Book Review: The 10 Principles of a Love-Based Culture

Industry long-timers Ivo Nelson and Dana Sellers hit a couple of massive health IT consulting company home runs. They created Healthlink and Encore Health Resources and then sold them to large companies in 2005 and 2014, respectively. Those brands have disappeared, existing only as a fond memory for the former employees who ended up working for companies (IBM an Quintiles as the original acquirers) whose corporate culture was considerably different than that of the “love-based” companies that are described in this book.

The Title

The title of this book will likely limit sales volume. It sounds pretty hokey, like those self-help books written by self-proclaimed gurus that can’t deliver on the title’s promise. I cringed every time I read “love” in the book because it doesn’t seem to fit what the book is actually saying. My observations:

• The principles described have little to do with the squishy, feel-good concept of “love” within the corporate walls. Offering a customer a refund for poorly done work isn’t really love. The authors never claim to love all of their former employees or to have been loved by them. “Compassion” or “trust” are more accurate. I don’t remember any part of the book stating that anyone loved someone else other than family, although it contains examples of compassionate executive behavior.
• I don’t think “love” and “business” share much common ground. I don’t expect to love my employer and I don’t expect them to love me. Our relationship is mutually beneficial, but I expect to get most of my emotional rewards elsewhere. My employers have admittedly operated far from the love-based culture described here and that makes me wonder whether any companies really follow the 10 principles.
• Most corporate executives would not read a book with this title because they would correctly realize that they can’t just flip a switch to turn on love that they don’t really feel. They probably also aren’t looking to retool their management style by reading business self-help books. They  aren’t likely to make a gazillion dollars just by using the book’s ideas to create the next Healthlink.

The book’s subtitle is better even though it’s no more actionable: “How authentic business leaders trust their employees to do the right thing.”

The Actual Book

A lot of health IT books are poorly produced. Authors use a vanity publisher or ghost writer, don’t hire a skilled editor, skip performing research in favor of just spitting out folksy non-wisdom, or scrimp on the physical production of the book. The result is embarrassing, or at least should be — a lazy way to check a resume box in hopes of finding a better job or adding “author” to join the questionable “speaker” or “thought leader” on business cards.  

This isn’t one of those books. It is well written, edited well, and designed and printed professionally. It’s a real book, in other words. It isn’t super long at just over 200 pages in the hardcover edition, but it has good, easy-to read stories and examples.  

The Intended Audience

I’m struggling to understand the intended and desired outcomes of this book. Ivo and Dana created two consulting companies that grew like crazy. Starting from scratch allowed them to hand-pick their co-workers and to intentionally create and maintain the culture they wanted.

Most of the book’s ideas don’t seem to fit well with larger organizations: companies whose culture isn’t easily changed (which I suspect is nearly all of them); those organizations that sell products rather than services or to consumers instead of to other businesses; and for employees who aren’t in a position to change culture.

I’m picturing the average reader wishing that they could have worked for Healthlink before IBM screwed it up or that they could quit their jobs and find the rare employer that embraces even some of the 10 principles. The biggest takeaway for many readers might be that their employer is not a great place to work.

The 10 Principles

1. Make every customer happy enough that they would offer a positive reference if asked.
2. Put employee needs first.
3. Make sure executives live the company’s core values.
4. Define a purpose that goes beyond profits.
5. Focus on long-term growth.
6. Reward employees based on the overall value they provide to the company, even though such value is subjective.
7. Create positive energy from company successes.
8. Develop company policies and processes based on trust.
9. Empower frontline employees to do what’s right for the customer.
10. Hire executives who demonstrate that they care.

The Credibility Factor

Healthlink is the example given through the book. Ivo sold that off to IBM in 2005, so a critic might question whether what he and Dana learned there 15 and more years ago is applicable and relevant now. They did it again with the more recently formed Encore, however, so that’s a plus even though it was still in the go-go industry years that have cooled off considerably since.

The book mentions that Healthlink spawned at least 15 CEOs who carried on with a love-based culture. Hearing their stories would have been enlightening. What kind of companies are involved? What cultures existed, if any? Which Healthlink principles did they find useful and which did they skip? Were any of them involved with larger companies and thus on the hook for delivering quarterly results and changing a culture at large scale? Did they apply what they had learned at Healthlink to a turnaround situation? What kind of personalities did they have and how did that affect their leadership style?

Ivo and Dana say in the book that Healthlink’s culture wasn’t necessarily designed up front – it happened on the fly as a by-product of the team they assembled. I’m not so sure that a CEO would read this book and suddenly vow to make personal and corporate changes that would make their company look like Healthlink, especially if they didn’t create the company in the first place. Nor am I sure that I would expect great things from a CEO who had to learn concepts such as empathy and employee satisfaction from reading this book.

In short, would any of theses ideas actually work if Ivo and Dana weren’t involved? I’m not so sure. They give themselves too little credit in the book. Consulting is a people business, Ivo and Dana have a long industry track record and a Rolodex full of contacts to earn services business, and they are obviously outstanding entrepreneurs.

Fear-Based Culture

Ivo says that the opposite of a love-based culture is a fear-based culture. That’s the type of employer that nearly all of us know. The book provides a checklist to determine whether your workplace is fear-based, which I can assure you is both enlightening and depressing. Your boss thinks they are smarter than everyone else, people are promoted and paid illogically, everybody is afraid to speak up, and corporate backstabbers play a zero-sum game in trying to diminish everybody else to improve their own standing.

The challenge is, what do you do having read the book? Send a copy to the CEO and hope for the best? Demand that the CEO change the culture? Find a new job working for a company whose culture is love-based? You’ve read this book and are thus enlightened — then what? I worry that readers will be able to recognize a fear-based culture while simultaneously realizing that it is unlikely to change.

What Would Have Made This Book Better?

• Provide examples that go beyond Healthlink to prove generalizable applicability.
• Identify a large company that follows most of the 10 principles and interview the CEO about that company’s culture.
• Interview the former Healthlink employees who are now CEOs to see how much of the company’s culture they carried over, especially for companies that aren’t in the consulting business.
• Describe how a company could start the slow turn toward the culture described, or how to assess where they stand and what they might expect along the way.
• Describe how a manager might use the principles even though they don’t have the power to change HR or financial processes.
• Expand the chapter on governance into its own book to help startup or small-company CEOs understand how to optimally work with their boards and the executive team. This is where I would want to pick Ivo’s brain, along with having him explain how and when to sell a company.

My Ivo Interview

I interviewed Ivo as he and Dana were getting Encore Health Resources off the ground. It’s one of my favorite interviews because Ivo is honest, reflective, and likeable (we would all love to have Ivo or Dana as our mentors, no doubt). Just about everything he said was worth considering and remembering, but this stuck with me most:

I’m perfectly happy with having an expectation that says we’re going to hire really good people and we’re going to do great work for our clients and the growth is going to be whatever the market has to give us. If this is a 30, 40, or 50-consultant company in five years and we’ve got 100% referenceability and we’re considered the place to work in the industry and every time I talk to a consultant they tell me how much they love working for Encore, I consider that to be a grand slam home run.

If it’s 500 people and we’re not providing great services to clients and we’ve got people quitting because they hate working for Encore but we’re making a ton of money, I’ll consider the company a huge failure. Dana and I, we really just want to build a really good company that clients can be proud that we’re working for them and our consultants can be proud to say that they work for Encore …

Having been acquired and watched other similar companies get acquired, too, I think it’s extremely difficult to take a people company like a consulting firm and have cultures meshed with a technology company that’s more asset-based …

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy.

I asked Ivo several questions about company culture, starting a company, and consulting vs. other businesses. It’s worth a read to get to know him better. His philosophy is simple, although I think his ability to strategize, execute, and sell is always understated and he is disarmingly unaffected in person.

My Final Points

• I enjoyed the book even if I can’t quite figure out how most readers who aren’t CEOs (me included) can actually use its concepts.
• I enjoyed every story from Ivo and Dana and I appreciate their use of them to illustrate concepts.
• This is a great book if you worked or Healthlink or admire its history, maybe less relevant or credible if not. Healthlink ceased to exist half a generation ago and people outside of healthcare IT have likely never heard of it.
• The book’s jacket makes the simplistic promise that companies that follow the 10 principles (the “no-brainer steps”) will have happy customers, energized employees, and high revenue growth. That’s a stretch.

I would have enjoyed reading a company history of Healthlink or autobiographies of Ivo and Dana and this book contains some of those elements. Still, I found myself wishing for a broader range of stories that weren’t necessarily chosen to back the questionable argument that the 10 specific principles can be easily implemented to guarantee business success. I don’t think it’s nearly that straightforward.

You now know the 10 principles. You know that the book contains a lot of Healthlink anecdotes. You understand that Ivo and Dana have created some great businesses in somewhat unconventional ways. You therefore have enough information to decide whether you are likely to get $15 worth of useful ideas or entertainment from “The 10 Principles of a Love-Based Culture.” My guess is that you probably will, even if you aren’t convinced that a company can just flip the switch on a nice, round number of love-based principles and find Healthlink-like success. It’s a fun read that contains enough information to be useful to nearly everyone in business.

Ivo and Dana need to write more books. Cover topics that distill a lot of practical knowledge that CEOs need. Write anonymized stories about mentoring CEOs and observing their boards and executive teams in action. Find a large company with a fear-based culture, help the CEO turn it into a love-based culture, and describe the process and results. This book proves without a doubt that Ivo and Dana have a lot of good information and are highly capable of presenting it well.

Morning Headlines 6/12/19

Humana and Epic to Enhance Patient, Provider and Payer Collaboration

Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow.

EQT to Sell Press Ganey

Swedish investment firm EQT will sell healthcare advisory and analytics company Press Ganey to a consortium of funds managed by Leonard Green & Partners and Ares Management affiliates.

