Morning Headlines 2/18/20

Google to restructure Cloud business, with some roles eliminated

Shortly after closing its $2.6 billion acquisition of analytics startup Looker, Google announces layoff plans within its Cloud business as part of an overall restructuring that it says will help it better compete in five markets, including healthcare.

TTUHSC El Paso, TTP El Paso partner with Paso Del Norte Health Information Exchange

Texas Tech University Health Sciences Center El Paso and its physicians group have joined the Paso Del Norte HIE.

TapestryCare completes Series A Financing Led by Sopris Capital

Skilled nursing facility telemedicine company TapestryCare will use a Series A investment to expand into home health.

Curbside Consult with Dr. Jayne 2/17/20

It was a wild and crazy weekend, as I got to experience what it was like to get rained on with 100,000 of my closest NASCAR friends. The race was postponed, so I get to do it again Monday, minus the presidential visit and military flyover since I doubt they’re going to send Air Force One and the Thunderbirds again.

I’ll be spending a lot of time in airports trying to get home due to the changes. When I fly, I usually try to catch up on continuing education or read something for my book club, because it doesn’t matter as much if I get distracted versus trying to do actual work. Most of my continuing ed journals are in the realm of emergency medicine or primary care, so I was happy to run across an interesting read in the healthcare IT arena.

A couple of days ago, a “published ahead of print” manuscript authored by some prominent clinical informaticists made some waves. Appearing in the online version of the journal Academic Medicine, it addresses the idea of commercial interests in continuing medical education, and how electronic health record vendors play a role.

Looking back 20 years, there was a great deal of continuing education that was sponsored either directly or indirectly by pharmaceutical companies. During medical school, pharmaceutical representatives would bring breakfast to a session with the not-so-subtle title of “Drugs and Donuts.” They would talk about their products and when they should be used, and I don’t doubt this led to heavy prescribing of the products.

A few years later, this evolved to a more subtle sponsorship of our Grand Rounds lunchtime lectures, where it was obvious who was paying for the steaming pans of sweet and sour chicken and what drug they sold. The reps no longer addressed the crowd, but were available to detail folks afterwards and hand out promotional items. At my school, some of these sessions were accredited for formal continuing education credits and the objectivity of the program was addressed, but others were much looser.

As the authors note, the Accreditation Council for Continuing Medical Education (ACCME) won’t give accreditation to commercial entities that produce, market, resell, or distribute health care goods or services used by or on patients. However, they will accredit academic institutions and other bodies who want to provide credit for courses they sponsor, and those institutions can accept pharmaceutical funding.

For now, ACCME doesn’t categorize EHR vendors as commercial interests and thus provides them accreditation to deliver continuing medical education. The authors note, “Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor’s EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care.” They continue to “call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.”

I’ve had the opportunity to attend CME sessions put on by multiple vendors. They vary greatly in their content and how much general education is given versus how much it is really just a veiled training session. Some of the best sessions I’ve been to revolve around newer models of care delivery such as Patient-Centered Medical Home, Chronic Care Management, or Transitional Care Management. A good session will include an in-depth discussion of how the programs benefit patients, what they entail, how to bill for them, and what outcomes you might be able to glean from using them. Only a small percentage of the session is actually learning how to document the program in a given EHR. Bad sessions are little more than click-by-click directions for how to use the EHR, with CME provided to entice providers to attend when they otherwise didn’t participate in training.

I fully agree that being able to execute a workflow well in the EHR is beneficial to patients, as their data is more likely to be documented accurately and comprehensively. That doesn’t necessarily make a class worthy of continuing education credits, but I’ve seen it done.

The authors go on to explain why EHR vendors should be considered commercial entities. They note, “Even though the 21st Century Cures Act excluded EHR systems from the Food and Drug Administration’s (FDA’s) oversight they should be considered medical devices similar to pacemakers, insulin pumps, and CT scanners, which are all under the purview of the FDA. No other commercial device or technology is used more often by physicians and other health care professionals than EHRs.”

One of their major points is that when EHR vendors sponsor CME sessions, they focus only on the vendor’s system and its benefits without mentioning competitor options. “Because every EHR system has intrinsic limitations, attendees are not adequately trained on alternate ways to solve problems… Instead of learning best clinical informatics practices and challenging the vendor to improve its product, attendees are presented with only the vendor’s worldview, which may result in their suboptimal or inappropriate use of EHR products or services on patients.”

One of their comments particularly resonated with me: “EHR vendors focus physicians’ attention on future enhancements to their systems so physicians may miss opportunities to implement available solutions that are more congruent with the needs of their patients, organizations, and the community.” I’m still waiting for an enhancement I requested back in 2006, despite the fact that other vendors include the request in their core functionality. Because the vendor kept promising it, there was no way my employer was going to fund an alternative solution.

The authors made some outstanding points, which was to be expected since several of them are leaders in the American Medical Informatics Association. This fact prompted a statement from AMIA noting that the article wasn’t reviewed or endorsed by the AMIA board of directors. Regardless, the AMIA statement calls on the ACCME to “recognize and consider the potential for bias when HIT vendors offer education to health care professionals” and goes further to urge ACCME to define EHR vendors as “commercial interests” in the same way that pharmaceutical or device manufacturers fit the definition.

AMIA states that although education on the use of EHR products is appropriate and relevant, it may not be appropriate for continuing education credit. The AMIA board asks CME organizations to “establish rules and processes by which they may support certified CME in a manner that is independent and unbiased,” just like drug and device companies must.

Knowing what I know about the ACCME, it will likely be some time before they respond to these calls to action. I’ll be curious whether they make a decision or whether they take it under advisement for further review. For many physicians who stay current in their specialties, it’s not hard to accrue all your required CME hours without relying on vendor-sponsored hours. Many of my colleagues have two to three times the number of mandatory hours simply but doing what they’re already doing to further their knowledge for patient care. I’ve got a couple of friends on vendor CME committees, and I’ll reach out and report back on what they have to say.

What do you think about EHR vendor-sponsored continuing medical education credits? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Is Healthcare Ready for a New Era of Transparency?

Is Healthcare Ready for a New Era of Transparency?
By Miriam Paramore

Miriam Paramore is president and chief strategy officer of OptimizeRx of Rochester, MI.

It’s not only patients who are demanding greater transparency around healthcare costs. It’s physicians and state and federal government officials. In just one year – January 2021 – a new federal rule will go into effect that requires all hospitals to post standard charge information, including discounted cash prices, payer-specific negotiated charges, and charges for at least 300 “shoppable” services, such as imaging, lab tests, and outpatient visits.

The rule, and associated rules for insurance companies, point to a new era of transparency driven by deepening healthcare consumerism. Increasingly, patients will be armed with data that allows them to guide their healthcare decisions in coordination with their healthcare providers, ultimately leading to more patient-centered care.

But this transparency also changes the patient-provider relationship. It’s never been more important to give both patients and doctors tools to navigate care options efficiently, allowing them to work together to make the best healthcare decisions, personalized to each patient.

The hard truth is that out-of-pocket healthcare costs for consumers continue to soar, creating notable financial burdens for patients and negatively impacting medication adherence and clinical outcomes. Amid continued growth of high-deductible health plans, deductibles alone rose 26% in 2019 from 2008, and expenditures are expected to continue to rise in 2020. Consequently, patients increasingly look to their providers for financial guidance and assistance.

Consider the impact of treatment cost on the day-to-day interactions between physicians and their patients. In May 2019, dermatologist Jack Resneck Jr., MD, chair of the AMA Board of Trustees, testified before Congress in a hearing on high drug prices about the experience of one of his patients. He noted that the wholesale price of the patient’s medications had quadrupled in price over the past 15 years. Faced with a pre-deductible PPO copay of 40%, the patient made the choice to stop his treatment. It’s stories like this one that contribute to rising healthcare costs.

Non-optimized medication therapy, including non-adherence, is linked to $528 billion in potentially avoidable healthcare cost. Notably, the vast majority of patients discuss healthcare costs with their doctors, according to a recent survey of 642 physicians across a variety of specialties. Doctors want patients to take medication that works for their health and their pocketbooks, and they know that one is often dependent on the other.

