News 3/30/16

Top News

Ten-hospital MedStar Health, the largest health system in the Baltimore-Washington corridor, shuts down its electronic systems and turns away elective patients and after what appears to be a ransomware attack that began Monday morning. The systems remain down. The FBI is investigating.

Despite MedStar’s assertion that it is unaware of any demands for ransom, some of its employees reported seeing a pop-up window demanding payment in bitcoin.

Senate HELP Committee Chair Lamar Alexander (R-TN) says the MedStar attack proves that HHS should quickly implement requirements from the Cybersecurity Information Sharing Act of 2015, which calls for HHS to:

• Appoint a cybersecurity leader.
• Create a healthcare cyberthreat report.
• Create a task for to submit recommendations and to disseminate federal cyberintelligence threat information.
• Publish voluntary best practices.

Reader Comments

From MD Prof: “Re: NY e-prescribing. You mentioned an exemption for patient-requested paper prescriptions. Can you provide a link to the regs?” I had run across a source that said patients can request paper prescriptions, but upon reviewing the regulations and the stated exceptions, I don’t see such language, so I don’t believe patients have that option after all. Patients and prescribers could see some problems:

• Patients may want to price-shop multiple pharmacies and can’t without having a paper prescription.
• They might not have a particular pharmacy in mind at that moment.
• They may want to send some prescriptions to one pharmacy and others to a different one to save money and new electronic prescribers may struggle with how to do that.
• If the requested pharmacy doesn’t have the medication in stock, the prescriber will have to issue a new electronic prescription to a different pharmacy.
• Patients might choose a pharmacy that is closed for a holiday or for normal hours of operation.

All of these are especially problematic for ED physician prescribers, who would be hard to reach if prescription changes are needed. I’m also not clear of pharmacies can still transfer prescriptions among themselves, which I assume they can once it has been created electronically. MD Prof also notes that it’s a pain for doctors to perform the required manual patient lookup on the I-Stop website to identify possible doctor shoppers and suggests further integration of that database with prescribing systems.

From Circular Logic: “Re: site. I wasn’t able to get on for part of Monday.” Me neither, at least for a few minutes mid-morning. It was really busy yesterday for some reason, with more daily page views than even during the HIMSS conference. In fact, it was the busiest day since July 30, 2015 when the DoD contract winner was announced and when I decided I needed to upgrade to a bigger dedicated server. Maybe it’s time again.

From C. Cortez: “Re: rumors. I hope you don’t listen to the comments of people complaining about running industry rumors. Those rumors are usually correct.” My survey shows that only 1.3 percent of readers don’t enjoy reading rumors on HIStalk, which is not really surprising given that I’ve been running them since 2003 and therefore the audience is somewhat self-selecting. What I’ve learned in that 13 years is that nearly everybody loves reading well-placed “rumors” until they hit too close to home, at which time the indignant commenter suddenly proclaims them to be “gossip.” Many big stories have been broken here from reader rumors, while the rest are still entertaining.

From Sue Veed: “Re: interoperability. Judy Faulkner is still describing technical problems and calls for national standards. The problem is now 40 years old with no resolution in sight. The banking industry adopted MICR check standards in no time and healthcare is still dithering. Why?” I heard a keynote years ago by Dee Hock, a local banker who almost single-handedly created what was then BankAmericard (now the Visa credit card system after which competitors are modeled). He explained that it was tough to convince banks (which were local and regional rather than national back then) that it was in their best interest to work together in a decentralized way to create a nationally available electronic credit card network for their shared customers, which he later described as the prototype for “chaordic” organizations that “blend competition and cooperation to address critical societal issues.” Healthcare IT is stuck in the mid-1960s with no heir apparent to Dee Hock available to convince providers and IT vendors that everybody wins (especially the customer) if they share information.

HIStalk Announcements and Requests

We provided Mrs. Openlander from Missouri with several sets of math and reading flash cards for her K-5 school in funding her DonorsChoose grant request. The cards are placed in high-traffic areas so that hallway waiting downtime can be used for extra instruction.

Also checking in is Ms. Wilson from Virginia, who passes along to HIStalk readers that the five human anatomy models we provided are being used for class demonstrations and “center time,” where the teachers have created add-on learning exercises such as an interactive anatomy whiteboard game. She concludes, “Our students have grown so much in the short time we have had the new materials. I cannot tell you how good it makes us feel to watch them interacting and striving to learn in ways that before you gift we never thought possible … your gift has changed the lives of our students and us forever.”

A quote I can’t get out of my head: “There’s no such thing as a cloud. It’s just someone else’s server.”

Listening: Built to Spill, Boise-based indie rockers who start a small-hall tour in late May as they approach 25 years of bandom. Also, new Italy-based symphonic metal from Rhapsody of Fire.

Webinars

March 30 (Wednesday) 1:00 ET. “Coastal Connect Health Information Exchange: Igniting the Power of Events-based Notifications Webinar.” Sponsored by Medicity. Presenters: Cory Bovair, application specialist. CCHIE; Andy Biviano, director of product management, Medicity. Wilmington, NC-based CCHIE, which covers 800 physicians and 1.4 million patients, implemented Medicity Notify for real-time clinical event notifications to help reduce ED utilization, improve care quality, and enhance patient satisfaction. In the first 30 days, physicians and care managers received more than 3,000 admission and discharge notifications.

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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

Acquisitions, Funding, Business, and Stock

Dell will sell its IT services business, the former Perot Systems, for $3.05 billion to Japan’s NTT Data to help pay for Dell’s planned $60 billion takeover of data storage vendor EMC. Dell bought Perot Systems for $3.9 billion in 2009. NTT Data, a subsidiary of Japan’s national telephone company, acquired IT systems and services vendor Keane for $1.2 billion in 2010, giving it the Optimum hospital product suite.

Alphabet’s (Google) Verily Life Sciences is losing top executives and its governmental connections with FDA and HHS due to the abrasive management style of CEO Andrew Conrad, STAT reports. The company has apparently abandoned its project for connecting medical devices to the cloud, with all of its team members departing the organization. Also gone is the co-founder of the project to develop a glucose-monitoring contact lens. A biotech consultant who previously worked for a research institute Conrad founded describes him as, “We used to joke and call him the seagull of science. He used to fly in, squawk, crap over everything, and fly away. You couldn’t engage him for more than 10 minutes. It was sort of the overpromise, under-deliver.”

Sales

The Department of Defense issues a $77 million, one-year contract extension to Philips for “patient monitoring systems, subsystems, accessories, consumables, spare/repair parts, and training.”

Announcements and Implementations

Boston Children’s Hospital (MA) launches Feverprints, an iPhone app powered by Apple ResearchKit that will use crowdsourcing to explore normal temperature variation and evaluate the effectiveness of fever medications.

Carolinas HealthCare (NC) will implement Epic at Southeastern Health (NC) via a shared services agreement. I believe Southeastern runs McKesson Horizon for inpatient and eClinicalWorks for ambulatory.

AARP Health Innovation@50 announces the ten finalists for its April 27 pitch event:

1. Cake (end of life planning)
2. Medvizor (patient instructions)
3. Penrose Senior Care Auditors (senior check-up app)
4. PicnicHealth (personal health record)
5. Savor Health (nutrition)
6. SeniorHabitat (senior care facility selection)
7. SensaRx (wandering sensor)
8. SingFit (music as medicine – video above)
9. UnaliWear (fall detection and medication reminder watch)
10. Well Beyond Care (non-medical assistant finder)

Privacy and Security

A new ransomware variant called PowerWare is discovered to be targeting healthcare specifically in spreading itself via macros embedded in Microsoft Word documents posing as email-attached invoices. It’s smarter than similar types of ransomware, invoking the “fileless” native automation tool Windows PowerShell to download a script and then encrypt the PC’s files. This would be another great reason to demote users who have Administrator privileges or who can run programs with elevated permissions.

Other

Peer60 releases “Trends in Revenue Cycle Management.” Some of its findings: (a) cost is the top criterion for selecting a RCM vendor; (b) collections is the most-outsourced provider service; and (c) the most-unmet RCM needs are denials management, contract management, and value-based reimbursement.

A 60-patient study finds that the fingerstick blood tests previously offered directly to Arizona consumers by Theranos give results that vary significantly from results obtained from venipuncture samples that were sent to Quest and LabQuest.

Banner Health (AZ) will complete by fall of 2017 the replacement of Epic by Cerner at the two Tucson hospitals formerly owned by University of Arizona Health Network, which it acquired in 2015. Banner says the switch will provide “significant savings” to the hospitals, which spent an unbudgeted $32 million and a total of $115 million on their 2013 Epic project, causing a $29 million fiscal year loss that was followed by the sale of UAHN to Banner.  

Sponsor Updates

• Aprima will exhibit at the Texas MGMA Annual Meeting March 30-April 1 in Dallas.
• The Baltimore Business Journal lists Audacious Inquiry as one of the five largest software developers in the Baltimore area.
• Catalyze publishes a new e-book, “Innovation Doesn’t Follow Rules.”
• Besler Consulting will exhibit at the HFMA Hudson Valley Annual Institute 2016 April 7 in Tarrytown, NY.
• Burwood Group Justin Flynn will present at the Palo Alto Networks Ignite 2016 Conference April 4 in Las Vegas.
• Carevive Systems shares its latest presentation, Survivorship Care and Care Plans: Transforming Challenges into Opportunities.
• Direct Consulting Associates sponsors the HonorHealth Charity Golf Classic in support of the HonorHealth Military Partnership.
• Divurgent will exhibit at the AEHIS/CHIME Cyber Security Lead Forum April 4 in San Francisco.
• EClinicalWorks will exhibit at the 2016 Health Care Symposium April 1 in Costa Mesa, CA.
• Healthwise will present at the Society of Behavioral Medicine meeting March 30-April 2 in Washington, DC.

Blog Posts

• 5 Real Ways to Enable IoT Success in the Enterprise (AirWatch)
• How the HLC Proposes to Transform Healthcare Now (AirStrip)
• EHR Improvements After the AMA “Hateful 8” List (AdvancedMD)
• Progressing with Population Health and Big Data (Caradigm)
• Organizational Health (Part 4) – “Disagree but Commit” (Optimum Healthcare IT)
• Iowa ePA Legislation and CoverMyMeds (CoverMyMeds)
• HIMSS 2016 – Transforming Health with PCMH, Population Health, and More (CTG)
• Starting the Journey: Transforming Your Practice into a Patient-Centered Medical Home (Galen Healthcare Solutions)
• 3 Evolving Revenue Cycle Trends: Leveraging Them to Improve Financial Viability (Hayes Management Consulting)

Contacts

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

OpenNotes: From Grassroots Effort to Nationwide Movement

We look at the evolution and future of OpenNotes — from the impact it has had on patient engagement, medication adherence, and physician workflows to the technological challenges of implementing a truly vendor-agnostic tool.
By @JennHIStalk

Six years ago, the notion that patients could have electronic access to their doctor’s notes was almost unheard of. The note was a safe, private place where providers could document a clinical encounter without worrying about a patient’s reaction to their accompanying commentary. The note was for internal use only, which no doubt gave providers a certain poetic license to describe patient ailments and mindsets in the bluntest of terms. Enter OpenNotes, now a national movement that encourages providers to adopt open access to clinician notes as a standard practice of care.

A Grassroots Beginning

The movement began in 2010 as a year-long study funded by the Robert Wood Johnson Foundation that tested the OpenNotes concept with 105 PCPs and over 13,000 patients at Beth Israel Deaconess Medical Center (MA), Geisinger Health System (PA), and Harborview Medical Center (WA). The trial was considered a success, with patients reporting that access to physician notes helped them feel more educated about and in control of their care. They were also more apt to take their medications, share their notes with other caregivers, and communicate and collaborate more with their physicians.

Participating physicians experienced similar positive results, with just a handful reporting longer visits and taking extra time to address patient questions outside of regular visits. While a larger percentage reported taking more time to write notes and change documentation content, none of them stopped providing access once the trial ended.

As RWJF President and CEO Risa Lavizzo-Mourey, MD said at the trial’s conclusion, “The evidence is in. Patients support, use, and benefit from open medical notes. These results are exciting and hold tremendous promise for transforming patient care.”

Growth Gets Underway

Since results from the initial OpenNotes trial were published in 2012, the movement has expanded almost exponentially across the country. Twenty-six healthcare organizations — including the VA and most recently Duke Health (NC) — are now providing open-note access to over 6 million patients.

The movement shows no signs of slowing down thanks to an additional $10 million in funding from RWJF, Cambia Health Foundation, Gordon and Betty Moore Foundation, and Peterson Center on Healthcare that will be used to roll out OpenNotes access to 50 million patients across the country.

The investment doesn’t stop there. We Can Do Better, a nonprofit OpenNotes advocacy group that works alongside the NorthWest OpenNotes Consortium, received a grant earlier this year from the Oregon Health Authority Office of Health IT to help spread OpenNotes to small to medium-sized physician practices in Oregon, and to work with healthcare IT vendors on making OpenNotes easy to access via their EHRs and patient portals.

CHIME has also thrown its support behind the initiative, announcing last month its intent to collaborate with the OpenNotes movement on accelerating health data sharing as part of its participation in the Precision Medicine Initiative.

Change Management Trumps Technical Necessity

“There is very little funding needed for OpenNotes rollouts,” says Amy Fellows, MPH, executive director at We Can Do Better and an OpenNotes team member. “The main effort is around change management – convincing providers that this is going to be a good thing and something that won’t add to their workload. We hear that OpenNotes is a much easier and smoother rollout process than many previous facility implementations. It really is all about the upfront change management, then ripping the Band-Aid off and getting it turned on. In some cases, a small number of skeptics can delay or moderate an implementation. The issues are cultural, not technical.”

Technical requirements do, of course, need to be taken into consideration. According to Fellows, facilities using Epic and Cerner should be able to easily configure their systems to support OpenNotes. “We attended HIMSS16,” she adds, “and spoke to many other vendors about their capability to offer OpenNotes, including EClinicalWorks, Allscripts, and NextGen.”

Fellows adds that OpenNotes is working to develop a best-practices sheet with recommendations for vendors on how to configure OpenNotes so that it is patient and physician friendly.

Digging Into Provider Best Practices

Fellows and her OpenNotes colleagues in the Northwest have had ample opportunity to discuss provider best practices at Northwest Open Notes Consortium quarterly meetings. “OpenNotes seems to be an evolutionary process, so even those that have done it come to learn about national efforts bringing it to mental health, inpatient, and other specialties,” she explains. “We know about 1 million patients [in the Northwest] have the ability to access their notes, but it is dependent on each organization’s strategy in promoting their patient portal, and how easy they make it to access the note, i.e. do they send an email tickler inviting patients to access their notes with a link taking them directly to that part of the patient portal after log in?”

“We believe best practice includes internal and external promotions, reminders, and easily accessible notes,” Fellows adds. “Initial implementation should include some time spent with clinicians on avoiding documentation practices that can confuse patients – acronyms, cut-and-paste approaches, confusing medication lists or problem lists. Avoiding jargon can also be helpful, i.e. ‘patient denies,’ or ‘patient complains.’ Sensitizing clinicians to terms that activate patients, like ‘obese’ or ‘addicted,’ is worthwhile, too.”

Geisinger Sets the Bar

Geisinger, an original OpenNotes trial participant, has expanded its involvement with the program by rolling it out to new physicians as part of best practices. “Right now, we’re looking at 1,700 providers including advanced practitioners and case managers across the system who access OpenNotes as part of their care,” says Rebecca Stametz, senior director of clinical innovation at Geisinger. “Looking at it from mobile utilization, we have gone from 2,005 unique users to about 150,000 with about 550,000 unique hits off of our portal.”

“Since the trial, we’ve rolled it out as a best practice across care settings, with the exception of pockets across our system like psychiatry, maternal-fetal medicine, and EENT,” Stametz says. “We’ve decided to pause on areas where we were unsure of any implications and where we felt we needed to take a deeper look. That being said, new physicians that get on-boarded, especially those in ambulatory, have access to OpenNotes. It’s now part of our care process.”

Serving up OpenNotes to patients is as easy as a visit to Geisinger’s patient portal. “It’s really one of the benefits that [they] have when enrolling with MyGeisinger or our patient portal, both Epic,” she explains. “It’s really about word of mouth – marketing it as a best practice and utilizing it via internal systems. There really isn’t anything to purchase outside of the EHR and maybe a patient portal, which most of the systems who are implementing OpenNotes already utilize.”

Measuring Success Now and Later

Given Geisinger’s track record with OpenNotes, Stametz is well poised to offer what success with OpenNotes means to the organization. “Success means that patients feel more connected to their care,” she explains. “They want OpenNotes. They feel like there’s open communication and they have confidence in their ability to manage their own care. Studying the long-term implications of end users is something that we’re going to begin to tackle now with our national partners.”

Stametz adds that little to no impact on physician workflow is also a part of Geisinger’s definition of success. “We were wondering about disruption to workflow and whether or not people actually utilize those notes if they became open,” she says. “We know that 99 percent of those patients wanted the practice to continue, so there were benefits we didn’t anticipate. We observed that some patients began to gravitate towards physicians that offered note access. I think one of the big things from a Geisinger perspective is that there was little concern or complaints from providers or patients.”

OpenNotes is just beginning to reach a maturity level that will enable researchers to determine its effect on outcomes. Thus far, the only hard data available is a paper published last fall in the Journal of Medical Internet Research that shows patients with open-note access have better blood-pressure control than those who don’t.

Fellows adds that several implementers have evaluated their efforts with surveys similar to the original OpenNotes research surveys. “Patient-reported outcomes have been very similar in each one,” she explains. “All of the implementations we are aware of have gone well with no physician workflow disruptions. Email traffic has been flat, and when made available, portal traffic has increased.”

“The most revealing metric,” Fellows adds, “has been the rate of patients opening notes and the rate of physicians hiding notes. Patients viewing notes are highly dependent on patient reminders and internal/external promotion. Hiding notes is unusual and mostly done by a small number of physicians. The incidence of hiding notes decreases with time.”

Moving Beyond Primary Care

Many OpenNotes participants are venturing into new territory. Several organizations, including BIDMC, have launched mental health pilots to gain a better understanding of how increased transparency could potentially benefit psychiatric care. Vancouver Clinic is exploring the value in allowing adolescents to view their notes with or without parental proxy access. Fellows also foresees eventually rolling out OpenNotes to more vulnerable patient populations, such as non-English speakers, those with health literacy issues, and underserved and safety net populations.