Genome Medical Raises $23 Million in Series B Financing to Advance the Adoption of Genomics in Everyday Medical Care

Telegenomics company Genome Medical raises $23 million in a Series B round led by Echo Health Ventures.

French tech giant Dassault is nearing deal to buy health software company Medidata

Dassault’s interest in acquiring clinical trials software company Medidata is intensifying, with insiders reporting that a deal is imminent.

News 6/12/19

Top News

Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow, giving prescribers drug efficacy and cost information at the time of prescribing.

Other elements of the relationship include work with prior authorization, provider data sharing, sending claims information electronically, and providing clinical insights within workflow, such as possible diagnoses and health maintenance activities.

Reader Comments

From Barnabas Rubble: “Re: RWJ Barnabas Health. Moving from Allscripts and Cerner to Epic.” Unverified. I reached out to CIO Robert Irwin, but haven’t heard back. That’s a great phony name, by the way.

From Grift Certificate: “Re: HIMSS. Stole the idea for your conference survival kits!” It was actually Arcadia’s idea for the survival kits going back several years – we just helped hand them out and they included our logo to be nice. I actually used the contents to get through the week. The HIMSS20 version from HIMSS will cost a sponsoring company $40,000 even though it’s not as cool as Arcadia’s judging from the photo of its contents. HIMSS must be desperate to stem the attendee headcount bleeding because anyone who pays to emblazon their logo on the kits also gets four full conference badges and 10 exhibitor badges. HIMSS is also offering other branded tchotchkes in attempting to monetize every object and space within a mile of the Orange County Convention Center. Its website says Athenahealth has already signed up to plant its name on attendee bags at a cost of $47,500, maybe because Virence Health paid for the HIMSS19 bags and announced as the show started that it was retiring that name and using Athenahealth instead (suggestion to the company – if your $47,500 buys the same crappy bags as you gave out at HIMSS19, please spend more for something people can use after the conference – isn’t that the goal?) I won’t have a booth at HIMSS20 because I can’t justify the cost, but I’m sure Arcadia will be handing out the kits as usual. Consistency is key in branding and this is a good example – I automatically associate Arcadia with the kits because they provide them every year and theirs are the best.

From Shrunk Costs: “Re: hospital cost. Why don’t we go back to the old days of paying them a cost-plus on top of their actual costs?” Because their actual costs are the problem. Hospitals spend enormous amounts on employees and buildings, and unlike for-profit businesses, they don’t have much incentive to cut costs since they’re just an impenetrable black box for which insurers are stuck paying (at least as long as a nearby equally desirable competitor doesn’t undercut them). Communities and patients love seeing the tall architectural wonders that non-profit hospitals buy with money taken from the sick people among them; they also love having hospitals as the biggest and probably least-efficient employer in their community. Limiting hospital margins by mandating cost-plus pricing is a drop in the bucket compared to cutting hospital financial waste. However, squeeze their margins in one area and they’ll make it up elsewhere since that’s what businesses are supposed to do. It will get worse as health systems sprawl by acquisition and exert more market control. Hospitals have unfortunately outgrown the honor system that used to keep prices in check before the nuns and empathetic locals ceded control to suit-wearing MBAs.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor PCare. The Lake Success, NY-based company’s interactive patient experience solution helps providers engage, educate, and entertain patients across the care continuum, integrating with EHRs, patient portals, and mobile health apps to connect patients, families, and caregivers and to improve the lives of staff. It’s ranked #1 in KLAS’s Interactive Patient Systems for 2019 (and the three previous years as well) and can be deployed in an average of under 60 days. Patients get a personalized experience based on their orders, diagnosis, and their own actions that improves responsiveness, patient education, the care environment, and discharge and care transition. UPMC Children’s Hospital automated its patient education with Cerner integration, while Memorial Sloan Kettering Cancer Center integrated the PCare platform with a range of hospital technologies that manage RFID, HVAC control, dietary, and medical interpretation across multiple care settings. Thanks to PCare for supporting HIStalk.

I found this recent PCare intro on YouTube.

Webinars

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

Acquisitions, Funding, Business, and Stock

Salesforce will acquire analytics software vendor Tableau in an all-stock deal worth nearly $16 billion. Fun fact: Tableau co-founder Patrick Hanrahan is not only now a billionaire, he’s also an Academy Award winner from his movie work at Pixar. He says he works only 20% of the time at Tableau, preferring to spend the majority of day as a Stanford engineering professor.

This is good advice from the CEO of Box. Software vendors nearly always eventually overload their products with questionably useful and little-understood features, either to (a) differentiate the product from competitors and command a premium price; or (b) placate a small subset of vocal users who insist on adding fringe functionality that almost strays into custom software development. That second item is common with provider software since standardization across organizations is unheard of and everyone wants software to mimic their screwy processes from paper or other electronic systems. I might posit that the long-term success of a medical software vendor is to avoid pandering to clients (especially the loud ones from big hospitals) who demand the illogical and instead steer them toward the reasonable. A corollary would be that near-universal inpatient EHR adoption and the market shakeout to just a few dominant vendors has at least encouraged hospitals to standardize to the degree required to run off-the-shelf software.

Announcements and Implementations

Invenix announces that its smart infusion system — designed from the ground up to meet FDA’s 2014 infusion pump guidelines — has earned FDA’s 510(k) clearance. The company says the new device has better usability with a smartphone-like user interface, saves nurse time, and adds patented adaptive control technology, all of which can reduce total cost of ownership by 40%. Legacy IV systems, including earlier-generation smart pumps, are involved with a lot of serious medication errors, so this is a pretty big deal.

Government and Politics

Louisiana’s state auditor lists ethical problems with Louisiana State University’s creation of a private, non-profit organization to sell its self-developed, web-based physician inquiry tool called CLIQ that was implemented at Charity Hospital. LSU incorporated Louisiana Health Information Technology Foundation in 2014 to collect potential software revenue while bypassing state budgetary oversight. LaHIT later signed a licensing deal with a for-profit company who then hired several of LSU’s programmers, but LSU cut ties with both organizations in early 2017. LSU blames former EVP Frank Opelka, MD for overstepping the boundaries of his position.

Other

Technology investor Mary Meeker’s just-released influential, annual “Internet Trends Report” contains these nuggets:

• Global Internet penetration has risen above 50%, but new user growth will be hard to find and most of it will come from Asia.
• Smartphone shipments are declining and, as usual, IOS device sales are dwarfed by Android.
• Google and Facebook lead in ad revenue but Amazon, Twitter, Snapchat, and Pinterest are growing faster than both.
• The average American adult spends 6.3 hours per day consuming digital media and 28% of daily video-watching minutes comes from digital.
• 26% of Americans are online “almost constantly,” although the average daily time spent on social media is leveling off.
• The number of Americans using wearables increased from 25 million in 2014 to 52 million in 2018.
• Customers strongly prefer brands that provide personalized offers or recommendations, and most of them are willing to actively or passively share data to get them.
• The US profit and loss swung deeply into the red starting in 2003, with Medicare and Medicaid being the biggest spending drivers in doubling and tripling their entitlement percentages, respectively, since 1988. Overall entitlement spending grew during that same 30 years from $1.1 trillion to $4.1 trillion per year.
• The US leads peer nations in both preventable deaths and administrative healthcare spending.
• Consumer adoption of digital tools is growing steadily, with an especially large percentage increase in telemedicine.
• Major healthcare trends include research using data pools, aligning care teams, filling unused appointment slots, offering on-demand delivered prescriptions, participating in physician social networks, and using digital tools to reward health living.
• Among Internet leaders, consumers are most willing to share the healthcare data with Google, Amazon, Microsoft, and Apple.

A study finds that patients who ask a hospital for copies of their radiology images are nearly always offered only a CD option, with 8% also offering emailed copies and 4% making them available via their online portal. Charges ranged from $0 to $75 for a single CD.

A review of the LinkedIn profiles of former Theranos employees finds that some of them ended up working for tech companies (Apple was the #1 choice) and pharma; some tried to hide their previous employer by labeling them as an unnamed “biotech startup company;” and a few made light of their previous employment in humorously describing their work there. Former executives Elizabeth Holmes and Sunny Balwani still list their current jobs as working at Theranos even though the company shut down last year and Balwani left in 2016, although I doubt many companies are reaching out to put them on their payroll. I’m intrigued that the company’s compliance manager (a lawyer and an RN) still lists active employment there. My LinkedIn search ended prematurely at that point now that the Microsoft-owned site has limited people searching unless you pay “as little as $47.99 per month,” odds of which in my case are exactly zero. Facebook is the master of nudging people to take profit-generating actions that don’t cost anything, while LinkedIn beats users over the head with hammer in forcing casual users to log in so they can harass them with “try premium now” messages that, along with LinkedIn user-generated unsolicited sales message spam, have earned it my vote for most annoying site. Footnote: as I’m looking at the Theranos logo, I realize it’s a word jumble for “Sheraton.”

Intermountain Healthcare and it outsourced revenue cycle vendor R1 RCM open their 30,000-square-foot innovation center in Salt Lake City, the “innovation” being technology solutions that get insurers and patients to pay up (just in case it sounds like something that is beneficial to patients or that will advance medical knowledge). I don’t know exactly what’s in there unless it’s computers, collection letter printers, and sacks of cash.

UC San Diego Health opens another of its “one-stop shop” comprehensive health centers, touting online “save my spot” booking, in-room 40-inch monitors so patients can see what the doctor is typing into the EHR, and UCSD’s mobile app that offers a location finder, provider look-up, directions and parking information, appointment booking, and Epic MyChart. 

These reports always fascinate me. In India, the family of an elderly patient who died in the hospital ED attacks hospital employees and trashes the place, claiming that junior doctors were negligent and that handling of the patient’s body was delayed. One doctor was admitted to the hospital in critical condition, while 50 others later closed the hospital with a sit-in demanding better security. Bystanders say two truckloads of family members were joined by others to form a mob of 200 rioters who attacked the doctors as local police watched without intervening. The patient was a Muslim imam, and images being circulated suggest that a radical Muslim fundamentalist used social media to call for violence. I would like to think it couldn’t happen here, but I’m not so certain these days.