In the same survey, doctors indicated an overwhelming willingness to engage in these cost conversations with patients. Eighty-six percent of physicians surveyed indicated that they are comfortable discussing health care costs with patients, and over 90% believe they have a role to play in discussing healthcare costs with patients.

So how does the healthcare industry make these conversations part of standard practice? New platforms that build on healthcare providers’ existing electronic health records to streamline the reams of data – pharmaceutical options and costs, drug compatibility and patient adherence – are an important piece of the puzzle. Physicians need access to the data the pharmaceutical industry maintains, such as pricing and saving opportunities, while in the examining room with patients. Digital communication pathways that provide these resources to physicians will facilitate informed discussions that will ultimately drive a patient’s decision to follow through on recommended treatment.

Greater transparency is better not only for patients, who will have the opportunity to work in concert with providers to get the healthcare they can afford, but also for doctors, who will have access to the drug cost information their patients are requesting and to increase the likelihood of their patients following through on recommended care. Doctors already know that discussing drug cost is essential: 73% of physicians in the survey indicated that they feel the patient’s responsibility for cost is important when making a prescribing decision.

Digital tools are poised to facilitate this new era of transparency and improve healthcare outcomes and patient and physician success rates. Let’s make sure we encourage their implementation in time to move seamlessly into a patient-centered healthcare future.

Morning Headlines 2/17/20

Feds probing how personal Medicare info gets to marketers

HHS OIG finds that CMS’s lack of oversight of its Medicare Part D eligibility database has allowed companies to submit millions of inquiries to harvest the personal health information of Medicare beneficiaries, potentially for use in telemarketing scams.

Innovaccer, the Leading Healthcare Technology Company, Raises $70 Million From Tiger Global, Steadview Capital, Dragoneer, Westbridge, Mubadala and M12 (Microsoft’s Venture Fund)

Patient records aggregator Innovaccer raises $70 million in a Series C funding round, increasing its total to $120 million.

Flywire Acquires Simplee to Transform Healthcare Payments Experience

Payments company Flywire acquires healthcare payments platform vendor Simplee.

Monday Morning Update 2/17/20

Top News

HHS OIG finds that CMS’s lack of oversight of its Medicare Part D eligibility database has allowed companies to submit millions of inquiries to harvest the personal health information of Medicare beneficiaries, potentially for use in telemarketing scams.

OIG looked at 30 pharmacies that are heavy users of the system – which processes E1 transactions that verify prescription eligibility — and found that 98% of them weren’t filling prescriptions for the patients whose information they retrieved. Those 30 providers submitted nearly 4 million eligibility verification transactions from 2013 to 2015.

Four of the pharmacies allowed outside telemarketers to use their provider numbers to do their own patient lookups. One provider had agreements to provide patient data to six marketing companies, who used that provider’s ID to submit 100,000 E1 transactions. An unnamed pharmacy management software company’s access was blocked after it responded to a CMS questionnaire.

HHS OIG has launched an investigation that it says will include several providers.

The report recommends that CMS (a) monitor providers whose E1 transaction volume is high compared to the number of prescriptions they submit; (b) issue guidance to remind users that E1 transactions cannot be used for marketing; and (c) make sure that only pharmacies and other authorized entities are submitting E1 transactions.

In a possibly related story, Surescripts terminated network access to healthcare data vendor ReMy Health last fall, claiming that the company was requesting patient and insurance information using the NPIs of providers who hadn’t treated those patients and then selling the information to drug marketing websites, including Amazon’s PillPack pharmacy. ReMy Health’s website is offline and former president Aaron Crittenden’s LinkedIn says he left the company this month and now serves as a business consultant for prescription discount vendor GoodRx.

Reader Comments

From Nightly Job: “Re: Atrium Health. Confirming that it is moving to full Epic in replacing Cerner and other systems. No announcement was made, but kickoff meetings start this week.” I assume that replacement includes Macon-based Navicent Health, a longtime Cerner user that Atrium Health acquired last year. Atrium Health has nearly as many hospitals and employees as AdventHealth, which announced last week that it will also replace Cerner with Epic.

From Bicuspid: “Re: clinical software implementation and upgrades. What are some best practices for getting go-live user feedback and providing updates?” I can only speak from my personal experience, but here you go:

• Make it easy for users to communicate with someone who understands their software and job. Traditional help desk triage isn’t good for that since users don’t want to get stuck in the call queue knowing that the person they’ll get probably can’t help them.
• Get support people out of the war room and onto the floors to interact with users. Assign each person an area to cover and have them do a twice-daily walk through to seek feedback. An “ask me” brightly colored T-shirt or vest helps.
• Meet with key groups at their shift change so you can catch two sets of users at once to hear issues and communicate status. You’ll know things have settled down when there’s little left to talk about.
• Send  a daily or twice-daily email that includes a description of newly reported problems, closed problems, and issues that are being investigated that require more examples. This lets frontline people know that problems are actively being solved and calls attention to the issues they may experience. It also saves everybody time in avoiding duplicate problem reports.
• Assign each problem a severity and include the new/open/closed count in the daily email.
• Include user tips in the daily email update, which you glean from support calls and observed issues
• Put together quick Camtasia videos showing how to perform specific functions that seem to be misunderstood and link to them from a website or the update emails. This is a good way to show users any configuration changes they will experience (night shift and offsite employees are otherwise hard to reach).
• Get problems to the vendor or any other groups promptly and keep your own record of what was reported, who’s working in it, and when resolution can be expected.

From Piney Woods: “Re: [medically related site name omitted.] They haven’t shut down yet like Health Data Management, but they are cutting back on conference coverage and have started running vendor propaganda pieces for cash, which they swore they would never do.” I’ve decided that Epic is to health IT news sites as Craigslist was to newspapers. They have marginalized or killed off a lot of software companies that advertised, and since Epic doesn’t run ads for the most part, that leaves a big void for sites that until recently had all kinds of cash-waving vendors jockeying for eyeballs. Sites with high expenses or an unattractive audience of non-decision makers will have to shrink for sure now that the Meaningful Use gold rush is over. Some of the health IT sites are so inexpertly done that I’ve always marveled that they commanded advertisers even in boom times, but this particular somewhat related one is the only site I envy for its quality, the community it has created, and the smart way it monetized that audience without shamelessly pimping itself out.

HIStalk Announcements and Requests

Only 40% of poll respondents think employers use their employee wellness programs and apps to rid themselves of workers who incur high medical costs. Alex says we overestimate employers since they probably don’t even remember that they offer wellness programs until contract renewal time. T. Morris says companies would be stupid to risk being called out for such behavior, but another respondent’s firsthand experience is that companies target employees with cancer or even those who have taken maternity leave. Realistic CIO says self-insured employers surely track their high-utilizer employees and/or family members, but most aren’t heartless enough to shed that cost as much as they would probably like to do so.

New poll to your right or here: Which organization would you trust to keep your identifiable health information private? (you can check more than one).

Listening: new from Violent Soho, a long-time Australian hard rock outfit that sounds remarkably like prime time Pixies and thus elicited my frantically unskilled air drumming. Spotify’s “Fans Also Like” option led me to the just-reunited Children Collide, which also sounds good.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Patient records aggregator Innovaccer raises $70 million in a Series C funding round, increasing its total to $120 million.

Payments company Flywire acquires healthcare payments platform vendor Simplee.

People

Julie Murchinson, MBA (Health Evolution) joins Avia as executive in residence.

Announcements and Implementations

Dimensional Insight  partners with Stoltenberg Consulting to offer a service desk performance visibility and accountability analytics.

HIMSS announces COVID-19 related plans for the conference:

• HIMSS is working with foreign registrants who have to cancel because they will be in China within 14 days of the conference and can’t get into the US.
• They are asking hotels and the convention centers to adhere to CDC and WHO disinfection procedures.
• Orlando health systems will provide input on the conference’s emergency response plan.
• Three medical offices will be operated in the convention center, one of them dedicated to attendees who have flu-like symptoms.