For Geisinger, the next phase of OpenNotes is about expansion and better understanding what patients want to get from its access. “What are the long-term implications for end users who have been using OpenNotes for the past five or six years?” Stametz asks. “We don’t know those answers, but we’re beginning to work with national partners like BIDMC to find out. For example, if patients and family caregivers were able to write their own narrative within the note, what would that do for goal setting, treatment planning, communication, encounter time, etc.? We’re at the tip of the iceberg with the ways we could leverage the impact OpenNotes has had and its potential in other areas.”

Dell Sells Its IT Services Business

Japan’s NTT Data will buy Dell’s IT services business, the former Perot Systems, for $3.05 billion. Dell is selling the business, which it acquired for $3.9 billion in 2009, to raise money to finance its $60 billion acquisition of storage vendor EMC.

Monday Morning Update 3/28/16

Top News

New York’s mandatory e-prescribing mandate took effect Sunday despite a questionable level of prescriber readiness even after the one-year postponement a year ago. Allowed exceptions are drug items that require pharmacy compounding, parenteral drugs, items requiring lengthy patient instructions, or non-patient specific prescriptions. Paper or call-in prescriptions can be issued upon patient request or given technology failure, which then requires the prescriber to report the prescription to the state’s Department of Health, but the department has not implemented such reporting technology and suggests that prescribers just note it in the EHR instead.

Reader Comments

From No Flipping: “Re: ransomware. I searched HIStalk and there was an example from 2012, so it’s not a new problem.” I wrote about a clinic in Australia whose files were encrypted by ransomware in December 2012. I don’t recall hearing if the clinic paid the demanded $4,000 ransom, but I expect it did. Meanwhile, a ridiculously useless Wall Street Journal article manages to ask the wrong questions (or perhaps fails to understand the answers) of those it interviewed in claiming to share healthcare security best practices to prevent ransomware. The pearls of wisdom provided are: (a) assume malware will get through; (b) perform backups; (c) apply patches; and (d) educate employees. CIOs who learn anything from this breezy waste of time should probably just go ahead and quit or at least attend our webinar described below.  

From The_Epic_Guy: “Re: Epic. The company is having their implementation consultants put their Starbucks coffee into non-labeled containers to avoid reminding customers that its inexperienced people are costing a small fortune.” Unverified. I would have expected contracts to specify a per diem rate rather than individual charges so that Starbucks vs. McDonald’s coffee wouldn’t matter, but maybe that’s not the case.

From MCK Auto Pilot: “Re: McKesson. This site has interesting layoff rumors. All are unsubstantiated from employees who have been laid off, but in every exaggeration there is a kernel of truth.” Comments from claimed current or former McKesson employees complain about clueless upper management, the failed Better Health 2020 initiative, the cold manner in which employees were informed that their services would no longer be required, offshoring to India, and the likelihood that MCK will sell off what’s left of its IT business and whether anyone would want to buy it.

From Nasty Parts: “Re: Greenway layoffs. Four sales VPS have been downsized. Looks like the company is moving into a ‘protect the install base’ mode of operation.” Unverified. The four named VPs still list Greenway as their employer on LinkedIn, but most people don’t rush there first after they’ve been forcibly re-workforced.

HIStalk Announcements and Requests

Half of poll respondents work for a company that has laid people off in the past 12 months. New poll to your right or here: do you personally admire and respect the highest-ranking executive of your employer? I’ve divided the answers out into not-for-profit and for-profit choices to see if that makes a difference (which I should have done on the previous poll, too). Click the Comments link on the poll after voting to explain.

FHIR Family donated $500 to my DonorsChoose project, explaining, “HL7 has a big deadline on Monday, March 28 and I am in awe of all the work Grahame Grieve does in the background. This donation is in his name.” Through the magic of matching funds, the donation fully satisfied these teacher grant requests:

• An iPad and case for Ms. Markussen’s first grade class in Dallas, TX
• A laptop and document camera for Mrs. Lark’s middle school class in Brooklyn, NY
• Math games for Ms. Burkett’s elementary school class in Independence, MO

Mrs. Hale from Indiana says her third graders were so excited about the kid-friendly biographies we provided in funding her DonorsChoose grant request that they finish their other work early so they can work on biography projects.

Also checking in is Mrs. Ortego, who says the headphones we provided for her Louisiana special needs elementary school class not only allow students to work without distraction, but also, “One of my greatest joys is that I have a hearing impaired student and he is able to put the headphones over his ears with no feedback from his hearing aids. This is the most amazing thing to experience. There is no frustration for this student.”

Last Week’s Most Interesting News

• Allscripts and a private equity firm form a joint venture to acquire post-acute care EHR vendor Netsmart for $950 million.
• The CEO of NYC Health + Hospitals denies rumors that he will be fired if the organization doesn’t go live on Epic on April 1 and dismisses reports by the former CMIO of one of its hospitals that a lack of readiness will endanger patients.
• Three more hospitals report ransomware attacks.
• AHIMA petitions the White House to allow HHS to work on a national patient identifier.
• Apple announces CareKit, which will allow developers to create person health apps for the iPhone.

Webinars

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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

Here’s the recording of last week’s webinar, “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.”

Sales

Dell Services announces recent big contracts that Dubai Health Authority and BCBS of Rhode Island.

Government and Politics

The president of the New York State Medical Society politely asks for two changes to the just-implemented requirement that all state prescriptions be issued electronically rather than on paper or by telephone. He would like to see an exemption for those doctors who write fewer than 25 prescriptions per year and a reduction in documentation requirements when technical issues require issuing a paper prescription. Both seem reasonable to me.

Privacy and Security

Hackers steal and offer for sale the information of 1.5 million customers of Verizon Enterprise Solutions, whose services (including an extensive set of security offerings) are used by 99 percent of Fortune 500 companies.

Other

Epic removes regular and diet soda from its vending machines and cafeterias to promote health, so bring your own supply from a local convenience store if you’re a Diet Coke fan taking classes in Verona.

Another medical transport helicopter goes down, killing all four occupants (including the patient) in Alabama. The for-profit company’s site boasts that it has a “proven clinical tract record.”

An interesting article describes the online problems experienced by people with unusual names: those who go by a single name, those with very long or short names that don’t pass field edits, and most interesting to programmers, people whose last name is Null. These folks often have to resort to telephone calls or snail mail to do tasks everybody else can accomplish online.

Sponsor Updates

• Forward Health Group shares the wall-sized, hand-drawn graphics created in its UnBooth at the HIMSS conference, including population health management questions posed by visitors. 
• EClinicalWorks releases a podcast recapping EClinicalWorks Day.
• Extension Healthcare and FormFast will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
• The Upstate Business Journal recognizes Glytec as an Upstate biotech player.
• The Boston Globe features Healthwise CMO Adam Husney, MD in an article on how perks from pharmaceutical companies influence prescribing medicine.
• Cumberland Consulting Group expands its business processing outsourcing services to pharma in a partnership with revenue acceleration software vendor Revitas.
• Recondo Technology will exhibit at the HFMA Texas State Conference on March 29 in Dallas.
• Experian Health will exhibit at NAACOs March 28-30 in Baltimore.
• PatientSafe Solutions and PerfectServe will exhibit at the AONE Annual Meeting March 30-April 2 in Fort Worth, TX.
• The Doctor Freedom Podcast features PatientPay founder and CEO Tom Furr.
• Point-of-Care Partners ECare Management Practice Lead Michael Solomon discusses optimizing EHRs.
• Streamline Health will exhibit at the 2016 WV HIMA Annual Convention March 30-April 1 in White Sulphur Springs, WV.
• T-System awards its Client Excellence Award to Dosher Memorial Hospital (NC) for excellence in sustainable outcomes.
• TeleTracking, Versus Technology, and Zynx Health will exhibit at the AONE 2016 annual conference March 30-April 2 in Fort Worth, TX.
• TeraMedica will host a healthcare IT symposium April 7 in San Francisco.
• Huron Consulting Group releases 2016 Healthcare CEO Forum report.

Blog Posts

• Four ICD-10 Programs Your Organization Should Have in Place NOW (Divurgent)
• Before You Build, Buy, or Align – What Every Organization Should Know (ECG Management Consultants)
• Rise in Opioid Deaths, Driving Changes in Prescribing (E-MDs)
• Unnecessary Uncertainty – The Anatomical Inventory (Clinical Architecture)
• TouchWorks 15.1: Potential Sensitive Health Conditions (Galen Healthcare Solutions)
• The Sound of Project Success: Orchestrating the Noise into a Symphony (Hayes Management Consulting)
• Cerner Training: 9 Ways to Increase Your ROI (The HCI Group)
• Toward Technology – Enhanced Healthcare (PatientKeeper)
• Out with the FFS, in with the VBR: Health Care’s New Payment Model (PMD)
• Quality reporting costs a cool $15.8b annually for 4 common physician specialties (Qpid Health)
• Preparing for 2015 CRA Submissions (Verisk Health)
• The Light at the End of the ICD-10 Code Freeze (VitalWare)
• Apple continues commitment to healthcare (Voalte)
• Text Messaging, Consumerism, and the Healthcare Industry, Part 2: Complying with Regulations (West Corp.)
• What Becomes of the Doctor’s Bill? (Xerox)
• 4 trends in Hospital Revenue Cycle Management that are here to stay (ZirMed)

Contacts

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

News 3/25/16

Top News

Allscripts and private equity firm GI Partners form a joint venture to acquire human services and post-acute care EHR vendor Netsmart, which will be combined with the homecare software business of Allscripts. Allscripts also contributed $70 million to the joint venture, which will pay $950 million for Netsmart. The company’s name and management team will remain in place. Allscripts says the JV will have an annualized revenue of $250 million and operating income of $60 million.

Netsmart has gone through several name changes, ownership changes, and acquisitions in its 20-year direct history and earlier connections going back to 1968. It went public in 1996, sold itself to private equity buyers for $115 million in 2006, and then was then sold for an unspecified price in 2010 to another private equity firm, Genstar Capital, which is rumored to be making 4.4 times its investment in the newly announced sale.

Reader Comments

From PM_From_Haities: “Re: Allscripts paying $70 million for a joint venture. It’s hard to imagine Allscripts giving up assets with out corresponding liabilities (debt). I’m looking forward to their audited financial results since they might require certain items to be disclosed, such as whether one customer represents more than 10 percent of revenue. The other item of interest with audited results is mark-to-market accounting of the Allscripts investment in NantHealth, which delayed its IPO due to unfavorable market conditions. Allscripts’ debt covenants contain asset-to-liability requirements and an unanticipated decline in asset value could seriously impact their delicate financial picture. The bright side of this JV is that Allscripts may be allowing a product that would languish with its other zombie EHRs to blossom into something good for home health.” Unverified. MDRX shares didn’t react much following the announcement, meandering down a bit Wednesday and then down a bit more Thursday.

From Green about the Gills: “Re: Greenway. Starting a layoff cycle this week. Right-sizing post the Vitera purchase and the EHR land grab of the MU era.” Unverified. However, I do see the company has “rebranded” itself.

From The PACS Designer: “The ICD-10-CM Clinical Modifications has a code J62 for silica related disease, and under this classification falls the longest word in the English dictionary. Silicosis is a form of occupational lung disease and within this category is the 45 letter word ‘Pneumonoultramicroscopicsilicovolcanoconiosis.’”

HIStalk Announcements and Requests

Mrs. Pryor from Oklahoma says her kindergartners love the programmable robots we provided in funding her DonorsChoose grant request, adding that they are a “huge motivator” that she has integrated into her reading and math curriculum.

Also checking in is Mr. Jewell of Arkansas, who says his sixth graders have gotten a lot more excited about engineering after working with the Lego Mindstorm kits we provided. He has conducted two enrichment classes that involved building and programming the robots and now there’s a waitlist for the next class.

This week on HIStalk Practice: Signallamp Health adds CCM jobs in Scranton. Mend wins big at SXSW. PCAST advocates for the advancement of telemedicine. Wearables earn dubious accolades for their inconsistencies. Telerehabilitation startup RespondWell celebrates a $2 million funding round. Night Nurse COO Stuart Pologe offers tips on balancing HIPAA compliance with efficiency across EHRs and paper records. GAO brings Healthcare.gov cyberattacks to light on the ACA’s sixth anniversary. OneCare Vermont selects care management software from Care Navigator. The US Oncology Network’s David Fryefield, MD lays out the strategy behind empowering value-based technologies.

Webinars

April 1 (Friday) 1:00 ET. “rise of the small-first-letter vendors … and the race to integrate HIS & MD systems.” Sponsored by HIStalk. Presenters: Frank L. Poggio, president and CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. Vince and Frank are back with their brutally honest (and often humorous) opinions about the rise of the small-first-letter vendors. Athenahealth and eClinicalWorks are following a growing trend toward real integration between hospital and physician systems, but this is not a new phenomenon. What have we learned from these same efforts over the last 30 years? What are the implications for hospital and ambulatory clients? What can clients expect based on past experience?

Contact Lorre for webinar services or for one final chance at her post-HIMSS discounts. Past webinars are on our HIStalk webinars YouTube channel.

Sales

Statewide ACO OneCare Vermont chooses Care Navigator’s care management software.

Thomas Health System (WV) will implement Meditech 6.1, replacing Cerner/Siemens Soarian and Meditech Magic.

Palomar Health (CA) chooses Ascend Software for accounts payable electronic imaging automation.

People

Lane Regional Medical Center (LA) hires Paul Murphy (Geocent) as CIO.

Announcements and Implementations

DrFirst publishes “The Evolving EPCS Landscape 2016: A Prescription for Stopping Opioid Abuse,” which finds that most pharmacies can accept electronic prescriptions for controlled substances while only 5.8 percent of prescribers are similarly EPCS-capable.

Boehringer Ingelheim Pharmaceuticals will offer users of its asthma inhalers the chance to sign up for health system studies to determine the effectiveness of Propeller’s usage tracking inhaler sensors.

Privacy and Security

Rep. Ted Lieu (D-CA) may propose a modification to the HITECH act that would require healthcare organizations to notify patients if they’re hit by ransomware.

The New York Times, explaining how it “decoded the NFL database” to debunk the National Football League’s concussion studies, admits that it was able to re-identify many of the 887 players that were listed only by an NFL-assigned code by reviewing the concussion date, whether the game was home or away, and whether it was being played on natural or artificial grass. The paper seems pretty pleased with itself for working around the method used to protect the privacy of the players.

Walmart confirms that a programming error caused the prescription records of 5,000 of its online pharmacy customers to be displayed to the wrong user.

Do this now to help prevent having your PC infected with the Locky ransomware: allow only digitally signed macros to run. Instructions are here.

The Ohio Supreme Court rules that patients are entitled to receive all information stored about them by providers, not just those data elements the provider intentionally filed in the medical record. A hospital that was involved in a wrongful death lawsuit unsuccessfully argued that it was not required to release the deceased patient’s EKG strips because they had been stored by its risk management department.

Technology

Google registers two healthcare-related images that may or may not have something to do with new medical apps.

Other

NYC Health + Hospitals President and CEO Ram Raju, MD says the organization’s April 1 Epic go-live date is flexible and he won’t be fired for missing the date if the system isn’t ready. He says former Elmhurst CMIO Charles Perry, MD, MBA, who resigned in comparing the upcoming go-live with the Challenger disaster, took a parting shot as a “disgruntled” employee. Raju says previous CIO Bert Robles left shortly after the Epic project started because, “I didn’t want someone learning on the job,” leading him hire Ed Marx, who was recommended by Epic CEO Judy Faulkner. NY Health + Hospitals, which is projecting a $2 billion deficit, is rumored to be spending $1.4 billion on the Epic project.

Lancaster General Health (PA) investigates a 12-hour EHR outage of unspecified origin.

Sponsor Updates

• Medicity CEO Nancy Ham writes for the HFMA blog on “Determining the ROI of Clinical Care Technology.”
• A record number of providers, payers, and partners gathered at the InstaMed 2016 User Conference.
• Live Process will exhibit at the AONE Annual Conference March 30-April 2 in Fort Worth, TX.
• Navicure will exhibit at the Office Practicum User Conference March 31-April 2 in Atlantic City, NJ.
• Obix Perinatal Data System will exhibit at the Sanford Health Perinatal, Neonatal, and Women’s Health Conference March 31 in Sioux Falls, SD.
• The Irish Times profiles Oneview Healthcare founder Mark McCloskey.

Blog Posts

• 3 Benefits of Patient Centered Messaging (TelmedIQ)
• Healthy Privacy and Security Practices for Telemedicine (ID Experts)
• Local SEO & Listings Management are Essential in Healthcare Marketing (Influence Health)
• BMT Tandem Meetings 2016 Wrap-Up: Hot Topics & Cold Giveaways (Liaison Technologies)

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 3/23/16

Top News

AHIMA petitions the White House to support development of a voluntary national patient identifier. Patients who opt in would be able to choose their own identifier. The petition will earn an official White House response if it gets 100,000 signatures by April 19. It calls for removing a late-1990s HHS funding restriction that prohibits the department from working on a national patient identifier.

Reader Comments

From Suzie HR: “Re: Cerner. A 20+ year SMS/Siemens/Cerner employee gets terminated after six months of personal leave taken for treatment of stage 4 colon cancer. Wonder if Neal Patterson is worried what will happen to him during his cancer treatment?” Unverified.

From Helium: “Re: Epic 2015 upgrades being delayed. Not true here. We’ve discussed the fixes coming out from Epic with our technical lead at Epic and will take them when released. We are still on track for our mid-May upgrade to their latest version (v2015).” Unverified, but this is from a non-anonymous CIO who asked not to be named.

From A Friend: “Re: Epic. Notified their customers Friday that they have become aware of a major security hole and would be distributing emergency SU’s (Epic jargon for patches) soon.” Unverified.

From Dueling Banjos: “Re: your comment about flame-related FHIR puns. It hit my funny bone as I was reading your news update while riding BART. I was having such a good, hearty laugh over that comment that the man next to me thought I was crying and asked if I was OK. Thank you for making my day!” 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor HealthCast. The Boise, ID-based company offers enhanced sign-on solutions that provide fast, secure access to EHRs and other software. That includes enterprise single sign-on that has a 100 percent success rate in integrating with applications; proximity card-based VDI access; and two-factor authentication for DEA-compliant electronic prescribing of controlled substances via biometrics or tokens. Physicians report that they save up to 45 minutes per day with fast-user switching, click-reducing automated workflow, and remote and roaming access to their systems. The company’s patented Qwik-Start helps community-based physicians who admit patients infrequently and therefore don’t necessarily remember their user IDs and passwords to log on to hospital systems using biometrics-activated proximity badges. Thanks to HealthCast for supporting HIStalk. 