Sponsor Updates

• A Black Book survey finds that health system CEOs seek financial team executives who possess experience with technology acquisition and implementation, data analytics, financial business strategy, and financial operations administration through technologies.
• FDB will present at the UDI Conference June 11-12 in Baltimore.
• SiliconSlopes.com features Collective Medical CTO Adam Green and CISO Wylie van den Akker on its Meat & Potatoes podcast.
• CoverMyMeds will exhibit at the Greenway Health User Exchange June 13 in Columbus, OH.
• Cumberland Consulting Group will exhibit at the AHIP Institute & Expo June 19-21 in Nashville.

Blog Posts

• Patient Perspectives on Technology in Healthcare (Dimensional Insight)
• Access Honors Hospitals that Cut One Million Pieces of Paper or More (Access)
• Inspire, engage, and activate patients with patient education (AdvancedMD)
• Early season success for Agfa #BTheBestUCanB Athletes (Agfa Healthcare)
• Healthcare IT: Is Your Network Safe and Secure for All Your Connected Medical Devices? (Fortified Health Security)
• Celebrating AI’s 15th Year (Audacious Inquiry)
• When Customers Text, Everybody Wins (Avaya)
• AI, APIs, and the next frontier of clinical efficiency (Meditech)
• Make MyChart shine by focusing on these three areas (Bluetree)
• 3 Ways That Telehealth is Improving Healthcare (EClinicalWorks)
• What Providers Need to Know About EHR Replacement (ChartLogic)
• Accessing Epic Data in 3rd Party Business Intelligence Programs – New Features & Benefits (Culbert Healthcare Solutions)

Contacts

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

Morning Headlines 6/11/19

Connecticut and Illinois Open Investigation into Quest Diagnostics, LabCorp Data Breach

Attorneys general from Connecticut and Illinois launch an investigation into the cause of the American Medical Collection Agency breach, which may have exposed the data of 20 million people.

DLH Announces Acquisition of Social & Scientific Systems

Health and human services tech company DLH acquires Social & Scientific Systems, a public health research organization, for $70 million.

The AMA has a new president-elect

The AMA names allergist and immunologist Susan Bailey, MD president-elect.

Curbside Consult with Dr. Jayne 6/10/19

As much as clinicians complain about EHRs, they can be powerful tools for data analytics. I’ve worked with a number of organizations that have embraced the ability of the EHR and practice management systems to help them understand why their schedules are backed up and also to implement strategies to improve things. Sometimes it’s a patient panel that’s too big, or inefficient scheduling, or getting a late start in the clinic every morning.

Now there’s new data that shows that appointment scheduling isn’t just a point of frustration. It can actually impact patient care. The authors looked at screening for breast and colorectal cancers and whether the time of day the patient was seen makes a different on whether the patient actually receives a screening referral. Patients who were seen in the morning were more likely to be seen than those with afternoon appointments. The study looked at family medicine and internal medicine practices in a variety of settings in New Jersey and Pennsylvania during 2014 and 2016. Acute and sick visits were excluded, so these were times that physicians should have been managing preventive care or chronic health issues.

The authors cite factors such as lack of time (possibly due to physicians being behind schedule) and “decision fatigue” as potential causes. The latter occurs when clinicians are less likely to have screening discussions because they have already had similar discussions multiple times earlier in the day. There’s also concern that patients who decline screening earlier in the day may make it less likely for physicians to bring it up in later appointments. Additionally, patients who are seen later in the day may also be under time pressure and may not want to discuss screenings.

The authors recommend using non-physician care team members to assist in addressing screening gaps and adjusting clinic workloads so that physicians can better focus on patient care during visits. It’s tempting for physicians to have a knee-jerk reaction to these recommendations because they are used to being the primary point of contact with a patient. I continue to come across physicians that are resistant to team-based care even when they are stressed and burned out.

There are plenty of patient engagement solutions out there that can assist with encouraging patients to receive preventive services, whether they are blast messaging through an existing patient portal, email, or text system or novel apps designed specifically for patient engagement. Those reminders can reach patients when they’re not preoccupied with other discussions during an in-person visit. Of course, patients might be just as likely to blow off those asynchronous reminders, but it’s another tool for practices to use to try to better address patient needs in a way that doesn’t impact schedules.

These types of issues are also part of what primary care transformation programs are trying to address. Initiatives such as Comprehensive Primary Care Plus (CPC+) are designed to provide additional care management payments that would include coverage for these interactions. Other programs such as Primary Care First are designed to reduce administrative burdens and make payments more streamlined which theoretically should increase the capacity for practices to deliver patient-centric services.

Of course it will take time to gather data on these programs. The CPC+ program has been live for a little over a year and initial reports on the program indicate that it’s really too early to determine what kind of impact the program might have on overall spending related to clinical outcomes.

It’s not just screening services that are impacted by the duration of the workday. The study notes that other investigations “have found higher rates of inappropriate antibiotic prescribing and opioid prescribing later in the day. In each of these studies, behaviors improved slightly after lunch (a short break for most clinicians).”

Organizations that want to tackle issues like time pressure and decision fatigue need to be careful in how they address this with their providers. One author recommended that physicians set aside time for breaks throughout the day to address the problem. This is easier said than done in office settings where providers often don’t have time to take a break to eat a meal, use the restroom, or interact socially with staff because they’re just trying to grind their way through the day. Offering those kinds of suggestions without fully understanding the problem can come off as patronizing or antagonistic. Personally, the last time I ate food during a 12-hour shift that did not involve nibbling while charting was never.

Physicians are also becoming increasingly resistant to the idea that they are responsible for changing patients’ behaviors. Physicians are supposed to motivate patients who appear tired or uninterested in a conversation about screening. The study’s author commented that patients need to be convinced that their decisions have an impact and that physicians need to think about how to best organize discussions around patients’ health.

I know I’m not alone when I admit that I’m tired of trying to persuade patients who don’t give a damn about their health that they need to take charge of, or at least get involved in, their own health. There’s a dearth of personal responsibility in our society compared to what I’ve experienced in healthcare in other parts of the world. It feels like we are no longer practitioners of the art of medicine but cheerleaders, salespeople, and at times parent-substitutes for grown adults who should be able to at least participate in their own well-being.

I think this is a major part of why we see primary care providers defecting to the urgent care or emergency department care environments. They are not expected to manage anything beyond the acute issue in front of them. Providers who gravitate to direct primary care or concierge practices are at least being paid better for their time and effort, so there is higher satisfaction among my colleagues who have made that jump.

In the mean time, the study is important to illustrate that many variables affect patient care and we can identify ways to address some of them. There are plenty of relatively simple solutions out there that practices are still resistant to implement.

I was in an office the other day where the entire staff walked in two minutes to opening time. They were waiting outside because they’re not allowed to clock in before 7:57 a.m. There is no way that any of them were prepared for patients arriving at 8 a.m., but such was the office policy. Until we begin to tackle those obvious issues, addressing the more subtle ones will remain out of reach.

What do you think about decision fatigue, appointment schedules, and personal responsibility? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/10/19

Medisanté Enters U.S. Market and Chairs the Direct-to-Cloud IoT Activity Work Group in the Personal Connected Health Alliance

Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.

KRMC website shut down since April, possible security breach

Kingman Regional Medical Center (AZ) works to rebuild its website, down since April 8, after discovering that its configuration enabled unauthorized users to view information entered by KRMC patients.

NSA Cybersecurity Advisory: Patch Remote Desktop Services on Legacy Versions of Windows

NSA takes the unusual step of issuing a call for Windows 7, Windows XP, and Server 2003 and 2008 users to install a Microsoft-issued patch as a preemptive measure against the BlueKeep vulnerability.

Monday Morning Update 6/10/19

Top News

A physician’s New York Times opinion piece says corporatized healthcare is cynically taking advantage of the professionalism of doctors and nurses by assuming they will work extra hours without extra pay, with the biggest overtime culprit being the EHR.

The article concludes,

In a factory, if 30% more items were suddenly dropped onto an assembly line, the process would grind to a halt. Imagine a plumber or a lawyer doing 30% more work without billing for it. But in healthcare, there is a wondrous elasticity — you can keep adding work and magically it all somehow gets done. The nurse won’t take a lunch break if the ward is short of staff members. The doctor will “squeeze in” the extra patients. The EMR  is now “conveniently available” to log into from home. Many of my colleagues devote their weekends and evenings to the spillover work.

The author, internist Danielle Ofri, MD, PhD, also notes that the number of healthcare administrators increased 3,200% from 1975 to 2010, leaving healthcare with 10 administrators (and their salaries) for each doctor.

The always-thoughtful reader comments, many of them from clinicians, nearly all criticize the EHR and the transformation of healthcare from a calling to a greedy business dominated by mega-corporations whose richly compensated executives are rarely clinicians.

HIStalk Announcements and Requests

The most recent method use by most poll respondents to communicate directly with their doctor was patient portal messaging and in-person conversation, with telephone calls coming in a distance third and all others methods registering a negligible number of responses.

New poll to your right or here: What college education would be required of a candidate for your job title? I upset the longstanding apple cart at a previous employer by requiring two of my managers – hired before I came on board — who did not have college degrees to either start a degree-seeking program or accept a demotion since their job descriptions required it. It’s either a requirement or it isn’t, and in our case, it was, even though a wishy-washy predecessor had promoted them without it. On the other hand, good job candidates don’t necessarily possess degrees and employers often require those credentials only to reduce the number of applications they have to read. Worst of all are companies that waffle their job description language with “should have” or “preferred” rather than “must have” – the job description should describe only those credentials required to earn further resume review or an interview.

Webinars

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

Acquisitions, Funding, Business, and Stock

Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.

