Curbside Consult with Dr. Jayne 12/16/19

Winter has arrived in the Midwest, and with it the end-of-year slowdown in healthcare IT news. While sales-focused teams are scurrying to complete end-of-quarter sales to bolster their final financials, marketing folks seem to be holding anything remotely interesting until we get closer to HIMSS. That leaves us with a smattering of governmental and regulatory news items.

I admit sometimes I miss these kinds of items because of the noise of all the other things going on in the industry, so maybe it’s a good thing that we’re headed into a less-frantic time (at least until March, that is).

Sneaking into the news on Friday was the FDA approval of Tandem Diabetes Care’s predictive software that bridges the gap between continuous glucose monitors and the company’s insulin pump. Why is this a big deal? It’s the first insulin dosing software approved under a new FDA interoperability pathway, which gets interesting because different companies make components of the so-called “artificial pancreas” systems that result. You could be using one company’s glucose sensor, another’s pump, and a third-party algorithm between the two.

Tandem is already working with Dexcom Inc. and Abbott Laboratories to coordinate. This is great for patients whose insurance may only cover certain brands of one device or another, and who otherwise might not be able to take advantage of the newest technology. Typically payers only cover insulin pumps every four years, so being able to update a control algorithm rather than having to obtain a completely new device is a pretty cool thing.

Also in the news this week: glitches in the Healthcare.gov system where many people have to sign up for insurance coverage. It’s possible that up to 100,000 users were impacted by technical issues on the first day of open enrollment. CMS had to add a “waiting room” to the site to help manage traffic flow, and as of December 7, there have been 6 percent fewer enrollments compared to last year.

Patient advocates were concerned about the typical last-minute surge of enrollments and whether the site would be able to handle the traffic before the deadline. I haven’t seen any updated numbers this morning, but I’m sure there will be a lot of spin placed on whatever data becomes available this week.

A recent approval by the Federal Communications Commission is raising concerns. The group voted last week to create 988 as a nationwide suicide prevention hotline telephone number, much like 911 for emergency services. It would replace the existing number for the National Suicide Prevention Lifeline. The thought is that a shorter number would enable more people to call, but there are anticipated downsides: an increased number of callers would also increase the costs for crisis centers staffing those phones and many centers are struggling to make ends meet as it is.

The hotline is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Theoretically more people would be calling 988 rather than 911, so that’s a cost savings since fire and emergency services won’t be dispatched for a potential suicide attempt. It could also lead to significant societal savings by preventing loss of life, but those savings aren’t immediately passed to those institutions bearing the cost, based on the calculus of healthcare math. Another example that healthcare is complicated, y’all.

Other government news includes the impending release of millions of dollars in disputed Medicare hospital payments that were withheld due to a payment policy that was struck down in court. The American Hospital Association estimates that $380 million will begin flowing as Medicare Administrative Contractors start reprocessing claims that were paid at reduced rates. Reprocessing begins January 1, so get your data and claims engines running!

Just when I thought I was out of government news, I came across news about the recent report by the US Department of Health and Human Services, Office of the Inspector General, regarding concerns around chart reviews looking at Medicare Advantage payments. Not surprisingly since billing is such a game, claims were reflecting sicker patients and more comorbid conditions than patients might actually have. Apparently payers are adding diagnosis codes for conditions that aren’t documented in physician or hospital records and this occurred in 99.3% of chart reviews.

Medicare Advantage is a big piece of the Medicare spending pie — approximately $210 billion of the $711 billion spent last year went to Medicare Advantage plans. There are concerns not only about overbilling, but that plans are functioning like the HMOs of the past to deny care as a means of increasing profits. There are also concerns that if the patients actually have the conditions added by payers (which aren’t reflected in the medical records) that patients aren’t receiving adequate care.

The audit looked at data from 2016 to assess the financial impact in 2017. As payers get more creative, it’s possible the problem could be even more rampant now. A particularly damning sentence from the report: “Although limited to a small number of beneficiaries, almost half of all Medicare Advantage organizations reviewed had payments from unlinked chart reviews where there was not a single record of a service being provided to the beneficiary in all of 2016.” At least fee-for-service payment models require the patient to be in front of you before you bill for services.

HHS recommends that CMS provide oversight of organizations that had payments resulting from chart reviews where beneficiaries received no services; conduct audits to validate diagnoses; and reassess the practice of allowing unlinked chart reviews being used as a source of diagnoses for determining risk. CMS accepted these recommendations.

There’s one piece of governmental news that’s front and center right now, although patients aren’t talking about it. Influenza is on the rise, with 2.6 million illnesses, 23,000 hospitalizations, and 1,300 deaths so far. I can’t count the number of patients who said “I never get the flu shot” a couple of months ago who are now showing up at the office sick and miserable. There’s not a lot we can do for influenza, other than providing supportive care and symptomatic relief. For small children, there’s even less we can do. Please do your part – wash those hands and stay home if you are sick. And next year, consider a flu shot.

Email Dr. Jayne.

Readers Write: The Case for Compassion in Healthcare

The Case for Compassion in Healthcare
By Frank Myeroff

Frank Myeroff is managing partner of Direct Recruiters, Inc. of Solon, OH.

Working in the healthcare space my whole career, over 30 years, and having always been on the IT side, I always felt I was in healthcare. During my days, I have written code, supported systems, implemented all kinds of applications, managed IT teams, and run large implementations. My view changed when I moved to the staffing space to get off the road for my family. I felt it was a great opportunity to view the healthcare space from another perspective, and it was.

Then that view changed again as the result of a three-minute phone call that truly immersed me and allowed me to see what healthcare really means.

The ultrasound technician told me as I walked out after my test, “The doctor will be calling you today.” That three-minute phone call conveyed a diagnosis and led to immediate surgery and an ongoing treatment plan.

As professionals in healthcare — doctors, nurses, healthcare staffing, healthcare operations, healthcare IT professionals, etc. — we are largely in tune with the processes that go into the healthcare system. As a patient, the experiences are far different, and far more emotional, as I quickly found out.

Being thrust into the patient side unexpectedly has been invaluable in my career. What I realized from all of this is that while IT really impacts patients, we in IT need to work with our clinicians and teams to understand the impact of what we do and the compassion and sensitivity that is needed to pair with innovative technologies for successful patient outcomes.

The roles of healthcare IT professionals go beyond implementing applications and systems. They are responsible for developing and driving technology in the healthcare setting, but also for giving clinicians the tools they need to provide individualized care plans and to ultimately achieve efficient and improved quality of care. The final piece of that puzzle requires compassion and communication from healthcare professionals to patients.

Data and technology are essential. However, if clinicians only focus on the data and ignore the communication and explanation of that data to patients, we are missing something huge. According to a Harris Poll in the Wall Street Journal, and cited in “Compassionomics” by Stephen Trzeciak and Anthony Mazzarelli, three times the number of patients value human connection and caring from their physician versus valuing the prestige of the institution where the physician was trained. Another study showed that 85% of patients report that compassion is important to them when making a healthcare decision. Compassion and empathy are important in healthcare, which is clear to me from both the studies my own experience.

Whatever side of healthcare you’re on, keep in mind the factors that play into quality patient care. The experiences I have had as a patient not only make me proud of what we in IT to help people, they also help me to understand the true usage that in return helps provide better solutions. Healthcare IT professionals influence patient care and have a great impact on all who serve in the hospital.

We should all be proud of what we do and the tremendous impact we have on patients, providing quality care, compassion, and better outcomes. Isn’t that what really matters?

HIStalk Interviews Michael J. Alkire, President, Premier

Michael J. Alkire, MBA is president of Premier of Charlotte, NC.

Tell me about yourself and the company.

I’ve been at Premier for about 16 years, filling a number of roles. My current role as president is focused on driving the two big strategies that we laid out at the beginning of the year. We are technology-enabling the supply chain for our healthcare systems. We are also building out enterprise analytics, embedding machine learning and artificial intelligence into an analytics platform that helps our healthcare systems reduce costs, improve quality, and migrate to new payment delivery models.

What is the ownership structure of the company now that it is publicly traded?

Our healthcare system member owners hold 46% of the Class B shares. As of our last 10-Q filing in September 2019, we have 155 member owners. The remainder of shares are held by the public.

What challenges do employers have in managing their healthcare costs?

The rising cost of healthcare is the primary reason that large employers are looking for alternatives to how healthcare is provided to their employees. 

Our journey for Contigo Health started about 18 months ago. A very large, self-insured employer came to us. They spend billions of dollars on healthcare and believe that 20% of that spend involves unnecessary variation and waste in the system. They would call out things like wanting a total knee or total hip in Orlando done the same as it is in Fargo. The way they described it is that there’s huge cost variation and huge clinical outcomes variation. They had an interest in building a high-value network of healthcare providers, both healthcare systems as well as other providers, to participate in this network.

They provided interesting statistics. From an oncology standpoint, 10% of their employees who are diagnosed with cancer don’t actually have cancer. Of those who are diagnosed with cancer, 30% are placed on the wrong regimen. Not only is the patient not receiving the right medical attention, the employer bears a huge cost. The patient may miss work due to being on the wrong medication and then getting established on the right regimen. They use that as an example of lack of standardization of care across the country.