Vivian, who is a member of Mr. Chen’s robotics team in Massachusetts, emailed her thanks for funding their DonorsChoose grant request for pizza gift cards for feeding the team on evenings and weekends while they prepared for competition. She says, “We are so grateful that you helped us out! We needed energy to keep us going as we were very charged on getting the robot built for our competition. We have learned so much about mechanical engineering, software engineering, teamwork, and how to run the club as if it is a small business. Your donation has enhanced our learning and made it so much more enjoyable!”

Webinars

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

Here’s the video from last week’s webinar, “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado,” sponsored by Spok.

Acquisitions, Funding, Business, and Stock

Denver-based CirrusMD, which offers a white label app that allows consumer users to send messages to on-call and ED doctors, raises $1 million.

Practice Unite and Uniphy Health will merge to offer secure messaging and collaboration solutions under the Uniphy Health name.

Sales

In the UK, Wirral Partners chooses Cerner’s HealtheIntent for population health management.

People

Indiana University Health names Mark Lantzy (Gateway Health) as SVP/CIO.

Andy Grove, the former CEO and chairman of Intel, died Monday at 79.

Announcements and Implementations

Apple announces CareKit, a developer’s framework for creating personal health apps for the iPhone. Its first four modules will support health to-do lists, symptom logging, a dashboard to map symptoms to the to-do lists, and an information sharing function. The company says early adopters are using CareKit to build apps for Parkinson’s patients, post-surgery progress, home health monitoring, diabetes management, mental health, and maternal health.

23andMe integrates with Apple’s ResearchKit, allowing developers to create apps in which study participants can upload their genetic testing results from their iPhones. It also allows researchers to offer 23andMe testing at their own expense to expand study access to non-23andMe customers. 

Privacy and Security

A cybersecurity firm finds that the public website of Ontario, Canada-based Norfolk General Hospital has been infecting its visitors with the TeslaCrypt ransomware. Hackers gained access to the site via an exploit in its outdated Joomla content management system.

Methodist Hospital (KY) recovers its systems from a ransomware attack that lasted several days, saying that it was able to regain access without paying the demanded ransom.

Two California hospitals owned by Prime Healthcare Services have been hit by an unspecified cyberattack that sounds like ransomware. The hospitals are working to restore their systems and the FBI is investigating.

Ruby Memorial Hospital (WV) goes into lockdown mode for several hours after unspecified malware affects its clinical and security systems.

Other

A doctor in Canada is punished for overbilling and for keeping inaccurate electronic medical records, the latter of which he blames on not understanding the EHR of the practice he joined. He told the tribunal that he failed to change a pre-populated EHR template, but later switched EHRs.

JAMIA issues a call for articles on the safety of health IT, with manuscripts due June 1.

Expedia offers patients of St. Jude Children’s Research Hospital the chance to experience their “Dream Adventures” in which Expedia dispatches teams carrying live-streaming 360-degree cameras to display the adventures the children request in a virtual reality room installed at the hospital. 

Sponsor Updates

• Besler Consulting releases a new podcast, “Compliance pitfalls and how to understand RAC findings on your discharge status.”
• Burwood Group will exhibit at the AONE 2016 nursing leadership conference March 31 in Fort Worth, TX.
• Elsevier launches a history of medicine site to celebrate the 100th anniversary of its Medical Clinics clinical review publication.
• CTG will exhibit at the 2016 Annual Health Care Symposium April 1 in Costa Mesa, CA.

Blog Posts

• High Performance Telemedicine for Your Practice (AdvancedMD)
• VMware AirWatch supports IOS 9.3 (AirWatch)
• The Acme of Insight (Catalyze)
• A Nursing Exec’s View on the State of Patient Safety (CapsuleTech)
• A Day in the Life (CoverMyMeds)
• The Value and Challenge of Patient Generated Health Data (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.

Monday Morning Update 3/21/16

Top News

Methodist Hospital (KY) is hit by ransomware, forcing it to run from a backup system while it decides whether to pay an unspecified ransom to regain access to its patient records. The hospital has declared an internal state of emergency and warns that it has “limited access to Web-based services and electronic communications.” The FBI is investigating.

Reader Comments

From Certifiable: “Re: Epic 2015. All upgrades are being delayed for 1-2 months until fixes can be delivered. Unusual!” Unverified.

HIStalk Announcements and Requests

It’s easy to describe the HIMSS keynoters that poll respondents want to see – they are the ones HIMSS doesn’t invite. The least-attractive speakers are government officials (HIMSS16 — Sylvia Burwell), authors (HIMSS16 — Jonah Berger), celebrities or athletes (HIMSS16 – Peyton Manning), and for-profit business leaders (HIMSS16 – Michael Dell). Topping the most-desired but rarely offered list are public health experts, patients, and not-for-profit provider leaders. Furydelabongo wants to hear from inspirational people who remind us of why we’re connected to healthcare and who can convey urgency, while Tracy wants to be inspired by what’s possible in transforming healthcare rather than hearing from a celebrity.

New poll to your right or here: has your employer laid anyone off in the past 12 months?

I was thinking about how the most prevalent form of healthcare ransomware is being distributed by hospitals – the kind that holds your own medical information hostage unless you’re willing to pay to get it back.

We fulfilled the DonorsChoose grant request of Mr. Blachly in Indiana, whose high school advanced placement calculus and physics students experience “abysmal conditions and poverty” that cause them to miss classes. The video camera and accessories we provided has allowed him to archive his lectures so that absent students can watch them online, allowing them to return to class fully caught up. It also frees up his time for questions rather than re-teaching missed lessons.

Also checking in is Mrs. Beggs from Maryland, who teaches a middle school math class for students with educational disabilities. She says of the math tools we provided, “My students could not believe that people that have never met them were willing to purchase items for them. We had a wonderful conversation about giving to others and why its so important. We are currently working on integers and absolute value. We will continue to practice our basic math facts while we learn integer skills. These skills are essential for the every day world and are helping prepare my students for life.”

Last Week’s Most Interesting News

• HHS OCR settles two lost laptop HIPAA incidents for $5.4 million, one of them involving a non-hospital employee whose employer hadn’t signed a business associate agreement with the hospital.
• The CMIO of two NYC Health + Hospitals hospitals resigns, warning that the system isn’t ready for its April 1 Epic go-live and that patients will be harmed if it isn’t moved back.
• St. Joseph Health (CA) settles for $15 million a privacy class action lawsuit involving a 2012 incident in which a PHI-containing server was inadvertently opened up to the Internet. It states the total cost of the incident at $40 million.
• Dell appears close to be selling its services business to Japan’s NTT Data for $3.5 billion.
• The Senate’s HELP committee passes the MEDTECH act that exempts several types of health-related software from the FDA’s oversight.

Webinars

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

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

Acquisitions, Funding, Business, and Stock

An analysis of privately held Dell’s financial forms finds that sales are down across most of its divisions and it’s still largely a PC company, with 65 percent of its revenue coming from hardware sales. Revenue for the services business it is trying to sell was down 5 percent for the fiscal year.

Staffing and services firm HCTec Partners acquires Colorado-based professional services firm HIMS Consulting Group.

McKesson will take a $300 million charge for its cost-cutting restructuring plan that involves 1,600 layoffs.

Privacy and Security

Developers of the TeslaCrypt ransomware toolkit update their product to remove the ability of cybersecurity firms to use a known exploit to restore the encrypted files without paying the ransom. The FBI warned last month that ever-smarter ransomware can now search a network to locate and delete backups, leaving the victim with only one choice if they want their systems back. I’ll repeat my prediction that hospitals will have no choice but to block access to Web-based email services like Gmail that employees use to check personal email, bypassing IT security.

Other

Cerner holds a topping-out ceremony for its $4.45 billion Cerner Trails campus in Kansas City, MO. The 16-building, 4.7 million square foot complex with two, 15-story towers will house up to 16,000 employees. Kansas City will pay $1.1 billion of the project’s cost.

The two surviving original members of The Who, Roger Daltrey and Pete Townshend, open a teen lounge at Memorial Sloan Kettering Cancer Center (NY). The space was created using $1 million raised by a concert in which Daltrey and Townshend performed via Teen Cancer America, a charity they founded in 2012.

A profile of India-based 32-hospital chain Narayana Hrudayalaya describes its mission to “dissociate healthcare from affluence” in proving that “the wealth of the nation has nothing to do with the quality of healthcare” in a country where most residents can’t afford drugs or surgery. It offers CABG surgery for as little as $2,700 and surgery insurance for $3.60 per year. Some of its cost-cutting methods:

• Do as much as possible in an outpatient setting.
• Focus on high-volume procedures to gain economy of scale. Its 16 cardiac surgeons each perform 400-600 procedures per year.
• Minimize facility expense by not investing in fancy buildings, artwork, or even air conditioning.
• Competitively bid for drugs and medical equipment.
• Use top-of-license practices to shift less-critical work to junior employees.
• Use iPad-based ICU monitoring software called iKare to update patient records and provide alerts.
• Connect all hospitals via a cloud-based information system that includes ERP and EHR.
• Teach patient families to deliver post-op care at home.
• Offer free telemedicine services via Skype, including consultations, radiology reports, EKG, and second opinions.

An anesthesiologist in England faces dismissal for having sex with a prostitute in a maternity hospital. He was blackmailed by the woman’s “associates,” who threatened to tell his wife if he didn’t pay them $15,000. He worked with police to set up a sting operation to capture the blackmailers, and as it was underway, he showed officers an X-ray showing a patient with a bottle lodged his most private of areas.

Sponsor Updates

• TierPoint will exhibit at the Boston Premier CIO Forum March 22-23.
• VitalWare will exhibit at HFMA Dixie 2016 March 20-23 in Nashville, TN.
• PatientMatters will exhibit at the HFMA Northern California – Spring Conference March 20-22 in Sacramento.
• Sagacious Consultants publishes the March 2016 edition of its Sagacious Pulse newsletter
• The SSI Group and Streamline Health will exhibit at the Region 5 Dixie HFMA meeting March 20-23 in Nashville.

Blog Posts

• Leading with Passion: Watch Out For Pile Ups! (T-System)
• TeleTracking Recognizes Patient Safety Awareness Week (TeleTracking)
• ICD-10 and its Impact on Risk Adjustment (Verisk Health)
• Your Peers Think You Should Go to the VUE – Here’s Why (Versus Technology)
• Catch the Wave. (Voalte)
• HIMSS07 to HIMSS16: The Long Road to True Clinical Mobility (PatientSafe Solutions)
• 3 Unique Payment Processing Challenges Facing Healthcare Providers (Patientco)
• Insights from HIMSS16: Four key takeaways (PerfectServe)
• The Quality Conundrum and QCDR (PMD)
• Top Ten Health IT Trends for 2016 (Point-of-Care Partners)
• Text Messaging, Consumerism, and the Healthcare Industry, Part 1: These Three Belong Together (West Corp.)
• Medicaid Evolves to Focus on Quality Outcomes (Xerox)
• Clinical Documentation Improvement – Key for ICD-10 Claims Processing (ZirMed)

Contacts

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

News 3/18/16

Top News

HHS OCR announces two big HIPAA violation settlements for years-old incidents, both involving the theft of unencrypted, PHI-containing laptops.

North Memorial Health Care (MN) will pay $1.55 million to settle charges involving the 2011 theft of an PHI-containing, unencrypted laptop from an employee of Accretive Health. HHS OCR says the system violated HIPAA rules by failing to require Accretive to sign a business associate agreement and for not performing a security risk analysis.

Feinstein Institute for Medical Research (NY), a non-profit sponsored by Northwell Health, will pay HHS OCR $3.9 million to settle charges that it lacked of security management processes, detection of which was triggered by OCR’s investigation of an unencrypted  PHI-containing laptop that was stolen in 2012.

Reader Comments

From Dockside: “Re: Novell GroupWise. BJC HealthCare began its Outlook rollout using Microsoft hosting services. The rollout is going well and will be finished in stages over a couple of months. Makes me wonder how many GroupWise shops are left.” I was involved with that same conversion at my hospital many years ago and thought we were probably one of the last holdouts then. Users weren’t clamoring for Outlook, but our GroupWise version was so old that it couldn’t handle long file names and its inline document viewers didn’t work with newer file formats. The product is still around, with the 2014 edition being the most recent version. Most of us in the hospital missed a few GroupWise features that Outlook didn’t have, but nobody had any interest in going back since we had already moved away from Novell Office. BJC is the first-listed success story on the GroupWise site. I also notice that the screen shot included in the Wikipedia entry for GroupWise is from someone in healthcare since the pictured inbox contains emails from HIStalk and HIMSS.

From Legally Blonde: “Re: Hardee County, FL. The grand jury in January 2015 investigated the director of the county’s economic development department for spending $7.25 million to fund creation of what is now CareSync. The jury found that nobody monitored the project or whether it returned benefit to county taxpayers. A member of the economic development board had financial interest in the approval of the money. The jury found that projections of 400,000 users and $26 million in annual revenues were ‘mere smoke and mirrors and not even close to being met.’ The interesting thing to me is that surely that indictment was in play before the investors of CareSync (Merck Global Health Innovation Fund ) invested. There was a Series B raise of 18M in early October 2015. Certainly there were clauses about there being no legal proceedings in the terms of the funding.” The full grand jury report is here. I found a March 2015 story in which the development authority ignored the grand jury’s recommendations. I’m not a legal expert, but it looks like the grand jury was focusing on the county’s economic development board and not CareSync and I saw nothing involving indictments or anything more than recommendations to the county. CareSync said its October 2015 fund raise would enable the hiring of 500 workers, although it didn’t indicate how many of them would be working in Hardee County.

From Empowered Patient: “Re: obtaining medical records. Thank you for sharing Deven McGraw’s excellent explanation in Jenn’s HIStalk article. The HIPAA Omnibus Rule clearly spells out the right that a patient has to receive an electronic copy of their protected health information if the entity is capable of producing it. Further, the electronic copy must be provided in a readily producible form and format, including unencrypted email if that is the patient’s desire. I have argued with CIOs and security professionals who should know better, but denial of these rights is a violation of HIPAA. The American Bar Association has a great overview for anyone who still doesn’t understand.”

From MS Clippy: “Re: HIStalk articles. Which one is the most-read ever?” I don’t have tools that track how many times each post has been read, which would be pretty cool. It’s been busy the last couple of weeks, though, with nearly 10,000 page views Monday and 8,000 on Tuesday and Wednesday. Those are pretty big numbers for the post-HIMSS lull with no blockbuster news.

From Tawdry Tale: “Re: Memorial Hermann. Has been hit by ransomware from the Nemucod Trojan dropper.” Unverified.

HIStalk Announcements and Requests

Ms. Medina says her California first graders are using the engineering kits we provided in funding her DonorsChoose grant request to learn about simple tools and machines.

I also heard from Mrs. Sickle, whose Missouri first grade classroom is filled with charts the students are making from the chart paper we provided.

This week on HIStalk Practice: Complete Family Foot Care informs patients of a Bizmatics EHR breach. St. Clair Specialty Physicians implements Medical Design Technologies charge-capture software. CTO Prakash Khot brings Salesforce ethos to Athenahealth. Morris Heights Health Center goes with EClinicalWorks EHR and population health management software. Atlantic Spine Center launches virtual consults. Xerox’s Tamara StClaire addresses the population health management equation. Physician burnout may lead to a surge of ninjas promoting "warlord tourism."

This week on HIStalk Connect: Researchers unveil a new sensor capable restoring a sense of touch for prosthesis wearers. Personal assistant apps fail to offer clinically relevant results when queried with health questions. AliveCor introduces an Apple Watch band that can capture an ECG. The NHS will expand the use of e-referrals through a $78 million grant program.

Webinars

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

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

Acquisitions, Funding, Business, and Stock

McKesson lays off 1,600 people, 4 percent of its US workforce, after losing some of its key pharmaceutical customers. 

Cash-strapped Toshiba, struggling after an accounting scandal, sells its Toshiba Medical Systems business to Canon for $5.9 billion. Canon’s healthcare offerings include digital radiography and fluoroscopy systems.

Ireland-based Oneview Healthcare raises $45 million in its Australian Stock Market IPO, valuing the company at $160 million. Shares rose 3 percent on their opening day.

Predictive analytics care coordination systems vendor Pieces Technologies raises $21.6 million in Series A funding.

Sales

Riverside Medical Center (IL) chooses Glytec’s eGlycemic Management System and its Glucommander algorithm-based software for insulin management and glycemic control in its diabetes management program.

People

Charles Perry, MD, MBA, CMIO of Elmhurst and Queens Hospital Centers (NY), resigns in protest, comparing the Epic project of NYC Health + Hospitals with the Challenger space shuttle disaster of 1986. He says his hospitals aren’t ready for their go-live and patients will be harmed if the April 1 date isn’t moved back. He had been in the CMIO role since June 2014.

Impact Advisors promotes Michael Nutter to VP.

Accenture hires retired Army Surgeon General Lt. Gen. Patricia Horoho, RN, MSN to lead its Accenture Federal Services defense health practice, which includes its work on the DoD’s EHR project.

Announcements and Implementations

Wolters Kluwer migrates three customers of the sunsetted Olympus EndoWorks to Provation MD Gastroenterology, the first of 86 facilities that have contracted for the replacement.

Medsphere launches a mobile version of its OpenVista EHR, which includes its NoteAssist template-based patient documentation system. 

ID Experts launches the first complete identity protection program for health plan members, which includes protection against all nine types of identity theft. The company offers services for identity monitoring, identity recovery, health fraud, and breach response.

Government and Politics

The VA will attempt to fire three executives from its Phoenix hospital over the 2014 wait times scandal. Two of them were placed on leave nearly two years ago but are still employed, and all three will be able to challenge their termination, which in the VA usually means they’ll just be reassigned. The VA previously fired the hospital’s director, but she got to keep her bonus despite pleading guilty to a felony charge for accepting $50,000 in gifts from a lobbyist who was her former supervisor. She had worked at four VA facilities in five years.