Sales

• Integris Health chooses Health Catalyst’s Data Operating System for enterprise-wide performance improvement.

Decisions

• The Mary Black campus of Spartanburg Medical Center (SC) will go live on Epic this month.
• Baylor Scott & White Medical Center – Grapevine (TX) will go live on Epic in 2020.
• Surgeons Choice Medical Center (MI), which replaced CPSI with Athenahealth in December 2017, will move back to CPSI this month.
• Advanced Surgical Hospital (PA) will remain with CPSI instead of moving to Cerner because of cost considerations.

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

People

Scott Hill (Allscripts) joins Change Healthcare as VP of strategic accounts.

Geisinger hires David K. Vawdrey, PhD (New York – Presbyterian Hospital) as chief data informatics officer.

Announcements and Implementations

Mobile Heartbeat adds secure mobile video chat to its MH-CURE clinical communication platform for face-to-face team member collaboration. Use cases include diagnosis, specialist consults, remote huddles, and staff training. It supports cross-platform use between Android and IOS devices. Meanwhile, Yale New Haven Health’s Bridgeport Hospital goes live on MH-CURE in all units, integrated with caregiver assignments in Epic and alarm management with Connexall. 

Clinical Computer Systems, Inc., which offers the Obix perinatal data system, announces the BeCA Fetal Monitor and the Freedom wireless transducer solution that allows cable-free monitoring during labor.

Healthcare Growth Partners summarizes the health IT funding themes for May 2019 as fitness technology manufacturers, telemedicine-related companies, and vendors of patient engagement technology.

Other

Another female novelist’s New York Times editorial calls for curtailing the wellness industry:

The diet industry is a virus, and viruses are smart. It has survived all these decades by adapting, but it’s as dangerous as ever. In 2019, dieting presents itself as wellness and clean eating, duping modern feminists to participate under the guise of health. Wellness influencers attract sponsorships and hundreds of thousands of followers on Instagram by tying before and after selfies to inspiring narratives. Go from sluggish to vibrant, insecure to confident, foggy-brained to clear-eyed. But when you have to deprive, punish, and isolate yourself to look “good,” it is impossible to feel good. I was my sickest and loneliest when I appeared my healthiest.

A women and children’s hospital in Australia doubles its antenatal pertussis vaccination rate after changing the optional “did you offer the vaccine” clinician EHR dropdown field from optional to mandatory.

Sponsor Updates

• Gartner includes Lightbeam Health Solutions in its report, “Healthcare Payer CIOs, Leverage Vendor Partners to Succeed at Clinical Data Integration.”
• Waystar will exhibit at the Homecare Homebase Annual Users Conference 2019 June 12-14 in Dallas.
• NextGate publishes a new case study, “Enterprise Patient Matching Helps KeyHIE Establish Integrated Network of Accurate, Accessible Health Records and Drive Down Duplicate Record Rate to Less than 1%.”
• Nordic, Surescripts, and Vocera will exhibit at the Epic Michigan User Group Conference June 10 in Ypsilanti.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, adds Stephanie Martin, DO to its executive advisory board.
• Recondo Technology partners with analytics vendor VisiQuate to reduce claim denials and shorten the process of correcting and resubmitting them to payers.
• DoD program Employer Support of the Guard and Reserve honors CloudWave with its Pro Patria Award for its support of Guard and Reserve employees.
• PreparedHealth will exhibit at CMSA June 10-14 in Las Vegas.
• Redox will exhibit at the Innovation Conference 2019 June 13 in Santa Fe.
• Relatient publishes a new case study, “Seven Hills Women’s Health Centers Recover Over 1,300 Patients to Bridge Gaps in Care Using Automated Health Campaign.”
• Sansoro Health releases a new 4×4 Health Podcast, “America’s Opioid Crisis: How IT Enables Better Care.”

Blog Posts

• Triple Threat: How Technology, Training, and Tenacity Transformed a Hospital Contact Center (Spok)
• The Big Money is Betting on Healthcare. What That Means for Providers and Patients (Loyale Healthcare)
• 6 easy ways physicians can use social media to advance their practice (Meditech)
• EHR Flaws and Fixes (Medicomp Systems)
• Are You Ready for Reimbursement Changes? (Netsmart)
• The Case for Outsourcing Your Level 1 Support: Why it Helps (CereCore)
• Are you giving too much care away for free? (Experian Health)
• How to Win Over Millenial Patients (PatientBond)
• Care Coordination Spotlight: Helping At-Risk Patients Stay at Home (PatientPing)
• A Five-Star Payment Experience is Something to Strive For, Especially in Health Care (Patientco)
• Case Manager Leans on “Patchwork Quilt” of Services to Address Social Determinant Issues (PreparedHealth)
• AI and Cybersecurity: Are We Fueling Hackers’ Fire? (SailPoint)
• Why It Matters: Prescribers Can Now Access Accurate Medication History Data for Virtually Every American (Surescripts)
• Founder Letter: How to Win Patients for Life (WebPT)

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 6/7/19

Weekly News Recap

• A breach of American Medical Collection Agency exposes the information of 19 million of patients of national lab companies LabCorp and Quest Diagnostics
• The six former National Coordinators express their support for the proposed interoperability rules of ONC/CMS
• CVS announces plans to reconfigure 20% of each drugstore’s space into HealthHubs that will offer health and wellness services as well as kiosks and digital health tools
• A KLAS report on newly developed small-hospital inpatient EHRS from Athenahealth, EClinicalWorks, Epic, and Meditech finds that only Meditech has brought sites live 
• Vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability
• Politico details problems with the implementation of Epic in Denmark’s Copenhagen region

Best Reader Comments

The cost of implementing a slicker front end essentially best-of-breed system [Athenahealth’s inpatient system) that presents great, but functions horribly in the real world, was too much. Hospital executives who were enamored by the presentation and sales pitch were not aware of the fact that best-of-breed was fully vetted and wholly rejected by the industry. They just got a front row seat and the results have not been surprising. It’s hard enough for a hospital who can afford the required staff to implement a complete proven system with proven implementation methodology. Imagine trying to do that with a IT staff usually one-fifth the size of most community hospitals who could afford a traditional cost structure install – – – as your vendor tries to piece together a system using interfaced stopgap third-party modules that are the absolute core elements for safe workflows within an acute care setting. (Freedom’s just another word for nothin’ left to lose)

Poor Judy got cheated. $3.6 billion? No way. The company grosses $2.9 billion per year and the typical successful high-tech company sells for over five times gross. She owns at least 80% per other stories I read, so 5 X $2.9 billion X 0.8 = $11.6 billion. I think she should sue Forbes for publishing fake news. Judy is numero UNO! (HISJunkie)

I’d be interested to see how many places are using Home Health from Epic. That’s a new market they entered. They have the skill and ability to create a new product. They could easily come up with a LTC product quickly, give a sweetheart deal to the first few clients to test it out, and then sell it. Another facet would be if we see more consolidation in the healthcare space. Maybe hospital chains start buying SNF and LTC chains. If that happens, Epic would be foolish to not move into the space. (Ex epic)

Interoperability became a regulatory issue because despite making all that money on MU largesse, EHR vendors were not moving the ball on interop. On the one hand, EHRA vendors talk about innovation, and on the other hand, they claim that creating an API-based, standardized data exchange system is too onerous for them? Some of the reasons that you laid out are valid, but they are a direct result of poor application and data architectures of these platforms. If I have to take a guess, these vendors, over the years, have added new functionality and features without taking a pause to re-architect some of the core aspects of their systems and without making an investment into paying down the technical debt. As a result, many, if not all of these systems are being held together by duct tape and baling wire and even the smallest change causes big ripples in an integrated system, leading to tremendous testing and bug fixing efforts. But if interop is important (which most people agree that it is), then EHR vendors just need to suck it up and do it. (NonInterOp)

Everyone forgets the complexity of the underlying terminology mapping and integration if the goal is seamless exchange of meaningful information. I don’t see M or SQL as barriers. There are training and adoption barriers, contextual barriers in the meaning of something someone is documenting, true issues in working with legacy documentation that was created before any semantic standards were defined, and most vendors have a potpourri of applications running in their suites. Simple API calls aren’t so simple, especially when clinical teams rely in the integrity of the information. (NonInterOp)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. P, who needed help paying for bus transportation to take her special education fifth- and sixth-graders to a farm and home museum in their rural Maine followed by a visit to a college campus. She reports, “Our trip to Page Farm and Home Museum was amazing! Our students enjoyed every moment of this experience. They were able to see many objects that they read about in ‘Farmer Boy,’ from oxen yokes to sleds, tinware, butter churns, ice harvesting tools, spinning wheels, looms, and more. All of these 19th century tools and implements were described in the book so it was exciting for students to see them for real. Another trip highlight was visiting the University of Maine campus and eating lunch at the student union. Our students used their money skills to choose and purchase their meals in a real-world setting. We then ate at tables in a cafeteria-type room, mingling with university workers and students, thus raising their aspirations to consider college as a future endeavor. In all, the field trip was a huge success. Thank you for your generosity in sponsoring this experience for our students.”

A former intensivist pleads not guilty in Ohio court to charges that he intentionally killed 25 patients by ordering fentanyl overdoses. The attorney for William S. Husel, DO argues that he was practicing “comfort care” for end-of-life patients by ordering fentanyl doses of 500 to 2,000 mcg and several grams of midazolam, all of which were dutifully removed by nurse via overrides from the hospital’s Pyxis dispensing cabinet. It would seem that some nurses and pharmacists might need to have their professional conduct reviewed as well, and indeed some of them have been named in a civil suit. Dispensing cabinet overrides very often are the symptom of questionable technology, workflow, or clinical practice and there’s not much excuse for not monitoring them carefully.