They also talk about OB and C-section rates. Somewhere around 30% of all US births are done via C-section. In western Europe, the C-section rate is 22% or 23%. CDC says that C-section rates should be near 20%. This employer studied markets in which C-section rates were more than 50%. This creates significant cost as well as significantly more risk to the mother.

The prevalence of data that is available to these large employers is helping them understand where variation is occurring. They are looking for a partner that can help them manage this variation. I think they came to Premier because of our history of using discharge data from 45% of all US hospitals and our work with physicians and their quality reporting to Medicare. They liked the idea that we have the data. They also liked the idea that we have been working in collaboration with our healthcare systems for the better part of 15 years in improving the standard of care.

Is it an awkward conversation to tell health systems, which may be Premier’s members or owners, that your employer customer thinks they charge too much and don’t practice evidence-based medicine?

When this large player came to us and we built this collaborative that was the precursor to Contigo Health, we reached out to 35 healthcare systems that represented 440 hospitals. We said, “Very large employers are interested in building this high-value network, but we need your data, your claims data, and your electronic health record data.” We had clinical and safety data for many of them, but we needed to build data capability for this initiative.

At least 90% of the folks who participated in those first meetings provided us with their data or their interest in sharing their data with us. I think their reasons are twofold. One, they know that the market is moving in this direction, where the necessity for care to be standardized across the country is an imperative to drive down the cost of healthcare globally. Two, being part of a high-value network provides them leverage when they are negotiating with the payers in their markets. Saying that they adhere to and implement these standards and that they use the highest, best capable analytics to implement clinical protocols will differentiate them in their markets.

I don’t think that the idea is that employers will demand lower costs. They see so much variation in how care is being provided that their interest is reducing waste and standardizing the approach to providing care, as opposed to a negotiated perspective of wanting procedures done at a lower cost. The initial goal is to create a high-value network of a high standard of care.

Does this involve offering fixed prices for certain procedures, and similar to what Walmart is doing, sending employees out of their local geography to receive care from providers whose cost or quality may be better?

Payers are providing a lot of ancillary benefits to the employees of large employers, who aren’t taking advantage of them. Think about smoking cessation. We have the ability, given our Stanson Health acquisition, to write detailed analytics into the workflow. Large employers are interested using these workflow protocols to help ensure that employees are taking advantage of the ancillary benefits that they have access to. When an employee meets with the physician, it pops up on the screen that they work for Employer X, which has a smoking cessation program that they would like this patient to enroll in. There’s a free benefit that’s helping them do that. We will focus on these ancillary benefits as we get the Contigo Health programs started.

Then I think there will be two parallel paths. We will create this high-value network for things like maternal health, which will be nationally based and will involve certain protocols that these large employers would like these providers to follow. Second is exactly what you said. Large employers like Walmart call them centers of excellence, where they send employees out of geography for specific services. There will be a path for that in the short term.

But I will tell you that unless it’s something that’s very serious, very rare, or where the expertise just doesn’t exist in the local or regional markets, these large employers have an interest in getting care provided as close to the patients as possible. You will have these centers of excellence in the short term and mid term. They are nationally based today, but you’ll see more regionality of these centers of excellence, where you’ll have them in pockets along the various regional geographies of the US. Eventually I think they will become more localized to the extent that those geographies actually have the providers who can provide those services.

Premier’s health system customers should have been able to recognize and address their clinical variation given the reports you send them that highlight it. Why did employers have to apply the financial pressure to make them take action?

We work with some of the largest IDNs in the country, many of which span states and regions. They have their own focus on driving standardization of care across the entire healthcare system.

As healthcare systems are moving more towards taking downside risk, it’s imperative for them to standardize the way that care is being provided. It provides a benchmark for them to improve from. For quality outside of healthcare, such as in the automotive or high tech industries, you want to have that basis way to produce product, use that as the baseline and then always innovate off of that baseline. That’s what healthcare systems are attempting to do when they are trying to create that baseline. It’s two- sided risk.

Second is the movement to ACOs and capitation. A number of our healthcare systems that are creating partnerships with ACOs know that they have to be on the hook to provide standardized care across the communities that they serve.

The final driver will be differentiation. I spoke about this earlier in terms of their leverage with commercial health plans, but organizations that can prove that they are standardizing care and can prove that their outcomes are different than the big brands in their markets — or in some cases, bigger and smaller systems in the market — are the ones that are going to be the winners in the long term.

All of this is going to become transparent. That’s the fourth aspect, that healthcare systems are becoming aware that their outcomes are going to be transparently shared with the communities that they are serving.

Clinicians don’t always believe or follow evidence that is accepted elsewhere, or they think evidence needs to be tailored to local practices. How will you weigh the available evidence for a national group of health systems that haven’t followed it so far?

Stanson Health’s CEO is Scott Weingarten, MD. He was CEO of Zynx, which was all about creating standards of care, trying to standardize different protocols, and those kinds of things. They have had a very successful run. We were interested in Stanson because it takes those clinical decisions that come from the analytics and embeds them into the workflow.

For the first time, you will see a lot of this evidence-based clinical decision information show up in the workflow, when the physician is practicing or at the point of having conversations with their patients. They will see the clinical evidence at their fingertips.

The tool itself is unique. If organizations don’t want to use it from a proactive standpoint to provide alerting and other capabilities to the clinicians during the time of care, then a function on the back end can audit whether clinicians are following standard protocols that they have set up. Technology has allowed us to take this issue to the next level, both in being proactive at the point of care and to understand whether clinicians are following the standards of care.

Do you have any final thoughts?

Premier is working to fix US healthcare from the inside. We believe that healthcare needs to be consumer centered and provider led. Leveraging the providers, the data, and the analytics that we deliver to providers, along with the ability for them to collaborate, is the best way to solve our national healthcare issues.

Morning Headlines 12/16/19

NJ’s largest hospital system forced to pay ransom in cyber attack

Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its computer systems.

GV Backs Kindbody As The Company Expands Employer Benefits Offering

Fertility clinic and technology company Kindbody secures financing from the former Google Ventures, bringing its total funding to $32 million and enabling it to further scale its direct-to-employer service.

US health insurance firm Cigna is using AI to check if patients are taking their medications but experts fear the controversial scheme may be used to cancel policies or avoid paying out

Privacy experts are concerned that Cigna’s new AI-powered medication adherence monitoring program will be used for the benefit of the payer’s bottom line rather than improved patient care.

VirTrial Acquires SnapMD and Bolsters Virtual Care Management Platform

Virtual clinical trial company VirTrial acquires telehealth vendor SnapMD.

Monday Morning Update 12/16/19

Top News

Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its computer systems.

Some of those systems remain down two weeks after the attack began.

The health system did not reveal the amount paid, but says it carries insurance for that purpose.

Meanwhile, the city of New Orleans declares a state of emergency after shutting down all of its servers and websites following ransomware threats.

Reader Comments

From Student Union: “Re: new jobs listed in the ‘people’ section. Why do some of them not include a link to the announcement?” I learn of some of them via LinkedIn notifications from my 3,000 connections and I don’t link in those cases. My criteria for mentioning someone’s new job are: (a) I only list VP and above since I would be overwhelmed with job changes otherwise; and (b) the person has to be recognizable to many readers based on their healthcare history.

From Pleiades: “Re: Monarch Medical Technologies. FDA has recalled both of their EndoTool glycemic management / insulin dosing software products. They only offer these two products and can’t implement them at any hospital because of the open recall.” FDA recalled EndoTool IV in June 2019 because of calculation errors and and recalled EndTool Subq in November 2019 because it was distributed without FDA’s approval or clearance.

From Meaningless Use?: “Re: patient portals. A recent HIStalk interviewee said they were important because they were part of the Meaningful Use requirement. How is that important? Also, where would we be today without the HITECH Act and Meaningful Use? Many of those in the industry who started pre-MU know no other reality.” My thoughts:

• The stimulus-focused MU program artificially goosed EHR demand similarly to the “cash for clunkers” program. Although to be fair, MU payments were tied to use rather than purchase – if you already had an EHR, you could get free money by simply using it per federal government requirements.
• Sales jumped for products nobody wanted when they were spending their own money, encouraging vendors to lie and providers who were anxious to lap at the taxpayer trough to buy products without due diligence or commitment to process change.
• Innovation was stifled because the industry’s collected wad was shot on the same old systems that weren’t selling before.
• Health IT was chosen as a shovel-ready project that could pump a lot of stimulus money into the economy quickly, and those involved made an earnest but fumbled attempt to give taxpayers $35 billion worth of benefit by conditioning the payouts on accomplishments (or lies about accomplishments via unverified attestation) on metrics that did little to improve patient outcomes, access, or cost. Providers were thinking only of their taxpayer welfare payments rather than the welfare of their patients when they bought these systems and attested that they were using them magnificently.
• Patient portals seemed sexy to an industry with a poor technology track record, but nobody bothered to ask patients if they wanted them or demanded that providers do more than to simply offer them to earn their taxpayer payday.
• Portals also gave providers an excuse for doing nothing else to improve communication with their patients, They could simply pat themselves on the back and cash their checks for turning on a portal that few patients signed up for and far fewer actually used. People do what they are paid to do – no more, no less.
• But as with most technology, it’s the people rather than the tools that are the problem. Providers like Kaiser embraced both EHRs and portals and have delivered pretty amazing benefits to patients, to the point that its portal is extensively used for patient-provider messaging, routine refill and appointment requests, and inquiries. They made their portal a competitive differentiator because it was profitable for them to do so.
• Patient portals are the technological manifestation of healthcare paternalism – patients are expected to use them (a separate one for each provider) even though the doctors may or may not, those multiple providers don’t exchange information, they are just as provider-protective since providers don’t promise quick or detailed responses to portal-posted patient concerns, and users still get a clipboard full of blank forms shoved in their face when they show up for a visit. You would likely change banks if the best technology they could come up with looked anything like a patient portal.
• Without MU, EHR sales would have picked up more gradually and smaller medical practices would probably have opted out. But that would have forced vendors to improve their products and encouraged new entrants to offer something better. The market was speaking before MU artificially manipulated it.
• I would be uneasy claiming in the absence of evidence that EHR adoption has improved outcomes, access, or cost to any extent, much less $35 billion worth. I would also cite endless surveys showing minimal patient use of portals and minimal improvement in any type of outcome as a result.