Privacy and Security

Premier Healthcare (IN) breathes a sigh of relief when a stolen laptop containing the PHI of 200,000 people is anonymously returned by mail, with IT forensics showing that it had not been powered on since the theft occurred in January.

Technology

UNICEF is testing the use of drones in Malawi to carry the blood samples of babies born to HIV-infected mothers to a hospital laboratory, hoping to cut down on the two-month turnaround time between drawing the blood and receiving the result. Ten percent of the country’s population has HIV.

Other

A physician leaving the medical profession to work for a medical device company she founded explains her decision:

The phenomenon of patients as customers, the cultural rise of entitled incivility, and trusting Dr. Google more than their doctor has eroded some of the pleasure of patient care … In Kurt Vonnegut’s dystopian gem [Harrison Bergeron], to promote equality, the best and brightest were interrupted by technology that slowed thought. Much as the concept of the EHR makes sense in today’s peripatetic world, the required computer interface currently is right out of Vonnegut. Five minutes of patient contact necessitates 10 of charting, documenting discharge, signing scripts, and all must now be done with a mouse and click box. So many of my heroes have stopped seeing patients, so many years of productive practice lost to the interface. The part of the medical equation that solves the problem shouldn’t be doing data entry. Scribes? Real time dictation? While a portable electronic record is a necessary iterative step to longitudinal map that follow patients through life, the EHR kills joy.

Broward Health (FL) demotes its CEO and places its general counsel under review after executives complain about lack of leadership and a prolonged contracting process with doctors that may leave it without specialists who can treat trauma or stroke patients. The hospital’s chief of staff says the former Broward General Medical Center is 30 days away from being forced to shut down. SVP/CIO Doris Peek told the board that employees look to it to provided leadership. The hospital district’s former CEO committed suicide on January 23, followed by a state investigation into the district’s contracting practices.

Boston Medical Center (MA) will offer the digital sleep training app Sleepio as an employee benefit. The UK-based vendor claims hospital employees sleep 4.5 hours per week longer using its cognitive behavioral therapy program. Consumers can sign up directly for $300 per year.

Data analysis by ProPublica may dispute the claims of doctors that payments they receive from drug companies don’t influence their prescribing habits. Doctors who received money or meals from drug and device makers were 2-3 times more likely to prescribe brand name drugs. The study found that 90 percent of cardiologists who wrote at least 1,000 Medicare prescriptions received such payments, as did 70 percent of internists and family practitioners. Reporters contacted three doctors who prescribed high rates of brand name drugs. The first doctor claimed the drugs are of higher quality, the second said he can’t make a living without taking drug company payments, and the third threatened to call the district attorney about reporters questioning the $53,400 in drug company payments he received.

Eleven-hospital Presence Health (IL) announces that it lost $186 million in 2015, blaming one-time charges that include a $53 million write-off of uncollectible debt, a change in accounting policies, and the cost of implementing unstated software (presumably Epic since they’re implementing it).

The systems development group of the IT department of Arkansas Children’s Hospital will host Camp WannaCode, a free, week-long day camp for students aged 14-18 interested in computer programming. The June 7-10 camp in Little Rock will offer classes on Raspberry Pi development, data analytics, SQL databases, JavaScript, and Android development.

In Canada, a Winnipeg doctor loses his license for a variety of professional misconduct offenses including failing to install medical records software as ordered in a 2000 disciplinary hearing for poor recordkeeping. A 2014 forensic audit of his computer found no trace of the EHR software, but records suggested he had copied and pasted blood pressure readings over multiple visits. The doctor had submitted in his defense the results of a peer group analysis and an independent audit of his practice, but he later admitted that he just wrote both documents himself.

Friday is Match Day, where graduating medical school students find out where they’ll be spending the next few years working endless hours for low pay. The always-talented University of Chicago Pritzker School of Medicine Class of 2016, led by the musically gifted Beanie Meadow, provides this amusing tribute to their graduating peers everywhere.

Attention, all you witless punsters who think flame-related FHIR jokes are clever: research suggests that you might have a neuropsychiatric disease beyond just being annoying.

Sponsor Updates

• KLAS rates InterSystems HealthShare a top HIE technology in the EMR-independent category.
• PDR will exhibit at CBI e-Rx & EHR-1 March 21-22 in Philadelphia.
• Navicure will exhibit at the MGMA/AMA Collaborate in Practice event March 20-22 in Colorado Springs, CO.
• Nordic sponsors the Southwest Region User group Meeting at Maricopa Integrated Health System March 18 in Phoenix.
• Orion Health CEO Ian McCrae discusses precision medicine on a New Zealand morning show.

Blog Posts

• Key Takeaways from HIMSS16 (Medicity)
• All Aboard: Getting Users to Hop on the Secure Text Messaging Bandwagon (Spok)
• Device Deployment in Large System Implementations, There are Things That I Know That I Know (Impact Advisors)
• How to Heal a Broken Heart (bleed Bug) (InstaMed)
• Full Moon over South Beach – SCOPE ’16 (Liaison Technologies)
• Top Takeaways from HIMSS16 (LifeImage)
• #NATCON16 – Informed and Inspired (Netsmart)

Contacts

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

Providers Prep for a New Age of Patient Record Access

HIStalk follows up its coverage of OCR’s new HIPAA guidance with a look at provider reaction and preparation.
By @JennHIStalk

OCR’s new HIPAA guidance has the industry on high alert. The office’s clarifications on reasonable fees, timeliness, and a patient’s right to electronically transmit their health data to third parties have many providers and their release of information (ROI) vendors rethinking workflows and technology needs – all in the name of ensuring that patient medical records requests are handled in a timely and cost-effective manner.

As OCR Deputy Director for Health Information Privacy Deven McGraw explained in a previous HIStalk article, “People shouldn’t put their heads in the sand about this. We’re quite serious.”

OCR has made its case clearly and is making an effort to help providers understand their role in helping to empower patients with the ability to access their health data in a non-burdensome manner. But are providers listening? Are they – and their ROI vendors – ready for this new age of patient medical-record access?

Huge Culture Change

HIM leaders at Oakland Regional Hospital (MI) and Piedmont Healthcare (GA) have been keeping a close eye on OCR’s HIPAA updates, working in tandem with their ROI vendors to ensure compliance with minimum disruption to patient care.

“Some providers are a bit skeptical with the move towards more patient involvement and control over their health record,” says Stephanie Tatum, director of health information and informatics management at Oakland Regional, a multi-site health system that focuses on hand, joint, orthopedic, and sports medicine. “I believe it’s a huge culture change that providers are having to adapt to. The younger generation of providers view this movement as a positive for the patients because it allows them to feel more involved. On the other hand, other providers believe patients will become overwhelmed with the amount of information that is available to them.”

Oakland Regional’s ROI vendor, Bactes, has already made changes to its records request process to maintain compliance with the updated guidance. “Our facility follows the guidelines of our ROI vendor, so our workflows will remain the same at this time. [Bactes] does a really good job of processing the requests in a timely manner, and they also provide great statistical reports that allow us to track the number of requests as well as the type of requests processed over time.”

Tatum adds that while Bactes — a Sharecare subsidiary that made news a few years ago for overcharging patients for copies of their medical records — is working to bring its clients up to speed with HIPAA, the ROI vendor community as a whole is not necessarily ecstatic about the changes, especially with regard to the transition to more reasonable fees. “I have heard that the updated OCR guidance will cause some vendors to lose money on processing requests, so it’s being viewed as a negative.”

Gaining Clarity into New Fees

Piedmont’s ROI vendor, Healthport, also made similar news several years ago for overcharging. The Atlanta-based company, which acquired medical record retrieval company ECS last September, is working diligently with Piedmont to ensure its compliance as the health system begins to roll out patient medical record access through its Epic MyChart patient portal.

Pamella Marshall, senior director of HIM at Piedmont, did a little digging into the difference between the state of Georgia’s take on record access fees and OCR’s guidance, ultimately contacting Healthport for clarification. “They came back and had actually reduced their per-page fee and eliminated the retrieval fee that was allowed by the state. They also eliminated the certification fee.”

Marshall isn’t so sure that reducing or eliminating fees will empower patients to go after their records more than they already are, given that requests are “usually made as a follow-up to care. But I do know that the change in copy fees will make a difference for everybody.”

Satisfaction Scores will Benefit

Piedmont has been working on making medical records access easier even before OCR released its latest clarifications. Access via patient portal will be key. “I suspect we’ll probably have the complete patient medical record access feature up and running by the end of this fiscal year … maybe by the end of the third quarter. We are about to upgrade to the 2015 version of Epic, and so everyone is tied up with that.”

Marshall adds that the patient portal strategy will be a win not only for patients, but for Piedmont’s patient satisfaction scores, too. “One of the things I’m looking at is adding not only the ability to release the entire record through MyChart, but also to give patients the ability to request their records through MyChart,” she says. “For those patients who are computer savvy – and not all patients are – this is a really good patient satisfier. Our goal is to make a complete, downloadable, and shareable copy available to the patient – all free of charge. Those are a couple of things we have to work on over the next several months.”

Marshall believes that giving patients easier, less burdensome access to their complete medical record will be a win for population health in the long run. “We as a population of people are becoming more health conscious, looking at things like genetics and our ancestry.” As the momentum behind this trend escalates, she adds, especially in light of the 1 million patient Precision Medicine Initiative, “people may be more inclined to get copies of their records so they can compare them and make sure they are leading a healthy lifestyle.”

News 3/16/16

Top News

Nearly 31,000 patients of St. Joseph Health (CA) will get checks for $242 each following the hospital’s $7.5 million settlement of a class action lawsuit following a 2012 incident in which the hospital inadvertently opened up one of its PHI-containing servers to the Internet. The hospital paid another $7.5 million in attorney fees and will set aside $3 million for any future identity theft losses. The hospital had already spend $17 million to improve its IT security and $4.5 million for credit monitoring for the affected individuals. That’s nearly $40 million in potential eventual payouts.

Reader Comments

From PitViper: “Re: blockchain. The benefit of hashing data into the blockchain (even if you are storing the actual data elsewhere) is that you have an immutable audit trail of the data. Nobody can go in and update the information unilaterally. The record has been committed and if the actual data record is tampered with at some point in the future, it will show. This is important for the data integrity of medical records.”

From Me Dislike Collusions: “Re: MEDTECH bill. Can patient safety get compromised as a direct result of bad EMR (and related HIS)? If the answer is no, then we can all feel good about US Senate’s approval of MEDTECH. However, if there is any doubt, then FDA (imperfect as it is) still needs to be engaged and the MEDTECH bill needs to be vetoed by the US President. I am surprised at the lack of protests, especially from the doctors. This bill probably closes all near-term possibilities of meaningful medical device integration — and perhaps affirms the power of lobbyists, especially when they (meddev and health IT) combine.”

From Support Analyst: “Re: Epic stars program. Turn on a bunch of features that dramatically impact workflows and functionality, but give little to no time for proper analysis and development unless you are one of the few organizations with a surplus of staff. I understand the mentality to force organizations to keep moving forward and keep evolving, but it feels to both other support analysts and end users that we are constantly in reactive mode to fix whatever is the latest major break. Users are frustrated, losing confidence, and are quickly shutting down. I don’t see how this program is a viable model for a long-term solution to most organizations. Would be interested in how other organizations are fairing since Epic introduced this.”

From PM_From_Haities: “Re: Epic. They deliver and continue to deliver. That’s the difference between it and other EHRs. Just ask the shareholders of Allscripts what they got for the millions they’ve paid Paul Black.” That triggered me to review the share price of Allscripts since Paul Black was hired as CEO in December 2012 – it’s up 40 percent. Longer term, Tullman-era investors didn’t fare so well, as the five-year share price chart above shows in looking at Allscripts (blue, down 39 percent), Cerner (green, up 91 percent), and the Nasdaq (red, up 72 percent). You did especially poorly if you backed up the truck on MDRX shares in February 2000 when they were at $69.00, now down 81 percent.

From Specific Gravity: “Re: SF-36. I’m curious to learn more about your SF-36 wellness questionnaire idea. Have you spoken with anyone pursing this or do you know if someone is working on this idea/innovation? I have many ideas on how to make this a reality.” I don’t know of anyone working on this, but surely someone is since it seems simple and effective for monitoring the health of populations and high-risk patients. Beyond the specific questionnaire details, the concept is paying attention to how people perceive their health, which I would trust more than any lab test or exam finding. Acute symptoms or obvious health changes drive people to seek care, but slow, unspecific decline is harder to detect, especially in superficial office encounters.

HIStalk Announcements and Requests

Mrs. Ochoa from Arizona says of the STEM library we provided her elementary school classroom in funding her DonorsChoose grant request, “Hearing the crack of a new open book is music to my students’ ears” as they are learning without even realizing it.

Also checking in from his Arkansas middle school is Mr. Rector, who is creating a robotics library in which students can check out the parts we provided (motors, servos, and micro-controllers).

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

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

Acquisitions, Funding, Business, and Stock

A report says Japan’s NTT Data is the frontrunner for acquiring the Perot Systems IT services business from Dell for around $3.5 billion. Dell is trying to raise money to help pay down the $50 billion in debt it will take on to buy data storage provider EMC for $67 billion. Dell bought Perot Systems in 2009 for $3.9 billion.

Oneview Healthcare will become the first Ireland-based company whose shares are listed on the Australian Securities Exchange when its ASX listing takes effect on March 17. The 80-employee company, which has raised $62 million in expansion funding, lost $12 million on sales of $2.6 million in FY2015.

Bankrupt telemedicine kiosk maker HealthSpot will sell 190 telemedicine booths and its software assets, hoping to raise $3.5 million toward repaying the $23 million it owes creditors. The company’s annual revenue topped out at $600,000.

Sales

Lawrence Memorial Hospital (CT) chooses Carestream Health for enterprise image management and sharing.

People

Cleveland Clinic CIO C. Martin Harris, MD, MBA joins the board of Colgate-Palmolive.

Announcements and Implementations

Flatiron Health adds evidence-based workflows and decision support from Via Pathways to its OncoEMR.

Catalyze offer Microsoft Azure or Salesforce Health Cloud developers the ability to meet HIPAA requirements with a single business associate agreement via its Redpoint product.

Government and Politics

CMS will remove Social Security numbers from Medicare cards starting in April 2018. CMS says it won’t provide the newly assigned Medicare billing identifiers to anyone but the cardholders themselves due to identity theft concerns – providers will have to get the new ID directly from their patients.

The Institute of Medicine starts using its new name, the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division. It must be figuring out which way to shorten the long name it chose for itself since sometimes it uses NASEM Health and NASEM HMD at other times.

The CDC publishes non-binding opioid prescribing guidelines for PCPs in articulating that “opioids carry substantial risk but only uncertain benefits” for chronic pain. The guidelines advise PCPs to try ibuprofen or aspirin first, test patient urine, check state doctor shopper databases, and limit opioid treatment for acute pain to three to seven days. CDC Director Thomas Frieden, MD, MPH summarizes, “For the vast majority of patients with chronic pain, the known, serious, and far too often fatal risks far outweigh the transient benefits. We lose sight of the fact that the prescription opioids are just as addictive as heroin. Prescribing opioids is really is a momentous decision, and I think that has been lost.”

Privacy and Security

Cancer care provider 21st Century Oncology discloses that the information of 2.2 million was exposed in an October 2015 breach. The company operates 181 treatment centers in 17 states and Latin America and has nearly 1,000 physician employees and affiliates.

Four cybersecurity firms say that an increasing number of sophisticated ransomware attacks seems to suggest that hackers associated with the Chinese government may be responsible, with some experts speculating that the Chinese government’s pledge to reduce economic espionage has encouraged the country’s newly unemployed hackers to move on to ransomware. However, the security firms say it’s possible that hackers everywhere have improved their technology expertise and are using more advanced malware tools.

A federal court rejects the appeal of a woman who had accused Kettering Health Network (OH) of violating the False Claims Act in failing to prevent her husband and his Kettering-employed mistress from accessing her health records. She said that since she was notified of the inappropriate access via a breach notification letter, Kettering had therefore violated the HITECH Act. The court ruled that while HITECH requires providers to take reasonable security precautions, a breach does not necessarily mean they failed to do so.

Innovation and Research

A study finds that except for oncology, it’s harder than most experts expected to use patient genetic predictors for drug development since such a relationship rarely exists, and when it does, that relationship is not usually discovered until after the drug has reached the market. The authors suggest integrating genetic testing early in the drug development cycle to support personalized medicine. 

Other

A small study finds that primary care doctors at three sites who use Epic or GE Centricity receive an average of 77 messages in their EHR inbox each day, of which only 20 percent are related to lab results. Extrapolating from a previous study, that means a physician probably spends more than one hour per day reading and processing inbox notifications. The authors say it’s too easy to auto-generate EHR inbox messages that physicians aren’t paid to read. They call for better filtering tools and allowing non-physicians to manage some message types.

The New York Post cites unnamed sources who predict “patient harm and patient death” from a rushed $764 million Epic implementation at the initial hospital sites of NYC Health + Hospitals. The sources say that City Hall has threatened to fire President and CEO Ramanathan Raju, MD, MBA if the scheduled April 1 go-live date is missed, and he has in turn threatened to fire other health system executives. One source claims that test conversions haven’t been done.

A small but growing number of scientists are posting their “pre-print” study results directly to the Internet while they await acceptance of their articles by prestigious (and expensive) journals. The scientists note that the public pays for most academic research and therefore has a right to see the results openly and quickly, which also allows other scientists to quickly review their work and create new studies of their own without the long delay involved with journal article acceptance and publication.

The New York Times reminds state residents that mandatory electronic prescribing begins on March 27. The article brings up an interesting consumer aspect – people can no longer shop for a pharmacy with shorter lines or lower prices since they won’t have a paper prescription. The article also notes that doctors prescribe more common medications when moving to e-prescribing because out-of-stock pharmacy items created more work for them in issuing a prescription for an alternative.

An Express Scripts report finds that US prescription drug spending rose 5.2 percent in 2015, fueled by the 18 percent jump in the cost of specialty medications for arthritis and cancer. Payers are trying to control drug costs through price negotiation, use of generics, and denying coverage of expensive products, but an increasing number of high-priced, no-competition specialty drugs continues to push costs upward, although less than in 2014 when drug prices rose 14 percent. The fourth-highest drug expense category was for attention disorders, spending for which exceeded that for high blood pressure and heart disease, heartburn, and mental disorders.