Some great local journalism in Missouri profiles the “cast of characters” who have used struggling rural hospitals to bill insurers at higher rates for questionable lab tests. Among them is Seth Guterman, MD, president of EHR vendor EmpowerSystem, who is being sued by Aetna for taking control of a rural Oklahoma hospital under his People’s Choice Hospital company and running up its lab billing to $21 million per year, a process that a lawsuit says he repeated at other Aetna-affiliated facilities.

A healthcare cyberattack report by cloud endpoint protection vendor Carbon Black notes that hackers are going after administrative records of physicians that can be used to fraudulently bill Medicare and other insurers. They are also breaching systems that contain medical insurance information, offering for sale such items as a forged BCBS insurance card and forged prescription labels that buyers use to justify drug test results and to carry drugs through airport security. 

I’m enjoying the tight, pleasurable LinkedIn writing of ED doctor Louis M. Profeta, MD, who also wrote the 2010 book “The Patient in Room Nine Says He’s God.” He explains why he searches for the Facebook of patients who died of overdoses or driving while drunk or texting before notifying their families:

I’m about to change their lives — your mom and dad, that is. In about five minutes, they will never be the same, they will never be happy again. Right now, to be honest, you’re just a nameless dead body that feels like a wet bag of newspapers that we have been pounding on, sticking IV lines and tubes and needles in, trying desperately to save you. There’s no motion, no life, nothing to tell me you once had dreams or aspirations. I owe it to them to learn just a bit about you before I go in. Because right now . . . all I am is mad at you, for what you did to yourself and what you are about to do to them.

Virginia’s medical board finds that an urgent care doctor and owner left for a week-long vacation while requiring his unlicensed staff to continue diagnosing, treating, ordering tests, and prescribing controlled substances. The board found that Khaled Moustafa, MB created phony visit notes afterward to make it appear that he was following regulations and to bill insurance companies. The doctor’s license was revoked, but his clinic is still open for business, with patients been seen by the doctor’s wife, who is also a doctor.  

The group that bought Athenahealth’s lakefront Maine corporate retreat in March announce just three months later that they will close it as a destination for weddings and other events, saying it presents too many problems to operate profitably. The couple whose hotel operating company eventually bought the 387-acre resort sued Athenahealth last year, claiming Athenahealth was reneging on its promise to sell it to their hotel operating company for $7 million. Athenahealth paid $7.7 million for the property, which the county values at $14 million, in 2011. It includes a gym, a bowling alley, two event centers with 40,000 square feet of space, 106 cabins, hiking trails, and a mountaintop executive retreat overlooking Penebscot Bay.

A 22-year-old roofer in Scotland who was performing his signature party trick of swallowing a coin is rushed to the hospital when it becomes lodged in his throat. He’s probably not the best source of advice on the topic, but here’s his root cause analysis: “It was weird because it always goes according to plan, as it would come out in the toilet later. I could feel it in my chest but I just kept on drinking … my dad thinks I’m an idiot.”

In Case You Missed It

• News 6/7/19
• EPtalk by Dr. Jayne 6/6/19
• News 6/5/19
• Curbside Consult with Dr. Jayne 6/3/19
• Readers Write: Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare
• Monday Morning Update 6/3/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 6/7/19

Champion Healthcare Technologies Receives Investment from The Riverside Company

The Riverside Company acquires medical device tracking software vendor Champion Healthcare Technologies from Jump Capital for an undisclosed sum.

Bain Capital, 5 others in race to buy CitiusTech

Industry insiders say Bain Capital, Blackstone Group, and several other investment firms have advanced to a second round of negotiations for the purchase of health IT consulting, services, and software company CitiusTech.

OmniSYS Acquires Automated Pricing Solution Provider, Rx-Net

Pharmacy technology vendor OmniSys acquires Rx-Net and its ProfitMax automated prescription pricing software.

ChartSpan Raises $15 Million Series A Round led by BIP Capital

Chronic care management company ChartSpan will use its $15 million funding round to expand its services beyond the Southeast.

News 6/7/19

Top News

LabCorp joins the roster of companies impacted by the American Medical Collection Agency breach, notifying nearly 8 million customers that their personal and financial data may have been exposed.

Opko Health’s 422,000 BioReference Lab customers were also caught up in the hack.

The records of nearly 20 million patients are involved in the breach of the medical billing company.

HIStalk Announcements and Requests

Listening: new from the newly reformed, all-female L7, my favorite 1990s Riot Grrrl group except for maybe Hole. Lead singer, Flying V guitarist, and songwriter Donita Sparks — who is still tough, angry, and foul-mouthed at 56 — is about as far as you can get from “singers” whose “concerts” consist of prancing and lip syncing to pre-recorded songs written by anonymous hit-writing consortia. I’m pretty sure that if some guy in the front row harassed her that she would leap off the stage and punch him out.

Webinars

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

Acquisitions, Funding, Business, and Stock

Pharmacy technology vendor OmniSys acquires Rx-Net and its ProfitMax automated prescription pricing software. The Dallas-based company’s last acquisition was its 2017 purchase of competitor VoiceTech.

The Riverside Company acquires Champion Healthcare Technologies from Jump Capital for an undisclosed sum. Riverside will combine Champion’s tracking software for implanted medical devices with its HemaTerra Technologies business, which offers supply chain management software for hospitals and blood and plasma collection centers.

Waystar acquires Paro Decision Support, a predictive analytics vendor that helps hospitals identify patients who are eligible for charity care.

Industry insiders say Bain Capital, Blackstone Group, KKR, CVC Capital Partners, GIC, and ChrysCapital have advanced to a second round of negotiations for the purchase of health IT consulting, services, and software company CitiusTech. General Atlantic acquired a controlling interest in the company in 2014 with a $111 million investment. A final sale decision is expected next month.

People

Data archiving company Olah Healthcare Technology hires Wayne Trochmann (Allscripts) as VP of sales.

Announcements and Implementations

St. Anthony’s Memorial Hospital (IL) will soon switch from Meditech to Epic, wrapping up the Hospital Sisters Health System’s four-year, $112 million implementation project.

Northwell Health (NY) implements DataMotion’s Direct Secure Messaging to improve its HIE capabilities.

British Columbia’s Northern Health system adopts Nuance’s Dragon Medical One and Power Mic Mobile speech-recognition technologies.

AWS announces GA of Textract, a service that uses machine learning to identify and extract text and data from documents in any format. Extracted data is available via an API that developers can then use to analyze and query for their own analytics projects. Use cases include patient registration forms and scanning medical charts for undocumented diagnoses that lead to referrals.

In West Virginia, Williamson Memorial Hospital goes live on Meditech.

Black Book names the top client-rated software and services vendors for achieving financial digital transformation, derived from surveying 484 hospitals and 713 practices. Among the 20 winners:

• Hospital inpatient accounting: Meditech
• Patient access software: Recondo
• ERP: Premier
• Document management: Ciox Health
• Charge master: NThrive
• Ambulatory claims management and clearinghouse: Availity
• Inpatient claims management: Waystar
• Patient payment technology: Waystar
• EMPI: Verato

Government and Politics

The VA issues a $140 million task order to Cerner for interface support over the next four years. The order is part of the agency’s original $10 billion EHR modernization contract with Cerner. The VA expects to begin piloting the new software at several sites in the Pacific Northwest early next year.

The NHS has promised financial incentives to providers who use AI for diagnostics, screenings, and outpatient appointments as part of a system-wide effort to meet productivity targets. The health service agreed to those goals last year in exchange for an extra £20 billion a year.

Other

Politico rehashes stories reported here earlier about Epic implementation problems in the Copenhagen region of Denmark, adding more details:

• A consultant says the group from Denmark “went to Epic and fell in love” in being overly influenced by its campus.
• Doctors and nurses dispense medications directly rather than pharmacists and Epic won’t allow nurses to prescribe in emergencies as is done in hospitals there, leading to workflow problems.
• Medical terminologies had to be translated using Google Translate, creating problems such as when surgeons were offered two choices for the leg they intended to amputate: “left” or “correct.”
• An anesthesiologist working on the project says the first hospital that went live was in “indescribable, total chaos” as Epic recommended going live with no pilot sites, which he describes as “worse than amateurish” when doctors and nurses were forced to use a system they hadn’t seen, after which they were “weeping openly for days.” The regional health administrator admits that he was overzealous in trying to get Epic implemented quickly to avoid the cost and integration challenges of running it alongside the old system.
• Epic still isn’t integrated with the national medical record system.
• Eighty percent of patients in Denmark move casually from hospital to home or other care setting and back over long periods, creating problems for clinicians who are forced to follow the American standard of re-entering diagnoses and medications each time using different screens for inpatient and outpatient.
• Discharge letters to doctors include “nonsense that’s a copy-paste of everything in the patient record … five pages of gibberish [in which] there are five lines the doctor probably should read but doesn’t.” The government hired a consultant to use AI to extract the useful information.
• Physician satisfaction with Epic is at 12%, and the country’s physician association said of Epic’s offer to let them run its system free in their offices, “You couldn’t give us enough money to install Epic. We’ve seen how it works.”
• A leading breast cancer surgeon concludes, “You have exported burnout.”
• The rest of Denmark decided not to follow the Copenhagen’s region’s lead, selecting Systematic over Epic, leading some politicians to call for Epic’s replacement in Copenhagen, but the Health Ministry’s digital director says Epic is “too big to fail” after they have spent $500 million on it. 

Australia’s Queensland Health opens a search for a new EHealth Queensland CEO to replace Richard Ashby, who left in January over a conflict of interest issue.  His replacement will take responsibility for the over-budget Cerner project that has raised concerns from the auditor-general that Queensland Health has little negotiating leverage when contract extensions become due.

Google Product Manager Prem Ramaswami reflects on the impact the company’s custom executive education program at Harvard Medical School has had on its healthcare endeavors. The 15-day course focuses on understanding the digital hoops patients jumped through to learn about treatments and clinical trials, physician interactions with EHRs, and ethical discussions on how the company could leverage its technology for global healthcare projects. “Taking this course, I felt like our work on health search would not be complete until doctors were prescribing Google to their patients,” he says.

