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News 8/17/18

August 16, 2018 News No Comments

Top News

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Best Buy acquires GreatCall for $800 million.

GreatCall is perhaps best known for its senior-friendly mobile phones currently being hyped in TV ads by vice chairman and former “America’s Most Wanted” host John Walsh.

The San Diego-based company also offers medical alert wearables, emergency response services, and apps that offer medication reminders and connect a user’s GreatCall device with family members.

This is not the big box retailer’s first foray into healthcare. It launched its smart phone-based Assured Living service for seniors and their family members last fall and added health and wellness content and symptom checking capabilities from Mayo Clinic to the companion app in January.


Reader Comments

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From I’ve Been Everywhere, Man: “Re: US News top 20 hospitals. You are correct (in a technicality) that all 20 use Epic. Mayo Phoenix was one of Epic’s first ambulatory sites in the early 1990s, then was forced off in a Mayo corporate decision to self-develop in hacking Phamis Lastword to try to work in ambulatory. Meanwhile, Mayo Rochester, WI, and MN are live on Epic and Mayo Phoenix will go back on Epic this fall.” 


HIStalk Announcements and Requests

The paucity of interesting news will confirm that we’re in the Summer Doldrums, when everybody is focused on getting the kids back in school and squeezing in those last summer vacations and family cookouts. That’s also the time when I get bored and offer new sponsors a special deal just so I don’t feel ignored as page views and reader interaction take one last break before Labor Day. Contact Lorre, get on board now, and spend that budget money on something useful before it evaporates.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Patient payments company AxiaMed raises $12.4 million.

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The USPTO awards Zynx Health a patent related to using machine learning to analyze clinical decision support documents. The company will incorporate the technology into its Knowledge Analyzer clinical content management solution for EHRs.


People

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Patient safety expert Peter Pronovost, MD, PhD has left his position as chief medical officer of UnitedHealthCare after three months on the job. He resigned after seven years at Johns Hopkins Medicine in February 2018 to become UHC’s SVP of clinical strategy, then became CMO in June.

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Healthwise promotes Jay Reynolds to CTO.

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Dan Speicher (Omnitracs) joins Medecision as CTO.

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Fortified Health Security hires William Crank (Medhost) as COO.

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Michael Cantor, MD, MA (Pfizer) joins Regeneron Pharmaceuticals as head of clinical informatics.


Sales

  • Carteret Health Care (NC) and Ozarks Medical Center (MO) choose consulting services from Engage.
  • HIEs HealtheLink, Quality Health Network, Health Current, Indiana Health Information Exchange, and ClinicalConnect select data normalization and cleansing applications from Diameter Health.

Announcements and Implementations

Michigan Health Information Network Shared Services implements 4medica’s master patient index.

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MedStar Health implements several FormFast form management technologies across its facilities in Maryland and Washington, DC.


Privacy and Security

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In an effort to cut through the “white noise” of data breach news, HGP publishes a concise review of cybersecurity incidents in healthcare since 2010. Items of interest include:

  • Email has become a favored entry point for hackers; breaches of personal devices have decreased by 50 percent.
  • Paper and film breaches continue to account for 20 percent of breaches.
  • Business associate-related breaches have decreased by 10 percent, while payer breaches have increased by 5.
  • Of the 23 cybersecurity companies listed, Armor, Imprivata, Olive, and FairWarning have secured the most funding over the past two years.

Other

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A Black Book report on health IT consulting predicts firms will rake in $53 billion by the end of this year, with the bulk of that coming from software implementation, optimization, integration, and support. The top three consulting needs are for cloud technology adoption, increased digitalization, and to supplement a lack of internal resources. Top wish-list engagements include help with transitioning to value-based care, cloud infrastructure, compliance, and decision support and analytics. The Chartis Group, ECG Management Consultants, Huron, and Impact Advisors top the list of favorite consulting firms, according to survey-takers.

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A new KLAS report on business intelligence finds that Epic leads the pack by far in deep adoption despite immature native functionality and a lack of cost effectiveness, while HBI Solutions and Health Catalyst have the highest overall score and Dimensional Insight is #1 in driving outcomes and delivering value. Health Catalyst’s combination of software and services places it high on the list, especially for those looking for help with readmissions, opioid use, length of stay, and sepsis. Cerner’s offering is “still immature” as most clients are just getting started, with users telling KLAS that it lacks a testing environment, it doesn’t bring in external data easily, and it doesn’t yet offer predictive analytics. IBM, Microsoft, and SAS declined to participate.

Google is developing an AI-powered wellness assistant for smart watches that will proactively encourage users to make healthy choices based on their appointments, recorded activities, reminders, and location.


Sponsor Updates

  • Elsevier receives several Digital Health Awards from the Health Information Resource Center.
  • EClinicalWorks will exhibit at the NACHC Community Health Institute & Expo August 26-28 in Orlando.
  • Spok announces that the 20 hospitals named to US News & World Report’s 2018-19 Best Hospitals Honor Roll and the 10 hospitals named to the Best Children’s Hospitals Honor Roll are its clinical communications customers.
  • FormFast will exhibit at the 2018 GHIMA Annual Meeting & Exhibit August 19-20 in Pine Mountain, GA.
  • Glytec publishes a new video, “Digital Diabetes Management from a Patient’s Perspective.”
  • HBI Solutions will exhibit at the SHIEC 2018 Annual Conference August 19-22 in Atlanta.
  • Gartner includes Imat Solutions as a sample vendor in its latest Hype Cycle report for US healthcare payers.
  • Influence Health announces 43-percent bookings growth for its Consumer Experience Platform solutions, and a 131-percent increase for its multi-channel campaign managed marketing services.
  • Intelligent Medical Objects will exhibit at Aprima’s annual user conference August 17-19 in Grapevine, TX.
  • PerfectServe will host the Hospital for Special Surgery Educational and Networking Open House September 21 in New York City.
  • Meditech publishes a new case study, “Clatterbridge Delivers More Efficient Cancer Care to the UK with Meditech, and a video titled “How Do Doctorrs Want to Spend Their Free Time?”
  • PMD successfully completes its first SOC 2 and HIPAA security audit.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 8/16/18

August 16, 2018 Dr. Jayne 1 Comment

CMS has posted a new presentation covering the proposed rule for the 2019 Medicare Physician Fee Schedule. For those who have not yet started to dig in for review, it’s a nice 35,000-foot summary of the E&M coding and virtual care pieces. Plus, it’s only 17 slides long, which might possibly make it the shortest document to come out of CMS in a long time.

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My fortune cookie revelations are usually pretty bland and I’ve never had my palm read. However, I wonder if my inbox is trying to predict my future. I had back-to-back emails about the best ways to onboard physicians from MGMA and the top 10 things to think about when you’re thinking of leaving your practice from AAFP’s Family Practice Management journal. It made me laugh, particularly because my current clinical situation is the best one I’ve ever worked in. The support team members are great, the owners are extremely supportive of my life in healthcare IT, and I feel energized and valued at the end of the day even when it’s been a very tough shift. I wish I had found that kind of clinical fulfillment earlier than halfway through my career, but I’m glad I found it when I did. Still, the documents were good advice, so I’ll tuck them into my consulting portfolio for the next client.

From Noteworthy: “Re: news. It’s amazing what passes for a news item in healthcare today. It’s not outcomes data, it’s not a new gamma knife offering, or even mobile mammograms — it’s vinyl flooring.”Actually, it’s both vinyl flooring and new blinds to give the practice greater “curb appeal.” The practice administrator is quoted regarding how important it is to have vinyl flooring in order to provide a clean environment for patients. Does that mean that their previous carpet provided a less than sanitary space before this week’s renovation reveal? Inquiring minds want to know. Perhaps I should pitch a new show to HGTV for renovating disastrously outdated physician offices. I’ve definitely seen more than my share.

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Earlier this week, Mr. H mentioned the phenomenon of medical students skipping classes and instead using YouTube videos and other resources to prepare for their licensing exams. There is a great comment posted by reader AndyWiesental, who details the non-content skills that physicians need to learn. The diagnostic process and how to determine the appropriate care for a given patient take time to learn, but despite the push for patient-centered care and individualized medicine, educational and quasi-regulatory bodies are still pushing us towards fact-based testing that quickly becomes obsolete. Board certification exams are a case in point, with questions such as “which of the following drugs is the most effective therapy for XYZ” where the answers are items that are 70, 72, 80, or 85 percent effective. In the world of in-the-trenches medicine, those numbers are not terribly relevant. It’s more complex than lab-based effectiveness; one needs to look at the cost vs. efficacy, tolerability and side effect profile, whether it’s on the insurance formulary, and more. And by the way, there’s a chance that a formerly-effective drug will be recalled, so all the numbers go out the window. It all depends on the patient sitting in front of you, as well as the statistics, and the way we are currently tested doesn’t take that into account.

I recently had a conversation with a physician as I was waiting for a plane, and we were lamenting the idea of recertification exams. His board is taking a more progressive approach and allowing more of an extended open-book format that demonstrates the ability to find knowledge rather than memorize factoids. That’s how we practice now, finding the best evidence through curated sources rather than trying to regurgitate what we learned to pass the exam. Although medical education is progressing, the students I work with tell me it’s not a lot different from when I was in school, just more high-tech. Where we recorded lectures on a cassette tape and had a classmate transcribe them, print them, and stuff them in our student mailboxes, today’s students view recorded videos of the lectures.