From Darth Vader: “Re: UnitedHealth Group. With all this talk about reducing healthcare costs, why isn’t anyone in Congress talking about UHG, and in particular, Optum? How ingrained is this organization in every nook and cranny of the US healthcare ecosystem?” We’ve societally accepted that US healthcare is a business in which patients are the widgets of production, so it was inevitable that the whole mess (or at least the most profitable parts of it) would be controlled for maximum profit by publicly traded companies, private equity firms, and profit-admiring health system executives. Those groups are also big political donors and advertisers. The track record of a constituent-focused member of Congress dismantling a hated and excessively profitable monopoly, at least in the past few dozen years, isn’t very good. One person’s excess costs is someone else’s income and the latter don’t readily give it up.

HIStalk Announcements and Requests

Most poll respondents believe that patients own the data that providers record about them. Actually I should probably say that they wish it were true, but are aware that legally (and with ownership, that’s all that counts) patients have no such claim. Reader Conflated added a poll comment that provides a thorough overview of the issue:

It seems like three concepts are being conflated in this conversation. One is ownership of the records of the services performed by a provider (“the data”). The second is rights to access the data. The third is rights to “do stuff” with that data.

It would seem the original copy of the records stored on a provider’s EHR (or the paper records in their record closet) belong to the provider. The patient doesn’t own that copy of the records. It documents the work the provider did, the observations and results the provider captured, the medical recommendations the provider made, and is the basis of mounting a legal defense if the provider is sued for malpractice. Not to mention, there are record retention requirements the provider is required to follow, another hallmark that they own those records.

However, the patient also has a right to access and copy ALL of the provider’s records about them. That copy belongs to the patient.

Taking these two points together, then, it seems like the provider and the patient both have a right to own a copy of the same data. On a right to “do stuff” with the data, this is the more complicated thing, and the area in which HIPAA most needs a refresh. Just because a provider “owns” their copy of the records doesn’t inherently give them rights to “do stuff” with it. We have also seen some legislation that the provider has an obligation to do some stuff at the direction of the patient with said data (e.g., securely transmit it to another provider), but the provider still gets to retain a right of ownership of their copy of the data.

New poll to your right or here: What data sharing issues, if any, did you experience in your 2019 provider visits?

The “like” button you see on each article tells me that the most-liked HIStalk items in the couple of years I’ve been using it (like votes minus dislikes) are, in order:

1. Pretzel Logic 9/30/19
2. Readers Write: To Douse the Flames of Physician Burnout, Target the Four Biggest Time-Wasters in the EHR
3. A Machine Learning Primer for Clinicians — Part 1
4. Book Review: Bad Blood
5. Readers Write: A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing
6. Neal Patterson’s Final CHC Speech — November 16, 2016
7. HIStalk Interviews Vince Ciotti, Retired HIS-torian
8. The Smokin’ Doc Celebrates a Successful HIMSS
9. Readers Write: The Big Fib
10. CIO Unplugged 3/21/18

My Anonymous Vendor Executive (AVE) offered to provide more Donors Choose matching money, but I’m stymied since I still have nearly $10,000 of AVE’s previous donation in my account. Reason: most of the larger donations I’ve received came from HIMSS-related activities, such as lunch with a CIO or other promotional event, and I haven’t done those lately. I propose that we put that money to work as follows:

• I will (since the AVE suggested it) match donations $2 for every $1, and other matching will surely increase the bang for your donation buck.
• For company donations of $1,000 or more, I’ll include a text message of your choice in an HIStalk update email in addition to the usual thank-you message on the site.

I’m open to other ideas as well. Let’s spend AVE’s money on a great cause. If you want to donate, here’s how:

1. Purchase a gift card in the amount you’d like to donate.
2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded.

Webinars

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

Acquisitions, Funding, Business, and Stock

Blue Cross Blue Shield of Massachusetts integrates its member app with Amazon’s PillPack pharmacy, allowing members who take multiple medications to order their prescriptions, pay for them, and schedule their delivery. The app will encourage those patients to switch their pharmacy to PillPack, in which case all of their information will be automatically transferred.

Sales

• DHR Health Institute for Research and Development (TX) joins the TriNetX global health network to improve clinical trials access to Hispanic residents of the Rio Grande Valley.

People

Rx Savings Solutions promotes Daron Sinkler to VP of sales.

Announcements and Implementations

Partners HealthCare announces a five-year digital health initiative that includes online appointment scheduling, video visits, implementation of OpenNotes, procedure and imaging cost estimates, improved interoperability, posting of ED wait times, and customized patient communications. The program also includes an incubator component. The Boston paper says the program will cost at least $100 million

Other

An article in Wired predicts the end of drug trials that use a placebo group, i.e. patients who receive no actual treatment for their conditions to determine the benefit to those who do. EHR data can identify similar patients, then compare the new product’s results with those of the existing standard of treatment as a “synthetic control arm.” The author wisely notes that this is probably why drug company Roche paid nearly $2 billion to acquire oncology EHR vendor Flatiron Health in early 2018, having foreseen the use of real-world data for drug approvals now that EHRs are ubiquitous.

I like this proposed rework of HIPAA that appeared in the Health Affairs blog last week. It calls out HIPAA’s most glaring deficiencies in falling short of broad patient privacy protection – it regulates only covered entities and those covered entities get a free pass under “treatment, payment, and operations.” Not to mention that the US lags behind in failing to protect the information of its citizens via Europe’s GDPR.

Florida pain management practice chain Korunda Medical will pay $85,000 to settle HIPAA charges that it ignored a patient’s request to send an electronic copy of their medical records to a third party, then charged the patient an excessive amount for the paper copies it sent. The patient filed a complaint in March 2019, OCR provided penalty-free “technical assistance” to the practice and closed the complaint, but the patient filed a second complaint four days later when Korunda ignored the records request again.

Cigna will implement an AI-powered medication adherence monitoring program in January. The company says knowing whether patients are taking their meds as prescribed will allow it to improve care, while privacy experts worry that the objective of insurers is always to pay less and that the “digital dystopia masquerading as healthcare” will allow Cigna to cancel policies or avoid paying claims. Cigna paid $54 billion to acquire pharmacy services vendor Express Scripts earlier this year.

A PGY-1 osteopathic resident at AdventHealth Orlando and self-proclaimed “influencer” apologizes for pitching several healthcare products on his social media accounts, one of them a sketchy nutritional supplement for rave music festival attendees that he sells as a company rep. He explains, “It makes a lot of sense that I shouldn’t be using my medical degree as a platform to sell products. But no one teaches you this stuff.” He’s also planning to use his experience to start a business that will monitor medically related social media posts for appropriateness.

An interesting New York Times article describes how Amazon Web Services “strip mines” startups by copying their software, especially open source, and then selling it themselves. AWS generated $25 billion in revenue last year and is Amazon’s most profitable business.

In Pakistan, several cardiac inpatients die when hundreds of lawyers in their customary black suits storm a hospital, angered that one of their peers told them he had been mistreated when he brought a relative in for treatment. At least 200 lawyers vandalized hospital property, damaged vehicles, set fire to a police van, and beat several doctors. Physicians and employees then fled the hospital, leaving patients unattended, and the hospital then closed when the doctors mounted a protest strike.

Sponsor Updates

• Redox releases a new podcast, “An interview with Dr. Fatima Paruk, Microsoft’s Chief Medical Innovation Officer.”
• OmniSys launches the Pharmacy Talk newsletter.
• PatientPing releases a new customer success video featuring UI Health Senior Director, Care Continuum, Rani Morrison.
• Academic Radiology features an editorial from Visage Imaging’s MingDe Lin, “Accelerating the Translation of Artificial Intelligence from Ideas to Routine Clinical Workflow.”