Here’s more savagely accurate satire from The Onion.

Sponsor Updates

• Ellkay sponsors Alpine Learning Group’s Go the Distance for Autism event.
• EClinicalWorks will exhibit at the Telehealth Summit 2019 June 6-7 in Atlanta.
• Ensocare will exhibit at the CMSA 2019 Conference June 10-14 in Las Vegas.
• Hayes Management Consulting hires Paulo Santos as director of business development and Pej Ayandeh as client success manager.
• HGP publishes “Health IT May Insights.”
• Healthwise will exhibit at the Epic Michigan User Group Conference June 10 in Ypsilanti.
• Information Builders showcases innovations for scaling advanced analytics and data management at its Summit 2019 user conference.
• InterSystems will exhibit at the HL7 FHIR DevDays June 10-12 in Redmond, WA.
• Intelligent Medical Objects holds a grand opening ceremony for its new headquarters in Rosemont, IL.
• ConnectiveRx publishes a new white paper, “Communicating with HCPs based on their observed prescribing behavior.”
• Halifax Health becomes the first member of the Access Million ESignature Club.
• Greenway Health wins a 2019 Fortress Cyber Security Award in the application security category.
• Frost & Sullivan awards Medicomp Systems its 2019 Customer Value Leadership Award for Clinical Decision Support for the Quippe suite of solutions.
• Apixio achieves HITRUST CSF Certification.
• Black Book announces the top client-rated software and services vendors that have achieved financial digital transformation.

Blog Posts

• We Need Your Help! #eCWNC19 Call for Presenters (EClinicalWorks)
• Defining Care Team Roles According to Population Needs: The Second Attribute in a Modern Care Management Model (Ensocare)
• Reflecting on the Patient Experience Summit 2019 (FormFast)
• Website Taxonomy Can Predict What Your Patients Want to Read (Healthwise)
• Automation makes a difference in A&G (Hyland)
• Data Scientists in High Demand for Payers (Imat Solutions)
• “Becoming” a Great Advisor (Impact Advisors)
• CHIME Opioid Task Force Playbook released, underscores importance of EPCS in fighting the opioid epidemic (Imprivata)
• Three Advancements in Mental Health: A Reflection on Mental Health Month (InterSystems)
• Your guide to selecting a quality D&A partner (Nordic)
• 3 Keys to Effective Use of IT in Healthcare (Optimum Healthcare IT)

The Medtech Breakthrough Awards recognize:

• Kyruus for its ProviderMatch for Consumers in Spanish
• Vocera’s SmartBadge for “Best Internet-of-Things Healthcare Wearable Device”
• Patientco’s payment software as the “Best New Healthcare Payments Solution”
• Sansoro Health’s Emissary Platform as the “Best Healthcare Big Data Solution”

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

EPtalk by Dr. Jayne 6/6/19

The American Board of Family Medicine takes a step towards interoperable encounters of the professional kind by becoming the first American Board of Medical Specialties member Board to implement automated licensure updates for US licensees. Instead of Diplomates having to log in and update their state licenses annually, ABFM will receive the data directly from the Federation of State Medical Boards. Licensure details will automatically update monthly and providers will receive notification when updates occur so that they can confirm accuracy. It’s a small thing, but can be a big issue for physicians who fail to update. Automation makes it one fewer thing to worry about.

I truly enjoy working in the realm of informatics, but would miss patient care if I didn’t get to do it as well. Being in a patient-centric practice environment helps since we’re all working together to ensure our patients have a great experience. Even when it’s a difficult day, it’s still better than a lot of the days I have had with other employers.

Today I celebrated the best chief complaint ever and made sure to memorialize it in the chart: “Patient states: We were walking out of Starbucks and saw you open over here, so we decided to come in.” I probably wouldn’t have heard that one a decade ago, but it underscores that patients sometimes value convenience and accessibility more than other variables. The flip side of this was the patient who arrived at the front desk at 5:30 p.m. and wanted to be sure she could be out of the office by 5:50 since she had plans to meet someone for dinner at 6:00. We get 90% of our patients out in under an hour, but trying to squeeze it under the 20-minute mark is pushing it when there is only a single provider on duty and other patients are awaiting care.

Device of the week: Researchers conclude that the home use of video goggles that measure eye movements can provide an early and accurate diagnosis of vertigo. Patients were instructed to use the goggles to record eye movements that can help confirm which specific type of vertigo is occurring so that providers can determine the best course of action. Since vertigo symptoms can wax and wane, this would be a benefit to patients whose symptoms might be gone before they make it to a provider, or who have issues limiting travel to see a clinician. I’ve had vertigo that forced me to crawl through the house because I couldn’t stand, so I can’t imagine the frustration of patients who have symptoms frequently but may not have a definitive diagnosis.

Speaking of devices, it might be time to fire up those Fitbits. An article recently published in JAMA Internal Medicine and presented at the American College of Sports Medicine 2019 Annual Meeting shows that the risk for all-cause mortality fell among older women who walked at least 4,400 steps per day. As the number of steps increased, the risks continued to fall, leveling off at 7,500 steps per day. This is great news for individuals who might not be able to meet the oft-touted but poorly-researched 10,000 steps per day.

The authors note that current US Health and Human Services physical activity guidelines recommend a weekly time goal for exercise, but that counting steps may be more easily translated into real-world practice given the widespread nature of step-counting devices. The mean age of women in the study was 72 and they were followed for a mean of 4.3 years. The study adjusted for other risk factors including age, smoking status, alcohol use, general health, and 10 other factors related to risk for cancer or cardiovascular disease. As with many studies, there were some limitations – participants were predominantly Caucasian and of high socioeconomic status, which may have made them more active than the general population, so the results may not apply to different demographics or to men.

Telehealth continues to be a hot topic, and Epic recently added the American Well telehealth app to the App Orchard. The app is supposed to add one-click virtual consult functionality within the EHR workflow. It includes control of remote cameras and digital collaboration for non-Epic sites.

I have a couple of colleagues who use Epic and are trying to get into the business of virtual consults, but their organizations haven’t committed to allowing providers to block time to handle the requests. It is becoming just “one more thing” that causes time pressures in the office. It’s disheartening to see that administrators think they can just add these programs without a thought since that’s a recipe for employee dissatisfaction. One of my former employers tried to add evening appointments and it was a bust – patients didn’t take advantage of the appointments as much as was hoped and providers felt they were losing even more time away from family.

A reader sent me this article about health skills for the Amazon Alexa platform. Functionalities include diabetes management tracking, virtual physical therapy, and general health management.

Although I don’t doubt that personal assistant-based technology can be a benefit, especially for patients who have access issues or who otherwise wouldn’t go to a brick-and-mortar healthcare facility, I would caution people about changing to this manner of care without data that shows it’s at least equivalent. The virtual physical therapy in particular makes me nervous. I have several friends who are PTs and understand how difficult it is to get patients to do exercises correctly even when they’re present in face-to-face encounters. Doing PT incorrectly can not only lead to stalled progress, but it can actually cause harm.

The author notes one of the major consumer concerns about telehealth, that “my doctors have long answered my questions and dispensed phone and email advice for free.” It’s difficult for patients to accept that physicians are not only tired of doing this for free, but that the constant ratcheting down of healthcare payments and the addition of administrative burdens have made it untenable. You wouldn’t call your lawyer for free advice and even my auto mechanic won’t talk about my car without a diagnostic visit (which isn’t free).

She notes that her OB offered great advice, but probably doesn’t realize that OB care for a pregnancy is part of a global fee that the OB is paid for the entire episode of care. Virtually no one outside the industry understands those nuances of healthcare finance. She complains about a $235 bill for a virtual visit, but never says what the accepted amount or the actual payment was. I bet it wasn’t $235.

What do you think of the rise of personal assistants in healthcare? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/6/19

Carbon Health Secures $30 Million Series B Funding To Reimagine The Consumer Healthcare Retail Experience And Accelerate Expansion Into New Markets Nationwide

San Francisco-based primary and urgent care company Carbon Health raises $30 million in a Series B funding round led by Brookline Growth Partners.

LabCorp discloses data breach affecting 7.7 million customers

LabCorp joins the roster of companies impacted by the American Medical Collection Agency breach, notifying nearly 8 million customers that their personal and financial data may have been exposed.

Hospitals to get extra cash for using robots and AI to replace humans

The NHS has promised financial incentives to providers who use AI for diagnostics, screenings, and outpatient appointments as part of a systemwide effort to meet productivity targets.

Morning Headlines 6/5/19

Former National Health IT Coordinators Respond To Proposed ONC, CMS Interoperability Rules

All six former National Coordinators pledge their support for the proposed ONC/CMS interoperability rules, saying they will transform information flow, spur innovation, and empower consumers.

CVS turning 1,500 stores into HealthHUB locations with less retail, more health care

CVS will expand its HealthHub store layout pilot to 1,500 stores that will retool 20% of the floor space to offer health kiosks, digital health tools, and expanded MinuteClinics.

RxRevu – the Industry Leader in Prescription Decision Support – Secures $15.9 Million in Series A Funding Led by UCHealth

Denver-based RxRevu, which offers EHR-integrated prescription pricing decision support, raises $15.9 million in a Series A funding round.

Cerner Calls for App Ideas That Improve Consumer Access to Health Records

Cerner challenges developers to build apps on top of its platform that can help consumers access, understand, and use their EHR information in the 2019 version of its Code App Challenge.