I once failed a medical microbiology exam because I actually learned the material and didn’t memorize the old test papers that my classmates circulated. When I sat for the exam, the questions were so poorly written that you often couldn’t tell what the correct answer was, with double negatives, multiple correct answers, typographical errors, and more. Yet, many of the members of the class scored 100 percent where a full third of us failed. The dean actually advised us to spend more time with the old tests and allowed us to retake it. With no studying but time spent memorizing questions, I aced it. Hopefully those days are long gone and we’re testing the ability of students to apply information rather than hoping they know the correct answer to the question about E. coli is D.

In response to Mr. H’s question: “If medical school education is vastly different from the content mastery required to pass Step exams, is either set of knowledge incorrect or are students expected to complete a self-managed, dual-track education?” In my experience the latter is correct. Students have to memorize the minutiae for certain, but it’s also often up to them to identify suitable mentors and clinicians whom they want to emulate, and try to learn how to be “that kind of doctor.” Some professors in academic settings aren’t the kind you want to copy, and it can be challenging to find opportunities to rotate with “regular” physicians in the community. There are similar issues in residency training, with some rotations being irrelevant to the trainee’s chosen career path. Statistically, only 17 percent of family physicians practice obstetrics, yet we’re all required to spend several months on rotation. I’d rather have had that time to take extra behavioral health rotations or emergency rotations since those were areas I was more likely to use in my planned future career.

Other rotations are woefully inadequate. My residency’s family medicine program ran a private practice clinic where we learned to code and bill and how to document, which are key for surviving in medicine today. We received productivity and utilization reports. By the time we were in the second half of the last year of residency, we were running full clinic days seeing a volume of patients equivalent to the faculty attending physicians, mostly in 15-minute visits. The internal medicine program ran a clinic where no one ever had to code or bill and every appointment was 30 or 60 minutes. Which trainees came out better equipped to succeed in practice? It was in those 15 minute slots that we learned how to prioritize patient issues and how to best use limited time and resources for individual patients. Of course, we’d all have preferred at the time to have the half-hour or hour slots that our peers did, but when we made it to the real world we were grateful, and our former classmates were shocked.

I’m coming up on a milestone reunion for medical school and it will be interesting to see where people have landed. Our class was an outlier, with nearly 10 percent of graduates not pursuing residency training. Some went to research, others to the pharmaceutical industry, a few to law school or business school, and a couple left medicine altogether. I’m definitely making a point to connect with some of my former classmates who are in academic settings, to see what they make of all of this.

Are you working at an educational institution? How does your employer support student learning? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/16/18

August 15, 2018 Headlines No Comments

HHS awards $125 million to support community health center quality improvement

HHS will award $125 million in grants to 1,352 community health centers to help them improve care access and outcomes, and advance their use of health IT.

Best Buy Acquires GreatCall, A Leading Connected Health Services Provider

Best Buy acquires GreatCall, which offers emergency response services and digital health devices for seniors, for $800 million.

Kindbody Purchases Cloud-Based Software From IVFqc

Women’s health and fertility care company Kindbody purchases the IVFqc cloud-based EHR and billing software assets of Althea Science.

Readers Write: A Person-Centered Approach for Success in Intellectual and Developmental Disability Services

August 15, 2018 Readers Write No Comments

A Person-Centered Approach for Success in Intellectual and Developmental Disability Services
By Andrew Mersman

Andrew Mersman is senior director at Netsmart Technologies of Overland Park, KS.

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It’s no secret that limited resources and funding have historically been a challenge for providers of Intellectual or Developmental Disabilities (I/DD) services. That’s why it’s important for healthcare providers to break down information silos and work collaboratively to achieve the best outcomes possible. With the introduction of value-based care payment models, it will be even more important for providers to find effective and efficient ways to manage resources across the healthcare continuum to deliver the right care for every individual’s needs. The continued evolution of Home and Community Based Services (HCBS) waiver plans and emphasis on conflict-free case management also make person-centered care more important than ever before.

To aid organizations in providing the best I/DD services with a person-centered approach, awe’ve narrowed down four key elements to keep at the forefront of managing an individual’s care.

Person-Centered Planning

To deliver the best services possible, it’s important to address it with a holistic, whole-person outlook. Keep the individual at the center of this universe and take in surrounding factors into consideration as you plan and coordinate delivery. Important items to consider in person-centered planning include:

  • Taking direction and considering feedback from the individual receiving services, including from their support system
  • Integrate the person’s strengths, preferences, and desires – example is integrating pictures into the ISP to help an individual be more active in their services
  • Drawing on insight gained from the individual’s relationships within their community
  • Enabling individuals to express satisfaction with service delivery through feedback, allowing for course correction as needed

Care Coordination

Care coordination should focus on the health, social, and personal desires of the individual. When approaching care coordination for a person with a developmental or intellectual disability, it’s important to ensure that a person’s service plans are self-directed by the individual and are aimed toward meeting their personal goals, including day-to-day living and other life factors such as independent living or employment goals. Additionally, modern reimbursement models demand more accountability for care coordination between different services and settings.

Comprehensive Assessment and Planning

Person-centered care requires the ability to plan and provide the right type of services that can result in the best outcome possible. To do that, providers need to assess many aspects of a person’s life when determining the best plan for them. This is essential to determine the kind of services that should be provided along with the method in which they are delivered, and account for any potential obstacles that may prevent the individual from being successful. Factors to be assessed can include things like housing, family support, social skills, personal care, communication, financial stability, nutrition, activity level, and more.

When developing a person’s care plan, it’s critical to ensure that all essential elements of the person-centered plan drive the planning process. This is also the time to determine that tasks based on valued outcomes are specific, measurable, achievable, relevant, and timely to make sure that an individual can progress and be successful. Planning should also emphasize community inclusion and participation, independence, and the use of informal community supports when possible.

Data Collection, Measurement, and Reporting

Creating a care plan alone isn’t enough. It’s essential to prove the effectiveness of the support and services your organization provides. The way to tackle that is through collecting, analyzing, and reporting data to demonstrate outcomes. Your organization should be able to look at results and determine if the plan was successful, not just that the tasks were completed.

An integral part of applied behavioral analysis requires the ability to measure an individual’s growth and development. You can’t report progress without any data, so the first step is to gather and collect it throughout their journey. Once they are accessing and receiving the services outlined in their plan, it’s time to record progress. What has been the outcome of the services they’ve been receiving? Are they improving with the method of delivery your organization is providing?

Your EHR should allow your support staff to easily record and track a person’s progress through streamlined, intuitive workflows. And in an age where services are delivered in a variety of settings, mobile functionality is essential for entering important data on a tablet or other portable device. Going mobile is an effortless way to build staff efficiencies and supports the move away from a paper-based system, allowing data to be accessed and retrieved in real time.

Once the data is collected, it’s time to look at what it collectively means in the bigger picture. Here’s where robust reporting and analytics comes in. The ability to display data in a variety of outputs (i.e. raw data counts, compliance or achievement percentage, or graphical representation) is important with respect to who is viewing the data. Also, the ability to provide real-time analysis is important to provide on demand.

No matter what care setting, keeping an individual and their needs at the center of their care plan is essential. Remembering these factors while establishing, assessing, and achieving an individual’s personal goals, care providers across all settings – not just I/DD – are sure to provide the best services to meet the unique needs of everyone.

Readers Write: Capturing Patient-Reported Outcomes for Population Health Management Yields Dividends

August 15, 2018 Readers Write No Comments

Capturing Patient-Reported Outcomes for Population Health Management Yields Dividends
By Gary Hamilton

Gary Hamilton is CEO of InteliChart of Fort Mill, SC.

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As the industry pushes towards value-based care, a greater emphasis has been placed on listening to patients, particularly regarding how they view their own health status and quality of life. These patient-reported outcomes (PROs) are essential to help identify obstacles to effectively manage chronic conditions. Patient-reported outcome measures (PROMs), of which there are many across numerous specialties, are also increasingly important to payers under value-based care payment models.

Capturing PRO information can occur in the exam room or hospital, but it is often time-consuming and may be sidetracked if the patient has an acute condition they prefer to discuss. Fortunately, the ubiquity of the Internet, smartphones, and the increasing sophistication of data analytics technology is helping healthcare organizations obtain PRO data and analyze associated measures efficiently so they can improve performance.

PROs are defined by the National Quality Forum (NQF) as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” These outcomes are, in some cases, more important to the patient than the clinical outcome because it reflects how they are feeling and their ability to pursue daily activities. For example, how many times has a patient told you that they stopped taking a medication due to its perceived side effects and now feel “better than ever?”

Learning about medication side effects and how a patient feels about other elements of their care plan aligns with many value-based care goals. After all, if patients are not achieving their personal health or quality-of-life goals, they may not perceive any value for their care. A treatment then cannot be considered fully effective, even if clinical indicators of health improved along the way.

Listening to patients’ goals is key to designing a care plan that will yield health status improvements or eliminate symptoms, but also improve quality of life. When a patient notices and reports these improvements, they are likely to engage in their care plan or follow through with a recommended procedure recovery regimen.

Capturing PROs can be tedious and not always accurate, especially when the patient is distracted by another condition or other factors, such as being discharged from the hospital. This is where advanced population health management (PHM) technology helps providers save time while improving the patient’s experience.

At discharge, for example, a patient who underwent a procedure may be so concerned about how they will resume their activities at home, they may not be aware a medication prescribed at the hospital is giving them intolerable side effects. After they adjust to the care transition, an automated survey would be sent from the PHM platform to their smartphone to learn about the recovery from the procedure, as well as the new medication. Based on patient preferences, PROs could be captured through an automated interactive voice response (IVR) phone call or a secure electronic message, both initiated through the PHM technology.