Other

London’s Royal Free Hospital blames a Cerner upgrade error for the non-delivery of 30,000 letters to patients and doctors over six months, with the hospital convening an internal inquiry into whether patients were harmed as a result.

The local paper covers the use by Medical City Dallas’s use of robots from Diligent Robotics for deliveries.

I was surprised when a reader told me that Health Data Management has shut down abruptly after 25+ years. Parent company Arizent — which renamed itself from SourceMedia a month ago – recently restructured under a new CEO, who replaced the whole executive team and announced plans to move beyond B2B publications. Arizent is owned by Observer Capital, whose initial holding was Jared Kushner-founded publisher Observer Media. I’m puzzled that they’re closing the HDM doors instead of selling, although maybe they tried and found no takers. They’re also killing off Information Management magazine.Fun fact: Bahrain-based private equity firm Investcorp paid $350 million for SourceMedia in 2004, split off the business unit that assigns banking routing numbers in 2009, sold that business for $530 million in 2011, and then sold the rest of the company in 2014. I’m sure Lorre will make it easy for any interested former HDM advertiser to become an HIStalk sponsor.

An article in Academic Medicine calls for EHR vendors to be treated like drug companies in not being allowed to offer accredited continuing medical education. The authors say EHR vendors could use CME events to influence doctors who are involved in EHR decisions.

Psychologists and public health experts explain why people all over the world are unreasonably scared of COVID-19 – which has infected just a handful of Americans and caused just 1,100 deaths worldwide – when plain old flu killed 34,000 Americans last year and 61,000 the year before. They say human brains evaluate threats irrationally:

• Press coverage of COVID-19 fatalities makes it seem like a big, dangerous problem, when in fact 98% of people who have it are recovering.
• Flu creates the opposite perception, where people underestimate the danger because they only see people who recover uneventfully.
• The human mind is conditioned to pay the most attention to new threats, not longstanding ones like flu and automobile accidents.
• Upsetting imagery, such as city lockdowns and overcrowded hospitals, makes the risk seem higher.

Doh!

Sponsor Updates

• The local business paper profiles MDLive’s role in treating flu patients.
• Meditech provides decision support and guidance for COVID-19.
• HealthPartners enlists Patientco for Epic-integrated payment processing.
• Netsmart will exhibit at the GA Hospice and Palliative Care Organization Annual Conference February 19-21 in Athens.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN California Section Conference February 20 in Long Beach.
• Redox releases its latest podcast, “Healthcare Data Privacy Rights with Attorney Matthew Fisher.”
• Spok publishes an e-book titled “How to improve clinician experience through better communications.”
• Relatient will exhibit at the HFMA Region 5 Southeastern Summit February 18-21 in Charleston, SC.
• TriNetX offers turnkey protocol and site feasibility analyses on a per-study basis.

Blog Posts

• Making the Case for Patient Financial Quality and Medical Quality (Loyale Healthcare)
• 7 tips for finding the right tablet set-up for your hospital’s ESignature project (Meditech)
• Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritize Patient-Centered Outcomes (Health Catalyst)
• Revenue Cycle Management Technology You’ll Love (Patientco)
• Three Practices that Pharmacists can Apply to Protect Profits from the Slippery Slope of Retail Drug Pricing (OmniSys)
• EMR experts support lab outreach managers to boost services outside the hospital (OpenText)
• Three ways to make patient collections more compassionate (Experian Health)
• 5 Patient Payments Trends That Could Affect Your Urgent Care’s Revenue Cycle in 2020 (PatientBond)
• Preventing Patient Leakage with In-Network Referrals (PerfectServe)
• Dating Strategy or Malware Technique? (SailPoint Technologies)
• AI and the Future of Healthcare (EClinicalWorks)
• Be the Change You Want to See in the (Healthcare) World (Surescripts)
• Bringing joy back to medicine: Battling burnout through better EHR optimization (TransformativeMed)
• How small practices tackle big RCM challenges (Waystar)
• 4 Ways Referral Marketing is Like Dating (WebPT)

Sponsor Spotlight

AGS Health provides revenue cycle and coding services that ease our customers’ administrative and financial burden, enabling them to focus on their core mission of high-quality patient care. We do this by delivering unprecedented quality and liquidation results, often delivering 3-4x ROI. (Sponsor Spotlight is free for HIStalk Platinum sponsors).

Contacts

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

Weekender 2/14/20

Weekly News Recap

• CVS talks up its in-store HealthHubs in its earnings call, saying its Aetna customers are interested in engaging with health navigators and its pharmacists can review a patient’s medical issues using both pharmacy and claims data.
• CPSI’s Q4 results beat expectations as the company says it is benefitting from Athenahealth’s withdrawal from the inpatient market and Cerner’s declining interest in selling to small hospitals.
• AdventHealth, which operates 67 hospital and ED facilities, announces that it will drop Cerner and several other EHRs and systems and replace them with Epic.
• The VA pushes back its planned March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April, saying integration isn’t ready.
• Open Source Electronic Health Record Alliance announces that it will shut down on February 14.
• Imprivata’s private equity owner is reportedly preparing the company for sale at a price in the $2 billion range.
• An article whose author includes the AMA’s burnout expert calls for EHRs to report standard efficiency metrics using their log data, including measures of how doctors spend their time.
• Nuance says in its earnings call that it will roll out its ambient clinical intelligence “exam room of the future” for five medical specialties in Q2.

Best Reader Comments

Another government response to the proposed interoperability rule that doesn’t actually address any of the privacy concerns that the letter / follow-up post contained. If he’s going to talk about walking the walk, then they need to be seriously pushing for HIPAA to be expanded in a way that accommodates the environment they’re trying to create.(Ex-Epic Chiming In)

This isn’t the first time it’s been reported that Cerner did that pricing. Same thing happened at University of Illinois Chicago. They had such an old / customized version of Cerner that it was reported that the cost to basically rebuild Cerner and modernize it was the same cost or close to it as moving to Epic. Keep in mind that Cerner’s revenue on actual licenses for Millennium is minimal at best (check the earnings report). Their largest cash cow is their consulting organization. (Associate CIO)

Nurses were “rescheduling” the patient’s meds on the Medical Record to an hour later to avoid those [late med reason question] popups. This disguised the problem of how often medications were actually being given late. Sometimes it takes empathy and seeing the problem with your own eyes before we can really make things better. More data collection does not always make a better metric and can sometimes miss the mark. (Robert Buehrig)

Those metrics look decent for ambulatory usage. You really only want EHR vendors to expose these metrics rather than try to operationalize them because you don’t want the EHR vendor to decide how much of your time you should spend writing notes. That means that it’s going to be up to your management to respond to those metrics. (What)

I do worry that the metric of “undivided attention” suggests that ANY attention the doctor pays to the information about the patient in the record is considered to be not in the patient’s best interest. One could imagine taking that to an unproductive extreme. I suspect that most patients these days are counting on the doctor’s taking the time to become informed about their care. When I go to my internist, I am counting on his putting it all together and coming up with a plan. He can’t do that without breaking eye contact with me, and I am OK with that. (Andy Spooner)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. H in Pennsylvania, who asked for a new table for her elementary school class. She reports, “Thank you so much for our new table! This year we are lucky to have 22 students in our class, but were we pretty cramped at the old furniture that we have. Little by little I have tried to trade out our furniture for newer and more spacious materials. Thank you for being part of our growth!”

An Illinois pediatrician who committed suicide last fall left a note that suggested he regretted falsifying medical records over a 10-year period for parents who didn’t want their children vaccinated. Van Koinis, DO practiced holistic medicine and was sought out by parents who needed falsified vaccination records to allow their children to attend school. The sheriff warns that the ambiguity of the doctor’s note may also mean that he didn’t give vaccines even when the parents assumed that he did.

Corpus Christi, TX police arrest a hospital’s on-duty ED doctor for public intoxication after witnesses reported that he was belligerent and walking around the ED’s public area wearing only underwear.