Blog Posts

• Seasonal Depression Awareness Month (Lightbeam Health Solutions)
• Hospital Budgets 2020: Resist the Cost-Cut Bias and Invest for Success (Loyale Healthcare)
• Helping organizations focus on care, not IT: Discussing Meditech’s cloud journey (Meditech)
• Survey Points to Major Burnout Concerns Among Clinicians (Health Catalyst)
• Enable Multidisciplinary Care with Smarter Team Tools (Mobile Heartbeat)
• Physical Therapists, Physical Therapy Assistants, Physical Therapy Aides – Looking at the Core Clinical Workforce of a Practice (MWTherapy)
• Top integration challenges in healthcare IT (OpenText)
• Five Keys to Planning EHR Go-Live Support for Providers (CereCore)
• 4 ways to boost patient engagement (Experian Health)
• What Are Millenials Looking for During Patient Payment Collections? (PatientBond)
• Three Decades of Nursing: Looking Back to Move Forward (PatientSafe Solutions)
• Satisfied Patients Say What??? (Patientco)
• #GetToThePoint: Six strategies to take action on tests pending at discharge (TPADs) and prevent potential harm. (Pivot Point Consulting)
• The Role of Patient Engagement in Remote Patient Monitoring (PerfectServe)
• Identity Goes to Vegas: Gartner IAM (SailPoint Technologies)
• Managing diabetes: High-touch, high-tech collaboration between patient and care team (StayWell)
• The Critical Importance of Patient Matching Capabilities (Summit Healthcare)
• 2018 Progress Report Myths v. Reality: How Healthcare Providers are Using Powerful Solutions to Deliver Better Care Nationwide (Surescripts)
• Beyond the Electronic Health Record: Human-Centered Design to Reduce Clinicians’ Cognitive Burden (Vocera)
• 4 Facts Every PT Should Know About Telehealth Compliance (WebPT)

Contacts

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

Weekender 12/13/19

Weekly News Recap

• Hackensack Meridian Health (NJ) brings its clinical systems back online after a downtime of several days, rumored to be the result of a ransomware attack.
• Former Outcome Health EVP Ashik Desai pleads guilty to wire fraud and agrees to cooperate with prosecutors.
• Emergency medical services technology company ESO acquires trauma registry software vendors Clinical Data Management, Lancet Technology, and Digital Innovation.
• Proteus Digital Health’s previously announced restructuring will include eliminating 292 jobs and closing several facilities by January 18.
• The DoJ will look into Google’s $2.1 billion acquisition of Fitbit for possible antitrust violations.
• Partners HealthCare (MA) will spend $100 million on a five-year digital health initiative focused on developing self-service technologies for patients.
• BJC HealthCare (MO) lays off 200 employees as it outsources some IT services to an unnamed managed service provider.

Watercooler Talk Tidbits

The DoJ charges 10 former NFL players for alleged fraud after they filed nearly $4 million in claims for medical equipment that was never purchased or received through a health reimbursement account plan set up for former athletes. Claims were filed for hyperbaric devices, ultrasound equipment used for imaging on pregnant women, and electromagnetic therapy devices used on horses.

Former debt collection agency employee Shaunna Burns takes to TikTok to share advice on dealing with medical debt collection. In just a few weeks, she has gained over 100,000 followers and over 1 million likes. “The fact that there are people out there thinking debt equals deadbeat … debt doesn’t equal deadbeat,” she says. “I’m not a deadbeat, and I have great credit, and I’m still having to deal with debt collection. I literally spent hours a week fighting with insurance companies over stupid bills that shouldn’t have been charged … having to do all that is annoying and frustrating, and I thought if I could help one person [with the TikToks], it would be worth it.”

Zuckerberg San Francisco General Hospital notifies 1,174 patients of a months-long privacy breach resulting from employees who failed to shred patient-identifying meal tray tickets, instead throwing them away in regular garbage bins.

Harvard Medical School geneticist George Church develops dating app technology designed to pair users based on their DNA. Church says the app could help wipe out inherited diseases.

Advocate Children’s Hospital  (IL) launches the Santa Connection program with help from Burwood Group and Cisco.

In Case You Missed It

• News 12/13/19
• EPtalk by Dr. Jayne 12/12/19
• HIStalk Interviews Michele Perry, CEO, Relatient
• News 12/11/19
• Curbside Consult with Dr. Jayne 12/9/19
• HIStalk Interviews Doug Cusick, CEO, TransformativeMed
• Monday Morning Update 12/9/19

Get Involved

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

Morning Headlines 12/13/19

Partners HealthCare Launches Digital Health Initiative

Partners HealthCare (MA) will spend $100 million on a five-year digital health initiative focused on developing self-service technologies for patients.

Senate confirms Trump’s nominee to lead FDA

The Senate confirms MD Anderson Chief Medical Executive Stephen Hahn, MD to lead the FDA.

Caresyntax to Acquire Operating Room Analytics Provider, Syus

Surgical automation and software vendor Caresyntax acquires OR analytics company Syus alongside a $45 million funding round.

BJC outsources IT services, cuts 200 jobs

BJC HealthCare (MO) lays off 200 employees as it outsources some IT services to an unnamed managed service provider.

NextGen Healthcare Announces Agreement to Acquire OTTO Health

NextGen acquires telemedicine vendor Otto Health.

News 12/13/19

Top News

In Boston, Partners HealthCare plans to spend $100 million on a five-year digital health initiative focused on developing patient self-service technologies including online appointment scheduling, ED and urgent care wait times, and cost estimates; virtual care via text and video; and access to aggregated medical records including OpenNotes.

Reader Comments

From Darth Vader: “Re: Optum/UHG layoffs. See UHG latest results? Talk about systemic risk. With all this talk about reducing healthcare costs, why isn’t anyone in Congress talking about UHG and in particular Optum? Just how ingrained is this organization in every nook and cranny of the US healthcare ecosystem?” Vader’s observation comes just a few days after OptumRx’s purchase of Diplomat Pharmacy for $300 million.

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Tampa Bay Lightning owner and former hedge fund manager Jeff Vinik invests $5 million in health IT integration vendor Bridge Connector, bringing its total funding to $25 million. Vinik is also a minority owner of the Boston Red Sox.

Surgical automation and software vendor Caresyntax acquires OR analytics company Syus alongside a $45 million funding round.

Proteus Digital Health’s previously announced restructuring plans will include eliminating 292 jobs and closing several facilities by January 18. According to the local paper, the company will turn its focus from digital therapeutics for blood pressure, hypertension, and cholesterol to infectious disease and oncology, “expensive therapies that tie payments to the actual use of the drug.”

BJC HealthCare in Missouri lays off 200 employees as it outsources some IT services to an unnamed managed service provider. The health system cut about 10% of its IT workforce in July 2018 after wrapping up an Epic roll out.

NextGen acquires telemedicine vendor Otto Health.

LeanTaas raises $40 million in a Series C funding round led by Goldman Sachs. The Silicon Valley company has developed predictive analytics for optimal utilization of ORs, infusion centers, and labs.

Pharmacy benefits manager Express Scripts develops a list of recommended digital health tools for payers and providers organized into treatment categories that include depression, anxiety, asthma, and diabetes. Products and services from Livongo, Omada Health, Propeller Health, and WellDoc are among the initial group of recommended solutions.

The Chartis Group acquires The Greeley Company, a consulting and staffing firm based in Boston.

Sales

• Lakeland Regional Health (FL) will implement care team coordination technology from Andor Health.
• The NC HealthConnex HIE will use CarePort Health’s real-time care notifications and reporting capabilities to improve care coordination at UNC Health Care’s 12 hospitals.

People

CynergisTek names Tony Douglas (Symantec) SVP of sales.

Gregory Adams becomes chairman and CEO of Kaiser Permanente after serving in the interim role since the unexpected death of CEO Bernard Tyson last month.

NIH names Joshua Denny, MD (Vanderbilt University Medical Center) CEO of the All of Us research program.

Charlie Greenberg (Merck) joins PatientPoint as SVP of campaign quality and compliance.

Announcements and Implementations

Faith Regional Health Services (NE) goes live on Epic.

Government and Politics

The Justice Department will look into Google’s $2.1 billion Fitbit acquisition for possible antitrust violations related to amassing data on American consumers.

Privacy and Security

Korunda Medical (FL) will pay OCR $85,000 to settle potential HIPAA violations related to multiple complaints from the same patient that it wanted an unreasonable fee for medical records, and failed to provide the records in the requested format in a timely manner.

Other

Baxter Regional Medical Center (AR) will use a donation from community members to fund in-house development of an interface between its Cerner EHR and 400 smart IV pumps.

Avante Skilled Nursing and Rehabilitation Centers (FL) pilot the Furry Palz Program from Thrive Behavioral Sciences. Designed to rest in the laps of dementia patients, simulated breathing sounds from the robotic pets help to relieve symptoms of agitation, isolation, and depression.