Although automated methods are most efficient, a live phone call with a clinician is just as effective at gathering crucial patient information. The PHM technology assists in these situations by automatically reminding the care manager to conduct the interview and offering to create the electronic questionnaire form to be completed. Based on responses from any of the PRO outreach methods, the physician can then decide to adjust the prescribed treatment.

For patients with chronic conditions, here again, a survey can be sent to a mobile device or patient portal periodically to ensure associated care plans are helping them achieve their goals. Electronic surveys or interviews using an IVR or live phone call would include quality-of-life questions concerning physical function, mental health, sleep, or the ability to participate in daily activities. An analytics platform would then flag and compile negative responses for follow-up.

Remote-captured PRO can also support many elderly and rural patients who may have transportation challenges. Instead of these patients coming to the office for routine consultations regarding their chronic conditions, an automated survey, secure portal message, IVR, or live phone call can capture PROs and allow them to avoid unnecessary travel.

The benefit of using a mobile device or a computer to capture PROs is that patients can report their perspective at the right moment, when they have time to reflect away from the distractions of a busy practice, hospital, or workplace. Surveys or automated interviews delivered on a consistent schedule prove to patients the organization is focused on their care, nurturing engagement, and motivating them to improve their outcomes.

For the provider organization, identifying PROM trends among these populations is easier when the PRO module is part of an advanced PHM platform that is integrated with the electronic health record (EHR) system, other information systems, and fed by comprehensive and aggregated data from around the care continuum. When a physician reviews a patient’s chart, they can view PROM trends at a glance to support their decisions.

PRO insight, in conjunction with other data included in the EHR, can help the physician design an effective treatment plan that achieves clinical objectives as well as the patient’s quality-of-life goals. Combined, improving performance on these outcomes can secure greater reimbursement under value-based care payment models while building stronger engagement from patients throughout the year.

Morning Headlines 8/15/18

August 14, 2018 Headlines 1 Comment

Alphabet puts another $375 million into Josh Kushner’s Oscar Health, just months after previous investment

Alphabet invests $375 million in data- and technology-focused insurance startup Oscar, following participation by two Alphabet subsidiaries in a funding round a few months ago that valued the company at over $3 billion.

Geisinger and Merck Unveil New Applications Developed to Help Improve Patient Communication and Care Delivery

Geisinger and Merck launch a patient-caregiver communication, and medication reconciliation and adherence app, both of which will use SMART on FHIR to connect to EHRs.

Sansoro Health Raises $8M to Accelerate Electronic Health Record Interoperability

Digital health-EHR integration platform vendor Sansoro Health raises $8 million in a Series B investment round, increasing its total to $14 million.

News 8/15/18

August 14, 2018 News 7 Comments

Top News

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Amazon, Google, IBM, Microsoft, Salesforce, and Oracle pledge to support interoperability at Monday’s Blue Button 2.0 Developer Conference, announcing their support for FHIR open standards, cloud computing, and artificial intelligence.

The event was hosted by the White House’s Jared Kushner-led Office of American Innovation.

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Integration experts and technologists – should we care about Blue Button 2.0? Will it significantly impact interoperability and patient access to data?


Reader Comments

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From The World is a Vampire: “Re: Allscripts. Hosted clients are having difficulty connecting to their EHR and other applications due to a data center issue.” I’ve reached out to the company, but haven’t heard back. The Raleigh data center was the site of January’s ransomware attack that left users unable to connect to their Allscripts PM/EHR systems, although the telephones of angry users remained up so they could call their lawyers to join a class action lawsuit over the downtime.

From Ozone Lawyer: “Re: prescriptions. Pharmacies won’t quote a price until my doctor calls or faxes my new prescription, after which the pharmacy will use my insurance to quote co-pay, etc. That puts extra work on my doctor. Is it legit for the pharmacy or just an obstacle?” They might do that to discourage competitive intelligence, but I can see why they would be reluctant to give a price without running it through your insurer’s test claim for pricing your co-pay. That way they have the complete prescription details without being tied up on the phone while you read them your prescription. Cash patients would do best to go online and pricing all local pharmacies (at least the chain ones) on GoodRx. InteliSys Health also offers an EHR-integrated pricing tool that would be super useful, but your doctor would need to use it on your behalf. An integrated solution would get you and your doctor the answer, allow reconsidering your choices, and then having the prescription sent electronically to the right pharmacy the first time.


HIStalk Announcements and Requests

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Did you ever take work time off to go on a spiritual retreat, attend a university’s resident summer camp for adults, participate in a church mission, delve deeply into a newfound hobby, bond with your grandchildren, join a cult, travel as a punk band’s roadie, or bum around Italy for a month in search of the perfect Montepulciano d’Abruzzo? Perhaps you were understandably enriched and motivated, in which case those of us less fortunate would enjoy living your experience vicariously.

I’m getting flooded with emails and announcements from folks who are still listing times as EST, apparently clueless that we’re on EDT until November 4 (like we have been every summer for 100 years – DST started in the US in 1918). Those who can’t master this simple concept should instead just list times with “ET.” Someone will always proclaim indignantly (as they do for their incorrect grammar or spelling) that “you know what I meant,” suggesting that it’s everybody else’s job to interpret their lazy errors.

Listening: new, outstanding contemporary Christian music from 26-year-old Lauren Daigle, who’s on a very long tour that covers a giant chunk of the US. Also: new from LSD (Labrinth, Sia, and Diplo), which takes a toe-tapping trip into doo-wop and reggae territory. There’s also a new album from St. Paul & The Broken Bones, infectiously giddy, horn-heavy, 1960s-style soul from Birmingham, AL. And in a goosebump-inducing moment, there’s Renaissance doing “Ashes Are Burning” live in 1976. I’ll eat the vocals-enhancing software of any diva singer who can match Annie Haslam  — who wasn’t even in her five-octave top form toward the end of a rigorous, long concert — starting at the 22:00 mark through the end. 


Webinars

August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Digital health-EHR integration platform vendor Sansoro Health raises $8 million in a Series B investment round, increasing its total to $14 million.

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Alphabet invests $375 million in data- and technology-focused insurance startup Oscar, following participation by two Alphabet subsidiaries in a funding round a few months ago that valued the company at over $3 billion. Wired reports that Alphabet owns 10 percent of Oscar, which has expanded into new states, plans to enter the Medicare Advantage market, and is rumored to be interested in bidding with insurers to manage care in risk-based contracts.


Sales

  • Triple-S Salud Blue Cross Blue Shield of Puerto Rico will use HMS’s Essette care management software for its health plan members.
  • New York’s Healthix HIE will implement the cloud-based Verato Universal MPI.

People

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Integration technology vendor MedicaSoft hires Helen Figge, PharmD, MBA (CareFully) as chief strategy officer.

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Health IPass promotes Ryan Navratil, MS to VP of product management.

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Holly Spring (Athenahealth) joins ReviveHealth as SVP and public relations department lead.


Announcements and Implementations

Geisinger and drugmaker Merck launch apps Family Caregiver (patient-caregiver communication) and MedTrue (medication reconciliation and adherence). The apps will use SMART on FHIR to connect to disparate EHRs.

SwedishAmerican goes live on Epic.


Government and Politics

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Relevant to a couple of polls I’ve run recently: former CMS Acting Administrator Andy Slavitt lists the items the White House hopes to eliminate from federal insurance law in a September 10 hearing, all of them affecting anyone with health insurance even if they get it through employers instead of the marketplace.

The San Francisco business paper covers huge companies using complex equipment depreciation rules to claim low value for property taxes, with the extreme case being two Apple properties in Cupertino valued at $1.4 billion that the company claims are worth just $400. Maybe the county should add a requirement that any business be forced to sell its property to a willing buyer at the assessed value it accepts. 


Other

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Adventist Health System will change its name to AdventHealth early next year, also renaming its 45 hospitals that include Florida Hospital Orlando. The health system will also launch the Center for Genomic Health next year.

IBM posts a rare publication rebuttal in disputing The Wall Street Journal’s report that says Watson Health hasn’t accomplished much in oncology. The company cites a few articles from hospitals and oncology groups – including the VA’s contract extension for genomics – in claiming patient benefit as its work “is only getting started.”

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Florida Today profiles Health First EICU intensivist Mark Pessa, MD.

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Apple lists an open position that suggests the company is considering developing its own “health, wellness, and fitness sensors.”

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The local paper says 80 of 300 doctors at Central Maine Healthcare left in the most recent fiscal year, citing conflicts with health system executives, staffing cuts, increased patient loads, and an unwillingness to use its new Cerner system.

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US News & World Report’ “Best Hospitals” list puts Mayo, Cleveland Clinic, Johns Hopkins, Mass General, and University of Michigan Hospitals as its top five. I glanced down the top 20 list and, from my admittedly occasionally unreliable memory, I think every one of them uses Epic (although UPMC is one of perhaps several on the list that also run other systems, Cerner in its case). 

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Meanwhile, that #1 ranked hospital Mayo is accused of “medical kidnapping” by the family of a high school student who was unhappy with her care during a two-month stay in 2016 for a ruptured aneurysm but was refused a transfer to another hospital. The dispute came when she was transferred to the rehab unit following four surgeries, where her stepfather complained that her doctors wouldn’t order opioids, they missed her bladder infection, and a social worker was overheard discussing financial information about her. The family also demanded that several employees be fired or removed from her care and posted near-hysterical Facebook rants. They finally signed her out against medical advice, triggering a “patient abduction” 911 call from Mayo and the family being trailed by three police agencies. The core issue seems to be whether the adult patient was capable of making her own medical decisions and the reports that a Mayo social worker was trying to appoint either the county or Mayo itself as her guardian. They family ended up at the ED of Sanford Medical Center (SD), which decided she didn’t need to be hospitalized and that she was capable of making her own medical decisions, after which the police ended their hunt.