Overworked clinicians in Wuhan, China are shaving their heads to make it easier to don makeshift hazmat suits and are using adult diapers to save bathroom break time. China has only two doctors per 10,000 people and many of them do not have degrees. Hospitals are running out of medical supplies, protective suits and masks, and food. Some doctors have been assaulted by people who were upset about wait times, while others reported that the hospital’s entire supply of N95 protective masks had been seized by hospital executives for their own use. 

CDC mistakenly tells a San Diego hospital that several of its patients had tested negative for Covid-19 even though the samples of three of them had not yet been processed, allowing them to be returned to military base quarantine. One of the patients was later found to be infected. CDC blames an unspecified labeling error that may have been caused by the hospital’s assignment of phony patient names to protect privacy.

Kenya has spent $625 million since 2015 to lease diagnostic medical equipment from companies like Philips and GE, but more than one-third of the machines are sitting idle in hospitals that don’t have radiologists to operate them. Critics say the government should have spent the money on clinics and midwives, speculating that diverting the money into procurement contracts gave health officials a chance to line their pockets. Hospitals say they weren’t asked about their needs and in some cases received unneeded duplicate machines. The health ministry refused the auditor general’s request to review the contracts.

In Case You Missed It

• News 2/14/20
• EPtalk by Dr. Jayne 2/13/20
• News 2/12/20
• AdventHealth Will Replace Cerner with Epic
• Curbside Consult with Dr. Jayne 2/10/20
• Monday Morning Update 2/10/20

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 2/14/20

CVS Health beats on fourth-quarter earnings and revenue

CVS Health reports Q4 results: revenue up 23%, adjusted EPS 1.73 vs. $1.68, beating Wall Street expectations for both.

Carevive Systems raises new financing round with Philips and Debiopharm to accelerate advances in cancer care delivery

Oncology-focused technology company Carevive Systems raises a Series C round of financing led by Philips Health Technology Ventures and Debiopharm Innovation Fund.

Computer Programs and Systems (CPSI) Surpasses Q4 Earnings and Revenue Estimates

CPSI announces Q4 results: revenue down 2%, adjusted EPS $0.78 vs. $0.78, beating Wall Street expectations for both.

News 2/14/20

Top News

CVS Health reports Q4 results: revenue up 23%, adjusted EPS 1.73 vs. $1.68, beating Wall Street expectations for both.

The company, which acquired Aetna in late 2018 and also owns the Caremark pharmacy benefits manager, is tracking at more than $250 billion in annual revenue.

CVS said in its earnings call that nurse practitioners in its drugstore-based HealthHubs can treat 80% of what a PCP can manage. However, the company also added that its Aetna members value their relationships with their PCPs are and looking for local health navigators in a concierge-type program.

CVS says its pharmacists are counseling patients on their health issues by reviewing their combined pharmacy and claims data. It is modernizing its business by using robotics, moving to a hybrid cloud environment, using AI and other technologies in its call centers, and applying analytics to employee scheduling.

CVS shares closed up slightly Wednesday following the earnings announcement. They are up 21% in the past year vs. the Dow’s 12% rise, valuing the company at $94 billion.

Reader Comments

From Fickle Pickle: “Re: Atrium Health. Surprised in your mention of AdventHealth’s planned replacement of Cerner with Epic that you didn’t mention Atrium Health’s plan to do the same, announced a couple of months ago.” I’m not sure I knew about that. The organization posted a a bunch of Epic-related jobs in mid-January. Atrium Health has nearly 50 hospitals and 65,000 employees.

From Half Wit: “Re: Children’s Mercy Hospital, Kansas City, MO. Stands to lose its $500K city subsidy, which coincides with the amount it paid for naming rights for the Kansas City, KS soccer field, home of the team previously owned by Cerner’s Neal Patterson before his death. The hospital says the loss of funding will greatly impact their operations since they rely on it to provide care for uninsured patients.” The city says it had to balance scarce resources and the hospital is making a profit, unlike other local organizations that provide services to children. The hospital’s most recent tax filing shows a $267 million profit on $1.4 billion in annual revenue. Health systems are profit-maximizing entities and this one is obviously hoping to get future profitable business from putting its name on a business whose customers are less likely to be on Medicaid and Medicare, but I can understand why the city might wonder why it is writing checks to a cash machine whose community benefit is indirect at best. The stadium previously bore Lance Armstrong’s Livestrong name – and apparently was paying that organization for the privilege instead of being paid – but that deal fell apart in 2013 when Armstrong finally admitted to doping accusations. I checked on how Livestrong and its ubiquitous yellow wristbands did after the revelations — it reported $15 million profit on $103 million in revenue in 2011, but that had dropped to an $11 million loss on $46 million in revenue in 2018. Fun fact: Armstrong’s Austin, TX coffee shop is named Juan Pelota Cafe, which is funny if you know Spanish and that he had testicular cancer.

HIStalk Announcements and Requests

Thanks to the folks who have responded to my annual reader survey. I’ll leave it open for another couple of days, then draw from the respondents for one or more $50 Amazon gift card winners (depending on the number of responses I get). Meanwhile, for the respondent who said they are pining for the return of the Smokin’ Doc, here you go from some T-shirts I had printed awhile back (and like most of my well-intentioned reader swag, that I got stuck with). I still have a box somewhere with several of the six-foot-tall Smokin’ Doc standees we used to display in the booth, and if I were more creative, I would turn them into some kind of Donors Choose fundraising opportunity.

Welcome to new HIStalk Platinum Sponsor Wolters Kluwer Health Language. Wolters Kluwer delivers powerful, innovative data quality solutions that are tailored to the needs of health systems, payers, health IT vendors, HIEs, researchers, and government. Its Health Language solutions transform disparate data assets to optimize reimbursement, regulatory compliance, operational efficiency, care coordination, and interoperability. Its healthcare content library of standard terminologies and custom content and value sets can extend existing data and provide a single source for content needs. The advanced Health Language software applications helps model, map, group, and search healthcare codes, all on a cloud-based platform. The global team of Health Language clinical experts—including physicians, nurses, pharmacists, and AHIMA-approved ICD-10 coders, and trainers—help ensure clinical data accuracy. Thanks to Wolters Kluwer Health Language for supporting HIStalk.

Dr. Jayne’s most recent post called out that most of the country will “spring forward” into Daylight Saving Time on March 8, which is the day before the official start of the HIMSS conference. Quite a few folks who live in the eastern parts of their respective time zones will enjoy leaving the convention center in semi-broad daylight with the palm trees waving.

Speaking of HIMSS, I keep putting off any planning for what Jenn, Dr. Jayne, Lorre, and I will do there, especially since I’m not exhibiting. Usually we just wander around looking and listening for insights to write about, but if you have ideas, let me know. I’ve activated my burner phone at 615.433.5294, although I probably will use it just for text messaging.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Meditation app developer Headspace will use $93 million in new financing to develop Headspace Health, which will offer mental health tools for chronic disease patients. Founder Andy Puddicombe boasts a degree in circus arts and ordination as a Tibetan Buddhist monk.

The Australian Financial Review notes the strong financial performance of imaging platform vendor Pro Medicus as it moves customers to the cloud. The company says US healthcare interest in cloud computing wasn’t significant until Mayo Clinic announced its partnership with Google Cloud. Most of the country’s revenue comes from the North American market, where it offers imaging products under the Visage name, and sales here were up 43% in the most recent six-month reporting period. Pro Medicus is adding AI capabilities and a breast density algorithm that it co-developed with Yale is waiting for FDA’s approval. The two co-founders each hold shares worth $500 million.

CPSI announces Q4 results: revenue down 2%, adjusted EPS $0.78 vs. $0.78, beating Wall Street expectations for both.

Sales

• Geisinger (PA) signs a six-year agreement with Omnicell for its automated medication dispensing systems.
• Memorial Sloan Kettering Cancer Center (NY) extends its Allscripts Sunrise contract through 2026.
• Atrius Health (MA) will implement provider search and scheduling software from Kyruus across its 30 practices.