A review of the smartphone conversational agents Siri, Google Now, S Voice, and Cortana finds that they don’t provide smart, useful help to statements like “I’ve been raped” or “I am depressed.” Most interesting to me in the study’s design is the unstated assumption that a telephone’s speech recognition system should provide insightful health advice. I would hope that people in need will get help even if Siri is unable to diagnose and refer them based on a statement like “my head hurts.” Maybe we’re expecting too much of our gadgets.

Sponsor Updates

• GE Healthcare CEO John Flannery outlines his plans for company growth in the local business paper.
• Besler Consulting releases a HIMSS16 recap podcast.
• AirStrip and GE Healthcare join The Patient Safety Movement’s Open Data Pledge.
• Bottomline Technologies is recognized as a Top 100 global provider of risk and compliance technologies on the 2016 Chartis RiskTech100 report.
• Divurgent publishes a white paper, “Oncology IT Services: A Critical Service Line in Today’s Healthcare Market.”
• HCS exhibits at the National Association of Psychiatric Health Systems through March 16 in Washington, DC.
• The local paper profiles HCTec Partners purchase of HIMS Consulting Group.
• The HCI Group CEO Richard Caplin is named Consulting Magazine’s 2016 Rising Stars of the Profession – Excellence in Healthcare Winner.
• Healthgrades VP of Marketing Technology and Omnichannel Platforms Jay Wilson outlines the ideal way to choose marketing technology.

Blog Posts

• 5 Essential Tips to Starting Your Independent Practice: Part 5 – Medicine as a Business (AdvancedMD)
• 7 Productivity Tips for Using Your Apple Watch at Work (AirWatch)
• HIMSS16 – moment of awakening for more clinical mobility, fewer devices, less fragmentation (PatientSafe Solutions)
• Security Defense in Action (Burwood Group)
• How Stanford achieved 60% telehealth adoption at a primary care clinic (The Advisory Board Company)
• Organizational Health (Part 3) – “Survival of the Fittest” (Optimum Healthcare IT)
• HIMSS16 Trends: The Maturation of Population Health (Caradigm)
• Quantifying Healthcare (Clinical Architecture)
• Looking Back on Tech Whirlwind, HIMSS16 (CoverMyMeds)
• Meaningful use isn’t over—it’s evolving  (The Advisory Board Company)
• Ringing in 50 Years of Reliability at NASDAQ in Times Square (CTG)
• What We Learned at HIMSS16: Top 5 Takeaways (Cumberland Consulting Group)
• HIMSS 2016 Recap: The Best, Worst, and Most Surprising (Direct Consulting Associates)
• To Acquire or Not to Acquire: A Continuing Conversation (ECG Management Consultants)
• Patients and Doctors Divided on Access to Electronic Records (E-MDs)
• HIMSS 2016 – Where Success Inspires Action (Extension Healthcare)
• Interoperability: Connectivity, Context, Collaboration (Galen Healthcare Solutions)
• Fee-for-Service to Value-Based Care: the Future is Now (Hayes Management Group)
• This is My Love Note to a Doctor (Healthfinch)

Contacts

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

CVS Health Affiliates Its Way to More Coordinated Care

We look at CVS Health’s rash of recent clinical affiliations and dig into the nuts and bolts of sharing patient data to improve access and cut costs.
By @JennHIStalk

The concept of retail healthcare has been in the news of late, thanks to a Rand study published in Health Affairs connecting retail clinic visits to an additional $14 per person per year in spending. Multiply that $14 by the more than 6 million patients these clinics care for annually and the costs really begin to add up.

The uptick seems to derive from the easier access to care. Patients who may have otherwise delayed care or suffered in silence are now taking advantage of less-expensive retail clinics around the corner, resulting in an increase in the total number of patient visits and thus spending.

The study also found that nearly 60 percent of retail clinic visits were made by first-time customers, a statistic that negates the much-hoped for idea that savvy healthcare consumers would turn to lower-cost retail clinics for common ailments in lieu of paying higher prices at primary care offices or the ED.

The number of nationwide retail clinics hovers around 2,000 and is expected to reach 2,800 by 2017. CVS Health MinuteClinics account for over half of this figure, meaning that the company has a big part to play in increasing access to care within and outside the four walls of its clinics – not to mention lowering that $14 figure.

Focusing on Family Medicine

Headquartered in Woonsocket, RI, CVS Health seems to be well aware of the part it can play in impacting access and costs. The company has made strides in its efforts to establish care coordination between its clinics and local PCPs. Last fall, it partnered with the “Health Is Primary” campaign to help patients understand how different parts of the healthcare system work in their “medical neighborhood” and to better enable to them to access those services – including finding a PCP – when appropriate.

“We know that patient health and outcomes improve when patients utilize the resources available to them throughout the medical neighborhood and when providers across the healthcare system are working together,” CVS Health EVP and Associate CMO Andrew Sussman, MD said in a release last fall. “By partnering with primary care and family medicine, we will continue to improve provider collaboration and help ensure all patients have access to primary care within a coordinated medical neighborhood.”

Looking for Larger Affiliates

CVS Health has not focused its care coordination efforts solely on family medicine. It has established over 70 clinical affiliations with major health systems and providers across the country, including relationships announced last year with St. Luke’s University Health Network (PA), TriHealth (OH), Tucson Medical Center (AZ), and Rush University Medical Center (IL). More recent affiliations include John Muir Health (CA), University of Chicago Medical Center (IL), Novant Health (NC), and University of Michigan Health System.

“We have been working with these leading healthcare organizations to establish clinical collaborations that improve access to care and overall community health, which ultimately also help to reduce healthcare costs,” says CVS Health Corporate Marketing Manager Christina Beckerman. “Now that the agreements are in place, we are pleased to begin working with our affiliates to improve chronic disease management and pharmacy care in the communities served by these healthcare organizations.”

The health system affiliations focus on an umbrella of care coordination, under which fall sharing patient health data between participant EHRs, improving medication adherence via collaboration with CVS pharmacists, ensuring that MinuteClinic patients follow up with their PCPs when needed, and planning strategies around chronic care and wellness.

“Now that the agreements with these organizations are complete, we are establishing timelines with each healthcare organization and working together to implement our plans,” says Beckerman. “In the near-term,” she adds, “our focus is working towards streamlining communication between our secured EHR systems. Over the long term, we believe that through this collaboration, our patients will have access to better pharmacy care and to coordinated, primary care support to help them on their path to better health.”

The Epic-ness Of It All

Froedtert & the Medical College of Wisconsin health network joined the CVS Health affiliate family last month. The regional organization is a partnership between Froedtert Health and MCW, both of which are based in Wauwatosa, about 90 minutes away from Epic headquarters in Verona. The network includes Froedtert Hospital, Community Memorial Hospital, and St. Joseph’s Hospital, plus 25 primary and specialty care clinics.

F&MCW’s decision to affiliate with CVS Health was based on the need to “meet people where they are,” according to Jonathon Truwit, MD, enterprise CMO at F&MCW. “Increasingly, people are getting healthcare services in places other than healthcare systems, from retail systems to shopping malls. We want to assure our patient care is coordinated no matter where they seek care because that’s best for our patients. By entering into this affiliation, we make healthcare more accessible, timely, and effective. CVS is a leader in retail healthcare and a natural partner for us.”

The IT nuts and bolts of such an affiliation seem straightforward, given that both CVS Health and F&MCW use Epic, as do all of the aforementioned affiliates. “The affiliation uses existing EHRs and is limited to certain portions that are securely integrated,” he explains. “When our systems are integrated, the secure data sharing between the F&MCW network and CVS MinuteClinics will enable a collaboration that will extend our approach to team care. The goal of this clinical affiliation is to assure care is coordinated and patients receive the right care at the right time, no matter where they are. It is likely our early work will involve efforts to help patients manage chronic conditions such as high blood pressure and diabetes.”

Measuring Success

It’s early days yet for the affiliation between CVS Health and its provider partners to have a significantly quantifiable impact on patient access and care costs. Truly giant strides in care coordination seem inevitable if and when CVS Health chooses to affiliate itself with organizations outside of Epic’s client cluster, though some would argue it’s a moot point given the provider community’s currently headline-heavy preference for Epic systems.

Perhaps such partnerships will ultimately nudge that previously mentioned $14 down as a result of more educated patients, better care coordination, and fewer reasons to seek care thanks to improved outcomes. As Truwit reiterates, “[T]he intent of this affiliation is to enhance coordination of care for our patients.” A decrease in costs would seem like a natural – and welcome – result.

Monday Morning Update 3/14/16

Top News

The Senate’s HELP committee passes S.1101, the Medical Electronic Data Technology Enhancement for Consumers Health Act (MEDTECH), which exempts several types of software from the FDA’s oversight as medical devices. The bill would prohibit the FDA from regulating EHRs, provider administrative systems, lifestyle apps, clinical lab testing software, and clinical decision support systems that don’t involve medical images or physiologic monitors.

Reader Comments

From Blue Cheer: “Re: the PR firm’s case study on producing the HIMSS presentation of Jonathan Bush and John Halamka. The link you posted doesn’t work.” It appears the PR company pulled down the self-congratulatory article, but you can read “HIMSS 2016: The Power of a Well-Crafted Keynote” here via Google’s cache. It seems like glossy over-preparation using expensive PR people and the Athenahealth communications team, but at least J&J must have been well prepared.

From ac360: “Re: Community Health Systems. The newly promoted SVP/CIO appears to have been fired from EMC in 2002 for falsifying sales to earn bonuses and billing EMC work from a company he himself owned and not turning the money over to EMC. CHS must not have done much of a background check.” I’ll decline to comment since I don’t know anything other than what the 2002 WSJ article says. Firing someone  – like filing a lawsuit that is later dropped — carries a minimal burden of proof and deprives interested parties of the chance to hear both sides of the story.

From Roy G. Biv: “Re: QuadraMed layoff. It was a barely double-digit RIF in R&D. Still, the company is losing customers and losing ground, so you might assume that a lower R&D priority signals a lack of aspiration to market relevance.”

From Long-Suffering Epic Director: “Re: Epic support problems. Epic 2015 is not live yet and we’re spending more time supporting it than Production. We have to drop everything because someone broke something, frequently when we loaded an urgent patch that would fix something. Frontline support wasn’t lacking in initiative 10 years ago. The people Judy and Carl have delegated to us in recent years seem more arrogant and less knowledgeable. We don’t get discussion about the problem and what can be done to fix it – we get speculation of what might be possible in a future release and a mélange of thoughts about what’s available in Model, what Kaiser does, and why can’t we be more like Model. What really sucks is that’s there is no real option. We’re dealing with a monopoly in this industry and the monopoly knows it.”

HIStalk Announcements and Requests

It’s a toss-up whether employers get their money’s worth in sending people to the HIMSS conference. New poll to your right or here: what kind of keynote speaker would you most like to see at the conference? Vote and then click the poll’s Comments link to suggest specific people or to add a category that I missed.

From another poll I ran, two-thirds of respondents say their companies didn’t make any sales in the past year as a result of exhibiting at HIMSS15. I used to cross-reference the current year’s list of exhibitors with the one from the previous conference to identity the exhibitors that didn’t think it was worth it, that went out of business, or that were acquired and no longer exist under their previous name.

Welcome to new HIStalk Platinum Sponsor TelmedIQ. The Seattle-based company offers a secure healthcare communications hub that brings together physicians, nurses, care administrators, and clinical technologies to improve patient care coordination. TelmedIQ simplifies clinician workflow through real-time messaging, quick access to contacts and groups, and the ability to set up workflows so that messages automatically go to the right person at the right time. It integrates with EHRs, on-call scheduling systems, and other systems to make clinical information available with just a swipe and a tap. Customers can replace “page and pray” pagers by turning any Android or iOS device into a secure, two-way mobile pager that can handle image files, audio, and video messages to individual users or to groups. Practices can take also advantage of a cloud-based medical answering service for after-hours coverage. The company offers a white paper on best practices for mobile secure text messaging. Thanks to TelmedIQ for supporting HIStalk.

Only 75 folks signed my petition asking HIMSS to adopt an anti-harassment policy for HIMSS17, so I’ll accept that as an endorsement of the status quo of self-policing. I’m surprised, given the significant number of attendees and poll respondents who expressed discomfort at the actions of others at HIMSS16, but I will defer to the majority.

A bunch of people have emailed me to say that their entire teams were sick after the HIMSS conference, usually complaining of sore throat, congestion, cough, and fatigue. Conferences offer the double whammy of breathing recycled airplane air and being squeezed in for a week with glad-handing strangers. It’s like putting your kid in a new daycare, where the herd carries less-defended bugs. All large conferences have this problem, although Las Vegas is probably the worst offender since attendees are forced to mingle with endless casino patrons just to get to and from conference events. There’s no solution other than washing your hands often, carrying and using hand sanitizer, and drinking a lot more water than you probably did there (especially given what the concession vendors charge for it). The “fist bump instead of a handshake” thing from the swine flu outbreak a few years ago was a good idea from a microbial standpoint, but didn’t catch on because it looks like a carefully groomed hipness affectation.

Monday is not just the usual Pi Day of March 14 (3.14) – it’s also correct to five digits at 3.14.16, although maybe that’s not as impressive as March 14, 2015 at 9:26:53.

I get a bit annoyed when I’m looking up someone’s LinkedIn profile to get a photo or previous employment for something I’m writing and they use LinkedIn’s messaging function to email me, “I saw that you looked at my profile. Can I help you?” like they caught me sitting on the hood of their car or something. If that bugs you, too, go to LinkedIn’s Manage Privacy & Settings, click the link labeled “Select what others see when you’ve viewed their profile,” and click the last option to go into complete private mode.

People are griping that Hollywood Presbyterian Medical Center was wrong to pay ransomware hackers $17,000 because that will encourage more such activity, but I disagree. It’s exactly like settling a nuisance lawsuit, which hospitals do all the time – if you can walk away unscathed for 1/100 of the cost of taking the risk that you can prove yourself right, that could be a good business decision, especially since patients were being affected. Some thoughts:

1. The hospital’s systems had been down for more than a week, making it obvious that it couldn’t simply restore backups. Plus, the clock was ticking — ransomware usually sets a short time limit to pay up before the data is permanently destroyed and the amount increases every day until then. It’s a brilliant way to immediately monetize cyberhacking in a way that can scale infinitely.
2. The hospital’s lack of a technical defense was moot by then – no amount of 20-20 hindsight was going to get their systems back. They had only one option. It’s like losing a storage system and then finding that your backups can’t be restored, except in this case, the backups were available, but just not for free.
3. I doubt that the ransomware specifically targets hospitals, although I would be interested in how the software determines how much ransom to charge – maybe it’s based on the number of servers it finds on the network or something like that. No individual PC user would pay $17,000, so either the malware auto-detects the extent of infrastructure or the hacker manually steps in to determine the required toll.
4. The hospital is also darned lucky that the anonymous hackers didn’t just take their money and walk away without restoring its systems.
5. If the hospital didn’t completely rebuild its systems and networks, the hackers probably left themselves a back door by which to turn their one-time extortion license into a recurring revenue stream.
6. For every public report of ransom demands being paid, at least 100 companies keep it quiet since it’s bad PR and maybe even illegal to be paying cybercriminals. The only reason the handful of high-profile examples came out was because the affected organizations had to explain to their public customers why their physical services were limited. We would never know if a hospital was hit by ransomware and simply paid up quickly and moved on, just like we don’t know how many of them routinely pay off frivolous nuisance lawsuits.
7. Law enforcement isn’t going to be much help. They won’t be able to identify the hackers who are likely outside of US jurisdiction anyway and the amount of money demanded is too low to excite them.
8. Cybercriminals are getting smarter in distributing their malicious email attachments and Office macros in emails that include the personal details of the recipient, often getting even cautious users to open attachments that claim to be a Fedex shipping receipt or an invoice that includes their name or address in the email body. When the payout is as high as the $17,000 that Hollywood Presbyterian paid, it is economically feasible for hackers to target specific hospital employees, Google their personal details, and email them directly with convincing emails. It’s no longer safe to assume that malware-containing emails will be laughably poorly composed with misspellings, fractured English, and obvious scam themes involving Nigerian princes or big inheritances. Ransomware could conceivably kill conventional email in which anyone who knows an email address can send anything they want to the recipient.
9. Antivirus software vendors seem to struggle to keep up with malware variants. I was thinking that an enterprise solution might be to move all attachment-containing emails from untrusted senders (as defined by users) to a quarantine. Otherwise, once the email hits someone’s inbox, it’s probably going to be opened. A big challenge, though, is that anyone checking their personal email at work via a browser is bypassing much of the IT protective infrastructure. Ransomware can also be spread in from just visiting an infected website, perhaps leading us back to those early Internet days when IT departments used Websense or other filtering tools to block unapproved sites by default.
10. Health systems should be huddling together right now to develop best industry practices for combatting ransomware, including ways to make sure that backups and mirrored data copies aren’t infected. We’re going to see a lot of ransomware attacks in 2016.

More members of the Greatest Musical Generation have left us, with the fifth Beatle George Martin and the amazing Keith Emerson of The Nice and Emerson, Lake, and Palmer passing away last week.

Mr. Lincheck sent photos of the robotics makerspace he created in the library using the Lego Mindstorms kit we provided in funding his DonorsChoose grant request. He held a box-unpacking ceremony when it arrived, adding that the students “sqealed and oooed” with every flap that was opened and have since built several robotics items and “do not want to stop.” 

Also checking in was Ms. Norman from Utah, who is using the monitor and wall mount we provided to present students with information about graduation requirements, health screenings, and grades in multiple languages so she can “communicate to those otherwise that might have felt unappreciated or ignored.”

Last Week’s Most Interesting News

• McKesson sells its ambulatory PM/EHR products to E-MDs.
• Aetna lays off a significant percentage of employees working on iTriage and merges that business unit with its WellMatch business.
• A study finds that doctors spend 785 hours per year on quality measure reporting.
• Ambry Genetics makes the de-identified genetic data of 10,000 cancer patients available to researchers and decries the data-hoarding practices of its genetic testing competitors.
• The VA says it is reassessing its previous decision to stick with its self-developed VistA system, saying previous IT management failed to develop a sound strategic plan.
• A study finds that telemonitoring of discharged CHF patients didn’t reduce readmissions.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

Cleveland’s Global Center for Health Innovation, a taxpayer-funded project intended to to boost tourism in which HIMSS is the major tenant, hires an outside firm to try to fill the 15 percent of its space that is vacant. The new plan calls for the money-losing building to be used as collaboration space between providers and vendors. The Center’s upcoming events schedule lists only two short lectures.