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Medical students are skipping classes to the point that 25 percent of second-year students say they almost never attend lectures, relying instead on YouTube videos (like the one above from SketchyMedical) and other outside prep materials to ready themselves for the Step exams. They say those tests cover material glossed over in their med school courses. A student says, “That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step.” I observed that personally from a relative whose medical school attendance mostly involved listening to recorded lectures at double playback speed. This raises questions:

  • If medical school education is vastly different from the content mastery required to pass Step, is either set of knowledge incorrect or are students expected to complete a self-managed, dual-track education?
  • What’s the level of relevance of physician education to actual medical practice?
  • Medical education involves coursework, endless test-passing, and residency that takes many years and a ton of taxpayer money – is all of that really necessary for knowledge that quickly becomes obsolete?

Sponsor Updates

  • AdvancedMD announces AdvancedCQM, a free module to support MIPS Quality Reporting.
  • Aprima will integrate payment solutions from ClearGage.
  • Florida HIE Services expands its Encounter Notification Service, powered by Audacious Inquiry, to FQHCs.
  • The KLAS Performance Report 2018 identifies Agfa Healthcare as a “strong and guiding partner” for health systems rolling out enterprise imaging.
  • Arcadia CMO Rich Parker, MD and Sales Engineer Stefanie Groner will speak at the CHESS Move to Value Summit August 19 in Winston Salem, NC.
  • AssessURHealth receives Greenway Health’s 2018 Partner Rookie of the Year Award.
  • Practice management vendor Nextech Systems will integrate and co-market Solutionreach’s patient relationship management product suite.
  • Burwood Group names Renee Lawrence (Ingram Micro Cloud) director of product marketing.
  • CarePort Health and Clinical Architecture will exhibit at the SHIEC Annual Conference August 19-22 in Atlanta.
  • The Better Business Bureau awards CompuGroup Medical US BBB Accreditation and an A+ for customer care.
  • The Angel Investor’s Network podcast features Datica CMO Kris Gösser.
  • CoverMyMeds will add its electronic prior authorization app to the Greenway Health Marketplace.
  • Diameter Health will present at the SHIEC Annual Conference August 21 in Atlanta.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 8/14/18

August 13, 2018 Headlines No Comments

Watson Health: Setting the Record Straight

IBM SVP John Kelly rebuts a Wall Street Journal article that called Watson Health’s effectiveness in oncology into question, saying that, “To suggest there has been no patient benefit is to ignore both what we know The Wall Street Journal was told by a number of physicians around the world and these institutions’ own public comments.”

Microsoft, Amazon, Google, IBM, Oracle, and Salesforce issue joint statement for healthcare interoperability

Amazon, Google, IBM, Microsoft, Oracle, and Salesforce pledge to break down barriers to interoperability at the CMS Blue Button 2.0 Developer Conference in Washington, DC.

Staffers are fleeing as central Maine hospital system is roiled by turmoil

Central Maine Healthcare EVP David Tupponce admits the health system’s Cerner EHR has been a big contributing factor to high physician turnover.

Google DeepMind’s AI can detect over 50 sight-threatening eye conditions

A study conducted at Moorfields Eye Hospital in London reveals that DeepMind’s algorithms can detect over 50 eye conditions with 94-percent accuracy.

Curbside Consult with Dr. Jayne 8/13/18

August 13, 2018 Dr. Jayne 1 Comment

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For many of us in healthcare IT, our primary arenas of work tend to fall within hospitals and health systems, ambulatory organizations, payers, and the vendor space. There are plenty of subdomains within each of those areas, such as tribal health, community health centers, post-acute care hospitals, rehabilitation facilities, and more. I had the chance this week to dig into a segment of healthcare IT that I haven’t done much work in – a university health center. This is the time of year that millions of students are making the leap from college to the university environment, and I was pleasantly surprised to see how digital health is playing out in that space.

At the university in question, students submit their health histories and physicals online via a secure patient portal, including immunization records. Given the volume of international students, the system has to be configured to accept different types of immunizations and offer enough patient-facing help features so that the incoming students understand what they are documenting and can fill out the online forms accurately. Copies of examinations and records can be submitted online, either through scans from the student or via secure email from transferring physicians. I was pleasantly surprised that there were no fax machines to be found at the facility.

Once the initial records come in, a member of the health center staff reviews them with a couple of areas of focus. Immunizations are first, because without them or a notarized waiver document, students can’t attend. Many of the students receive diphtheria and tetanus boosters prior to attending, along with meningitis vaccinations. When I began to think of the size of the entering class, plus the number of transfer students, times the number of doses administered, multiplied further by the cost of the vaccines, it was a large number representing a significant healthcare investment. If the immunizations don’t meet the requirements, a nurse reaches out directly to the student to discuss the issue, eliminating any back-and-forth related to misunderstanding of the questions or errors in documentation. Students are directed to resources to obtain needed vaccines, rather than simply being told they need to get them.

If the student’s documentation passes the immunization requirement, the file is routed electronically to a different part of the clinical team for a general review. Histories are screened for chronic conditions which may require care from the student health team beyond the routine conditions that people typically assume are cared for at a health center. I was impressed by the level of review given to some of the files – given some of the “medical miracles” we’ve seen over the last several decades, students are coming to college with fairly complex histories and specific medical needs. There is a special team to perform second-level review on these files, flagging students with conditions such as congenital heart disease (often following surgical intervention), transplants, cystic fibrosis, and more. Often the students have included their own supporting information that they wanted added to the file, whether it is a transfer of care summary from their pediatrician or a recent referral or consultation letter from a treating physician. It’s a testament to these doctors “back home” as well as to the families of these students that the necessary information is being supplied up front so that the best outcomes can be possible.

Since the patients (students) in this situation are voluntarily attending the institution, and many thousands of dollars are being spent, nearly everyone involved has a vested interest in making sure they stay healthy. Students are made aware of all the services the student health center offers – psychological counseling, preventive services, treatment for sexually transmitted infections, interventions for chemical dependency and eating disorders, screening for depression and intimate partner violence, and more. It reminded me of what many of my community health center clients are trying to do, but on a less-fragmented and better-funded platform. Of course, students are able to find a physician in the community if they choose, but with a team like this, who would want to?

The student health center is more than a walk-in clinic. It staffs a couple of beds where students can stay overnight for observation or delivery of IV fluids for fairly straightforward illness such as gastroenteritis or medications for conditions like acute migraine headaches. The physicians have referral arrangements with a group of hospitalists, which is happy to accept student patients when they have more complicated conditions like influenza, pneumonia, or the occasional appendicitis. They run a women’s health clinic and an orthopedic clinic. Given the presence of an athletic program with a notable football component, I was pleased to see they have a concussion clinic to not only follow up on symptoms and management, but to work with the patients’ academic advisors and professors to address any ongoing cognitive issues.

All of this is being managed in a state-of-the-art electronic health record, hooked up to the state HIE and also to Carequality. They’re routinely sending data to students’ home physicians of record and are electronically managing consents to make sure they can talk to parents when appropriate or to other members of the students’ support systems. The clinic is all about interoperability and coordination because they can be and want to be, not because they have to be. Since they’re not billing Medicare, Medicaid, or commercial payers, they’re not subject to a lot of the regulations and box-checking that the rest of us are. It made me think I was stepping back in time to pre-2009, back when health systems were embracing technology because it was the right thing to do, not because they were being forced to. There was a level of enthusiasm back then and in this practice now that I don’t typically see.

I’ll be working with these folks for a while and am excited about it, not only for the opportunity to see a well-oiled machine and not have to fix very much, but also because of the providers. They are happy and it seems legitimate. Maybe it’s because their systems are optimized, maybe it’s because they don’t have to bill insurance, and maybe it’s because most of their patients are young and healthy with fairly self-limited conditions. Regardless, it’s a good way to experience a different part of the healthcare space and see what pearls of wisdom I can find as I continue on my travels. I’d be interested to hear from student health informaticists – their challenges and opportunities. It’s certainly a bit of a different space for me, but I like it.

What’s your favorite college fight song? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Rich Berner, CEO, MDLive

August 13, 2018 Interviews No Comments

Rich Berner is CEO of MDLive of Sunrise, FL.

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Tell me about yourself and the company.

I approach this as technologist, having grown up programming computers since fourth grade. I got into healthcare about 15 years ago, working in a variety of roles across a number of the big EMR and population health management companies. While I come at this as a technologist, I spend most of my day with teams and clients, getting them to focus on the outcomes versus technology.

MDLive was founded in 2009 and serves over 27 million members, providing virtual care for urgent care, behavioral health, and dermatology needs. We have over 1,200 clinicians across the country, operating in all 50 states 24/7.

Surveyed Americans love the idea of virtual visits, but the number who have actually experienced them is small. What will drive adoption?

Our greatest challenge is getting the word out there. People who use this service tend to come back about 1.8 times per year after the first visit. Where payers or employers are covering most of not all of the cost of the visit, we can get adoption rates as high as 30, 40, or 45 percent.

Have state-specific virtual visit restrictions mostly been eliminated?

2017 was an inflection point. It felt like the regulatory environment, payer environment, provider environment, and consumer demand came together. We’re seeing significant growth this year. Now you’re seeing CMS continue to talk about the future rules, and now that they are seeing the results, they’re going to be covering more types of visits virtually.