Sponsor Updates

• AdventHealth Waterman and Sentara Virginia Beach General Hospital showcase reductions in hypoglycemia and glycemic practice variation utilizing Glytec’s glucose management technology and services.
• Healthwise receives a Gold Digital Health Award for a patient education video in the Health Information Resource Center’s 2019 fall competition.
• InterSystems releases a new PulseCast podcast, “Dave Menninger: Discovering the Hidden Dollars Within Your Data.”
• Vanguard profiles Intelligent Medical Objects General Counsel Charlotte Tart.
• Nordic releases a new podcast, “Avoiding common pitfalls of an affiliate extension program.”
• Arcadia congratulates its ACO customers in achieving over $423 million in Medicare Shared Savings Program savings in 2018.
• Wolters Kluwer Health adds Clinical Insights with enhanced content from UpToDate to its Lexicomp drug information resource.

Blog Posts

• Key Benchmarks for Process Improvement & Success (EClinicalWorks)
• EPSi welcomes Mosaid Healthcare, Mercy and Texas Health Resources to AWS (EPSi)
• Healthcare data exchange increases access through Intergy (Greenway Health)
• Why Troubleshooting Tools are Important to Any Citrix Upgrade (Goliath Technologies)
• This Groundbreaking Program Proves the Value of Health Literacy (Healthwise)
• Rethinking IT infrastructure in healthcare (Hyland)

Contacts

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

EPtalk by Dr. Jayne 12/12/19

My bedtime routine includes checking HIStalk for comments and doing some light Web surfing on my phone, so my attention was captured by yesterday’s JAMA article entitled “Matters of the Mind – Bedtime Procrastination, Relation-Induced Anxiety, Lonely Tweeters.” No surprise, studies linked smartphone use with bedtime procrastination. The piece also looks at how relaxation can be stressful for individuals with anxiety and depression, as well as how Twitter posts could help identify loneliness. These are areas of research many of us wouldn’t have dreamed of a decade ago. I’ve thought frequently about consumer technology (particularly smartphones) and how it’s collectively one huge experiment, albeit one without an Institutional Review Board to make sure the participants aren’t harmed. I think we’re just scratching the surface at learning what technology does (or doesn’t) do for or to us.

Jenn clued me in to this article about startups focusing on nurses as a target audience. There are 3.8 million nurses in the US, so it makes sense that companies would start designing around their needs. Clove is one of them, and their name is an inside joke as well – the C with a line over it is medical shorthand for “with” so their products are “with love.” The name is subtle but the medically-inspired design of its shoes aren’t – although they’re a running style, they have a solid smooth surface over the toe area which is great to protect from the spills and goo of the job. Ventilation holes are relocated to the sides, where splashes and drips are less likely.

The company is savvy in other ways, showing that they understand healthcare folks by shipping a three-pack of pens with every pair of shoes. The pens are marked “For Borrowing Only.” Anyone who keeps a spare (and usually crummy) pen in their pocket to deal with people who ask to use your pen and who are unlikely to give it back knows what I’m talking about. Nike also recently launched a healthcare shoe, but it’s not nearly as cool. I was a little put off by their unisex sizing as well as their use of the “star of life” logo most commonly used by emergency medical services. In contrast, Clove has both women’s and men’s sizing as well as color names that make clinicians smile: Grey Matter, Night Shift, and Pink Up.

Public health informatics is a big part of clinical informatics, and I was shocked to learn about a measles outbreak on Samoa, where measles is running rampant. The country has a population of around 200,000 and nearly 4,900 people have become ill with 71 dying. Similar outbreaks are also occurring in Tonga, Fiji, and American Samoa. Several of the Pacific island nations have vaccine rates below World Health Organization recommendations. There are numerous reasons for the low vaccination rates, but my thoughts go out to those who are sickened and their caretakers. Hopefully the outbreak is a brief one.

In other news, analytics folks must be cheering at the possibility that flu season could peak early this year. The Centers for Disease Control and Prevention’s FluSight Forecasting initiative gives it a 40% chance of peaking this month, as flu levels have been at or above the national baseline for several weeks. The chance it will peak in January is 30% and February is 20%. I’ve significantly reduced my clinical work for January and February because I loathe driving in icy conditions, so we’ll see if I played the odds right or not.

Intelligent Medical Objects has launched IMO Precision Sets, which are designed to allow clients to quickly define various value sets needed for quality work and value-based care. Based on IMO’s solid terminology and maintained by their dedicated clinical terminologists, they are available in various sets – Oncology, Reporting, Behavioral Health, Chronic Conditions, Perioperative, and Acute Conditions. I spent way too much time in a past life trying to maintain those groupings for reporting, through ICD codes and SNOMED codes. IMO’s original Problem IT product was the only solution I ever deployed as a CMIO where my providers proactively reached out to say thank you, so I’m a big fan of their work.

Congress is looking for feedback on a new bill nicknamed “Cures 2.0,” which is designed to go beyond the content of the original 21^st Century Cures Act to address topics like digital and connected health platforms. They also plan to focus on real-world evidence in the FDA’s approval process, and to speed up coverage of FDA-approved drugs by payers. Feedback is requested by December 16 at cures2@mail.house.gov if you’re interested in sharing your thoughts.

As we approach the end of the year, it’s a time for many to reflect on the months that have passed and our hopes for the coming year. Since we work in healthcare technology, we’re not immune to the influence of various trends and fads, especially where health-related tech is concerned. Like many, I’ve had my adventures with wearable tech, startups, and various apps that proposed to make my life better. Lots of people have stories to tell about how we can live our “best lives,” from tech gurus to TV personalities. In a fit of decluttering I had my Marie Kondo moment, so I giggled when I came across this article about “The life-changing magic of making do.” I’m a frugal person (as evidenced by writing this wearing 20-year old pajamas on a 20-year old sofa, watching Netflix on a TV smaller than some computer monitors), but was shocked by some of the statistics in the article as far as sheer consumption in North America.

The piece’s comments on the lack of fixability with technology resonated with me – it’s one of the reasons I hope my geriatric washer and dryer never fully give up the ghost – I don’t need something with a motherboard to control how my clothes are cleaned. (I’ve had enough of that drama with the refrigerator to last a lifetime). I’ve rehabilitated both the washer and the dryer courtesy of Repair Clinic and its videos. (Have you ever seen inside a gas dryer? It’s pretty crazy in there.) It gives me hope for what I want to do professionally in the next year – to help healthcare organizations get the most out of the resources they’ve already paid good money for and that they might not be using to the fullest. It’s a good goal, but difficult for some organizations because it often involves hard work. It’s much easier to throw out a “problem” technology when the real problem is the people or processes that govern its use. We’ll see how that plays in the New Year.

What are your reflections on the past year and hopes for the coming one? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/12/19

Bridge Connector Increases Total Financing to $25 Million with Investment From Jeff Vinik & Axioma Ventures

Bridge Connector will use its $25 million in financing to help scale a new integration platform-as-a-service that connects health data systems without the need for code.

Proteus Digital Health plans hundreds of job cuts, facilities closures

Proteus Digital Health’s previously announced restructuring will include eliminating 292 jobs and closing several facilities by January 18.

U.S. Justice Department to review Google’s deal for Fitbit: source

The DoJ will look into Google’s $2.1 billion acquisition of Fitbit for possible antitrust violations.

HIStalk Interviews Michele Perry, CEO, Relatient

Michele Perry, MBA is CEO of Relatient of Franklin, TN.

Tell me about yourself and the company.

Relatient is based in Franklin, Tennessee, and was started in 2014. Our name is a combination of “relate” and “patient,” relating to the patient. We are 100% focused on patient outreach and engagement, and it reflects in our name. We do this only for healthcare. We get calls all the time to see if we do this for prisons, courts, schools and everything else, but we are focused on patient engagement.

I joined in 2017. I replaced the original founding CEO. I’m a Saas software solutions veteran. I focus on high-growth companies.

I’m not a Nashville native, which you’ve probably already heard based on the lack of R’s in my vocabulary. I’m originally from Massachusetts and have spent time in New York, California, and Virginia. I was in Annapolis, Maryland for the 20 years before I took this job.

Are hospitals and practices wrong in thinking that all consumers really want is a patient portal?

Patient portals served an important purpose. They were part of the Meaningful Use requirement. But they are not addressing the needs of today’s consumers and patients. Find me a patient who thinks they are.

We compliment a lot of the work that has been done with patient portals and the investments that have been made in them. Lots of times we’ll drive people to things that are stored in a patient portal. But we’re all about using that phone and making it easy for patients.

In this day of the consumerization of healthcare, we all expect to be able to access things easily from our phone. Every day I’m making reservations, planning a flight, calling an Uber, checking my bank balance, and Venmo-ing money to my kids. You can do it with just a couple of clicks. Try to make a doctor’s appointment, check for your lab results, or register for that appointment while you actually have the medicine sitting in front of you at home. Try to do any of that stuff and it’s painful.

That’s what we’ve set out to fix. We make it easy for the patient, and if you make it easy for the patient, you make it easy for the practice. We see hospitals and clinics and everybody else wanting to engage with their patients.

What are the ones that are doing a good job doing differently from those that aren’t?

I’d love to say that it’s concentrated in different areas, but it’s not. We are seeing it across all specialties. Nebraska Cancer in the oncology area is using it to reduce no-shows by 47%. I was surprised – don’t cancer patients show up? The answer was that we need to alleviate the confusion around all the different providers and appointments people have during the cancer treatments.