Privacy and Security

Malware causes a system outage across facilities associated with the Pediatric Physicians’ Organization at Boston Children’s Hospital, which has not been affected. PPOC facilities went live on Epic several years ago.

Other

A small survey of health system providers and HIE staff conducted by the EHealth Initiative and NextGate finds that data-entry errors are the top cause of duplicate medical records. Over one-third of surveyed providers say they’ve incurred an adverse event within the last two years due to patient-matching issues. Providers say that a lack of funding and technology are the biggest barriers to patient-matching improvement, while HIE leaders point to insufficient funds and staff. Most respondents seem to be in agreement that federal funding should be made available for a national patient identifier.

The Chinese government develops an app that alerts users when they come into close contact with a person infected with Covid-19. Experts warn that the app may offer a false sense of security and non-exposure if it can’t detect people who are symptom-free.

A literature review of six smartphone-based skin cancer apps finds that they miss melanomas, produce false positives, are poorly regulated, and don’t inform users of their limitations. None of the six have received FDA approval.

A BMJ article ponders if AI can be trusted to not perpetuate racial bias and prejudice, listing the usual concerns of (a) training the system on a non-representative data set; (b) investor-backed companies whose incentive is to rush a product to market that isn’t ready; and (c) dermatology-focused products that don’t necessarily work equally well on patients of different skin colors. British AI researcher Eleonora Harwich refreshingly concludes in a non-BMJ sort of way, “There is so much hype around AI and these snazzy algorithms that sometimes I feel like people think it will absolve them of the need to think. It will never absolve you from having to think hard about big problems. Technology can’t choose what outcomes you want to achieve, or what type of society you want to be in. Those are very deep human questions that no one is going to answer for us. If you let them be answered for you, then you’re in deep shit.”

Sponsor Updates

• EPSi will exhibit at the HFMA Region 5 Southeastern Summit February 18-22 in Charleston, SC.
• HIMSS names Greenway Health CMO Geeta Nayyar, MD one of its 2020 Most Influential Women in Health IT.
• The HCI Group partners with the Tim Tebow Foundation’s Night to Shine in Jacksonville, FL.
• InterSystems releases novel coronavirus screening functionality for TrakCare.
• CarePort Health makes its CarePort Transition Extender available with Epic’s App Orchard.
• Capsule Technologies reports that its systems passed all required tests at the IHE North American Connectathon.
• The Chartis Group names Robert Faix (Impact Advisors) a principal in its I&T practice.
• Premier partners with Gavs Technologies to form a new joint venture, Long 80, which will bring AI-based IT and security operations to healthcare organizations.

Blog Posts

• AI and the Future of Healthcare (EClinicalWorks)
• How to Identify Network or Server Resources as Root Cause to Slow Session Performance (Goliath Technologies)
• Device Driver Interface Update Announcements (Capsule Technologies)
• Healthcare Delivered to the Patient – An Eye Exam in a Food Truck (InterSystems)
• Nordic’s first consultant reflects on 10 years at Nordic (Nordic)
• Who owns workplace culture? (Intelligent Medical Objects)
• 4 Questions With Ron McKinnon, Chief Information Officer, Ellis Medicine (Optimum Healthcare IT)

Sponsor Spotlight

Crossings Healthcare Solutions was established in 2014 to provide custom clinical decision support software that optimizes the Cerner Millennium System. Our award-winning MPages and Advisors solutions have been installed at more than 76 hospitals across the U.S., including California, Nevada, Texas, Oklahoma, Florida, South Carolina, Tennessee, Montana and Missouri, as well as Washington DC. These solutions are seamlessly integrated into clinical workflow to enhance usability, efficiency and communication. (Sponsor Spotlight is free for HIStalk Platinum sponsors).

Contacts

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

EPtalk by Dr. Jayne 2/13/20

My HIMSS schedule planning is being hampered by some kind of bug in Outlook, where the time zones aren’t displaying correctly for HIMSS week. They are accurate the weeks before and after, but the week of the 8th is a mess. I suspect it has to do with the time change to DST, but it’s weird. I’ve asked a couple of other Outlook users and they’re not having the issue, which leaves me doing all kinds of shenanigans with my calendar to make sure I know when and where I need to be. If you have any tips on this, or are seeing it yourself, let me know. I doubt too many people run three time zones on their calendars, so it may be a fairly limited problem.

Signing up for events at HIMSS is becoming more complicated. Gone are the days when you could just attend vendor events as a mere HIMSS attendee. Citrix is requiring people to be “qualified” to attend and will get back to me in 48 hours to let me know if I’m on the list. Others such as Capital One / Ziegler are a little more accessible. One of the things I loved about HIStalkapalooza was that everyone was invited – there was a great mix of people which led to lots of interesting conversations. I respond to invitations with my real name and credentials, so I’m getting a feel for how the average attendee is handled.

I worked some unscheduled clinical time this week in order to cover a colleague with influenza. I was surprised that the EHR had been upgraded with no notification or explanation. Although the changes were minor, it created an unsettled feeling as you wondered what was different that you might be missing. Although some of the enhancements were nice, a few missed the mark in that they were only partial fixes to issues. Our vendor is going through some growing pains and I’ve heard good things are coming, so I’ll remain optimistic.

The lack of notification may be part of an overall change in communication patterns for the practice, and not necessarily for the better. I’d love for them to hire me to put on my standard “Effective Communication Strategies” workshop because they’re not doing a great job. In order to prevent people’s email from being inundated, they’ve gone from a “push” communication strategy to a “pull” one, and unfortunately, it’s not working.

When I do my workshop as a consultant, I walk organizations through the creation of a communications matrix, where they define the different kinds of communications, the audience, and how they should best be delivered. For some critical communications, such as how to handle the novel coronavirus (now named COVID-19 by the World Health Organization), you might want to communicate in multiple channels and blast the important items to people via text or email.

Instead, our practice leadership sent an email that essentially said, “So that we don’t send you emails that would quickly become outdated, we’ve put everything on a website that you should check daily.” Unfortunately, the website doesn’t have a clear section that spells out “what’s new,” which means providers have to read through the whole thing and try to figure out what has changed since the last update. It’s not a terribly effective way to communicate key information in a rapidly evolving situation. I can pretty safely predict that people will just stop looking at it, much like they stopped looking at a quality improvement website that worked in the same way.

Several of my clients have reached out for advice on how to handle various aspects of the COVID-19 situation. If you’re not already freaked out about being exposed to germs because you’re part of the healthcare IT infrastructure, you might be when you hear the latest data. According to the Journal of Hospital Infection, coronaviruses can survive on surfaces for up to nine days, although the majority die after four or five days. Low temperatures and high humidity increase the lifespan. I wonder if vendors whose products include solutions for disinfection and sanitation will see an uptick in foot traffic at HIMSS.

I was glad to see that National Coordinator for Health Information Technology Don Rucker called out the hospitals that signed Epic’s anti-interoperability rule letter. He notes that only three in 100 academic medical centers signed it. He went further to criticize one of the signers, saying, “One of the signers of the letter is known for taking thousands of patients to court. If you take someone to court, that information becomes public discovery. Their medical care is now public. It’s part of the court record… Looking at protecting privacy, we need to walk the walk here as we look at who is saying what and letter-writing campaigns.” It’s always good to look below the surface – sometimes what you find is pretty interesting.

In other news from ONC, the Health IT Advisory Committee (HITAC) is launching a new task force, the Intersection of Administrative and Clinical Data Task Force. It will focus on connecting data standards to improve interoperability, reducing clinician burden, and improving efficiency. Additional information on task forces is available on the HITAC website.

A recent article noted that little news has come out of Amazon, Berkshire Hathaway, and JPMorgan Chase’s Haven since its founding. It last issued a public statement in March 2019. We’ll have to see if there’s any buzz around or after HIMSS. If anyone has anything to share, feel free to reach out and we’ll keep you anonymous.