Have health systems mostly decided not to set up their own virtual visit service?

Whenever new technology comes out, people might be a bit threatened by it. But we have seen our hospital and health system clients view us as a partner, where they’re using our platform with their own clinicians, and where appropriate, they’re using our network to complement what they’re doing. We’re both trying to solve the same problem, which is how to improve the access and convenience of healthcare while increasing quality and driving down cost. We enable them to do that in partnership versus competition.

How do you recruit providers and prepare them to practice in a virtual environment?

We have nine years of hard work doing recruiting to bring these folks on board. They get credentialed with our groups. We also give them training, not only on the tools, but also things like webside manner and how you provide care virtually versus physically.

As a large, national medical practice, can you do a better job than small practices in terms of practicing evidence-based medicine and monitoring quality and patient satisfaction?

For our payer, employer, and even our health system clients, when you’re able to manage quality with fewer touch points, you have a better ability to drive quality initiatives. We’re doing it at scale across the nation. We definitely think that’s an advantage for us and our group to improve quality.

What expectations do virtual visit patients have and what do they like or dislike most often?

While many patients have a good relationship with their primary care physician, many don’t have a primary care physician at all. Or even if they do, for certain types of conditions, the most important thing they’re looking for is convenience or privacy. The ability to get the care they want, when they want, where they want. We are working with patients to identify situations when they are less likely to be satisfied. If they think they already know what the answer is and want a certain prescription or antibiotics or they have a condition that may not be appropriate to treat virtually, we do our best to identify that very early on in the process so they don’t get too far into a visit before recognizing that it may not be appropriate for virtual, or the condition they have may be different than they thought.

What patient information is available to the provider before the visit? What information from the visit is shared with the patient’s primary care physician or health system?

For our payer, employer, and hospital and health system clients that feed us data, the provider has access to all of the information that those organizations have. In addition, we have Sophie, our interactive chatbot, that collects a certain amount of data. We’re rolling it out this quarter, where she is automating the triage process so that the provider can get presented with predictive SOAP note. It’s our goal to give the provider as much of the patient’s story as possible before they see the patient, so that when they do, they can focus on the things that they were trained to do — empathize, educate, and make sure they get to that proper diagnosis quickly and develop the plan of care.

What technologies do your doctors use to document and complete the visit?

They choose the device they want to work from. Then we have a lightweight EMR that automates as much of the visit as possible to focus on letting the physician do what they’re trained to do, which is focus on the care they want to provide. We take out as much of the registration, billing, scheduling, and documentation as possible. We’re seeing this have a significant impact on helping solve one of the biggest problems that is out there, which is physician burnout.

What are the characteristics of doctors who most enjoy providing virtual visits and what is their satisfaction level compared to a more traditional setting?

We do surveys regularly and focus on addressing any concerns that are raised. We believe there will a movement for the rise of the virtualist. These will be classic clinicians who, more and more, want to do this full time, similar to the hospitalist movement in the 1990s. We are seeing a broad array of physicians who want to do this, from millennials who want work-life balance to people who are getting near retirement and want to pull back from the shifts but still want to be able to provide care and focus on care rather than a lot of the administrative stuff.

Are providers satisfied with working episodically and not having ongoing involvement with that patient’s overall health?

I’ll answer in two ways. One, our physician satisfaction is higher than most national groups and survey averages that we’ve seen. They get a lot of real-time feedback. Once consumers become aware of this service and use it, they are so thankful for not having been forced to go to the emergency room or urgent care or driving 50 miles. They are getting that real-time feedback. They’re also getting feedback from surveys. For a lot of our clinicians, the patient can select if they want to schedule an appointment with the physician versus see one in real time, so a number of our clinicians see the same patient when they request a visit with the same clinician.

Does the patient choose the doctor or their location before the visit begins? How is a patient matched with a provider?

The clinician they ultimately see has to be licensed to provide care in that state. The consumer has the ability to say, I want to see the first available, or I want to schedule an appointment from a list of clinicians who are licensed to practice in the state.

Are you seeing doctors seeking medical licenses in multiple states just to prepare themselves for offering virtual visits?

Yes. The vast majority of our clinicians have multiple licenses.

What are the benefits of virtual care for people who are seeking counseling or psychiatric services?

As much as 40 percent of the population has behavioral issues. Many of them aren’t getting addressed, either because of access or embarrassment. We’re excited about providing these services virtually, which gives these people the ability to do it in the privacy, comfort, and convenience of their own home.

How will virtual visits change in the next 3-5 years?

We’ve done great work over the past two to three decades in automating the healthcare industry with electronic medical records, population health management systems, and even incorporating genetic information to make sure plans of care are personalized. But we still fundamentally haven’t disrupted the healthcare industry or the way care is provided. Telehealth represents a real opportunity to disrupt healthcare — to put it on the consumer’s terms and to give them care where they want, when they want, and how they want.

Looking out three to five years, we can see a healthcare system where a large portion of primary care is not only provided virtually, but is also automated and optimized through things like artificial intelligence and machine learning and with chatbots like Sophie, to help make that shift to proactive, predictive health management as well as care.

Do you have any final thoughts?

We’re extraordinarily excited about the opportunity in front of us. It’s not often that you can provide a service that’s better for the consumer, better for the clinician, and better for the healthcare system overall. Consumers can access it conveniently, clinicians can focus on providing care, and quality and cost will improve. It’s an exciting time for MDLive and the healthcare system overall.

Morning Headlines 8/13/18

August 12, 2018 Headlines No Comments

IBM Has a Watson Dilemma

The Wall Street Journal posts another critical review of IBM Watson Health for oncology, saying that “the diagnosis is gloomy” for Watson’s ability to improve cancer treatments.

Cory Wiegert Named New CEO of CancerLinQ LLC

CancerLinQ, a non-profit data initiative of the American Society of Clinical Oncology, hires Corey Wiegert (IBM Watson Health) as CEO.

Lawmakers Decry Trump “Cronyism” at the VA

Legislators call for VA Secretary Robert Wilkie to provide unredacted copies of his correspondence with President Trump’s informal VA advisors following ProPublica’s piece on the “Mar-a-Lago Crowd” and its influence on VA politics and programs.

FDA allows marketing of first direct-to-consumer app for contraceptive use to prevent pregnancy

In an agency first, the FDA approves marketing of the Natural Cycles birth control app as part of its fast-track approval program for digital health devices.

Monday Morning Update 8/13/18

August 12, 2018 News 4 Comments

Top News

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The Wall Street Journal posts another critical review of IBM Watson Health for oncology, saying that “the diagnosis is gloomy” for Watson’s ability to improve cancer treatments.


Reader Comments

From Axe the Fax: “Re: fax machines. Finally someone is pushing to get rid of them in healthcare.” We healthcare folks are always embarrassed by technologies that, while understandably outdated in the consumer arena and in other industries, are nearly perfectly suited for our needs. We have a zillion things wrong with the healthcare non-system, and fax machines and pagers — while emblematic of healthcare’s resistance to change – can be swapped out whenever a provider finds a better alternative (and while CMS has jumped on the bandwagon, I bet they still require providers to fax in information to support claims or information requests). Fax machines are the one form of interoperability that data-hoarding and technically incompetent providers can’t suppress, and in that regard, are disruptive in their own way. They require no training, they always work, and incoming faxes are easily noticed and sorted without sitting down with a keyboard. I wish we would save the righteous indignation and smarmy dismissiveness for things that should truly embarrass us, like poor value, self-serving clinical and administrative practices, and treating patients like the widgets of profit. We spent billions of taxpayer dollars on EHRs, and while they allowed health systems to preen about their high-tech wonderfulness, most of those providers didn’t see their cost or quality needle move one iota and neither will dumping fax machines – a better hammer doesn’t necessarily make you a great carpenter.


HIStalk Announcements and Requests

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Most poll respondents don’t like the idea of someone having to file bankruptcy over medical bills. PFS_Guy says people don’t manage their money well and he doesn’t have good answers on how to help them, hoping that those in need look to charity or hospital financial assistance programs. Greg Park advocates Medicare-for-all because the profit-driven system preys worst on those with little or no insurance. Cosmos says someone has to pay for medical care, and if your short-sighted, invincibility-fueled decision to not buy insurance turns out to be unwise, you should have to take financial responsibility, including filing bankruptcy if needed. He adds a hypothetical example in which someone’s life is saved with a million-dollar hospital bill – is it unreasonable that bankruptcy gives that health system part of your life’s income in the form of a repayment plan? 

New poll to your right or here, continuing with the theme and getting right to the heart of today’s healthcare debate: Is it OK for insurers to charge sicker people higher health insurance premiums or refuse to cover them as was common pre-ACA and is about to become common again? A follow-up question might ask what should then be done when someone quickly runs out of resources and simply signs up for Medicaid so taxpayers foot the bill.

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Responses to last week’s question are here.

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We’re in peak vacation season, which raises this week’s question: what have you done with time off that turned out to be especially motivating, enriching, or transformative? Something that changed your life, maybe? Those of us looking for something beyond the usual vacations need some guidance.

Here’s my favorite quote of the moment, which I thought of upon biting my lip as an acquaintance who is dying of cancer explained that she still puts in endless work hours because nobody else can do her job: “Graveyards are full of indispensable men.”


