing to work for a salary that is lower than they appear to be worth. Sometimes you can get a bargain, but usually there’s a good story to go along with it. For example, a highly-skilled administrator who moves to a small town to care for aging parents or someone who needs a more low-key role to provide greater work-life balance. Usually these candidates realize that they may seem oddly matched for a position and will take the lead on explaining their desire to move down the ladder.

Other times, though, they might not have a good explanation for why they left their last position, or the references they provide don’t seem to make sense. I admit that it’s getting harder and harder to get a decent reference, particularly from past employers. Often organizations will simple verify the dates that the individual was employed. If you’re lucky, they might tell you if the person is eligible for rehire. Getting a true reference that you feel you can trust is like gold.

Other things that I sometimes don’t see smaller practices do: the consumer background check. They may do a criminal check, but not a consumer one. In this day and age, it’s important to know whether the people you are hiring have had any financial difficulties, particularly if they are going to be a position to handle funds within the office. Of course, that won’t tell you if the employee will make bad decisions, like the front desk staffer that I fired after finding $1,200 in co-pays in the sample closet. Why, you might ask, was the money in the sample closet? Because she didn’t have time to go to the bank and do the deposit each night, so she wanted to keep it somewhere “safe.”

Organizations should also make sure that candidates have valid experience for the position they’re trying to fill. Candidates might not have held the exact same job or title, but should be able to clearly explain how their previous experience will translate to the new position. Especially for higher-level roles, most organizations don’t have time to deal with someone who cannot hit the ground running. I do occasionally see it though, with groups that feel like they can mold someone into something that they may not be able to become.

Administrators should be able to talk about their achievements in previous roles and cite metrics for practices they’ve led. How have their days in accounts receivable been? Even if they weren’t stellar, did they show a positive trend? What initiatives did the candidate lead to try to move things in the right direction?

Potential employers need to have a list of solid questions to ask that relate to the needs of the organization. If you’re planning to become a Patient-Centered Medical Home, ask about that experience. If the candidate doesn’t have experience, ask him/her what he/she would do to get up to speed should they be hired. Anyone worth their salt should be able to articulate a plan to learn about a new discipline or new initiative, especially since the healthcare system we may be operating in over the next few years doesn’t exist yet. If they can’t come up with a reasonable strategy, they might not be a good fit.

Once an administrator or practice manager is hired, the practice should keep close tabs on their performance, not only in the initial hiring period, but in a regular ongoing fashion. Practice leadership (owners, partners, managers, etc.) should be having monthly meetings to review financials and potential problem areas in the practice. If the administrator says everything is rosy all the time, something is wrong. Even in the strongest practices there is always opportunity for improvement or some sort of personnel issue to make management aware of.

Owners or top leadership should also watch out for staffers that continuously spread blame around to vendors, payers, or other staff without showing even the smallest level of introspection about whether they could have done something differently.

Another good question to help assess a potential hire is this: “Given what you know about our organization, if you are hired into this position, what do you see the first six months looking like?” In my experience, candidates who plan to do a good amount of listening and observing before making too many changes are often the best. They’re willing to take their time to figure out what they have to work with, assess the team’s strengths and weaknesses, and make a careful plan rather than coming in with guns blazing.

What’s your worst hiring or firing nightmare? Email me.

Email Dr. Jayne.