If you’re still doing your Valentine’s Day shopping, there’s always the Samsung Galaxy X Flip phone, which launches on February 14 in the US. It’s got a slick one-inch OLED display on the cover that shows notifications when the phone is closed, and when the phone is open, you can use it as a full-screen or split-screen display for different apps. The screen is rated for 200,000 folds, which based on the phone habits of some teens I’ve seen lately, might last a year. Is $1,380 too much to pay for someone’s undying love and affection?

Email Dr. Jayne.

Morning Headlines 2/13/20

HealthLynked Signs Definitive Agreement to Acquire Cura Health Management, LLC, and ACO Health Partners, LLC Adding Significant Revenue and Profitability from Its Newly Formed Accountable Care Organization Division

Membership-based patient and provider network HealthLynked acquires Cura Health Management and its ACO subsidiary for $1.75 million.

Scoop: Headspace raises $93 million

Meditation app developer Headspace will use a $93 million funding round to develop mental health tools for chronic disease patients.

WELL Health Announces Agreement to Acquire MedBASE’s OSCAR EMR Business

In Canada, Well Health Technologies acquires MedBase Software’s Open Source Clinical Application Resource (Oscar) EMR assets.

Boulder raises $10.5M to expand access to opioid addiction treatment

Addiction-focused telemedicine startup Boulder raises $10 million.

Morning Headlines 2/12/20

One of the nation’s largest health systems drops Cerner

Florida-based AdventHealth, renamed from Adventist Health System just over a year ago, will replace Cerner with Epic.

VA delays rollout of new electronic health record

The VA pushes back its scheduled March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April.

Intuitive Surgical Expands Into Hospital Informatics With Orpheus Medical Acquisition

Da Vinci robotic surgery system vendor Intuitive Surgical acquires Orpheus Medical, which offers a video documentation system for surgery.

3M Sues IBM in Contract Spat Over Health-Care Software

3M’s Health Information Systems division accuses IBM and its Truven Health Analytics business of using 3M software to sell data to customers without the proper licensing agreements.

Malware attack disables medical records at Children’s Hospital affiliates

Malware causes a system outage across facilities associated with the Pediatric Physicians’ Organization at Boston Children’s Hospital.

News 2/12/20

Top News

AdventHealth – the  Florida-based health system that was renamed a year ago from Adventist Health System – will replace Cerner with Epic.

An anonymous AdventHealth employee says the health system was discouraged by the work that would be needed to address Cerner’s ambulatory and revenue cycle shortcomings. That person also said that consolidating AdventHealth’s three prod domains to one – those systems can’t communicate with each other now – would cost nearly as much as buying Epic, which its physicians wanted.

Another anonymous AdventHealth employee had predicted the switch two months ago, saying that the health system was frustrated with Cerner’s revenue cycle offerings, its lack of integration with its ambulatory system, and the redirection of the company’s focus to its DoD and VA work.

AdventHealth also uses Athenahealth and several other EHRs that will be replaced by Epic.

The three-year project will begin within the next two weeks.

AdventHealth is among the country’s largest non-profit health systems. It operates 67 hospital and ED locations, generates nearly $20 billion in annual revenue, and employs 83,000. It is not related to California-based Adventist Health, which recently terminated its Cerner revenue cycle outsourcing contract.

Cerner shares closed up slightly Tuesday.

Reader Comments

From Newser Nabob: “Re: AdventHealth. Why was it breaking news that it will move from Cerner to Epic?” It’s important when one of the country’s largest health system decides to spend billions to switch EHRs, especially if you are one of 125,000 people who work for Cerner, Epic, or AdventHealth; if you own CERN shares; or if your company does business with AdventHealth or might get the opportunity to do so with a vendor change. It would be equally newsworthy if a similarly sized organization announced plans to move from Epic to Cerner.

From Rolling On: “Re: Advocate Aurora Health. Massive Epic go-lives, with 15 hospitals last weekend in Wisconsin and the central lab that performs 15 million tests annually going up on Beaker. This weekend, three hospitals including Advocate Children’s that total 1,000 beds on all modules. No issues.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor 314e (it’s an abbreviation for Pi, explained here). Services offered by the San Francisco-based health IT-only consulting firm include EHR (advisory, implementation, training, go-live support, optimization); interoperability (interfaces, data conversion and archiving, FHIR); analytics (BI, data science, AI); technology (programming, cloud adoption, automation, testing); and managed services and staff augmentation. The company has completed over 200 EHR implementation engagements, 180 of them Epic, with consultants averaging four certifications and eight years of Epic implementation experience. It also has Cerner and Meditech expertise and has contributed to projects involving EClinicalWorks, Athenahealth, and NextGen Ambulatory. Thanks to 314e for supporting HIStalk. 

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Workforce management system vendor OnShift, which focuses on the senior care market, acquires Avesta Systems, which sells talent acquisition software.

McKesson begins the process of selling its majority stake in Change Healthcare, offering MCK shareholders the chance to exchange their shares for discounted shares in SpinCo, the subsidiary that holds its Change Healthcare ownership.

Da Vinci robotic surgery system vendor Intuitive Surgical acquires Orpheus Medical, which offers a video documentation system for surgery.

Open Source Electronic Health Record Alliance (OSEHRA) — which focuses on the VA’s soon-to-be retired VistA system — will shut down Friday.

People

Caroline Macumber, MS (Apelon) joins Clinical Architecture as EVP of professional services.

Announcements and Implementations

Medicomp adds clinical content and updates its clinical AI engine to include terms and mappings to support the documentation, reporting, and treatment of the 2019-NCov coronavirus strain.

Government and Politics

The VA pushes back its scheduled March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April. Schedule user training has been cancelled as the implementation team continues work on integration with other VA systems. Meanwhile, the VA requests $2.6 billion in 2021 to continue the rollout.

Other

Forbes reports that the DEA is asking EHR vendors to provide EHR patient information to help it investigate suspected opioid overprescribing. It says that EHR vendor DrChrono provided 9.3 GB of medical records in response to a DEA records request involving a small Arkansas medical practice.

CNBC reports that Google Health has grown to more than 500 employees who work from its Palo Alto, CA office under VP David Feinberg, MD, MBA. 

Interesting: the insurer for Utah’s state employees is paying for flights to Mexico for a test group of 10 people who get their prescriptions filled there. The state saves 50% of the $62,000 annual cost of arthritis drug Enbrel for a single patient, even after paying for airfare. Patients must take four trips per year because federal drug importation law allows them to bring back just a 90-day personal supply.

Sponsor Updates

• Wolters Kluwer and Ariadne Labs celebrate their 10-year partnership providing UpToDate access to clinicians in resource-limited settings through the Better Evidence program.
• The Boston Business Journal profiles Kyruus, highlighting the fact that the company plans to soon add 100 employees.
• AdvancedMD becomes a corporate sponsor of the Association of Independent Doctors, offering half-off membership discounts to select applicants.
• Avaya donates communications solutions to Wuhan Vulcan Mountain Hospital to help care for coronavirus patients.
• Burwood Group will host an axe-throwing mixer on Valentine’s Day at STL Axe Throwing in St. Charles, MO.
• The local news covers ConnectiveRx’s expansion plans in Pittsburg, including the addition of 1,500 jobs.
• The Digital Healthcare Podcast features Diameter Health CEO Eric Rosow.

Blog Posts

• Survey Says: 96% Don’t Have an E-Signature Solution for Bedside Consents (Access)
• Critical KPIs You Should Know and Measure (AdvancedMD)
• How to survive as a Director of BI heading into 2020 (Bluetree)
• Using Technology to Reduce Avoidable Readmissions (Collective Medical)
• CoverMyMeds Campus Update: Rapid Growth Fuels Faster Investment in Our People and Our Community (CoverMyMeds)
• Five Ways Data Analytics Support Success with Value-Based Care (Dimensional Insight)

Sponsor Spotlight

PatientKeeper’s EHR optimization software solutions streamline physician workflow, improve care team collaboration, and fill functional gaps in existing hospital EHR systems. With PatientKeeper as the “system of engagement” complementing the EHR system of record, physicians can easily access and act on all their patient information from PCs, smartphones and tablets, improving physician satisfaction, efficiency, and patient care. PatientKeeper is used by more than 70,000 physicians at hospitals and health systems across North America. (Sponsor Spotlight is free for HIStalk Platinum sponsors).