Webinars

August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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This should stir up some debate. FDA approves the first “gene-silencing” drug that treats a rare nerve destruction disease. The company spent $2.5 billion to develop Onpattro and will sell it for $450,000 per patient per year, including a money-back guarantee. The chief medical officer of Express Scripts applauds the company for “taking a responsible approach to pricing and patient access in the rare disease space.” About 50,000 people worldwide have the condition, of which 100 percent will want the drug versus the approximately 0.0 percent that can afford to pay for it. What do you do?


Decisions

  • Abington Hospital (PA) went live with Oracle HR software in January 2018.
  • Southeast Georgia Health System (GA) will go live with Kronos HR information system in September 2018.
  • Wake Forest Baptist Health (NC) plans to switch from Oracle HR information system to a new vendor that has not yet been chosen.
  • Sedgwick County Health Center (CO) switched from Azalea Health to MedWorks on February 1, 2018.
  • Parkside Psychiatric Hospital (OK) went live with Paycom HR software in spring 2018

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Ashish Sant (McKesson) is named SVP/GM of enterprise imaging of Change Healthcare.

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CancerLinQ, a non-profit data initiative of the American Society of Clinical Oncology, hires Corey Wiegert (IBM Watson Health) as CEO.


Announcements and Implementations

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Mobile Heartbeat launches CURE Analytics, which allows users of its mobile communications platform to improve communications processes and quality and to add communication data to a data warehouse.

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LOINC releases its FDA-funded “Guide for Using LOINC Microbiology Terms.”


Other

The government of India develops “e-mortality” software, hoping to improve on the 90 percent of death records that are not medically certified to include ICD-10 codes that indicate the underlying and contributing causes.

Minnesota’s health department finds that an appendectomy can cost as little as $6,600 or as much as $35,500, due not to which hospital is doing the work or how risky a particular patient is, but rather the secret price negotiations between health systems and insurance companies. Hospitals with little competition charged 15 percent more and patients are getting stuck with ever-higher bills because of high insurance deductibles and co-pays. 

In the UK, Alder Hey Children’s NHS Trust wants to use Microsoft HoloLens for a heads-up display for surgeons and Surface Hub for single-screen collaboration in sharing EHR data and medical images.

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Guess which country isn’t home to this market research firm whose website self-aggrandizes its “well-endowed research teams headed by true curators of talent and strong-headed individuals?”

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Weird News Andy confides that he heard about this in a tweet. A bronchoscopy reveals that a four-year-old boy’s mysterious, whistling-like cough is being caused, in fact, by an actual toy whistle.


Sponsor Updates

  • Medicomp Systems is exhibiting at Greenway Health’s Engage18 customer conference in National Harbor, MD August 10-13.
  • Iatric Systems posts a case study titled “Prevent Third-Party Breaches, Protect PHI, and Avoid the “Wall of Shame” with Iatric Systems SecureRamp.”
  • Black Book updates its mobile healthcare survey apps.
  • Liaison Technologies achieves record-breaking growth in the first half of 2018.
  • Lightbeam Health Solutions will exhibit at the SHIEC Conference August 19-22 in Atlanta.
  • Vyne President and CEO Lindy Benton joins the Florida State University Alumni Association National Board of Directors.
  • MedData’s Pulse intranet software wins ThoughtFarmer’s annual Best Intranet Awards in the Innovation category.
  • Surescripts will exhibit at the 2018 Aprima User Conference August 17-19 in Grapevine, TX.
  • SymphonyRM and ZappRx achieves AICPA SOC 2 Type 2 compliance.
  • TriNetX releases the agenda for its annual user conference September 25-26 in Boston.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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What I Wish I’d Known Before … Turning 40

That perception is nine-tenths of reality.


In the work context, learn how to spot an incompetent and/or malicious boss faster and get out quicker instead of trying to hold on because I liked the company. Job hop sooner, avoid the suffering, and find the good team. Regarding personal spending, committing to a higher level of savings to make retirement possible five years earlier. (Age 60, likely to work past 65)


That I’d be divorced the year I turned 40 because (in part) I traveled too much for my job.


I wish I’d understood more the importance of good body mechanics and specific techniques to maintain optimum physical health. It’s so easy to think you’re going to be able to do everything you do in your 20s and 30s but much of your bad habits won’t ‘tell their tales’ until after your in your 50s and 60s. Moral of the story: Never underestimate the importance of taking your body in for it’s regular maintenance and tune-ups!


I’m playing catch up now and often wonder how much better shape I could be in.


That I wouldn’t feel that much older! And that listening to coworkers moan about turning 25 would be extra hilarious.


Two things: the impact that a career can have on a family. A co-worker helped me with this one when I considered returning to school to get a bachelors degree with kids nine and 10 years old. She said, “Why do you want to go back to school? Because if you think you will get paid more, that may not be the case” AND how important it is to grasp opportunities as the “right” time will never come. An executive took me to lunch at the nicest place in town and offered me a position in management. I declined, stating that I was not ready, but maybe in six months. Well, the six months never came and the executive was one of the most successful in the company. Lesson learned, especially since we were both female.


I wish I had known before I was 40 that as a female salesperson, I didn’t have to, nor should I have to, put up with sexist behavior like having the sales team go out for drinks at a strip club after team meetings. Luckily much of that B.S. has become acknowledged as inappropriate, but before I was 40, I thought I had to blend in. No more blending, boys!


That turning 50 and 60 are a heck of a lot harder. Just a number and not a milestone!


That job hunting is exponentially harder. Despite claims to the contrary, ageism exists.


Life not only gets busier, but goes by quicker. Work to live and don’t live to work.


Trusting yourself that you can start a business and learn to be productive and likely successful long before you turn 40.


That your 40s are awesome if you let them be.


Quality of life makes a BIG impact on your business. Stress can ruin you from the inside out. Do not let your business ruin your health. Incorporating meditation, exercise, and getting adequate rest to reduce stress levels will improve working smarter. And incorporating meditation, exercise, and rest gives you time for a fresh perspective. Sometimes it’s best to not respond immediately!


That before I knew it, I would be 60.


Save, save, save. And all of the little pains.


Weekender 8/10/18

August 10, 2018 Weekender No Comments

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Weekly News Recap

  • CMS releases a draft rule that would overhaul the Medicare Share Savings Program
  • UnitedHealth Group is reportedly the only non-financial company that’s in the running to acquire Athenahealth
  • Northwestern Medicine (IL) lays off 60 IT employees after completing its Epic go-live
  • CVS Health adds MinuteClinic-branded virtual consults from Teladoc to its CVS Pharmacy app
  • Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged $35 to $100 for each booked appointment instead of paying just an annual fee
  • Allscripts announces that it will sell its joint venture stake in behavioral technology vendor Netsmart
  • Henry Ford Health (MI) signs its first direct contract with an employer, touting Epic’s MyChart as a patient perk for GM employees

Best Reader Comments

Auto insurance is required in all 50 states, with two limited exceptions: NH, where you are still personally liable for damage done, and VA, which requires you to pay $500 annually if you don’t want to insure. The premise for these laws actually map quite well to healthcare. Imagine without the legal requirement – one person without insurance crashes, damages a building, injures a bunch of people, and ultimately declares bankruptcy to avoid the expense for liability. Everyone else gets to cover the tab. Requiring insurance puts money into the system to spread some of the risk. (Ummmmm)

CommonWell hooks itself up to the rest of the world! Only three years late and still not generally available. (DoD will be first in line once it’s ready, so as to exhibit “leadership,”right?) This is the great golden spike moment for interoperability – except with the Carequality Railroad traversing the entire continent to connect CommonWell San Francisco trolley network. (Vaporware?)

[Project] branding becomes important at this scale. With departmental or smaller implementations, using the vendor/product as a brand isn’t usually a problem. However once you hit “whole organization” level systems, as you do with an organization-wide EMR/EHR, putting a bit of distance between you and the primary vendor becomes important. (Brian Too)

I worked in an organization that had policy of renaming all vendor systems to a name of the organization’s choosing. Although this might seems confusing, it was actually very useful. Many implementations consisted of more than one licensed product so calling it the name of the dominant product wasn’t accurate. It also reinforced the notion that it was our system running our processes for our patients and members. The name was first coined for the initial implementation and stayed with the system through retirement. Our marketing people were definitely involved because the names were thoughtfully chosen and reflected the purpose of the system and the aspirations of the organization for the benefits it would bring. (A Rose By Any Other Name)


Watercooler Talk Tidbits

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Reader donations funded the DonorsChoose teacher grant request of Ms. J in Missouri, who asked for building materials for her classroom of mostly refugee students whose primary language isn’t English. She reports, “This has been an extremely valuable learning tool in the classroom and very motivating for the students. We have done three challenges so far. The one in the pictures was to build a house. It had to have certain components, like a window, a door, some furniture on the inside. When the students finished their creations, they shared about them (first with a partner, then with the whole group). The reason I had them share with a partner first was so they could improve their houses with additional ideas. They really like their remodeling stage. Once we shared out as a whole group, the students wrote about their houses. We have done similar projects with math shapes and animals. The students love it when we get out the Legos. They are excited to hear about the challenge and their discussions of what fits in the expectations and what does not are amazing. Their reasoning is incredible. Thank you for providing these experiences for my students. Their ability to use their language and reasoning to convey their ideas will serve them very will as they move through school. We know that they are learning – even if they just see it as ‘Lego Challenges.’ We are grateful for all you do to support the growth of students — linguistically, socially, and academically.”

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In Germany, neuroscientist and empathy expert Tania Singe, PhD is accused by current and former colleagues of being overly controlling and prone to bullying. They claim she had little empathy of her own, reserving her harshest behavior for pregnant employees — denying moms-to-be parental leave, calling them slackers who would need to work twice as hard to make up for their absence, and telling one who had miscarried that she would no longer be allowed to keep doctor appointments during work hours.