News 6/5/19

Top News

All six former National Coordinators pledge their support for the proposed ONC/CMS interoperability rules in a Health Affairs article. They say the rules will transform information flow, spur innovation, and empower consumers. They also observe that:

• Rapid advancement of FHIR and APIs is critical.
• Expanding interoperability requirements to health plans is “game-changing.”
• Using Medicare’s Conditions of Participation to advance interoperability is a powerful tool.
• Strong enforcement of information blocking provisions should be high priority and access to the USCDI data set via APIs should be free since “price has unacceptably been used in the past to ration electronic exchange of information or to block it outright.”
• The federal government should work in parallel to create a consumer privacy framework, especially around third-party APIs and consent processes.
• Stakeholder education will be important.

Reader Comments

From Crown Victoria Secret: “Re: Atrius Health. Has become an allied member of The Permanente Federation.” The forwarded internal email announcement describes a vaguely defined collaboration that began on June 1 between the 715-doctor, Boston-based Atrius Health and the Federation, the leadership and consulting group for the eight Permanente Medical Groups that serve Kaiser Permanente members. The independent, non-profit Atrius has 75% of its nearly $2 billion in annual revenue tied to full-risk contracts. It just announced a $39 million profit for 2018.

From Orion’s Belt: “Re: executive coaching. What do you think of people earning a formal coaching credential and hanging out a shingle to advise executives?” I don’t know how many executives are seeking such assistance, and certainly just waving around a freshly printed certificate without a history of demonstrated personal success won’t be much of a draw (it’s a “those who can” sort of thing). I like the idea, though, and I even toyed with taking one of the (expensive and hard-marketed) certification programs not too long ago just because the courses sounded interesting. Certification requires quite a bit of hands-on training and completing a bunch of actual coaching hours that are critiqued by the person being coached, so it’s not a quick, cheap, or low-effort project, not even counting the fact that it’s all for naught if nobody hires you.

HIStalk Announcements and Requests

Industry long-timer and friend of HIStalk Vince Ciotti tells me that he and his partners have closed down their consulting business, HIS Pros, after 30 years. His long-running “HIS-tory” PowerPoint series on the history of the health IT industry was housed on the now-shuttered website, but Vince is sending me the files so I can post them permanently on HIStalk. The companies and people he mentions shouldn’t be forgotten and some of them offer lessons that we can learn all over again. Plus they are a heck of a lot of fun to read, especially if you’ve been around awhile.

Webinars

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

Acquisitions, Funding, Business, and Stock

Denver-based RxRevu, which offers EHR-integrated prescription pricing decision support, raises $15.9 million in a Series A funding round led by Colorado’s UCHealth.

Cerner challenges developers to build apps on top of its platform that can help consumers access, understand, and use their EHR information in the 2019 version of its Code App Challenge. Winners receive a year of assistance in getting their app ready to be published on Cerner’s app store. Last year’s winner in November 2018 was a smart glasses-powered EHR navigation and documentation tool that isn’t yet listed in Cerner’s store.

CVS, sweating under retail pressure from Amazon following its acquisition of Aetna, will expand its HealthHub store layout pilot to 1,500 stores that will retool 20% of the available floor space to offer health kiosks, digital health tools, yoga classes, dietitian counseling, expanded MinuteClinics. and SmileDirectClub teeth straightening (big companies really hate putting spaces between words). The space will come from reducing the inventory of slow-selling items such as greeting cards. The company’s #3 stated priority is to seamlessly connect digital and physical experiences, turn data into insights and action, and offer an intelligent engagement platform. CVS also expects big financial returns from chronic disease management.

People

CoverMyMeds, which was acquired by McKesson for over $1 billion in early 2017, promotes David Holladay to president and Scott Gaines to COO. Co-founder and CEO Matt Scantland will leave the 1,000-employee company by the end of the year, while COO Michelle Brown will move into a different role. 

Announcements and Implementations

A KLAS report covering recently announced inpatient EHRs for under-200 bed hospitals finds that only Athenahealth and Meditech have brought customers live, with those vendors having signed 115+ hospitals each. Just three hospitals each have contracted for ECW’s inpatient system and Epic Sonnet. Athenahealth customers worry about significant product functionality gaps (mostly clinical) and that the company has paused sales of the inpatient product during its corporate turmoil, with 22 hospitals cancelling their contracts in the past two years. Meditech Expanse earns high marks in both administrative and clinical areas, as does the company’s cost transparency. KLAS notes that Epic Sonnet isn’t really intended for small hospitals, but rather larger ones that are willing to start off with less functionality or lower cost with plans to eventually move up to the full Epic product, with Community Connect as provided by larger hospitals (rather than Epic itself) being the only real small-hospital option. ECW is losing prospects, most of them running CPSI or Allscripts Paragon, to other vendors due to delays in bringing any sites live. The bottom line is: (a) Meditech Expanse is the only successful new product; and (b) it’s not easy for ambulatory EHR companies to develop and implement a successful inpatient product.

Glytec will expand the capabilities of its EGlycemic Management System to create Therapy Advisor, a “Software as a Medical Device” platform that supports dosing and management of all diabetes medications, not just insulin. It will give providers evidence-based recommendations on product selection that also include patient affordability.

Sacramento-based non-profit medical technology startup support group MedStart shuts down, citing a drop-off in funding, plans by UC Davis to develop a similar program in Sacramento, and failed merger talks with other organizations. 

Government and Politics

President Trump responds to a reporter’s question during a joint session with Prime Minister Theresa May by saying that any post-Brexit trade deal needs to allow US companies to sell to the National Health Service. Response was quick and unflattering from everyone from British politicians to clinicians who don’t like people, especially those from other countries, messing with NHS.

Coffey Health System (KS) will pay $250,000 to settle the federal government’s claim that it falsely attested to Meaningful Use in 2012-2013 by failing to perform a security risk analysis. The whistleblower lawsuit was filed by two people, one of whom I was able to find online as an employee of the 25-bed hospital’s compliance office. 

Privacy and Security

The information of 12 million Quest Diagnostics lab patients is exposed in a breach of the systems of American Medical Collection Agency, which provides billing services to Quest contractor Optum360.

Other

Apple makes some health-related announcements at its WWDC developer conference, most of them pertaining to Watch:

• WatchOS6 will add menstruation tracking, which will also work on the IPhone’s Health app
• WatchOS6 will introduce a Noise app that will measure sound levels
• Watch’s fitness tracking will be displayed as rings that tabulate daily movement, exercise, and non-sitting time and will roll those into long-term trend displays
• WatchOS6 will allow using the App Store directly from the Watch
• The IPhone’s Health app will be redesigned to offer notifications, favorites, and health highlights

Verizon is hyping the heck out of its 5G service, with some of its questionable claims now including improving cancer treatment. The cell carriers like the opportunity to capturing market share, but 5G doesn’t seem like a silver bullet – it requires a ton of closely-spaced towers; it does nothing to bring broadband to rural areas where the cable company monopolies have stopped installing fiber and upgrading infrastructure; nobody has looked hard at what healthcare bandwidth limitations 5G expects to remove; and cell carriers (like the cable companies) provide notoriously poor user support. Eric Topol called them out for the TV commercial above, inviting them to show data proving that they improve cancer outcomes. I also winced at their use of the tired “fight” analogy.  

Stanford professor and investor Phyllis Gardner is earning fame for her comments about Theranos and founder Elizabeth Holmes that were included in two documentaries about the company, some of those critical observations made long before a series of investigative reports brought the company down. She says:

• She tried to tell Holmes early on that the company’s technology could not possibly work, but Holmes brushed her off and has since “been the burr under my saddle.”
• Many smart venture capitalists sent Holmes packing when she invoked “trade secrets” in refusing to explain how the Theranos technology worked.
• It was corporate malfeasance to load up the company’s board with people who had no science understanding, which she called “old men [whose] brains go to their groin.”
• She knew the phony deep voice, black turtlenecks, and “the glammed-up look” of Holmes was fake, but says you could never see her real self.
• “I didn’t find that many people at Stanford who thought she was amazing.”
• She rips Silicon Valley’s “fake it until you make it”mantra for healthcare: “In medicine, you do not fake it. Ever. That is verboten, and that is why we have regulatory agencies … you don’t fail 10,000 times and get it right on the 10,000st. That is absolutely evil to say that.”

Forbes releases its list of “America’s Richest Self-Made Women,” with Epic CEO Judy Faulkner coming in fourth with an estimated net worth of $3.6 billion. Wisconsin women took two of the top four spots, with #1 being Diane Hendricks of construction material vendor ABC Supply at $7 billion. The most bizarre winner – Suzy Batiz, whose toilet spray Poo-Pourri has sold 60 million bottles in giving her a not-so-crappy net worth of $240 million, tying Reese Witherspoon. 

Sponsor Updates

• Dimensional Insight earns top scores for customer experience and vendor credibility in the annual Wisdom of Crowds business intelligence market study.
• Avaya leverages Google Cloud to provide a wider range of global organizations with flexible, scalable communications and collaboration solutions.
• Bluetree will exhibit at the Epic Michigan User Group Meeting June 10 in Ypsilanti.
• Prepared Health will exhibit at the CMSA 2019 Annual Conference June 10-14 in Las Vegas.
• KLAS recognizes CenTrak for standout industry performance in its 2019 report on real-time location systems.
• CompuGroup Medical will exhibit at the New Mexico Primary Care Association Annual Conference June 13-14 in Albuquerque.
• Collective Medical helps providers support and coordinate care for homeless patients.

Blog Posts

• Dimensional Insight Book Club: Deep Medicine (Dimensional Insight)
• “Becoming” a Great Advisor (Impact Advisors)
• 5 Overlooked Systems & Processes to Boost Your Bottom Line (AdvancedMD)
• What ‘Google health care’ could look like in 5 years (Advisory Board)
• Limiting Unauthorized Access to Your Data by Instituting an Authentication Service (Atlantic.Net)
• Capitalizing on the Most Beneficial Use Cases of AI (Avaya)
• What you need to know about the latest on healthcare price transparency (Bluetree)
• Preventing Patient Emergencies and Enhancing Workflow with Smart Technology (CenTrak)
• How to Manage Bundled Payments? Build a Better Post-Acute Network (Prepared Health)
• Interoperability Rules! (Clinical Architecture)
• Shifting Health Care Horizons at Asembia 2019 – Helping Patients Through the Change (CoverMyMeds)
• Epic Reporting – New Features and Benefits for your Organization (Culbert Healthcare Solutions)

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 6/4/19

Biden Cancer Initiative Announces the Oncology Clinical Trial Information Commons

Former Vice President Joe Biden’s cancer initiative will include data from nine organizations including IBM Watson Health and Ciitizen as part of a new clinical trial data sharing platform.