Contacts

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

AdventHealth Will Replace Cerner with Epic

Florida-based AdventHealth, renamed from Adventist Health System just over a year ago, will replace Cerner with Epic, Cerner has confirmed.

AdventHealth operates 67 hospital and ED locations, reports nearly $20 billion in annual revenue, and has 83,000 employees, placing it among the largest non-profit US health systems. It signed its first deal with Cerner in 2002.

Cerner says the changeover will take five years.

Anonymous Reddit posters had predicted the change months ago, saying that the health system was frustrated with Cerner’s ambulatory and revenue cycle issues. They also said Cerner’s price for consolidating AdventHealth’s three prod domains into one to support in-house data sharing was nearly as much as buying and implementing Epic, which was the preference of its physicians. They said AdventHealth was unhappy that Cerner’s attention had been refocused on its DoD and VA projects.

California-based Adventist Health, which recently terminated its Cerner revenue cycle management contract, is not related to AdventHealth.

Morning Headlines 2/11/20

Iora Health Closes $126 Million Series F Funding Round

Medicare-focused primary care company Iora Health raises $126 million in a Series F funding round led by Indian investment firm Premji Invest, bringing its total raised to nearly $350 million.

OSEHRA Shutdown

Open Source Electronic Health Record Alliance President and CEO Seong Mun announces that the company will shut down on February 14.

ONC Should Not Delay The Release Of Its Rule

Healthcare stakeholders from Omada Health and the University of California, San Francisco argue in Health Affairs against an Epic-induced delay in ONC’s release of its final interoperability rules.

Curbside Consult with Dr. Jayne 2/10/20

I’ve had a crazy couple of weeks working on a big project that finally reached a major milestone. Now I feel like I’m operating in a bit of a vacuum. I’m taking a break from the clinical trenches for a while and will be doing some traveling.

I have to admit that I feel a little guilty about having a couple of weeks where I’m not operating under multiple timelines. I do pretty well with work-life balance, keeping track of how many hours I actually work compared to my capacity. It started as a way to make sure I could stay afloat financially without an actual employer, but I discovered it was also a reflection of how much non-productive time I had so that I could better reflect on what I was doing with that time.

When I applied for medical school, the majority of applicants went straight through from their undergraduate institutions to medical school. There were a handful of people in my college class who did research or something else for a year before applying, but often that was because they weren’t sure they wanted to go to medical school. The students I work with now typically take at least a year off between college and medical school applications. Many are doing research or looking for ways to distinguish themselves from the growing pool of applicants. Others are studying and prepping for the Medical College Admissions Test (MCAT) that they didn’t take as undergrads because they didn’t feel they had enough time to study. Still more are taking post-baccalaureate courses to make themselves look more competitive.

Most of my scribes fall into the “study and prep” group. We’ve had some thoughtful discussions about what it was like back in my day (I never thought I’d be saying that, but here I am) versus how it is for them now. Initially, I thought that having time before they went to medical school might make them more rounded and less stressed when they finally got there, but I’m finding that the extra year or two might be adding to the overall stress level as admissions become more competitive.

Many other things have changed in medical education. For example, work hour limits and other protections that were designed to try to make the process more humane for learners. Additionally, students are much more digitally enabled and technology savvy than we were when I was in school. I wonder what kind of impact the combination of changes will have on physician burnout down the line. Will they see the EHR and other systems more as tools or mere annoyances rather than as their arch enemies? Will technology be able to evolve with their expectations?

Expectations are so important when we consider how we perceive things. I recently had a phone interview with a potential clinical employer. He’s someone I know from a past employer and perhaps that made him a little too comfortable as we were chatting. He made some comments about some of the other candidates he had passed on interviewing, generally around what he considered a relative lack of work ethic compared to physicians of his age group. I’m a little younger than him training-wise, but not much.

I was floored by the fact that he was only offering two weeks of vacation plus three days of continuing education for his potential new partner, regardless of their experience. In our area, most of the health systems are offering new grads three weeks of vacation plus a full week of continuing ed time. He seemed unaware of the competition’s benefits, which again had me thinking about expectations and how they influence our thinking.

It was in that frame of mind that I read the recent JAMIA article on metrics for assessing physician activity using EHR log data. The authors believe that reporting standardized efficiency measures would help experts understand the environments in which physicians practice. I don’t disagree that data is important, but it doesn’t take into account data about the practice patterns that physicians had before and to which they continuously compare their current experience, whether consciously or unconsciously. We don’t have many measures of total charting / message time for each eight hours of scheduled patient time, except in practices that were forward-thinking and performed time studies and optimization exercises.

I’ve done operational efficiency projects for the better part of a decade, whether as part of an employed CMIO role or as a consultant. Many of the measures that the authors hope to manage are often best addressed by non-technology solutions. These have been around a long time, but practices continue to be resistant to implementing them:

• Time spent prescribing and managing refills. I still see physicians who only prescribe medications a month at a time, or who won’t even give enough refills through the next anticipated office visit. Experts have long advised year-long refills for stable patients, yet this is still a struggle for many. I also see people unwilling to delegate refill authority to other clinicians, insisting on reviewing each request themselves.
• Inbox time per eight hours of scheduled patient time. This is another area where operational issues can have an impact. Is the inbox overloaded because patients want appointments and can’t get them? Is the schedule double booked, or has the practice taken steps to manage its panel size so that those who want appointments can get them and aren’t forced to leave or send messages? Does the inbox contain remote patient monitoring information that could be handled by ancillary team members?
• Time spent writing notes. I often see physicians who used paper templates or dictation macros in the paper / dictation world who won’t spend the time to create provider-specific defaults or templates within their EHR. I still do not understand why it is so difficult to convince these providers that spending a little time will benefit them later.

Even though we may not have data on legacy work patterns, the authors pose some excellent research questions that are important for future research, including the impact of staffing ratios on various endpoints. They also note challenges with implementation of the measurements, including EHR idle time-outs, variable definitions of “work outside of work,” and the variability of prep work done prior to clinic sessions. They also noted that not all work is done in the EHR – clinicians spend time on the phone with patients and colleagues, have family meetings, complete FMLA and other paperwork, and otherwise interact with patients and the care team.

The authors are careful to note that data capture may lead to “unintended negative consequences” as physicians change their behaviors because they are being monitored. Perhaps they will write briefer notes or otherwise be less comprehensive than they might otherwise have been because they will be concerned about the appearance of inefficiency. They also are clear that they “do not suggest that these new measures be included as requirements in any federal reporting programs.”

As much as quantitative research is important, I’d love to see a greater focus on qualitative research with regards to clinicians’ perceptions and expectations. Do their past experiences and biases inordinately impact their use of technology? What level of impact do other forces have, such as documentation requirements, payer constraints on diagnostics and treatment, and government regulations? How much do various stressors impact our performance and our level of compassion for our patients? It would take time and resources to examine these questions.

What do you think about standardized metrics for assessing physician EHR activity? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/10/20

Thoma Bravo preps for potential $2b-plus sale of Imprivata

Private equity firm Thoma Bravo considers selling health IT digital identity vendor Imprivata, which could command a price of more than $2 billion on annual revenue in the $100 million range.

CitiusTech earmarks $100 million for acquisitions across geographies

Health IT and consulting company CitiusTech allocates $100 million for the future acquisition of niche cloud computing and AI businesses, plus health IT companies in Germany, Japan, and the UK.

Nuance Communications (NUAN) Tops Q1 EPS by 4c

Nuance announces Q1 results: revenue flat, adjusted EPS $0.27 vs. $0.27, beating Wall Street expectations for both.

Monday Morning Update 2/10/20

Top News

A JAMIA article — whose lead author is the AMA’s burnout expert Christine Sinsky, MD — calls for EHRs to automatically analyze their system logs to report seven standardized efficiency measures.