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CNBC gets a first look at augmented reality headset Magic Leap, which has been shrouded in secrecy during its seven years of development and $2.3 billion in investment. The $2,300 developer’s edition is now available and the writer’s experience was mixed, saying it’s pretty cool to view a 3-D world being displayed on untethered goggles, but it’s hard to describe what the device does, there’s no way to show real screenshots since the human brain does the processing, it has limitations with ambient brightness and displaying human-like field of vision, and it will probably take years to get the product ready for mass consumption. Potential medical uses include supporting surgeries and offering chats with an AI-powered image of a doctor, but then again those use cases didn’t save Google Glass. 

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The ambulatory surgery center lobbying group urges members to post positive comments on locally republished copies of a Kaiser Health News article that describes the lax state of ASC regulation. KHN found that state rules vary widely such that oversight of injuries and deaths can be minimal and doctors who have lost their hospital surgical privileges for misconduct are free to open their own surgery centers. One surgery center for colonoscopy had two patients die in the same month during what is normally among the safest of surgical procedures, and in at least 17 states, surgery centers don’t have to report patient deaths. 

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A Pittsburgh local news site’s guest op-ed piece by healthcare transformation organization Lown Institute says UPMC’s planned $2 billion expansion should not be allowed or the health system should be stripped of its non-profit status, observing that UPMC receives $200 million per year in tax breaks but wants to build three high-profit specialty hospitals (cancer, transplant, and heart care) that don’t address local health needs such as obesity, asthma, binge drinking, and health disparities. UPMC wants to market the hospitals to wealthy patients abroad and wants to build two of them in suburbs where the percentage of insured residents is higher. UPMC CEO Jeffrey Romoff says, “UPMC desires to be the Amazon of healthcare.” Romoff was paid $6.9 million in UPMC’s most recently reported fiscal year, joining 32 UPMC executives who earned more than $1 million.

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A New York Times opinion piece written by a hospice nurse and book author says more attention should be paid to the gut feelings of nurses, which she says aren’t really feelings but rather the clinical judgment that results from years of personal observations and experiences. Theresa Brown, RN, PhD notes that doctors generally ignore those feelings as documented in the EHR’s nurse notes. She talks up the Rothman Index, which combines EHR data – including that generated by nurses – to provide an early warning system for detecting at-risk patients. I interviewed co-creator Michael Rothman, PhD way back in 2010, but his comments are even more valid today:

We extract the amount of risk which is inherent in the value of each of these measurements and come up with a single score. Now in a sense, that’s what a doctor or nurse does when they go in. They come up with an overall sense of how the patient is and a good doctor does it well, or a good nurse does it well. But the problem is if a doctor is rushed, a nurse is rushed, how completely can they really evaluate all the data that’s there? Even even more importantly, do they really know how that patient was the day before when maybe this is the first time they’ve ever seen the patient? Getting that trend is very difficult to do, even if you’re a doctor and you’re sitting down and studying what’s in the medical record. It’s hard to figure out what the trend is, especially if it’s a gradual deterioration.

There’s one other thing, and that is, doctors tend to look at three things when they’re doing an evaluation. They look at vital signs, they look at lab tests, and they look at the last doctor’s notes. However, there is a source of information that they tend to overlook, and that is the nurse’s assessments. The nurses do what is called “the head to toe assessment” of the patient. It’s something that’s taught at nursing school. They evaluate each physiological system and they record it on the computer. Really, doctors don’t look at it. One of the things that we’ve done is we’ve said, “Hey, this is actually very valuable information about how someone is.” So we used nursing data in the calculation of our score. It gives the doctor access to something that he doesn’t normally look at.

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Total property values of Madison and Dane County, WI have exceeded that of the city and county of Milwaukee for the first time even though Milwaukee has nearly triple the population of Madison. Dane County’s population grew by 40.7 percent from 1988 to 2017 – largely driven by technology companies such as Epic — while Milwaukee County had just a 1.5 percent increase.

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Bizarre: doctors coin the term “Snapchat dysmorphia” to describe teens who seek plastic surgery to “look better in their selfies” and to make them look like their Snapchat-filtered selves.The JAMA Facial Plastic Surgery article summarizes,

Social media apps such as Snapchat and Facetune are providing a new reality of beauty for today’s society. These apps allow one to alter his or her appearance in an instant and conform to an unrealistic and often unattainable standard of beauty … it can be argued that these apps are making us lose touch with reality because we expect to look perfectly primped and filtered in real life as well. Filtered selfies especially can have harmful effects on adolescents or those with BDD [body dysmorphic disorder] because these groups may more severely internalize this beauty standard.

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Of course hacker conference attendees would quickly figure out how to override a hotel’s thermostat and then tweet out instructions so colleagues can try it at their own hotels. The guy above was asked whether it’s a tampering felony to mess with a hotel’s thermostat, which is says isn’t because it’s an intended feature of the thermostat (as long as the hotel doesn’t make guests sign a EULA before using, he says with nerd tongue in cheek).

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A 2 1/2-year-old toddler leaves Boston Children’s Hospital for the first time, having spent her entire life on a ventilator until she received a double lung transplant in September. It’s a feel-good (no pun intended) story as long as you can suppress your curiosity about what it cost and who paid.


In Case You Missed It


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Morning Headlines 8/10/18

August 9, 2018 Headlines No Comments

Pathways To Success: A New Start For Medicare’s Accountable Care Organizations

CMS Administrator Seema Verma summarizes the 600-page, just-published proposed rule that would overhaul the Medicare Shared Savings Program.

Amazon has plans to open its own health clinics for Seattle employees 

Amazon will open primary care clinics for employees at its Seattle headquarters with a pilot getting underway this year.

Connecting to Epic: Un-Users Group Meeting

Epic will hold its first Un-Users Group Meeting at its Verona campus on September 26, with an agenda aimed at non-Epic using provider leaders who want to exchange information with Epic customers.

UnitedHealth in second round of bidding for athenahealth

UnitedHealth Group, Bain Capital, and TPG are among the second-round bidders in the running to acquire Athenahealth.

News 8/10/18

August 9, 2018 News 1 Comment

Top News

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CMS Administrator Seema Verma summarizes the 600-page, just-published proposed rule that would overhaul the Medicare Shared Savings Program in a Health Affairs blog post.


Reader Comments

From Glandular Enlargement: “Re: MED3000. Heard that McKesson will stop supporting it at the end of the year.” Unverified. That revenue management product hasn’t received much attention since McKesson bought it in 2012.


HIStalk Announcements and Requests

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This weekend’s Monday Morning Update just won’t be the same unless you provide wisdom on what you wish you’d known before turning 40 (assuming you’re 40 or over, of course, otherwise feel free to read this weekend).


Webinars

August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Analytics and CRM company Trilliant Health raises $12 million in a Series A funding round. The company came together last year through the merger of Aegis Health, Clariture Health, and Expression Health Analytics. The unification coincided with the hiring of Hal Andrews (Shareable) as CEO.

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After hiring hundreds to implement its Epic system, which went live in March, Northwestern Medicine (IL) lays off 60 IT employees in an increasingly common thanks for a job well done.

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Insiders say that Amazon will open primary care clinics for employees at its Seattle headquarter with a pilot getting underway this year. Amazon’s primary care expertise includes Martin Levine from Iora Health, Christine Henningsgaard from One Medical, and Atul Gawande, MD, CEO of the company’s joint healthcare venture with Berkshire Hathaway and JPMorgan Chase.

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App-based New York City prescription delivery service Capsule raises $50 million.

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Dealreporter says that UnitedHealth Group Bain Capital, and TPG are among the second-round bidders in the running to acquire Athenahealth.

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Health and wellness technology vendor Dynamic Healthcare Strategies acquires the Connect patient check-in and secure communications technology from CrossChx and renames it DHS SecurePass. CrossChx announced last week that it was renaming itself Olive following a $33 million funding round that will allow it to move into AI-powered healthcare automation.  


People

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CHIME names Jennifer Ramstrom (Connection) VP of CHIME Technologies and the CHIME Foundation.

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Salesforce promotes Keith Block to co-CEO alongside co-founder and chairman Marc Benioff.

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Jennifer Musich-Rehmann (Cerner) joins Goliath Technologies as VP of corporate development.

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Recondo Technology promotes Heather Kawamoto to the new role of chief product officer.

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Justin Collier, MD (HCA) joins technology solution provider World Wide Technologies as US East CMIO.

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Just Associates names Robin Gates (NextGate Solutions) as VP of sales for the southern region.


Sales

  • Torrance Memorial Integrated Physicians and Torrance Health IPA (CA) select population health management and risk adjustment software from Evolent Health.

Announcements and Implementations

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Teladoc beats out American Well and Doctor on Demand to supply virtual care consults for CVS Health’s new MinuteClinic-branded offering in the CVS Pharmacy app. Aetna, which CVS is in the process of acquiring for $69 billion, rolled out Teladoc-powered visits to its members several years ago.

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ActX announces GA of GenoAct, a genetics-based, clinical decision support service embedded within a provider’s EHR.

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Epic will hold its first Un-Users Group Meeting at its Verona campus on September 26, with an agenda aimed at non-Epic using provider leaders who want to exchange information with Epic customers. The $100 registration fee includes transportation to and from the hotel; a welcome reception; a crash course on data exchange (Carequality, Care Everywhere, HIE, and Direct) and Epic’s patient offerings (MyChart, Share Everywhere, Lucy, and Blue Button); lunch with Epic developers; interoperability success stories from Sutter Health and Children’s Health System of Texas; an overview of coordinated care; and an optional campus tour.