We are co-presenting with Oklahoma Heart at HIMSS on driving patient engagement in a mobile-first market. We have FQHCs like Access Healthcare in Chicago, who wants to be able to message not just about your appointment, but to let you know that the food trucks that take SNAP are going to be there on the day that you are there for your appointment. Pediatrics organizations like Children’s of Colorado are doing interesting things with telehealth and remote access initiatives, reaching out into rural areas. Primary and women’s care, like Seven Hills or South Bend Clinic, are focused in gaps in care and things like that.

What percentage of hospitals and clinics are using electronic appointment reminders?

The first generation of those products was pretty basic, and it’s rare for us to run into somebody who hasn’t put in a first-generation solution. But now that they have it, they’re finding that they can do so much more with that communication. Do I need to fast before my appointment? Do I need to show up extra early for testing?

Some of our large hospitals have 120 kinds of appointment types, each of which require different messaging. They need support for multiple locations, especially now with telehealth and remote health, so they can say, “Your appointment is with Dr. Smith out of the Denver office, but you are going to be in the Grand Junction office.” The second generation of products needs these kinds of communications. But it’s really rare to find someone who hasn’t done a first-generation product, except for some small two- and three-doctor offices.

Why is patient self-scheduling uncommon?

Practices didn’t have it yet. They said, “Oh, we have a scheduler.” But people want to be able to schedule after hours, during lunch, or during conference calls. I want to quickly make that appointment off my phone or off my desktop. I want to be able to do that quickly. People hadn’t set those up.

We also found providers who wanted their front desk people to have ownership of that schedule. We’ve added to our product the ability to have a two-step acceptance. Let me make my appointment at 10:30 at night. When my kid’s not feeling well and I want to make an appointment, let me make that appointment. But let it actually have to be accepted by somebody in the office in the morning. They accept this one, accept that one, and then realize that they’re accepting all of them anyway, so they are comfortable skipping that step. But the ability to have ownership was important for a couple of our providers as we were bringing them on.

On the back end, does someone have to copy-paste from the self-scheduling application into the system that keeps the real schedule?

The way we do it is important. We actually write back into these schedules. People are sometimes kind of scared about it upfront, but then when they see that it works really well, then they give up. But yes, we don’t just send an email that someone has to then set up – we do all the write-backs right into the systems for appointment reminders, scheduling, e-registration, surveys, and all of the other components.

The culture of some hospitals and practices was built around a siege mentality, where patients aren’t allowed to communicate with a provider unless they make a billable appointment and come to the office. Is that changing?

Sometimes you can bill telehealth appointments, to have those paid for. People want to have access to their doctors, so they’re trying to make it easier to do these new types of appointments, because if I don’t make my physicians accessible to you, you’re going to go down the street to the urgent care or some other clinic. They would rather not have them go away to the Walmart clinic, the CVS clinic, or someplace else. They want you to come to their providers.

Your system offers broadcast messaging for unplanned changes to normal operating hours, like weather emergencies. Do practices who don’t have it just update their Facebook page and hope patients check there?

Some of the folks still change their websites or have a message on the answering machines. We have tremendous demand for demand messaging, or the broadcast messaging capability, when you have weather problems, like New England this week or during Hurricane Dorian. But it’s also used for non-weather things, like if a doctor will be out for the next two days on bereavement, or in OB-GYN for messages like, “This doctor was just called in for a delivery. Please call the office before coming to make sure they will be here for your appointment.” Specialists make appointments months ahead, so you have to keep up to make sure that you’re not blasting the whole patient base to get a message to the 20 patients who need it.

What about health campaigns such as disease-specific follow-up or seasonal items like vaccine availability?

There’s nothing we do that you couldn’t do manually, but it takes a lot more effort. Campaigns to close the gaps of care are important, especially in primary, women’s care, and pediatrics. Getting people back in to make sure their kids are getting the right vaccines at the right time.

We’ve learned the hard way how to actually do the notifications. Maybe 3,000 patients haven’t had this particular thing that needs to get done. If we just blast everybody, your call center gets overloaded the next Monday. We do a dribble campaign and send the messages in bunches so they don’t all go out at the same time. We pull the data from the EHR and practice management system, use the campaign to contact those people and get them to make appointments, and with patient self-scheduling, we can send them to the link so they don’t even have to call the office.

Consumers vastly prefer text message communication over all other forms for convenience, but it also offers better deliverability than email or phone calls and also gives patients a way to take action without writing something down.

What we have found, and what we recommend in our best practices, is a combination of all three. We do phone, email, and text, and we do them at a certain interval over time. We don’t want to stalk you, but we want to make sure you get the message. If you do just texts, your response rate will be lower. If you’ve heard it on an answering machine and you’ve seen it in the email, you might not have reacted to it, so it’s a combination of seeing those.

We send the final reminder at certain times of the day. Some at night, some in the morning, depending on time of your appointment. You might have accepted it and intended to go, but you drive to work and forget. But if I send you a text that morning for an appointment later that day, you’ll remember. I also can’t send them too late because you don’t want to be disturbing people at night and when they go to bed.

Do you have any final thoughts?

We’re still early on with patient engagement, how we’ll engage patients over time, and how we’ll do it within the constraints of HIPAA, GDPR, and other regulations. It will be exciting to see where this will go, with things like two-way chat. But as we do this, we’re committed to innovation. Not just product innovation, but throughout our company. We’re currently rated number one by KLAS for patient outreach, with a score of 95.6. We follow this score closely throughout the company. We believe it’s the best way to ensure that we are firing on all cylinders. We need to have great products delivered by great people to work with our customers to drive the ROI on our software.If we drive that ROI, we will help our practices have happy customers.

Morning Headlines 12/11/19

Google snaps up chief medical officer of health device maker AliveCor, weeks after buying Fitbit

Former AliveCor CMO Jacqueline Shreibati, MD joins Google Health’s clinical research team.

McKesson Appoints Nancy Flores as Executive Vice President, Chief Information and Chief Technology Officer

McKesson names Nancy Flores (Johnson Controls) EVP, CIO, and CTO.

ESO Acquires Clinical Data Management to Extend Product Portfolio in Trauma Registry Market

Emergency medical services technology company ESO acquires trauma registry software vendors Clinical Data Management, Lancet Technology, and Digital Innovation.

CommonWell Health Alliances Announces New Executive Director

Former Philips VP Paul Wilder joins CommonWell Health Alliance as executive director.

News 12/11/19

Top News

“Smart pill” medication management company Proteus Digital Health struggles to stay afloat after a $100 million funding round fails to materialize. Once valued at $1.5 billion, the Silicon Valley-based company furloughed employees for several weeks in November until it could acquire $5 million in emergency funding. Company officials say they are looking at restructuring options, while unnamed insiders point to a lack of traction with patients as a big reason for the company’s stymied growth.

Meanwhile, competitor EtectRx receives FDA clearance for its smart ingestible, which is being tested by researchers at Brigham and Women’s Hospital and Fenway Health in Boston for use with HIV medication.

Reader Comments

From Dr. Doyle: “Re: The Great NHS Heist. Interesting movie on the NHS.” Backers of the documentary make it available on Youtube ahead of the UK general election on December 12. The documentary, which aims to highlight increasing efforts to take the NHS private, has been in the works for a number of years. It made its theatrical debut in London last month.

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Emergency medical services technology company ESO acquires trauma registry software vendors Clinical Data Management, Lancet Technology, and Digital Innovation.

Former Outcome Health EVP Ashik Desai pleads guilty to charges of fraud, admitting that, “When I was at Outcome Health, there were practices going on there that were wrong. I participated in those practices that ended up defrauding Outcome’s customers.” Three other former employees, including former CFO Brad Purdy, have pled not guilty. Former CEO Rishi Shah and former president Shradha Agarwal will make their court appearances next week.

Sales

• Hospital Sisters Health System Medical Group (IL) will implement Relatient’s patient engagement software.
• Saint Peter’s University Hospital (NJ) selects Vox Telehealth’s FemmeCare for C-Section and Hysterectomy programs to help patients better prepare for and recover from surgeries.
• Precision medicine company Astarte Medical selects commercialization services from Get-to-Market Health.

People

Paul Wilder (Philips) joins CommonWell Health Alliance as executive director.

Innara Health promotes Chris Mathia to CEO.

AI-based diagnostics vendor IDx Technologies promotes John Bertrand to CEO, replacing founder Michael Abramoff, MD who has become executive chairman. The company has also hired Seth Rainford as president and COO, and promoted Danika Simonson to the new position of chief of staff.

Announcements and Implementations

Advocate Lutheran General Hospital (IL) implements AI-enabled stroke-detection software from Viz.ai. The technology will be rolled out to the entire Advocate Aurora Health network by early next year.

Floyd Medical Center (GA) launches a telemedicine program for stroke and neurology patients leveraging providers from Erlanger Health System (TN).

IntelliGuard integrates its RFID-enabled medication tracking technology for anesthesiologists with Epic.

Wyckoff Heights Medical Center (NY) goes live on Allscripts Sunrise and FollowMyHealth software.

LogicStream Health will make its Drug Diversion App available early next year.

With help from the Medical University of South Carolina’s Center for Telehealth, Roper St. Francis Healthcare adopts tele-ICU services from Advanced ICU Care at three of its hospitals.