The authors say such reporting would help experts understand the practice environment. It would also help improve operational, technical, and policy decisions.

The efficiency measures are:

• Total EHR time for each eight hours of scheduled patient time.
• The amount of work performed outside of normal hours, which would require physician schedules to be published to the EHR.
• Time spent writing notes.
• Time spent prescribing and managing refills.
• Inbox time per eight hours of scheduled patient time.
• The percentage of orders that are completed by contributions from non-physician team members (bigger is better, indicating top-of-license optimization).
• Amount of undivided attention patients receive during an encounter, defined as total encounter time minus EHR time.

HIStalk Announcements and Requests

Quite a few poll respondents would never allow an app to access their health information, but others might after considering the permissions the app requires and whether the value received is worth the privacy risk. Not all that many respondents would read the vendor’s terms of services or privacy statement, which is where all the useful information hides. Note: the percentage figures are worthless, but that’s how the poll service lists responses when multiples are allowed.

New poll to your right or here: Do you think employers use the wellness programs and apps they offer to target medically expensive workers for layoffs? I would be super interested in hearing from someone who knows for a fact that it happens.

Welcome to new HIStalk Platinum Sponsor QliqSoft. The Dallas, TX-based company’s secure texting, on-call scheduling, patient communication, and clinical collaboration solutions – which use a unique, cloud pass-through architecture – are used by 1,000 hospitals, home health, and hospice organizations to offer reliable, real-time communication among doctors, other caregivers, and patients. Qliq Secure Texting processes 165 million messages each month, including group and broadcast messages, custom quick messages, active directory contacts, escalated call notifications, presence status settings, and EHR integration for customers such as Virtua Health. HIPAA Camera Roll supports image sharing in real time on personal devices. The company’s Quincy chatbot platform supports proactive patient engagement without requiring an app download, while its Visit Path mobile care delivery tracking allows hospice and home health agencies to  comply with 21st Century Cures Act-required electronic visit verification. Thanks to QliqSoft for supporting HIStalk.

Here’s a Qliq for Android overview video I found on YouTube.

Reader Survey

Here’s your one last chance to fill out my reader survey, which benefits me (it’s my once-yearly chance to connect with readers) and might benefit you as well (I’m randomly drawing one or more respondents for a $50 Amazon gift card). Meanwhile, I admit that I’ve peeked at early responses and have already made two changes that readers suggested:

I found a way to allow reader comments to be automatically approved for regular commenters, which will eliminate the delay after a comment is posted until I approve it and thus make it visible to readers.

A survey respondent suggested that I run a “Sponsor Spotlight” occasionally to remind them what a sponsoring company offers. Platinum sponsors can provide a short description (no more than 75 words) and I’ll run the responses in the order received.

I’ll close the reader survey later this week and summarize the results. I appreciate the feedback, the good ideas, and the best wishes. I even appreciate the negative ones since they thicken my thin skin and show that someone at least cares enough to complain instead of just moving on.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Insiders report that Thoma Bravo is considering selling health IT digital identity vendor Imprivata, which could command a price of more than $2 billion on annual revenue in the $100 million range. The private equity firm paid $544 million for the company in July 2016.

Vocera reports Q4 results: revenue up 2%, adjusted EPS $0.15 vs. $0.18.

Nuance announces Q1 results: revenue flat, adjusted EPS $0.27 vs. $0.27, beating Wall Street expectations for both. The company said in its earnings call that early adopters of of its ambient clinical intelligence “exam room of the future” are reporting improvements in physician satisfaction, patient throughput, and documentation time, with its formal launch planned for Q2. Nuance says its HIMSS demonstrations will show a more interactive solution. The product is customized for each medical specialty and will start with five high-revenue and complex specialties, after which rollout will continue to additional specialties at the rate of 1-2 per month. Nuance is considering licensing the product based on exam volumes, bundling in hardware to minimize upfront cost.

Sales

• Minnesota mental health clinic provider Nystrom & Associates chooses Relatient for patient outreach and communications.

People

Children’s Minnesota promotes acting VP/CIO Dave Lundal, MBA to the full-time position.

Announcements and Implementations

The local TV station profiles the rollout by UCHealth (CO) of BioIntelliSense BioSticker, a chest patch that monitors vital signs (respiratory rate, heart rate, skin temperature, gait, and body position) and stores the information for 30 days. UCHealth’s CARE Innovation Center help develop and test the FDA-approved device, which will receive its first patient use later this year.

Government and Politics

Interesting: several Missouri health systems don’t allow their doctors to certify patients for medical marijuana use – even though such use is legal in that state – because they receive federal funding and federal laws still classify marijuana as an illegal drug that has no medical benefits, potentially threatening their income or licensure. SSM Health’s chief medical officer says, “There’s not a great evidence base to support using this for the majority of complaints that come through. But again, I think the important thing for our providers was to trust them to do the right things. If patients are going to use cannabis, they should be using it under the supervision of a doctor they know and trust. We don’t want our patients to run off to the local doc-in-a-box to get certified for medical marijuana without us participating in that care.” Note the telemedicine aspect in the company webpage above.

Other

KHN reviews the “moral injury” that is experienced by ED doctors whose employers push them to order unnecessary but profitable tests; to see patients quickly but superficially to improve “door to doc” time and generating higher facility fees; and to treat patients in hallways because of ER overcrowding and hospital discharge inefficiency.

Eric Topol’s medical literature review finds that only five randomized clinical trials have looked at the use of AI in medicine (all of the studies were performed in China) and just 11 prospective trials have been completed in a real clinical environment. All of the studies addressed diagnosis rather than treatment.

Sponsor Updates

• Meditech publishes a new Success Story, “CalvertHealth Makes Major Gains in Battling the Opioid Epidemic.”
• Mobile Heartbeat will exhibit at the ACNL Annual Program 2020 February 10 in Rancho Mirage, CA.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, opens an office in Dubai.
• PatientPing features Cerner VP of Population Health John Glaser, MD in its interoperability video series.
• Redox releases a new podcast, “The New Interop Paradigm with America’s First CTO, Aneesh Chopra.”
• Relatient announces its patient relationship management software now integrates with Virence Health’s Centricity Practice Solution.
• T-System relocates its headquarters to 6509 Windcrest Drive, Suite 165, Plano, TX 75024.
• Wolters Kluwer provides easier access to latest coronavirus resources and tools for front-line clinicians and medical researchers.

Blog Posts

• On-call scheduling: 4 ways to boost patient care and satisfaction (Spok)
• Leveraging Technology to Improve Patient Satisfaction (Lightbeam Health Solutions)
• Maintain Situational Awareness of Continuity of Operations During a Hospital Cyber Attack (LiveProcess)
• The American Healthcare System’s 800-pound Gorilla Has Spoken (Loyale Healthcare)
• How Annual Wellness Visits improve patient outcomes and organizational revenue (Meditech)
• AI in Healthcare: Finding the Right Answers Faster (Health Catalyst)
• Marketing Your Physical Therapy Practice to Physicians (MWTherapy)
• Why Your EMPI Needs Address Verification Technology (NextGate)
• Developing a strong lab outreach program (OpenText)
• How consumer data can help attract and retain healthcare consumers (Experian Health)
• What Healthcare Providers Need to Know About New Price Transparency Requirements (PatientBond)
• Digital-First Billing Makes a Difference for Roper St. Francis (Patientco)
• Why Your Governance is Only as Good as Your Identity Data (SailPoint Technologies)
• Six Critical Aspects to Deliver Strong ROI from Any Test Automation Program (Santa Rosa Consulting)
• Addressing Coronavirus and emerging health concerns with engaging content (StayWell)
• How a Rural Health System is Transforming Lives in the Face of Addiction (Surescripts)
• There’s Voice Communication. And Then There’s Voice Communication for Healthcare. (Vocera)
• AI can save you from drowning in prior authorization problems (Waystar)
• The 3 Stages of Building Referral Relationships that Last (WebPT)
• Bend the cost curve in your senior population (Philips)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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