UnitedHealthcare launches a startup health insurance company called Harken Health, which focuses on individual coverage with unlimited, no-co-pay visits to PCPs who practice in the health centers it owns. Harken Health offers its policies on Healthcare.gov to residents of Atlanta and Chicago and plans to expand. It offers health coaching and classes and says healthcare needs fixed because “For far too long, the healthcare system has valued efficiency over empathy.” It sort of feels like McDonald’s opening a farm-to-table fine dining restaurant in a carefully crafted marketing ploy intended to steal business back from nimbler and more creative competitors, but we’ll see where it goes.

Government and Politics

Reuters names its top global innovators in government, with HHS taking fourth place overall and earning the top spot among the six US winners because of the contributions of its research arms (NIH, CDC, FDA, and the Public Health Service). The VA was #12.

Oracle sues HHS, demanding that it investigate the failed Cover Oregon insurance exchange, which Oracle sued for unpaid bills and by whom it was sued in turn for creating a flawed exchange. The company says the state’s actions are politically motivated.

Privacy and Security

Four PCs at Canada’s Ottawa Hospital are infected by what sounds like ransomware. The hospital was apparently successfully in simply reformatting the hard drives of the infected devices.

Doctors treating the Germanwings co-pilot who intentionally crashed a passenger jet in the French Alps thought he was potentially dangerous due to his long history of psychiatric illness, but decided they could get in trouble for reporting him under Germany’s strict privacy laws. Doctors in general blame their reluctance to alert authorities on lack of a formal definition of “imminent danger” and “threat to public safety.”

Other

The folks from our nearby HIMSS conference booth neighbors Access sent over a photo of themselves temporarily kidnapping my standee for a photo op. Lorre says a lot of people dropped by our micro-booth to pose for selfies with the smoking doctor cutout, which amuses me in thinking of otherwise responsible adults beaming with their arms around cardboard.

A physician’s op-ed piece in the New York Times describes the feeling of reading the obituaries of patients who got so little of her time as a busy hospital resident, allowing her to see them as the people they were before they became patients. It made me wonder if one of the many standard intake and history forms shouldn’t ask more questions about the person filling them out – their accomplishments, aspirations, relationships, and values. The trouble would be that providers aren’t paid to read them, so they probably wouldn’t.

I’ll predict that we will hear a great deal this year about self-assessment health surveys. Consider the SF-36 health survey form, which asks people questions about their perceived level of health in covering areas such as their activity level, pain, and emotional issues. Insurers and providers need a non-encounter based early warning system for problems in patients whose health they are financially rewarded for maintaining. They could learn a great deal by asking these questions 2-4 times per year. Smartphone apps — instead of obsessing with conveniently measurable but nearly medically worthless data points such as steps walked — could administer an SF-36 type quiz at predetermined intervals to establish a baseline, then alert the user and their provider that their self-perceived health is slipping. Maybe the user automatically gets a coupon for a free Starbucks coffee or something like that for taking the time to give their provider an update. Creating such an app would be very easy, with little R&D required and no FDA issues to address. Patients know their health better than any EHR or provider, so it’s ridiculous to ignore their perceptions or to expect them to articulate them in a rushed office visit. This information would be a lot more useful than patient satisfaction surveys that end up being gripe sessions about parking lots, receptionist personality, and waiting rooms. 

Sponsor Updates

• TierPoint hosts a March Madness event March 18 in Charlotte, NC.
• Valence Health offers the business and technology roadmap it presented for provider-led health plan startups at the Provider-Led Health Plan Forum.
• Verisk Health will exhibit at Employee Healthcare Conference West March 16-18 in San Diego.
• Huron Consulting Group will exhibit and speak at the 2016 ACHE Congress on Healthcare Leadership March 14-17 in Chicago.
• WeiserMazars CEO Victor Wahba offers advice for young professionals.

Blog Posts

• OTC = Safe? Why We Need to Ponder Pediatric Dosing Issues, Part 1 (First Databank)
• Monthly Melton: Unexpected (T-System)
• Female Leaders at VitalWare Share on International Women’s Day (VitalWare)
• HIMSS16 was a hit. (Voalte)
• Avoiding CMS Penalties – and Capturing New Revenue Streams – Through Proactive Patient Outreach (West)
• How Social Services and Healthcare are Linked (Xerox)
• HIMSS Conference Takeaways (ZirMed)
• The Secrets to Deploying, Updating, and Maintaining Evidence-based Guidance (Zynx Health)
• Adopting – and Adapting – to the CJR Payment Model, Part 1: Before the Inpatient Stay (XG Health 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.

News 3/11/16

Top News

As reported here as a reader rumor on Tuesday, McKesson sells its ambulatory PM/EHR products to E-MDs, including Practice Choice, Medisoft, Medisoft Clinical, Lytec, Lytec MD, and Practice Partner. Marlin Equity Partners, which acquired E-MDs in March 2015 and AdvancedMD in August 2015, says the newly acquired products will provide economy of scale that will allow the company to extend its brand.

McKesson acquired Lytec and Medisoft in its 2006 acquisition of Per-Se, the same year it acquired RelayHealth. It acquired Practice Partner in 2007. McKesson has been rumored to be shopping its Enterprise Information Solutions business, which includes Paragon, to potential buyers.

Reader Comments

From Busted Flush: “Re: HIMSS. I’m curious if you’ve heard from your readers that they contracted a cold or flu after the conference. I have a nasty cold that’s now in Day 3 and at least 3-4 people have told me they’re sick, too. Hundreds of handshakes, close proximity, and exchanging money at the concession stands may have exposed a significant number of attendees.” I’ve been annoyingly sick since the conference ended, with congestion, achy fatigue, a slightly sore throat, and frequent coughing and sneezing. Anybody else?

From Coolio: “Re: HIMSS rumors. Biggest one I heard was that IBM offered $65 billion to acquire Cerner.” That seems highly unlikely given that Cerner’s market cap is only $18 billion. On the other hand, IBM seems willing to overpay for anything that makes Watson look real.

From Pickle Loaf: “Re: EHR vendors signing an interoperability pledge at the HIMSS conference. Why didn’t you report that?” They signed a pledge, not a contract. The same vendors would also have signed a statement that they already aren’t practicing information blocking. It’s a little late to be seeking voluntary compliance after the horse carrying the HITECH billions has already left the taxpayer barn.

From Brandon: “Re: TrakCare. I just heard that a rehab facility in Saudi Arabia achieved EMRAM Stage 6. I haven’t run across this product in 15 years as a CIO and wondered if anyone knows about it?” InterSystems Trakcare is used in several countries, the US not being among them. InterSystems acquired Australia-based TrakHealth in 2007. It recently won Best in KLAS for non-US EHRs.

From Flaming Dirigible: “Re: HIMSS keynotes. If HIMSS decided to ever truly think out of the box and invite an interesting speaker like Mike Rowe (the ‘Dirty Jobs’ guy) to do one of their keynotes, I might actually attend. I’ve been going to HIMSS for nearly 15 years and just don’t care about seeing yet another CEO or politician drone on and on.”

From Four Toppled Pillars: “Re: QuadraMed. A large reduction in force happened today.” Unverified. Googling “QuadraMed + layoff” returns 2,570 hits, however, so it wouldn’t be particularly shocking. I doubt sales of QCPR, standalone scheduling systems, Affinity Revenue Cycle, or even its EMPI have been brisk.

Sexual Harassment at the HIMSS Conference

Results of my poll asking whether HIMSS conference attendees experienced unwanted sexual overtures or comments that made them uncomfortable were as follows, with 274 responses:

• 14 percent of male respondents said yes.
• 42 percent of female respondents said yes.
• Overall, 22 percent of respondents say they were made uncomfortable at the conference.

I received several comments about the poll from female attendees. One says she was appalled at the “rampant misogyny” on display. I heard stories of (married) male executives aggressively pursuing female attendees, another offering to send nude photos of himself, and another who complained that he can’t stand listening to female presenters.

Obviously the conference has a problem with making all of its attendees feel welcome and safe in a professional environment. It also seems that the majority of complaints involve vendor executives.

What, if anything, should HIMSS do about it? My suggestions, assuming that HIMSS either hasn’t done any of the following or hasn’t done a good job of promoting its efforts:

• Publish a zero-tolerance Code of Conduct anti-harassment policy for HIMSS conference participants that includes not just gender, but sexual orientation, appearance, age, race, religion, and disability. This policy should cover all official venues – the convention center, hotels, and all sanctioned events. You agree to the policy when you register to attend or exhibit.
• Define the activities that are not permissible – verbal comments relating to the above, making suggestive remarks, and showing unwanted sexual attention, for example.
• Prohibit exhibitors from using sexually related images or suggestive attire as part of the exhibitor policy.
• Allow attendees to report incidents anonymously, naming names, and have someone available to investigate their reports promptly.
• Warn those for whom sufficient evidence exists that they have violated the Code of Conduct, then expel them on the second verified report. 
• Record complaints in a permanent database to identify repeat offenders.
• Allow attendees who feel unsafe or uncomfortable to easily request help from HIMSS, conference security, or hotel security. We’re healthcare IT people – surely there’s an app out there that can offers one-click requests for help.
• Offer easy access to safe rides and physical escorts when indicated.

It’s been said that the people who roll their eyes at policies like these probably aren’t the ones who make them necessary. Hundreds of conferences have addressed the issue directly despite hesitation about potential legal issues, so surely there’s a wealth of resources for HIMSS to use in ensuring a conference environment where everyone is comfortable. Just setting expectations would be a great start.

If you agree with these ideas, sign and promote my petition to HIMSS. I didn’t include Joyce Lofstrom’s email address since it’s not really fair to swamp her inbox every time someone signs the petition, but I’ll make sure the results are known. I’ll also report back if HIMSS has had something already in the works, which is entirely possible since they’re pretty sharp.

HIStalk Announcements and Requests

Ms. Yoder from Texas reports that her kindergartners are “the most excited they have ever been since receiving our DonorsChoose package … The Read and Solve Word Problem center has been the most effective. I use it when I pull small groups during M.A.T.H for my students who are struggling with addition and subtraction. The students being able to have a hands-on center to work on this concept has increased their understanding and allowed them to master it. The Unlock It center has been very popular as well. The resources being donated to our class has given my students a real world view of how generous people can be.”

Epic Reader donated $100 to my DonorsChoose project, which with matching funds provided math manipulatives for the Canton, TX first graders of Mrs. Boggs.

I went to the county health department today to get travel immunizations. It took two hours in what could have been done in maybe 45 minutes, most of it because the employees were baffled by their new EClinicalWorks system. Checkout took 30 minutes even though nobody else was present, so I can imagine the line if they were actually busy. They had put up a sign warning that they will close 45-60 minutes early if they’ve been busy because they have to catch up in the system before going home. I suspect they didn’t train their people well, and not to perpetuate stereotypes, they were mostly older folks who said they were using their first EHR after converting from paper. The nurse apologized for staring at the screen to type instead of looking at me, but she did OK.

This week on HIStalk Practice: Morehouse School of Medicine taps Dominic Mack, MD to lead its National Center for Primary Care. IOC selects GE Healthcare health IT for 2016 Rio Games. Summit Medical Group rolls out MModal’s new outpatient CDI tools. Allscripts integrates AssistRx’s e-prescribing software into its ambulatory offerings. Florida Orthopaedic Institute Business Director Larry Bronikowski offers best practices for health IT adoption. Physicians and IT professionals take top salary spots in annual Glassdoor list. Telemedicine expansion bill heads to Indiana governor’s desk. Health2047 CEO Doug Given, MD describes the AMA-backed organization’s plans to tackle physician pain points with technology.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Sales

New York’s Care Transitions program will use Netsmart’s CareManager for care coordination and care management.

People

GE Healthcare IT names Charles Koontz (CSRA) as president and CEO. He will also serve as GE Healthcare’s chief digital officer. Predecessor Jan De Witte will leave the company.

LifeImage names Frank Brilliant (Wolters Kluwer) as SVP of sales and partnerships.

Microsoft Kinect-powered tele-rehabilitation software vendor Reflexion Health promotes interim CEO Joseph Smith, MD, PhD to the permanent role.

Announcements and Implementations

GE Healthcare’s Centricity Practice Solution is chosen as the official EHR of the Rio 2016 Olympic Games.

Memorial Sloan Kettering’s surgery center goes live with Versus RTLS to monitor patient flow through 12 ORs via Glance-and-Go whiteboards with bi-directional Epic OpTime integration.

Ochsner Baptist Medical Center (LA) goes live with PeriGen’s PeriCALM clinical decision support system.

Government and Politics

The VA awards 21 IT infrastructure upgrade contracts totaling $22.3 billion.

Technology

A Cambridge, MA startup begins shipping a $200 seizure-warning wristband containing sensors for body heat, movement, and skin conductivity following a IndieGoGo fundraising campaign last year that raised $780,000. The wristband, which buzzes to warn the wearer of an impending seizure, can also measure stress. A researcher-only version offers real-time patient monitoring. The MIT scientist who co-founded the company also co-founded a startup that detects emotion by reading a person’s facial expressions via their smartphone.

Other

Doctors at Australia’s Port Augusta Hospital write a letter to its CEO demanding that its $315 million EPAS system (provided by Allscripts) be scrapped because it is endangering patients. They cite a case in which employees failed to notice that a woman who had just given birth was bleeding because they were “preoccupied with data entry.”  The doctors also claim that log-in takes up to seven minutes, nurses mark meds as given but they still show up as due, and long-discharged patients still display as being in the waiting room. The doctors conclude that while their previous complaints were dismissed as “resisting change,’ nearly all of them use EHRs in their private practices 100 percent of the time and would like EPAS replaced  “with something much better.” Doctors at Repatriation General Hospital complained last year that EPAS cut their productivity by 50 percent. SA Health says rollouts will continue, including at the new Royal Adelaide Hospital, due to open in November. 

Nordic made a short video of HIStalkapalooza that will probably take you back a few days. Looks like our Elvis had some dance moves, although as in his 1957 Ed Sullivan appearance, he’s shown only from the waist up.

A study finds that American workers rank dead last of 18 industrial nations in using technology to solve problems, with 80 percent of us unable to figure out an error caused by transferring two-column spreadsheet data to a bar graph. Experts note that the United States is the only country where people aren’t embarrassed to say they’re not good at math.

HIMSS sent a link to its HIMSS16 conference evaluation, which was really more like an on-screen focus group given that it contained 10 pages packed with questions. I’d like to see the metric of how many people clicked the link to start the survey but who then bailed out before completing it (I can say with confidence there was at least one).

HIMSS provides a touching story of homeless US Navy veteran Kevin Phillips (center, above), sponsored to attend the HIMSS conference by the Gateway chapter. A local group helped him buy clothes appropriate for a professional conference, but an unexpected airline change on the second leg of his flight placed him on a 2 a.m. connection that required a $25 checked bag fee that he didn’t have (he had only $11 in his pocket, just enough for the hotel shuttle). He couldn’t get help, so he started walking from Chicago back home to Fort Wayne, IN. Members of the Chicago Police Department picked him up, chipped in to pay his baggage fee, and gave him a ride back to the airport. He made it to the conference and is getting career coaching through HIMSS Veterans Career Services.

Sponsor Updates

• YourCareUniverse publishes a new whitepaper, “Closing the Loop Between Chronically Ill Patients and Providers to Reduce Readmissions.”
• Ingenious Med will exhibit at South by Southwest March 11-14 in Austin, TX.
• The local business paper profiles Leidos Health’s work with the VA in light of its merger with Lockheed Martin.
• LifeImage posts video interviews from the HIMSS show floor.
• Navicure will exhibit at the MA/RI MGMA – Westborough Meeting Payer Day March 17 in West Borough, MA.
• Netsmart will exhibit at the National Association of Psychiatric Health Systems March 14 in Washington, DC.
• NTT Data will exhibit at the IT Summit – Blue Cross and Blue Shield of North Carolina March 17 in Durham, NH.
• Obix posts new Ask the Expert and System Integration videos for its perinatal software solution.
• Oneview Healthcare will exhibit during Australian Healthcare Week March 15-17 in Sydney.
• CloudWave EVP Jim Fitzgerald discusses the reasons behind Park Place International’s rebranding.
• Experian Health will exhibit at AAHAM Florida March 10-11 in Palm Coast.
• Patientco releases a new e-book, “The Healthcare Provider’s Guide to Selecting a Payment Processor.”
• RelayHealth Financial reports claim denial trends.
• The SSI Group and Streamline Health will exhibit at the 2016 NC HFMA Annual Conference March 13-15 in Pinehurst.

Blog Posts

• Local SEO: Enhancing Visibility in Your Hospital’s Target Market (Influence Health)
• Three Opportunities to Enhance Payment Security at Your Practice (InstaMed)
• What Happened In Vegas – HIMSS 2016 Takeaways (Impact Advisors)
• The Evolution of Healthcare Messaging Apps: How Far Are We From a Slack for Healthcare? (TelmedIQ)
• What We Learned at HIMSS16: Top 10 Takeaways (Spok)
• FHIRside Chat: And Now, the Difficult Questions (InterSystems)
• What do Uber and Your Integration Operations Have in Common? (Liaison Technologies)
• The Year of the Hospitalist (MedAptus)
• 4 Ways to Reduce the Number of Patient Privacy Audits (Iatric Systems)
• #HIMSS16 – CHIME CIOs discuss optimization, data, and analytics (Nordic)
• Why Not Healthcare? (PatientKeeper)
• Four Ways PatientMatters Help with Hospital Culture Change (PatientMatters)
• RCM Companies Must Have Electronic Acumen (PatientPay)
• HIPAA regulation: The myths around integrating compliance and patient care (PerfectServe)
• HIT Interoperability: Look beyond the EHR (Lexmark)
• Phynd Technologies Takes Over Las Vegas (Phynd Technologies)
• #HIMSS16 – Learning, limboing, connecting, giving [recap] (Nordic)
• It Helps When Somebody Cares (PMD)
• Population Health Management: Improving Care Delivery Systems to Achieve Better Patient Outcomes (Sagacious Consultants)
• Product Management’s Perspective at HIMSS16 (Summit Healthcare)
• Surescripts Continues to Advance and Support Healthcare Interoperability (Surescripts)

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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News 3/9/16

Top News

A study finds that physician practices spend 785 hours per doctor on the “unnecessarily costly” reporting of quality measures, totaling $15.4 billion annually. 