Privacy and Security

Hopes of returning to normal operations within a week are dashed as the Government of Nunavut in northern Canada continues to recover from an early November ransomware attack that took its computer systems offline. Health department officials still have no idea when they’ll be able to get their Meditech system and telehealth capabilities back up and running. Chief of Staff François deWet, MD says several things have made the “IT apocalypse” eye-opening:

• Having a disaster plan already in place was key to communicating needs and updates with affiliate organizations, which in turn ensured healthcare services weren’t interrupted.
• The fact that the department was in the midst of a Meditech upgrade before the ransomware attack happened resulted in more reliable backups, which are in the process of being restored.

Other

A Bright.md survey of 521 consumers finds that they trust their current providers and healthcare organizations with their health data far more than they do their health insurance companies, technology companies like Amazon or Google, or telemedicine vendors.

Sponsor Updates

• Bluetree employees impact 23 organizations by volunteering 264 hours across 13 states and India during the company’s annual Give Back Week.
• HHS expands its contract with Audacious Inquiry for the development of a national Patient Unified Lookup System for Emergencies system.
• Avaya announces that Earvin “Magic” Johnson will keynote Avaya Engage 2020 February 4 in Phoenix.
• Data Center Knowledge features Atlantic.Net in its “Trends in Data Center Network and IT Security” report.
• Wolters Kluwer Health adds machine learning and AI capabilities to its Sentri7 healthcare-acquired infections surveillance software.
• Huron will provide consulting and implementation services for Omnicell customers.
• SymphonyRM releases a new podcast, “Edward Marx and Four Pillars of Innovative Leadership.”

Blog Posts

• Reduce Wear and Tear on your Hospital’s Patient Bedside Tablets (Access)
• Optimizing Your Revenue Potential (AdvancedMD)
• 2020: What lies ahead for payers and PACS? (CarePort Health)
• #RSNA2019 – Delivering high impact care at Zuckerberg San Francisco General (Agfa Healthcare)
• 2019 #BlueleafGiveBackWeek: A recap (Bluetree Network)
• Addressing Social Determinants of Health with Technology (Collective Medical)
• 10 Things Nurses Say They Need Right Now (CoverMyMeds)
• 5 Technologies That Will Shape Healthcare in 2020 (Dimensional Insight)
• Nordic’s company culture ranks among nation’s best (Nordic)

Contacts

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

Morning Headlines 12/10/19

etectRx Announces U.S. FDA Clearance of Novel Ingestible Event Marker

EtectRx’s smart pill system receives FDA clearance after news breaks of competitor Proteus facing financial difficulties.

Alleged billion-dollar fraud scheme leads to guilty plea by former Outcome Health exec

Former Outcome Health EVP Ashik Desai pleads guilty to wire fraud and agrees to cooperate with prosecutors.

For Concussion, MS, Other Neurologic Disorders, Telemedicine May Be as Effective as Office Visit

A retrospective analysis of 101 telemedicine studies finds virtual visits may be just as effective as in-person visits for several neurological conditions.

Curbside Consult with Dr. Jayne 12/9/19

As part of the Maintenance of Certification process for my clinical informatics board certification, I have to complete a quality improvement project related to practice. Although there is quite a bit of flexibility in these projects, it’s been challenging for me to come up with something because I don’t have what many would consider a “typical” informatics practice. Many of my peers are either part of academic institutions where they have clear roles and/or titles. Others are part of healthcare delivery organizations where they have the ability to use data and processes for quality improvement. As an independent CMIO for hire, I often have a seemingly random mix of employers, ranging from startup technology vendors to large healthcare systems.

In these situations, I have contractor status. It’s a strange limbo where often you are treated like an employee but you’re actually not – you have many of the same responsibilities and are subject to the same rules as employees, but at the end of the day you don’t have the ability to direct your own work or propose new initiatives that would make sense for a straightforward project for board certification. My clinical situation is unique in that I’m employed, but very much part time and with no formal informatics role these days. My informatics influence is limited to cranky emails to our IT team asking why the system is suddenly allowing us to e-prescribe controlled substances when we do not have legitimate EPCS technology in place. My employer is reluctant to allow me to do anything with our data, since I’m essentially just an hourly physician.

I have another year or two before I have to finish this project, but I still feel somewhat adrift with it. Still, I am always on the lookout for ideas. One recently came across my desk, and I wonder if the practice would be willing to let me use their data if I could find some “what’s in it for me” for them. As an urgent care, we certainly see our fair share of trauma. Recently, JAMA Otolaryngology-Head & Neck Surgery published a study investigating a surge in cellphone-related facial trauma. Reported injuries range from being injured by a dropped or thrown phone to distraction-related falls.

The authors looked at 20 years of data from the US Consumer Product Safety Commission database looking at ER visits. They found 2,500 patients with phone-related head and neck injuries between 1998 and 2017, with a surge beginning in 2007, coinciding with the advent of smartphones. Approximately 40% of the subjects were between the ages of 13 and 29, and they were generally injured while walking, driving, or texting. Although cell phone use has also been linked to repetitive motion injuries, these were excluded from the study. The most common injuries were facial and head lacerations, followed by contusions, abrasions, and injuries to internal organs. The majority of patients were treated and released. Apparently there are more than six million patients treated for lacerations every year, with an estimated cost of $3 billion.

I’d be curious to find out how cell phones compare with other sources of trauma in our urgent care practice. We see over 300,000 patients a year so there should be a reasonable amount of data. Anecdotally, I think that sports-related injuries likely make up the lion’s share of our head trauma, followed by motor vehicle accidents, and falls. I’m betting that the causes would have to be determined by a chart audit, because many of my partners aren’t as specific with their coding as they could be. My quality intervention could be to assess whether visits were documented more accurately when physicians or scribes were doing the work, and to develop a curriculum to try to increase the specificity of coding. It’s kind of a soft project, but it at least addresses something that is clinically relevant in my practice. Still, it’s unlikely that I could talk my employers into it, since there’s not a clear return on investment for the time that would need to be spent educating clinicians and staff.

Another option for the quality project is for informaticists to conduct a 360-degree evaluation project. We did a 360-degree evaluation in residency and I’ve done it with a previous employer, and also with one of the community service organizations I work with. All three times I found it to be useful, although the episodic nature of some of my work might make this challenging. Some of my projects only last a month or two, which makes it hard for someone to get to know how you work, critique it, and then re-evaluate after you’ve completed some kind of intervention or change in how you work.

These are all part of the hoops that we have to jump through to maintain our board certification status. It’s particularly challenging in clinical informatics, since there can be such breadth in the type of work that we do. Our practice environments can be very different, and we may spend anywhere between 1% and 100% of our time doing informatics work depending on how much our employer wants to fund. I am glad that the American Board of Preventive Medicine, which is my certification body, recently approved a proposed Longitudinal Assessment Pilot as an alternative to the one-day board certification exam. It is supposed to launch in early 2021 and run for 24 months. Participants will answer 24 questions a year. This differs significantly from the longitudinal assessment pilot in my primary board, where we have to answer 100 questions a year for four years in order to replace the exam. It’s hard to imagine how the scope of clinical informatics can be distilled down to 24 questions a year, but unlike my primary board, it doesn’t seem that we have the opportunity to opt-out of this pilot.

I’m curious whether non-physicians are aware of the clinical informatics quality projects and whether your board-certified colleagues have pulled you in to help them get across the finish line. How are the projects perceived? Have there been positive outcomes? Or are they just a nuisance? On the physician side, is anyone else dreading their project? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Doug Cusick, CEO, TransformativeMed

Doug Cusick, PharmD is president and CEO of TransformativeMed of Seattle, WA.

Tell me about yourself and the company.

I’m a clinician by background, although I’ve not practiced for many years. I’ve been in the electronic health industry for 35 years and I have the gray hair to prove it. I spent five of those years overseas, running a large healthcare and life sciences division for a large technology and services company.

TransformativeMed was a spinout from the University of Washington back in about 2012. It was co-founded by a practicing trauma surgeon, who continues to practice, and at that time the applications director at the University of Washington, who had overseen its Cerner implementation. The two of them together quickly saw a need to make the EHR usable, primarily for the doctors.

Does offering products that extend Cerner’s system limit the company’s opportunities?

The applications director was one of the inventors of MPages, which is used by organizations — including Cerner — to develop customizations to the Cerner Millennium software. The co-founders recognized that the EHR was just a platform, and in many cases, one that was challenging for clinicians to use. They went about inventing a series of applications that are embedded within Cerner and that have bi-directional information exchange. That allows specialty-specific workflows to be built.

By example, if you’re an endocrinologist, you need certain data at certain times in the decision-making process as part of the hospital’s overall care team. You want it in the format that is intuitive to how you practice. They developed 40 specialty-specific and subspecialty-specific clinical workflows.These are embedded in the clinical workflow, where all the action happens. Those users can manage their patient lists, the rounding and hand-off process, and care team coordination. They can also take advantage of disease-specific workflows, such as inpatient diabetes management and thrombolytics.

We continue to consume more and more of the breadth and the depth of what the clinicians need in order to make the electronic health record usable. We are moving pretty broadly across that realm.