Quest Diagnostics Statement on the AMCA Data Security Incident

Quest Diagnostics notifies customers of a data breach at its billing services vendor, American Medical Collection Agency, that could potentially affect 12 million patients.

Best Buy takes new steps to grow its healthcare business

Best Buy acquires personal emergency response and telemedicine company Critical Signal Technologies.

Curbside Consult with Dr. Jayne 6/3/19

Maybe I am becoming less tolerant as I get older, but I seem to be very easily tired by people in this industry who talk a good game, but are unable to get any of their ideas to fruition. It’s especially tiresome when these folks are hired by major organizations at high salaries and they can’t seem to solve the basic problems that plague clinical technology projects.

I worked with one of these folks a year or so ago when he was hired by one of my clients as a senior vice president for clinical transformation. I had been doing clinical transformation work for them for almost a year, so I was excited that they were finally putting some leadership and visibility behind the effort other than just third-party consultants. What I immediately found, however, was that he had no experience with physician adoption or creating workable timelines. His only healthcare experience was in the finance realm, and he immediately alienated nearly everyone on the project who had been working hard for incremental change.

A lot of us asked ourselves how he was hired and came to the conclusion that the organization was looking for a social media wunderkind, someone who was an “influencer.” But it turned out he was only an influencer in his own mind. He curried favor with the physicians by agreeing with their (largely unfounded) complaints about the EHR and by offering to throw the entire project out and get the group moved over to Epic per their request.

This was during his first 30 days of employment. He didn’t bother to do the due diligence to find out that the EHR project was suffering because providers had contracts that financially rewarded them for bad behavior and refusal to use the EHR. He didn’t find out that the rest of leadership had no stomach for either changing the contracts or doing something else to change the behavior, but instead took the easiest route in condemning the vendor.

The organization is now in the throes of a significant software spend. They still have no governance, no change control, and no plan. But by golly, they’re going to be on Epic, so all their problems will be solved.

I continue to watch this individual on Twitter and am surprised he doesn’t have tendonitis in his shoulder from patting his own back so much. I still have some consulting work going on with the client, although thankfully outside of his area, and it’s been hard to watch the carnage. I wonder at times whether anyone above him has read the story about the emperor having no clothes. Most of the workers under and around him see through it, and I feel for them.

I was having flashbacks this week when I met someone at a conference who reminded me of him. He was full of great ideas about how his organization was going to use data to drive outcomes and change clinical behavior. It sounded great until it took a dark turn towards volume-based incentives. I watched others in the roundtable session nodding their heads and listening attentively and I wondered if they were missing the fact that he was talking about incentivizing providers for ordering more tests, medications, and procedures.

His independent provider organization is somewhat boutique-y and has a large population of young and middle-aged patients who value convenience. Due to their relatively low Medicare population, they’re not part of an Accountable Care Organization and they’re not worried about readmission rates. They offer a significant spectrum of cosmetic services along with all kinds of wellness testing that isn’t typically covered by insurance.

Essentially, his organization has come up with what I would consider bogus metrics, a “compassion index” that uses interventions as a proxy for good clinical care. Using point-of-care tests rather than medical knowledge or those pesky clinical decision rules raises a provider’s index. Prescribing multiple medications to treat patient symptoms also raises that index (however, over-the-counter medications that the patient might already be taking do not). He (and I assume the rest of the leadership of the organization, since the presentation was clearly bragging on their outcomes) has latched onto a word-track that “patients know we care by how much we do for them.”

I wondered for a minute if the presentation was straight out of The Onion. Certainly no one in the current healthcare environment would be talking about running up charges? As a former primary care provider, I always thought patients knew we cared by the fact that we sat down and talked with them, counseled them through their issues, and made sure they had follow-up.

I hid in the tall grass and waited for the opportunity to ask a question about what most of us would consider “real” metrics, such as antimicrobial stewardship or appropriate use criteria for advanced imaging. I asked it nicely, and it was fun to watch him blow it off saying that they don’t find those types of metrics to be relevant to their practice. You could see the light bulbs come on over a couple of the attendees’ heads because those types of actual clinical quality metrics have been so drilled into our heads, why would someone not use them?

He went on to describe some of their other metrics, which sounded more like defensive medicine than anything else. He explained their push for imaging as “patients feel better when they know beyond a doubt that nothing serious is going on,” which I immediately translated to “our accountant feels better when we radiate people.”

Nothing in medicine is “beyond a doubt” because there is great variability in patients and how their bodies react to various biological challenges. Medicine throws me curve balls all the time, including the patient last week who was very, very anticoagulated but still had a new deep venous blood clot form in his leg. Trying to use shotgun-style testing as a substitute for clinical intuition, experience, and evidence-based care is a dangerous construct.

He went on to talk about their interventions to drive clinician behavior and raise the “compassion index” alongside patient satisfaction scores. It sounds like they look for outlier physicians and sit them down and use peer pressure to try to raise the volume of order interventions. It didn’t sound like they overtly bonused physicians based on ordering volume, but instead use emotional hooks to try to keep clinicians on track. They do bonus physicians on throughput, which makes it easier for people to just order tests rather than sit down and explain a decision process to patients, since education and shared decision-making take time.

I found their bogus metric even more bogus when he explained that they judge the usage of interventions based on the documented chief complaint, not on the diagnosis. At this particular facility, the chief complaint is self-selected by the patient on a kiosk at check-in, so judging whether providers order testing based on that is particularly obnoxious. I’ve had patients who say their complaint is “throat pain” that is really poison ivy on the neck, so if a provider is going to be dinged for not ordering a strep test for throat pain that’s actually a neck rash, they’re fighting an uphill battle.

I can’t imagine working at a place like that. He did note that they have some issues with provider turnover. I’ve found that when people talk about their turnover issues, it’s kind of like talking about how much alcohol they drink – it’s likely to be underestimated.

I’m not sure how long payers are going to put up with this, or how long patients will keep coming back if they have to shoulder the bills for over-testing. Not to mention that over-testing is not a harmless intervention. Sometimes you find things that lead you to additional interventions when it would have been better if you hadn’t done the test in the first place. It falls into the “do no harm” piece of what we trained for as physicians.

I’m curious if this is a new trend or if this guy is as much on the fringe as I think. Have you seen anything like the compassion index in your area? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare

Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare
By Russ Thomas

Russ Thomas is CEO of Availity of Jacksonville, FL.

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) have proposed new rules designed to give patients greater control over their own data and advance interoperability across the healthcare industry. Should the rule be finalized in its current form, millions of patients will have unprecedented access to and control over their own health information by 2020.

With some limited exceptions, including several related to privacy and security, the Interoperability and Patient Access Proposed Rule would make patient data exponentially more accessible and portable through open data-sharing technology and patient-facing apps.

Ideally, this would not only provide patients greater ownership of information related to their diagnoses, procedures, and tests, but also would mandate the seamless transfer of information from one healthcare organization to another as patients transition from physician to physician – enabling the promise of coordinated care within a complex healthcare system.

HL7 FHIR will be required as the standard for supporting all APIs under the proposal. Nearly 90% of hospitals and 70% of MIPS-eligible clinicians are using FHIR-enabled EHRs, according to ONC.

On paper, the rules are a logical extension of the Triple Aim—delivering better quality, better population health, and lower costs. Our industry has long advocated for the migration of patients to the center of the healthcare ecosystem.

However, empowering patients as consumers is only as effective as the tools they have to make more informed choices about their care. In this regard, healthcare is woefully behind the curve. Consumers can easily and securely access banking transactions and retail purchases over their smartphones, but not, say, their own clinical information, which is often tangled in a web of data silos, privacy rules, and vendor competition. Implementing and standardizing these rules will not be an easy lift.

In the real world of healthcare, the free flow of data and determining how, where, and when it is routed to the appropriate person is a daunting task with the highest of stakes. Although applying the proposed rules industry-wide will be time-consuming and resource-intensive, I believe the effort is both worth it and long overdue.

These proposed rules are a critical tap on the shoulder, a reminder that achieving healthcare’s future is impossible without first solving the foundational problems rooted in our present moment.

Healthcare technology companies should be at the forefront of supporting industry standards that drive efficiencies and interoperability and reduce costs and administrative burdens for their customers. Tools like FHIR enable healthcare organizations to efficiently exchange well-defined information.

I believe that this standardization is essential to the shift to value-based models of care, where payers and providers are seeking secure ways to better communicate and exchange information.

Standards, however, are only one part of the solution. Creating a more solid foundation for healthcare’s building blocks requires several key ingredients: widespread adoption of automation; more efficient channels for sharing and maintaining healthcare information; and modernization of laws governing healthcare data access and sharing, like HIPAA. It also requires evolution of business models to reward transparency and information sharing and penalize data duplicity.

On the payer side, many health plans still store provider data on legacy systems in multiple disconnected databases. As business requirements have evolved, insurance organizations have implemented incremental stopgap measures to address data limitations, but these don’t address the core challenge, the lack of a single source of truth.

It’s important to hear from all concerned stakeholders in order to get these rules right. However, I believe that at the core of these rules lies an essential truth. Unlocking and harnessing the power of data and providing patients the ability to access it is the truest course to a more sustainable and patient-centric healthcare system.

We have been presented an opportunity to fundamentally transform the American healthcare system for the better. It would be a mistake to miss it.