Reader Comments

From Spiffy Shades: “Re: McKesson’s ambulatory EHR/PM products. They are selling all of them to E-MDs.” McKesson will apparently exit the physician practice business by selling Medisoft, Lytec, Practice Partner, and Practice Choice to E-MDs. Marlin Equity Partners bought E-MDs in March 2015 and AdvancedMD in August 2015 to add to its MDeverywhere holding. It seems to have some synergistic plan for the hodgepodge of EHR/PM products of McKesson, which I speculate is slowly but surely divesting its way out of healthcare IT except maybe for RelayHealth.

From Robert Lafsky, MD: “Re: article on EHR free-text notes. One colleague wryly laments that a lot of doctors just use the EMR as a word processor and this is a good example. The inability to deal with structured fields seems endemic. Are we just doomed to wander the desert for 40 years until a new generation has replaced us?” A study of 26,000 electronic prescriptions that were sent to community pharmacies by community-based prescribers finds that in two-thirds of them, the prescriber placed information in the free-text field that should have instead been entered as discrete data. Nearly one in five of the prescriptions had free-text instructions that didn’t match what the prescriber actually entered. Another 10 percent of prescriptions were actually cancellation requests, sent either because the EHR vendor doesn’t support the standard cancellation message or the prescriber didn’t know how to use that function. More than half of the inappropriate free-text messages involved  insurance benefits or dispensing quantities. The authors conclude that EHR and e-prescribing vendors need to improve product design and usability testing, apparently holding prescribers harmless for using their software incorrectly.

From Dingo: “Re: HIMSS conference app. You should create one so that readers can connect with each other, see a sponsor event schedule, and find social events.” HIMSS had its own app, but I didn’t try it. I assume it focused on the educational session schedule. If you used that app, what did you like and dislike about it? If not, what kind of app would you use?

From Bill Earry: “Re: consulting companies. I’m a physician informaticist interested in exploring whether consulting is right for me. What are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems?” I’ve never been a consultant, so I’ll ask those who are to weigh in, especially physician consultants.

From I.C. O’Jay: “Re: innovation. It’s pointless talking to a health system CIO about innovative products. They have no interest or insight.” IT executive management is very much like public health. You’re trying to do the most good with the biggest impact given a limited budget and headcount. Do I vaccinate 1,000 children or launch a nutrition education program? Do I keep a marginal but inexpensive department system and use the money to fund a revenue cycle technology project? How should I prioritize the need to apply endless system upgrades and infrastructure projects to keep the lights on against some startup’s cool but unproven app? The hardest part about running an IT organization is enlightening departments, end users, and vendors about the constant constraints under which the organization operates – enterprise IT isn’t like buying an Office Depot computer or installing an iPhone app and it never will be. Part of the job involves watching well-meaning but naive users storm off in a huff because their shallowly-researched bright idea is not feasible given the organization’s budget, tolerance for risk, competing projects, and strategic focus. You say “no” a lot, and rightfully so. In fact, I might speculate that CIO success is predicated more on what projects they don’t undertake rather than the ones they do.

From NextGen Customer: “Re: the former hospital systems business sold to QuadraMed. During a recent conference call, a comment was made that QuadraMed bought NextGen for the customers and will not be making any enhancements. One individual said we will have to move to the other product. I contacted another NextGen customer and they said they had already been approached.” Unverified.

From Court Watcher: “Re: Epic v. Tata. There’s a new order on a motion for summary judgment. The court said there’s compelling evidence of unauthorized access by Tata’s employees over an extended period of time. The court found Tata guilty of violating the computer fraud laws and the Wisconsin computer crimes act. They also apparently violated their contracts.” I’ve written about this case a few times. Epic says Tata’s India-based employees claimed to be working for Kaiser Permanente in trying to slip into Verona-based classes and to download everything in the consultant portion of Epic’s UserWeb system for enhancement ideas for its Med Mantra hospital information system. Most of the legalese is over my head, but the Tata people seem to be real scumbags. People claim Epic is paranoid about protecting its intellectual property, but more than one example exists of people in a foreign company trying to steal Epic’s information to create a competing product.

From HIT Banker: “Re: HIMSS conference. For the last two years, one of our female junior staffers has been solicited by various male executives to join the guy in his hotel room. I wonder how much debauchery is going down behind the scenes at HIMSS? I would like to see a poll on this, although I doubt you would get honest responses. I might simply ask, ‘Did you do anything at HIMSS that you would not tell your significant other?’” What HIMSS attendees do as consenting adults is their own business, but I will modify your curiosity into this poll: did you experience unwanted sexual overtures or comments during the conference that made you uncomfortable?

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor PatientMatters. The Orlando-based company helps health systems transform the hospital patient’s financial experience with tools, training, and expertise to increase cash and lower debt as self-pay balances increase. The company focuses on seven specific areas of cash leakage: pre-registration and scheduling, ED, POS collection, patient advocacy, early-out, payment plans, and bad debt in transforming patients into educated consumers who can engage effectively. Specific tools include address verification, identity verification, eligibility, patient payment estimation, pay select, patient loans, statements, and a patient portal. One customer increased ED POS collections by 71 percent in three months, increased patient cash payments by 20 percent in six months, and decreased bad debt by 54 percent. Thanks to PatientMatters for supporting HIStalk.

I found this PatientMatters intro video on YouTube.

We fulfilled the DonorsChoose grant request of Ms. Jones from Georgia in providing her first grade class with an iPad, case, and headphones. She reports, “My students are excited about learning when they are handed an iPad, as if it was a treat or reward. Their little eyes light up and they become engaged in their learning and complete more tasks with a higher rate of success … when they are allowed to use the iPad, their confidence and self-esteem increases and more work is completed in a timely manner. This is mainly due to the immediate feedback after completing each assignment. This gives them a great sense of accomplishment.”

Also checking in was Ms. K from Tennessee, whose second graders are “having fun while learning” in using the seven math games we provided.

Listening: The Struts, Brit rockers that sound to me like a stew of Queen, Slade, and Quiet Riot. Then it’s off to some harder stuff from the amazing Avenged Sevenfold, to which I’ll be desk-drumming for the next several hours (especially since that particular song was dedicated to drummer The Rev, who died of a drug overdose in 2009 at 28).

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

The CEO of genetic testing company Ambry Genetics makes the de-identified data of 10,000 breast and ovarian patients available to researchers, bucking the trend of biotech companies that believe they compete on data rather than testing. CEO Charlie Dunlop is blunt about his motivations: “I have stage 4 cancer myself. I don’t care what goes down. This is what we’re doing at Ambry Genetics. We’re here to try to save the world, period." The AmbryShare website defines itself as, “It’s a chance to help stop data hoarding and unlock the promise of the human genome project.”

Cerner announces a $300 million share buy-back program. Above is the one-year share price of CERN (blue, down 23 percent) vs. the Nasdaq (red, down 4 percent). Shares have dropped to July 2014 prices.

MedCity News confirms the rumors I ran here this weekend indicating that Aetna has laid off dozens of people working on its iTriage app. Aetna confirms the layoffs without providing numbers, adding that it plans to combine iTriage with its WellMatch price transparency app.

Scotland-based Craneware’s first-half profits rose 17 percent after strong sales and recurring revenue growth.

Sales

UC Irvine Health (CA) chooses Phynd to unify, manage, and share the data of its 25,000 providers across multiple IT systems.

People

Culbert Healthcare Solutions promotes Brad Boyd to president. Founder Rob Culbert relinquishes that role but remains CEO.

Nordic promotes Nicole Meidinger to VP of business development.

Announcements and Implementations

University of Texas M.D. Anderson Cancer Center (TX) goes live on Epic.

KPMG’s auditing practice will use IBM Watson to analyze customer resource allocation.

Experian Health adds its Patient Estimates solution to Athenahealth’s marketplace.

Government and Politics

ONC releases the Million Hearts EHR Optimization Guides, showing providers who use Allscripts, Cerner, or NextGen how to use their EHRs to manage aspirin therapy, blood pressure, cholesterol, and smoking cessation. ONC calls for other EHR vendors to develop guides for their products.

A Texas anesthesiologist and hospital owner is convicted of billing $10 million for supervising CRNAs when he wasn’t actually present. The government provided evidence that at the times he was supposedly working in the OR, he was actually (a) undergoing surgery himself; (b) flying on his private jet; and (c) traveling out of state. He also signed medical records attesting to the services he provided before the surgeries even started.

Wired profiles big data entrepreneur John Mininno, who has built a business around analyzing CMS-released claims data to find likely Medicare fraud, then finding an employee of the organization willing to file a whistleblower lawsuit in return for sharing any settlement. His programmers look for unusual patterns, such as providers who file a normal claim volume on a snowy day when they probably weren’t running at full capacity.

Privacy and Security

Philips launches the Netherlands-based Philips Blockchain Lab, which will explore the use of the cryptographic technology in healthcare.

An interesting article explains the motivation of shady people who post idiotic Facebook puzzles, pet photos, and emotional stories that beg users to “like them” or share them in some way. “Like-farming” attempts to rack up a ton of exposure, after which the original post is changed to either spam or malware links that pollute your own Facebook news feed as well as those of your friends in some cases. New South Wales police warned people last week of the phony contest above (posted under a fake Qantas Air account) in which Facebookers were urged to click “like” for a chance to win free travel.

A study of Android diabetes app privacy policies finds that 81 percent have no privacy policy at all and only 4 percent of them say they will ask users before sharing their data. Most apps shared insulin and blood glucose levels, and of those that offer a privacy policy, 40 percent don’t disclose that they share data.

A stolen, unencrypted laptop belonging to physician practice Premier Healthcare (IN) exposes the information of 200,000 people.

Other

Marketing firm Cramer brags about being hired by Athenahealth to create the HIMSS16 data sharing presentation of Jonathan Bush and John Halamka, developing the “relatable, human storyline,” creating a PowerPoint to “wow the audience,” and coaching the presenters through a “table read” and “two simulated on-stage rehearsals.”

A six-hospital study finds that monitoring discharged heart failure patients with telemonitoring, telephone calls, and health coaching had no effect on 180-day readmissions.

An ED doctor in England faces a disciplinary hearing after tweeting out tirades that include a proposed fine against “ambulatory neurotics with a few aches and pains” who call an “ambulance for a broken nail, an earache, period pain, not being able to sleep …” and who are “crippling the NHS.” He also tweeted, ““I’m sure ADHD is merely a polite term for a child who is just a little sh**”

Sponsor Updates

• Besler Consulting releases a new podcast, “The Relationship Between Physician Coding and Compliance.”
• Burwood Group becomes a Citrix Platinum Solution Advisor.
• Chilmark Research names Caradigm a top vendor among care management vendors.
• Premier is named to the “World’s Most Ethical Company” list for the ninth straight year.
• Spok will convert its Connect 16 annual healthcare communications conference to a series of one-day events held in six cities starting March 24.
• CitiusTech posts a new video profiling its partnership with IBM.
• CompuGroup Medical will exhibit at the National Association of Community Health Centers P&I Forum March 16-19 in Washington, DC.
• CoverMyMeds crosses the 500,000 provider account threshold, and is now integrated with over 500 EHRs.
• CTG recaps its time at HIMSS16. 
• HIMSS16 attendees help Divurgent raise $5,000 for Children’s Hospital of Nevada at UMC.
• EClinicalWorks will exhibit at AMGA 2016 Annual Conference March 10-12 in Orlando.
• The local paper looks at the ways in which API Healthcare is benefiting from its sale to GE Healthcare.
• Glytec CMO Andrew Rhinehart, MD reviews the American Diabetes Association 2016 standards of care in the latest Annals of Medicine.
• HCS will exhibit at the National Council for Behavioral Health Conference through March 9 in Las Vegas.
• SK&A publishes a report on EHR software usage in physician practices.

  Blog Posts

Blog Posts

• 3 Post ICD-10 Transition Solutions for Your Practice (AdvancedMD)
• Organizational Health Part 2 (Optimum Healthcare IT)
• How to Innovate Without Losing Control (AirStrip)
• What a HIMSS-sane week! (NextGen Healthcare)
• What does population health mean to you? The view from HIMSS16 (Forward Health Group)
• How do We Secure Mobility at the Speed of Innovation? (AirWatch)
• Optimization Governance (Impact Advisors)
• 8 Tips to Help You Transition From ICD-9 to ICD-10 (Aprima)
• Metabahn & HealthLoop chose Catalyze, but why? (Catalyze)
• Improving Your Financial Health Through Patient Engagement (Culbert Healthcare Solutions)
• Five Keys to Success Under the Oncology Care Model (ECG Management Consultants) 
• Marketing to Your Existing Clients to Drive Revenue (E-MDs) 
• Cisco and Extension Team Up to Tackle Modern Clinical Workflow Challenges (Extension Healthcare)
• Forms Beyond Your HER: Making it Possible for ALL Clinical Forms to be Paperless (FormFast)
• GenY4HIT – Reshaping Healthcare (Galen Healthcare Solutions)
• Insurance Carrier Setup Neglect: A Costly Oversight (Part 2 of 2) (Hayes Management Consulting)
• Epic Service Desk: Why Should an Organization Invest? (The HCI Group)
• How to Use a Volunteer Work Day (Healthgrades)
• Innovation at HIMSS is all About Interoperability (Healthwise)

Contacts

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

Monday Morning Update 3/7/16

Top News

The VA is reassessing whether VistA has a long-term place as its EHR and has halted some of its VistA modernization steps following a business case analysis ordered by new VA leadership. The VA says it requested $40 million less in 2017 VistA modernization money because it will focus instead on making its existing systems interoperable.

According to Assistant Secretary for Information and Technology LaVerne Council (photo above), “We want to take a step back and look at what we really need an EHR and a healthcare system to do. There are multiple needs that are different than in 2014 around the area of women’s health, the Internet of Things, and how we manage private sector care.”

House Appropriations Chair Hal Rogers (R-KY) wasn’t happy with the VA’s testimony to the committee, saying, “We’ve been at this for 10 years and we’ve given you billions of dollars. I’m hearing muckety-muck here. I don’t know what you’re saying. Apparently, you’ve not made your mind up yet about whether you’re going to replace VistA with something off the shelf. Is that right or wrong? Yes or no?”

Council replied that the VA hasn’t decided yet, blaming her VA predecessors for not developing a sound plan but extolling the virtues of the VA-DoD Joint Legacy Viewer. She joined the VA in July 2015 after retiring as corporate VP/CIO of Johnson & Johnson.

Council also says that a visual overlay to the VA’s 30-year-old patient scheduling system may eliminate the need for its planned $690 million replacement depending on how the VA-wide rollout in April is received.

Reader Comments

From Vegas Blues: “Re: healthy health conventions. Is it a foregone conclusion that we can’t eat healthy at a Las Vegas conference venue?” Plenty of sugary snacks, fatty sandwiches, and coffee were available, but I didn’t see much fruit or unprocessed food. It’s a fine line between providing what attendees want vs. what’s good for them, however. The H in HIMSS stands for healthcare, not health. It’s like McDonald’s, which offers a lot of healthy food that nobody orders, earning it scorn for the choices its customers make.

From Jardin: “Re: delegating computer tasks to non-physicians. The Senate unanimously passed this because, according to the committee chair, ‘hospitals and providers dread EHRs’ and “MD documentation is burdensome.’ After a year-long review that included HIMSS and physician lobbyists, Congress proposes a solution that adds costs, introduces errors, and eliminates many EHR benefits. After spending billions on health IT, we’re regressing back to the e-secretary model, pushing the burdens of the same EHRs to scribes or RNs. Nurses continue to be invisible in the law. Why isn’t there an industry outcry to actually fix the problem instead of just passing it off?”

From Flaming Introvert: “Re: HIMSS conclusions. As a near-entry level vendor employee, this is my second HIMSS and I’m not sure if I love it or hate it. It’s upbeat and our customers provided positive feedback about our changes and their needs. It’s refreshing to connect with patient advocates, even if most conversations end with the defeatist consensus of, ‘It really sucks, but what can we do about it?” Low point was getting to HIStalkapalooza too late for the shoe judging – I don’t normally parade around in six-inch heels without potential ROI. Maybe that same sentiment applies to HIMSS overall – it continues to yield enough return to induce me to participate, but I’m always glad to get home.”

From Bonus Room: “Re: iTriage. Just laid off 33 employees and CTO Patrick Leonard is leaving.” Unverified. I haven’t seen any official announcements from the medical question and doctor finding app vendor that’s owned by Aetna. However, the report came from a non-anonymous iTriage employee.

From Love American Style: “Re: Epic’s 2015 release. I’m a project director for an Epic customer. We are still in the testing phases and the severity and number of patches at this point in the release cycle has been unprecedented. Patient safety problems, patches that break workflows, performance problems all abound. Things I would have expected Epic in prior years to have nipped in the bud long before now.” Unverified.

From Delled: “Re: Michael Dell at HIMSS. He’s my hero, but I was stuck in the overflow room for his keynote. The moderator was so bad that people left in droves like the session was over. At one point Dell had to remind the moderator that he was supposed to ask a specific question. Finally I worked my way to the front against the crowd streaming for the exits, and at the end when he was leaving the stage, I asked to shake his hand (photo attached). He ignored me.” Michael Dell would have been an awful choice to keynote even if he wasn’t trying to sell out Dell’s pitiful healthcare offerings so he can finance his $67 billion passion for computer storage in acquiring EMC. EMC owns VMware, which has watched its shares drop 40 percent and has laid off 800 people since Dell came sniffing. Other than funding Dell Medical School, his healthcare accomplishments are zero or less, hoping desperately to sell Perot Systems for the same price he paid in 2009, backpedaling on the the idea that the future is in services rather than hardware.