What kind of relationship with Cerner do you need to make this work? How would that translate into working with Epic?

Our solutions are built on cooperating with the large electronic health vendors. It’s like the Salesforce model, with a great platform that is open for innovations. Cerner specifically is that type of platform. We rely on the data that is populated in the EHR. Our solutions allow that data to flow between the apps and the EHR, because it is embedded within the databases themselves.

In many cases, particularly with Cerner, the client representatives themselves come to us to help solve problems around clinician satisfaction, gaining efficiencies, and delivering on the billions of dollars that have been invested in the EHR.

It’s funny that in my 35 years in this industry, I can count on one hand how many doctors and IT people have ever said anything positive about any software solution. But in our case, what was so attractive for me coming on as CEO was that I get emails and phone calls every day from doctors and IT folks who love our embedded applications products that make their EHR usable, particularly from a specialty-specific perspective. It’s pretty amazing that for the first time in my career, we get so many kudos because doctors and IT folks love us.

How do you see the company growing? Do you hope to replicate your success in having helped other companies move up to the next level?

[Laughs] Absolutely yes, and most certainly. What was so attractive about me coming on board was that I had never seen anything like it. It isn’t disruptive to IT. Doctors and clinicians truly love us because we make their day better by delivering solutions that are intuitive to how they practice medicine. That we don’t need trainers on site speaks to the intuitiveness.

We recently went through a fairly substantial series A raise in Seattle. Before that, we were moving the company forward on customer revenue, and most of those sales had been done by word of mouth. For example, clinicians practicing at the University of Washington were moving on to other health systems and logging onto the EHR and saying, “This isn’t what I’m used to. I really need Cores,” which is the name of our product line.

When I came on board, we had a pretty nice array of clients and we’ve expanded that dramatically. I think we’re up to about 140 or so hospitals in the US. We’re selling our first international deal this week, so we’re pretty excited to expand internationally as well. Cerner has a large footprint.

We will be cautiously moving into Epic. We just closed our first contract with a health system that is moving to Epic. We couldn’t be more excited about gaining that experience, especially as interoperability and FHIR begin to take hold of the industry.

What business arrangement do you have with those EHR vendors?

We do not have a formal business relationship with them. We contract directly to the health systems. But with so many articles being published around physician burnout and lack of efficiencies and crises galore, the EHR vendors are seeing opportunity to deliver more innovation through their platform. The EHR is just data storage and the ability to move data around.

Health systems are recognizing that the EHR vendors aren’t going to deliver everything they possibly need. With the amount of true innovation that is going on across the industry, how can they add applications that make it more usable in a standardized fashion, but personalized for the clinicians who have to use it?

Particularly in this era of EHR optimization, we need to move way beyond the re-implementation of the EHR as the industry currently conceives it. EHRs need a massive overhaul to make them usable by the clinical community, and we have lots of studies to support that. CIOs are beginning to recognize, along with the clinical community, that they have a responsibility to help solve some of the problems.

It’s surprising that you can work with Epic without the company’s participation, and also that you can create add-on products without having problems when Cerner or Epic upgrade their underlying EHR.

MPages allows us to be directly embedded within the Cerner databases and all clients use it. Once we are given access to the system, it becomes our heavy lift and not an IT department burden, so CIOs love us. Plus, we are delivering huge benefits to the clinical community, namely the doctors who are finding that it is much more usable.

Epic is a different model and a more closed architecture. But we’re finding, particularly today in our first engagement, that Epic has been collaborative in terms of bringing our solutions within this health system. We’ll go live with them later in 2020. We couldn’t be more excited about the opportunity to move further into the EHR world. And not just here — the problems we face are being seen worldwide as more countries and systems purchase American EHRs.

EHRs weren’t necessarily designed for physician shift work and the resulting handoffs, such as hospitalists covering large numbers of patients for a fixed period, residents whose work hours are limited, and the use of multidisciplinary care teams. What does the market need beyond basic EHR functionality to support that model?

IT needs to become more interoperable. The 21st Century Cures Act is helping drive that interoperability forward, but health IT vendors as a whole are slow to comply.

I can use my phone to take a picture, edit it before texting it to my kids, share it on Facebook or Instagram, and my sister can download it and post it to her Nixplay electronic picture frame. This is real interoperability, and it should translate to healthcare because consumers expect it.

Doctors and other clinicians are spending so much time today away from the bedside and tied to a device – desktop or mobile – trying to get the data they need to make decisions. They need solutions that make it seamless and allow them to function as part of a care team. In the old days, you had just one doctor, like Marcus Welby, MD, but today that’s not the case. How do we continue to coordinate care across the health system to get the individual clinicians what they need immediately to make clinical decisions that positively affect the patient?

Our philosophy is about making that seamless communication and hand-off process as beautiful as possible so that clinicians can get back to the patient. They can deliver care as they’ve always wanted to. They are not tied to a computer to get the data they need in hunt-and-peck fashion. They go about doing their business and, in the process, become happier, and happy clinicians deliver better patient care.

Health systems, because they’ve invested so many billions, are now trying to figure out how to derive further value after these purchases. Companies like ours that are delivering innovation directly into the clinical workflow, where all the action happens, will be important. Because we’ve had such a substantial jump on it for the last seven years or so, we’re excited about the opportunity moving forward.

Beyond usability, EHR-related burnout seems related to the timing of system interruptions or guidance and the lack of workflow cohesiveness. Does that differ across specialties?

Absolutely. Consider the difference between what an endocrinologist may require when making a decision versus the oncologist. Although there are standards of practice, each specialty requires certain elements of data in a certain format that’s intuitive to how they practice medicine so that they can acquire that data with just one click, get everything they need, review the most appropriate and non-nuisance decision support, and then pass that on to the rest of the team.

That approach has garnered improvements in clinician satisfaction and efficiency. Instead of spending an hour and a half preparing for rounding, as some residents do, they don’t have to prepare. It’s right there for them, everything they need to do for rounding and hand-off. Those kinds of gains are making a huge difference, recognizing that some personalization needs to be done, but in a standard fashion.

Less than 1% of our solutions are ever customized because they are already intuitive to how the specialists practice medicine. That makes a huge difference, particularly with IT and the implementation process itself. Instead of taking 12, 15, or 18 months to implement a big EHR, we’re providing our applications from start to finish in less than 90 days. That’s a huge opportunity for doctors and executives to get those quick wins that deliver value immediately.

What prevents EHR vendors from using your ideas to develop competing functionality?

In the Salesforce model, these big vendors can only do so much, and they have a heavy lift across the entire system. As companies like ours begin to specialize and create niche markets, particularly for us around clinical workflows and disease-specific workflows, it’s easy for a health system just to drop it in and use it without the big lifts that they are traditionally used to with the big EHR vendors.

How will your business change as EHR vendors start using technologies from Amazon, Google, and Microsoft?

The difference is being truly embedded within the clinical workflows. The struggle in the industry is that a lot of great companies are doing a lot of great things, but they’re doing it from the outside, trying to get in. You have to toggle over to another system, or do something that disrupts the clinical workflow. We are clinicians and we are deeply embedded within the clinical workflow, where everything’s actionable. If you are using our secure messaging system, you get an alert that a particular patient’s creatinine level is high. It’s important to be able to take action from that message within the clinical workflow.

There’s much disruption and opportunity across the industry, everything from machine learning to artificial intelligence and certainly population health and analytics. Sometimes just getting the basics right around making it more usable in the clinical workflow for the clinicians is the huge opportunity. These players, Amazon included, are making huge strides in making the practice of healthcare delivery better. We welcome all of the opportunity, because it will change all of our lives, help us deliver better patient care, reduce cost, and produce better outcomes. We welcome the opportunity for companies like Amazon and Microsoft, which has now stepped back in in a dramatic fashion, because it means that healthcare will be better.

Do you have any final thoughts?

As we continue to see the industry mature, EHRs will become the platform where data is entered and stored. Companies like ours will make it innovative and useful to those who interact with it every day. This is the most change I’ve seen in 30 years, particularly as EHRs have become standard and problems had begun to arise that were never anticipated, problems that we have begun to fix across many health systems. I couldn’t be more excited to be in the industry. I still have the passion and the drive to deliver the change that we’re expecting, and it feels really good.

Morning Headlines 12/9/19

Hackensack Meridian’s ‘core clinical systems’ back online after week-long disruptions

Hackensack Meridian Health (NJ) brings its clinical systems back online after a downtime of several days, rumored to be the result of a ransomware attack.

Partners reports stellar financial results as it preps for rebrand

Partners HealthCare, soon to be renamed to Mass General Brigham, cites Epic’s more accurate coding as part of the reason it took in $484 million of operating income in its most recent fiscal year.

Digital health start-up once worth $1.5 billion is racing to keep lights on as investors flee

Once valued at $1.5 billion, “smart pill” medication management company Proteus struggles to stay afloat after a $100 million funding round falls through.

NHS gives Amazon free use of health data under Alexa advice deal

In England, NHS gives Amazon the option to use its clinical content in the development of future products and services as part of its contract for an Alexa skill that offers medical advice culled from the NHS website.