Behavioral health management company Beacon Health Options will offer virtual consult services from MDLive to its customers, including employers, payers, Medicaid programs, and military personnel.

Boston Children’s Hospital will add Buoy Health’s smart symptom checker to its website. The hospital will work with the Boston-based startup on future AI product development.

England’s Cambridge University Hospitals goes live on Epics’ EpicCare Link, which allows medical practices to view the hospital information of shared patients.


Government and Politics

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A ProPublica piece on President Trump’s unofficial VA advisors, known to Washington insiders as the “Mar-a-Lago Crowd,” paints a picture of behind-the-scenes maneuverings by a good-old-boys network intent on shaking up VA leadership with little government oversight or healthcare knowledge. The trio – Marvel Entertainment Chairman Ike Perlmutter, Bruce Moskowitz, MD, and lawyer Marc Sherman – seem intent on privatizing the VA, and may have had a hand in stalling the agency’s decision to move forward with the Cerner deal. Insiders are now waiting to see if newly appointed Secretary Robert Wilkie will seek the their approval or move forward with staffing and project decisions on his own terms. 

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An HHS OIG report finds that Medicare Part D spending for compounded creams and ointments increased 24-fold from 2010 to 2016 and triggered a bunch of fraud cases. OIG recommends that CMS clarify its policies; that it remind companies providing the coverage that they can make it exception-driven; and that it recommend utilization management tools. OIG also suggests that CMS investigate 550 pharmacies that drove most of the charges that also had questionable billing (a high percentage of patients receiving compounded products, repeated billings for the same items, a high per-prescription cost, high dispensing for a specific prescriber, and a big billing increase from 2015 to 2016). OIG also suggests reviewing 124 prescribers who ordered more than $250,000 each of compounded prescriptions from those questionable pharmacies, many of them crossing state lines that suggest no doctor-patient relationship existed. This is a brilliant use of claims data, although it’s always frustrating to realize just how CMS’s pay-and-chase policies allow robbing the system for years without much danger of serving time.

The 10-Q quarterly report filing of Community Health Systems discloses that the for-profit hospital operator is the subject of unspecified investigations related to Meaningful Use payments and running servers that still use Windows 2003.


Privacy and Security

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Open-source EHR and practice management software collective OpenEMR issues a software update after patching security vulnerabilities found by cybersecurity consulting firm Project Insecurity. The vulnerabilities, found through a manual review of source code, could have given hackers the ability to access patient records and system data, upload files, and execute system commands.

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Tweeting from the Black Hat USA conference, @drnic1 discovers that the FDA is thinking about creating a CyberMed Safety Analysis Board that would weigh in on the “assessment and validation of high-risk/high-impact device vulnerabilities and incidents.”


Other

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A hospital consortium in South Korea, led by Asan Medical Center, will invest $32 million to develop an AI-based, precision medicine support tool Korean physicians are likening to IBM’s Watson. Dubbed Dr. Answer, the software will diagnose and offer treatment options for eight conditions, including heart disease, breast cancer, dementia, and prostate cancer.

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A CoverMyMeds survey of 1,000 patients on prescription pricing transparency finds that:

  • Half did not fill their prescriptions at the pharmacy because of cost.
  • 37 percent stopped taking a medication because it was too expensive.
  • 75 percent have been prescribed medications that cost more than expected.
  • 87 percent wish their provider knew medication costs at the point of care.

Sponsor Updates

  • CompuGroup Medical sponsors the Bowling for Barrow event in Scottsdale, AZ that raises funds for Barrow Neurological Institute’s Concussion and Brain Injury Center. CGM USA also earns BBB accreditation and an A+ for outstanding customer care.
  • EClinicalWorks will exhibit at the CPCA 2018 Billing Managers Conference August 14-15 in Monterey, CA.
  • Imat Solutions and Iatric Systems will exhibit at the SHIEC Annual Conference August 19-22 in Atlanta.
  • InterSystems will exhibit at the Medical Enterprise Systems Conference August 13-16 in Portland.
  • Intelligent Medical Objects will exhibit at Greenway’s Engage conference August 10-13 in National Harbor, MD.
  • Loopback Analytics adds its Connector App to the Epic App Orchard.
  • Audacious Inquiry publishes a new white paper, “Technology Reuse: Want to Avoid Recreating the Wheel?”

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 8/9/18

August 9, 2018 Dr. Jayne 3 Comments

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Throughout my medical training, my early days in practice, and during countless go-lives, I’ve experienced some degree of sleep deprivation. I look forward to weekends when I’m not seeing patients and when I can sleep in, trying to (at least psychologically) catch up on all those “lost” hours. Today my hopes were dashed, with news that sleeping too much might be bad for one’s health. Researchers conducted their analysis using combined data from three million patients across numerous studies. They concluded that sleeping more than the recommended 8 hours can be associated with a higher rate of death. The study, published in the Journal of the American Heart Association, also proposes that poor sleep quality can be associated with cardiovascular disease.

Sleeping for 10 hours was linked to a 30 percent higher risk of death, where the nine-hour threshold was linked to a 14 percent higher risk. The National Sleep Foundation’s guidelines recommend 7-9 hours of sleep for most adults under age 65 and 7-8 hours for the retirement set. It’s not just about the number of hours, though – increased sleep can be associated with underlying chronic diseases that cause fatigue or increase sleep including thyroid dysfunction, anemia, depression, and other conditions. Decreased activity levels and unemployment can also negatively impact sleep, as can social, psychological, and environmental factors. The authors note that clinicians should further explore both duration and quality of sleep when assessing patients.

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I’ve been doing some work with an organization that is considering enhancements to its clinical decision support capabilities. They’re looking at adding some provider dashboards along with peer data transparency as a way to drive adoption of clinical protocols. A recent study looked at how well physicians adhere to guidelines for prescribing certain cholesterol-lowering drugs. The physicians who had visibility into the prescribing habits of their peers showed a significant increase in prescriptions for statin drugs. The authors designed the study to be outside the EHR in order to better measure its effect and to create an ideal design. They did note, though, that although use of dashboards can increase compliance with guideline-based prescribing activities, the dashboards “may need to be designed to better fit within clinician workflow.” They also surmised that there may be better response to communications from physician and practice leaders rather than from researchers.

More frequent reminders or provision of peer data may also make a difference. I worked with a startup a few years ago that used single sign-on (SSO) technology to make that kind of dashboard data visible for individual patients at the point of care, but they had some challenges with overall adoption of the SSO platform that effectively killed the patient-centric display of data. The authors also noted that their approach allowed for physicians to complete the intervention by prescribing medication outside of an office visit. They note the challenge that “physicians with larger patient panels may face difficulties managing these types of decisions outside of their traditional clinic model when they receive a long list of eligible patients at one time without additional support.” They conclude that there may be benefit in delivering regular feedback over a longer period and leveraging “multiple opportunities to address gaps in care for smaller subsets of patients.”

When I was reading the article, I was having flashbacks to the annual “report cards” that a couple of my insurance plans would send to my practice before the days of EHR. They’d have large lists of patients who were identified as missing services. They were created using only claims data, and since they were only sent out annually, there was a high likelihood that they were outdated. The arrival of the reports would send my staff into a mad scramble of chart-pulling and review, followed by outreach to patients to determine whether they had the services somewhere else, paid cash, or attended a free screening. If not, we’d arrange the services. If they did, we’d have to get copies of the data, update the charts, prepare a response to the payer, and get ready to start the cycle over again once the next payer’s packet arrived. Of course, there was no coordination between the cycle on which I received my reports and when my partner received his, or among payers, so it seemed like we were in a state of constant chart-pulling and review. Thinking back, I have to laugh – we could have completed the exercise in the EHR in a matter of hours rather than days, assuming we hadn’t already identified those gaps in care and acted on them ourselves.

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WalletHub released its list of “Best & Worst States for Health Care” this week. The analysis looked at 40 measures of cost, quality, and access across the 50 states and the District of Columbia. Vermont, Massachusetts, New Hampshire, Minnesota, and Hawaii led the list based on aggregate scores; North Carolina, Arkansas, Alaska, Mississippi, and Louisiana round out the bottom. My own state lands somewhere in the middle, which really doesn’t make me feel that much better. There are also lists looking at average monthly insurance premium cost, hospital beds per capita, physicians per capita, and more.

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I’m a sucker for healthcare IT-related headlines, even though they may be clickbait. I was drawn in by mention of a CMS call to put an end to physician office fax machines by 2020. CMS Administrator Seema Verma delivered this challenge as part of a push for digital health information, leading up to the Blue Button 2.0 Developer Conference that starts next week. There wasn’t much more meat on the bone here, but I was suckered into reading nevertheless.

I continue to see fax machines in most of the offices I visit, even those that are live on nationwide data-sharing platforms. It’s not just physician practices that are complicit in the continuing need for “faxes” even if they are generated and received electronically. I recently had a change in my pharmacy benefit manager, which requires that either my physician fax a prescription to them or that I mail in a paper document. I specifically asked about electronic prescribing and the phone agent said no – even though I know they accept it – so giving that message to patients is not helpful. I mentioned to the phone agent that when I order new contacts, I can send a photo of my script to the vendor to speed things along – no such luck for drug prescriptions. I guess I’ll wait the advertised 10-12 days until my script comes in.

When is the last time you used a fax machine? Leave a comment or email me.

Email Dr. Jayne.

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Reader Comments

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