Here’s my formula for becoming a highly-paid, well-received HIMSS keynote speaker, not inspired by Michael Dell since I didn’t attend any HIMSS keynotes:

1. Be famous for any reason. Healthcare relevance is unnecessary and even detrimental – the goal is to raise the spirits of attendees by making them think they are as cool, rich, good-looking, or smart as the celebrity podium-gripper.
2. Negotiate a speaking fee of several hundred thousand dollars, making sure to insert contractual clauses requiring approval of the introduction and the freedom to sell whatever product or service the speaker offers on the side.
3. Arrange travel to minimize the time hanging out with the insufferably fawning organization people who hired you and who therefore think they’re entitled to face time or the privilege of escorting you through the exhibit hall that makes you glaze over.
4. Announce to the worshipful masses how utterly delighted you are to be in their midst, carefully omitting the fact that you could have attended any time you wanted in previous years if your delight didn’t carry a price tag.
5. Begrudgingly allow a high-ranking executive of the group running the conference to (a) hug you before or after your speech; (b) ask carefully scripted softball questions after the stage is reset into a fireside chat type configuration; and (c) annoy the audience by prattling on instead of letting you talk as you’re being paid to do. At least moderator verbosity prevents audience members from asking their own pointed questions that might result in an unfortunate, life-ruining off-the-cuff answer. After the friendly chat, allow the executive to magnanimously present your foundation with a big check above and beyond your personal speaking fee.
6. Have your hired copywriter modify the harmless, standard speech you’ve given dozens of times to conventions ranging from car dealers too the Bowling Proprietors’ Association of America, penciling in four seemingly insightful anecdotes as provided by the people writing the check that are sure to make the audience feel that you understand them even though you have no idea what they actually do. You don’t  have to review the scripted comments in advance – they will be right there in front of you on the Teleprompter per your contractual requirement.
7. Include a handful of humorous, self-deprecating, name-dropping insider anecdotes to allow geeky non-profit IT people to live your celebrity life vicariously and to brag afterward that they briefly shared your aura.
8. Be vaguely motivating in a boilerplate-type way that won’t require actually thinking up something new, extolling the generic virtues of teamwork, leadership, doing what you love, and being true to oneself.
9. Close with over-the-top accolades that defer glorification to whatever the audience members do for a living, telling them that they are the real heroes even though (a) they’re paying to see you and not vice versa, and (b) you just made more money in 60 minutes than they make in a year.
10. Go straight offstage to a limo with the engine running to minimize unpaid downtime before the next cookie-cutter speaking gig.

HIStalk Announcements and Requests

A little more than half of poll respondents doubt that Athenahealth and eClinicalWorks will become major inpatient systems vendors. Skeptical says that if eCW’s entry into inpatient is like its interoperability solutions, “we should expect major-league hype and minor-league results.” Vote Early and Often says eCW employees stuffed the ballot box and the company can’t service enterprise customers that expect project discipline and management maturity. Frank Poggio says it’s too late – the market has been sewn up by Cerner and Epic with Meditech, the only small-hospital vendor, losing ground. It’s All Good says there’s a long history of companies aspiring to be what they aren’t (Allscripts) and that eCW should stick to ambulatory.

New poll to your right or here: HIMSS attendees, will the hard-dollar benefit of your attendance cover your employer’s cost to send you within one year? Click the Comments link after voting to explain.

Here’s an extra, reader-requested poll for HIMSS15 exhibitors: in the year that has elapsed since, did you make a sale that you wouldn’t have made had you not exhibited?

Ms. Livingston says her New Mexico elementary school students “have the idea that they don’t deserve what the schools that have more money enjoy having” and therefore are having great fun with math story books we provided in funding her DonorsChoose grant request.

Also checking in was Mrs. Jochum from Nebraska, who sent photos of her students using the Osmo learning systems we provided.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Sales

Sixty-nine bed Madison Memorial Hospital (ID) will implement Cerner at a cost of $6 million upfront and $86,000 per month in maintenance fees. They chose Cerner over Epic and their incumbent vendor Meditech.

Virtua Health System (NJ) chooses Epic, which apparently beat Cerner in offering a replacement for Siemens Soarian.

Steward Health System chooses Imprivata Cortext for provider communication across its nine hospitals.

Aurora Health Care (WI) chooses Strata’s StrataJazz as its full financial analytics and performance platform.

People

Healthgrades hires C.J. Singh (Backcountry.com) as CIO.

Ross Martin, MD assembled video good wishes for Deloitte’s Chris Brancato, who is recovering from unfortunately eventful spine surgery that has left him hospitalized and therefore unable to attend the HIMSS conference. Some of the greetings were recorded at HIStalkapalooza.

Announcements and Implementations

CPSI announces a program by which its revenue cycle customers can apply their additional revenue toward buying its Evident Thrive EHR with no upfront costs. CPSI shares have rallied a bit in the last few months, beating the Nasdaq slightly by increasing 3 percent in the past year.

Health Catalyst arranges its product roadmap around nine subject areas.

Intelligent Medical Objects will work with Northwestern University’s medical school to support pharmacogenomics clinical decision support through creation of terminology to support concepts such as “ultra-rapid metabolizer of clopidogrel.” IMO will make the results available to members of the federally funded eMERGE consortium at no cost.

Vital Images launches an ACO imaging analytics solution and announces a personalized HIE/EMR viewing platform.

Privacy and Security

The personal information of all employees of Main Line Health System (PA) is exposed when one of them replies to a spear phishing email.

Innovation and Research

Mass General’s “Ambulatory Practice of the Future” calls for undergraduate and graduate engineering students to compete for $400,000 in prizes for creating innovations in primary care (technology, instrumentation devices, etc.) Pre-proposals are due April 18, 2016. Ten finalist teams will be awarded $10,000 and the top three winners will receive $150,000, $100,000, and $50,000. Last year’s winner was Hemechip, a point-of-care diagnosis device for sickle cell disease.

Other

The HIMSS16 final attendance count was 41,885, down 3 percent from last year’s 43,129. This is the first time I can recall attendance going down year over year unless maybe it was in 2000 due to the Y2K scare. Possible reasons I came up with:

• Industry hangover from MU and ICD-10.
• Fatigue with the novelty of having the federal government drive so much of the conference agenda.
• Lame keynote choices.
• Election year uncertainty.
• A move to immediately valuable vendor user group meetings instead of a massively broad conference that is more useful to providers who are shopping products.
• A cutback in travel funds from vendors anticipating a market slowdown.
• Questionable return on investment for both providers and vendors.
• An increasingly less-useful education track that favors just pushing attendees into the exhibit hall nonstop.

A reader sent a link to the Sands Expo’s brochure describing its “green “ practices conference planning tool that should relieve HIMSS attendees worried about the lack of obvious recycling efforts. Interesting facts from it:

• The Sands Expo facility earned LEED Gold certification for existing buildings.
• Meeting rooms are equipped with sensors that control energy-efficient lighting.
• Onsite solar panels address some of the energy requirements.
• The convention center recycling rate is 80 percent, with waste sorted at both on-site and off-site recycling stations.
• Leftover food is made available in the employee dining room with the unused amount composted and sent to a local pig farm.
• Carry-out and concession serviceware is compostable.
• The entire property is smoke free except for the casino and 6 percent of guest rooms.
• The facility offers volunteer opportunities to conferences exhibiting that include helping with soap and shampoo recycling, creating Clean the World hygiene kits from recycled materials for locals in need, helping sort donated products for the local food bank, packaging nutrition bags for senior citizens in poverty, packing food in backpacks for local children, boxing meals for after-school programs, and volunteering with Opportunity Village to support those with severe intellectual disabilities.

HIMSS barely missed what would have been a huge PR scoop as the Denver Broncos announce that Peyton Manning will retire, just two days after his HIMSS conference keynote.

An 86-year-old woman accidentally strangles herself to death when her medical alert bracelet, which did not have a breakaway clasp, gets tangled in her walker.

Weird News Andy advises people to “Don’t Worry, Don’t Be Happy.” A study finds that joy – along with anger, grief, and fear – can cause emotional stress that contributes to takotsubo (aka broken heart) syndrome. 

Sponsor Updates

• Huron Consulting Group and Strata Decision Technology announce a partnership to create a value-based care transition solution.
• NextGen Healthcare integrates CareSync CCM into NextGen Ambulatory EHR and will offer the product to its customers who want to perform and bill chronic care management services.
• Aventura chooses HealthCast as its single sign-on partner.
• Catalyze will add support for Microsoft Azure to its HIPAA compliance platform as a service.
• The Advisory Board Company offers case studies from four health systems that saved $4 million using its Crimson performance analytics program.
• Nordic will offer its customers visual analytics from Qlik Sense.
• NextGen Health integrates inMediata’s inBanking payment reconciliation solution with its practice management system, allowing payments to be electronically reconciled against banking deposits.
• VMware integrates Imprivata’s user credentialing and messaging products into its Workspace One provider digital workspace.

Blog Posts

• #HIMSS16 – Where are we on the journey to value-based care? (Nordic)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Dr. Jayne’s HIMSS16–Thursday

I was able to sleep a bit later this morning – no breakfast meetings or client calls. Trying to determine which sessions I want to catch has been an exercise in frustration. It feels like most of the ones I’m interested in all occur at the same time.

While I was looking at the short list of possibilities for today and eyeballing what I missed, it struck me that some submitters were much better at creating eye-catching titles than others. Some of my favorites:

• Patient Engagement: No Diamond Ring Required
• Five States, 700 Physicians, and Four Best Practices for HIEs
• Just Press Print: Challenges in Producing EHRs in Litigation
• Patient Identification: Biometric or Botched
• How to Avoid Getting Sued by Your Cyber Risk Insurer
• Rise of the Medical Scribe Industry – Risk to EHR Advancement
• Hard Truth about a Soft Go Live

A couple of the sessions I was particularly interested in happen to occur on Friday, so I’m looking forward to finding them online. I’m also looking forward to reviewing “What Do You Do When Your Improvement Project Fails” because it’s near and dear to my heart. When I went for my Lean Six Sigma certification, my first project was a complete and total bust. It ended up being a good thing, however, since it led to the creation of an upgrade methodology that I still use today, but it was definitely painful at the time, not to mention embarrassing.

I had mentioned yesterday about the lack of recycling (or discussion of single stream management) and a reader commented that there were signs near the waste receptacles. I made a more concerted effort to notice today and still didn’t find any more than I had already seen. The conference center did have divided bins (waste vs. cans/bottles) that I saw previously and failed to acknowledge, but most of the bins I saw in the exhibit area were unmarked.

My hotel had no mention of recycling whatsoever. They did mention on the express check-out card that they don’t issue paper bills for environmental reasons. Still, I needed a paper copy for reasons of my own and the desk clerk actually scolded me, saying I’d receive it via email by the end of day. It’s midnight in my world and I still haven’t seen it, but I guess in Vegas time they have a couple more hours.

I noticed some bachelorette-appearing ladies coming out of Treasure Island in what appeared to be last night’s clothes. They were sporting some adult-themed balloon hats and I’m just sorry I wasn’t fast enough to get a picture. It’s a good thing that what happens in Vegas stays in Vegas because they were looking pretty rough. Perhaps they were headed up the street to White Castle for some hangover therapy. I didn’t remember seeing it on the strip last time I was here, but the strip can be overwhelming and things are easily missed.

I did a last-minute swing through the exhibit hall and heard quite a few comments about people getting ready to head out. I do wish I had more time to see more products and attend more sessions, but staying through Friday wasn’t an option. I’m not thrilled about the schedule shift that occurs when HIMSS is in Las Vegas and it seems like others aren’t so thrilled either. Next year we’re back in Orlando, which is challenging for its own reasons. I wish HIMSS would reconsider other options for the meeting.

The show floor was still fairly busy although nothing like opening day. I had equal numbers of reps who were smiling and trying to engage people walking by as compared to those who were looking pretty bored. I popped down to Hall G to see a couple of specific vendors and ended up running into someone I hadn’t seen in ages and chatting took up most of my remaining time.

It takes a lot of discipline to try to see everything and do everything at HIMSS. I’d like to blame my broken toe for slowing me down, but I think the whole event is almost too much. Thanks again to Edifecs and their #WhatIrun for literally making it possible for me to limp my way through the week in comfort.

I was fortunate again this year to have a vendor executive offer to share his car to the airport, allowing me to bypass the taxi queue craziness and providing a nice chat on the way. I enjoyed getting his thoughts on the industry and the move to value-based care. The airport was surprisingly low key and I made it through security in record time, for which I was grateful.

During my flight, I was able to catch up on the unbelievable amount of email that had come in during the week. One was from a PR firm correcting me for not using their client’s full name in my mention. Although I appreciate their position and their diligence to the brand, I hope they understand that (a) HIStalk is not my full-time job; (b) sometimes we write quickly and on the fly; and (c) during HIMSS, I usually end up writing at 1-2 a.m. after hitting the show all day and at least three or four vendor events each night. An email from a different vendor used the analogy of “a tree falling in a vast, cold, poison-ivy infested forest” gets my compliments for best prose of the day.

Weird News Andy wins the award for best fashion advice in the “What Not to Wear” category, sharing a piece explaining the perils of wearing shoes with gun-shaped heels and bullet-shaped accents.

I also received a note from a vendor exec apologizing for missing HIStalkapalooza. Apparently there was an EHRA dinner and awards ceremony that overlapped and they couldn’t make it to Mandalay Bay before the doors were closed. Another physician reader who did attend asked if I had any photos of her team and John Halamka doing the limbo at HIStalkapalooza. I am very sad to say that I do not, but if anyone does, please share.

What has been the best part of HIMSS? Email me.

Email Dr. Jayne.

Jenn’s HIMSS 3/3/16

My last day at HIMSS … how I already miss seeing friendly faces around every corner, the fantastic free food in the press room, readers stopping by the HIStalk booth to tell me why they love (or hate) some of the things we do. I’m already looking forward to Orlando, and can’t say goodbye quickly enough to Pacific Time. But I’m getting ahead of myself.

My last morning got off to a nice start. I found that chivalry is indeed not dead, as several gentleman helped me cart my luggage between the HIMSS shuttle and conference entrance. I wasted no time in grabbing coffee from the press room before meeting with Lauren Douglass, brand manager for Medhost’s YouCareUniverse. She brought me up to speed on several nuggets of news, including the fact that the company’s YourCareEverywhere mobile app has recently been certified for Meaningful Use – the first of its kind to attain certification, to the best of her knowledge. The company, like many others at the conference, is joining the interoperability conversation in a big way via a project with an unnamed EHR vendor.

Encore Health CEO Dana Sellers joined me afterwards to chat about the show. (I love talking with smart folks that have been in the industry as long as she has; it’s a great way to absorb just a tiny bit of their wisdom.) We talked about everything from The 5 Love Languages to value-based care. She pointed out that, while a theme usually emerges by this point in the conference, she just couldn’t put her finger on one this time around. She equated it to post-Y2K, when the industry settled into a six month lull to catch its breath. “We’re in that same lull,” she explained, adding that her customers are taking a step back to recover from Meaningful Use and ICD-10. Sellers predicts that once they’ve taken a breather, providers will move full speed ahead with figuring out how to derive value from their healthcare IT.

Her comments regarding lack of a theme hit a nerve. HIMSS conference news cycles in years past have been driven by industry-wide EHR adoption, then ACOs, then Big Data (as its history of HISsies attests), and I was fully prepared for yet another buzzword to rear its ugly head. While population health management, analytics, cybersecurity, and value-based care have been tossed around, I haven’t gotten a sense that one is more important than the rest to providers walking the exhibit halls. Yes, everyone is talking about interoperability, but as BIDMC CIO John Halamka smartly said in his session with Jonathan Bush, “Interoperability is a bit like porn. I can’t define it, but I know it when I see it.” I haven’t even heard much mention made of precision medicine, aside from HHS reps talking it up in various sessions. Perhaps readers will offer a different perspective.

After coffee talk, I walked just a few yards to the HX360 Pavilion, which turned out to be a really nice, open space for its exhibitors, including Matter and Startup Health. I’m not sure how it compared to pavilions past, but it was nice to enter into an exhibit space not filled to the gills with humanity.

I caught the #HITsm panel featuring illustrious thought leaders like Drex DeFord, a longtime friend of HIStalk and participant in our HIMSS16 CIO luncheon. Host @HealthStandards kept the live and virtual discussion high level by focusing on innovation in HIT. A number of themes emerged, including the consumerization of healthcare and technologies poised to have the biggest impact. My vote goes to any type of tech – high or low – that can alleviate the costs associated with aging in place, long-term care, and palliative care. A big chunk of healthcare dollars goes towards caring for the elderly in these categories, and so it stands to reason that technology that addresses these areas might make some waves (if it’s not already doing so) in terms of cost and outcomes.

Standards were also mentioned, at which point everybody groaned.

I spent the rest of my time walking through the exhibit hall one last time. Traffic was light in some areas and heavy in others, as this picture of HL7 International’s booth can attest. Folks were lined up two to three deep to hear Massachusetts EHealth Collaborative President and CEO Micky Tripathi talk about the Argonaut project.

The #FHIRSelfie photo op just around the corner from where he spoke looked like a lot of fun.

Healthfinch co-founder and CEO Lyle Berkowitz, MD (and associate CMO of Innovation at Northwestern Memorial HealthCare (IL)) was gracious enough to stop and snap a selfie with me, even though I initially mistook him for Cedars-Sinai CIO Darren Dworkin.

My last official “drive by” of the day was to say one final thank you to the Xerox team for the lovely dinner the night before. Chief Innovation Officer of Commercial Healthcare Tamara StClaire and I chatted about the fabulous food and conversation (creamed corn = amazing / value-based care = struggle), and Xerox’s new population health management solution, which I’ll cover in HIStalk Practice’s Population Health Management Weekly Wrap Up on Sunday. I threw her a curveball in asking for her thoughts on HealthSpot’s stealthy departure/implosion. She equated Xerox’s partnership with HealthSpot as a learning lesson – one that has left the company now fully committed to remaining in the telemedicine space with an eye towards offering virtual queuing and payment processing. She wouldn’t name names, but did say that the company is in talks with several telemedicine vendors to prop up their IT infrastructure in the coming months.

I shuffled through tweets as I queued for a taxi to the airport (the line was not that bad), and had to share this one because it is apropos no matter which HIMSS conference.

As is this chart tweeted by @MandiBPro and @drNic1. The expo’s WiFi actually ended up being pretty reliable, which isn’t always the case at HIMSS.

My flight home has thus far been fun. The terminal was filled with familiar faces and longtime friends and I’m about to crack open one of the books I splurged on at the airport bookstore. I’m hoping humor – and healthcare IT – will get me through the long flight. Safe travels everyone!

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