Curbside Consult with Dr. Jayne 12/9/19

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

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

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

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

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

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

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

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

Email Dr. Jayne.

HIStalk Interviews Doug Cusick, CEO, TransformativeMed

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What business arrangement do you have with those EHR vendors?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

Morning Headlines 12/9/19

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

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

Partners reports stellar financial results as it preps for rebrand

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

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

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

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

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

Monday Morning Update 12/9/19

Top News

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

The 17-hospital system, New Jersey’s largest, rescheduled 100 elective surgeries.

The health system did not post updates on its social media accounts and declined to comment other than describe the problem as “externally-driven technical issues that are affecting the performance of our IT network.”

Reader Comments

From OptumOrange: “Re: Optum / UHG layoffs. Looks like it was 1,400 people who received two weeks’ notice. March 2020 is the next round.” Unverified, but several folks said they were affected. Company executives just told investors that Optum generates more than half of UnitedHealth Group’s profit in bringing in an expected $112 billion of the parent company’s $260 billion in revenue for next year. Optum offers pharmacy benefits management, direct care via urgent care centers and physician offices, post-acute care, analytics, and population health management.

Smartfood99 left a comment about EHR vendors offering low-margin RCM services that I thought was wise enough to deserve its own spot here. It explains the hazards in adding services that are profitable, but less so than the company’s core business:

Software may be high margin, but the cost to maintain customer relationships through service and updates is low margin. While there there is a built-in revenue stream, it weakens the balance sheet for new vendor-searching hospital executives concerned about the fiscal health of the EHR company. In short, hospital executives look very closely at the bottom lines of companies they are about to make a 10-year investment with. Profitability = survival, especially when rumors of EHR vendor demise are the norm over the past few years and planted by competitor sales people like a software bug.

If you are already paying for lots of support people and development people that cut in to the bottom line, you have to be careful how you add to that mix and what it does to the balance sheet. Losing even just two or three net-new business deals a year because hospital executives base their final decision on perceived vendor long-term viability can snowball for any EHR vendor not named Epic. Such decisions that seem to make short-term sense often put the EHR vendor on the path to the dustbin of history after a slow, drawn-out death that leaves the hospital partner in a lurch.

Sure, even marginal profits and larger revenues matter, but in this business, perception of sustainability means much, much more. This doesn’t even cover the fact that having the capital to enable your business to pivot as needs change and your systems age is served in no way by being a glorified consulting company, but with all the risks that come with employing and managing larger staffs as business ebbs and flows.

HIStalk Announcements and Requests

I’m super impressed with my $480 (Black Friday special) HP laptop. It’s sleek and made of metal rather than plastic, it’s fast because of its solid state disk drive and 16 GB of memory, it makes no sound at all, the touchscreen display is surprisingly large and vibrant, and setup took just a few minutes with no bloatware to de-install. It’s been years since I set up a new laptop, so I was surprised at how easy Windows makes it – you just log on with your Windows ID and a few minutes later it’s all done. Bitdefender reminded me that I don’t have a VPN installed and I pledged to be better about using one when on public Wi-Fi, so I chose Surfshark since it was Cyber Monday priced at $48 for 27 months and it works just fine.

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

Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre to present your own

Acquisitions, Funding, Business, and Stock

The best and most concise health IT investment and market report I’ve seen comes from Healthcare Growth Partners, which just posted its November highlights of M&A, buyouts, investments, news headlines, and public company performance. It notes that valuations are driven significantly by sentiment versus metrics, and both sentiment and the markets are at all-time highs. 

People

Zach Mortensen, MBA (ZM Advisors) joins pharma services provider Parexel as chief strategy officer.

Population health management technology vendor Geniq hires Jay Colfer (SSI Group) as co-CEO.

Government and Politics

The Bureau of Labor Statistics says healthcare added 45,000 jobs in November and 414,000 jobs in the past 12 months. We don’t know what those people are doing, but we know who is paying them (all of us).

Other

This is insightful. AI companies will focus on the US market because, unlike in the rest of the world, providers here can make money finding and treating undiagnosed patient conditions. That gives AI a business case.

Welcome to our American healthcare non-system. A tiny online survey finds that diabetics — most of them covered by health insurance — are buying, selling, and trading insulin and glucose strips on the black market because of lack of affordability or timely availability.

A study finds that unintentional ED ordering of duplicate laboratory and radiology orders was reduced more than 40% by swapping out interruptive alerts for a simple on-screen highlighting of the existing order in red, although no improvement was seen with medication order duplicates. The alert displays when the duplicate item is being selected instead of as a final step or after-the-fact order queue alert. The study raises an interesting point – how many duplicate orders are created because of poor visual layout or navigation of the active medication list? We assume that just because information is displayed somewhere, somehow in the EHR that duplicates are inexcusable, especially with the added layer of warnings. I speculate that clinicians are just too busy attempting to multi-task with poor keyboarding technique in disruptive environments since even smart and careful ones make mistakes.

In England former Oxford University Hospitals CIO and Chief Digital Officer Peter Knight pleads guilty to fraud for falsifying his educational credentials to get the job, which he held for two years before resigning.

Partners HealthCare, soon to be renamed to Mass General Brigham, reports earning $484 million of operating income on $14 billion in revenue in its most recent fiscal year. The CFO says the increased profit came from having sicker patients and raising its prices, along with Epic’s more accurate coding.

HIMSS announces Global Health Equity Network, which allows interested parties to support its work by (a) paying to attend HIMSS20; and (b) sponsoring HIMSS. You can also “dialogue” with leaders, probably via A and B.

Informatics troubadour Ross Martin, MD, MHA lays down “Put the Patient First*,” a healthcare protest song that Ross says he’s been contemplating writing for 15 years. The asterisk-referenced refrain is brilliant – “Put the patient first, right behind me.” I also note that Ross’s utterly amazing and complex “HITECH: An Interoperetta in Three Acts” celebrated its 10th anniversary this year.

Sponsor Updates

• StayWell contributes to the Las Americas Immigrant Advocacy Center.
• Black Book Research recognizes Netsmart as the number one post-acute technology platform for the fifth year in a row.
• CereCore collects and delivers supplies to the Tennessee Baptist Children’s Home.
• Pivot Point Consulting employees in Chicago work with Project C.U.R.E. to assemble medical supplies for delivery to hospitals in developing countries.
• Redox releases its first podcast, “An Interview with Jonathan Bush.”
• SymphonyRM releases a new podcast, “Edward Marx and Four Pillars of Innovative Leadership.”
• TriNetX expands into South Korea in partnership with EvidNet.
• Visage introduces semantic annotations for the Visage 7 Enterprise Imaging Platform.
• UASE Ministry of Health collaborates with Vocera to improve care team communication and optimize patient safety.

Blog Posts

• 3 Cs to Jumpstart Value-Based Care Programs (Lightbeam Health Solutions)
• How standardizing interdisciplinary wound protocols improves patient care at Hancock Regional Hospital (Meditech)
• Healthcare Quality Improvement: A Foundational Business Strategy (Health Catalyst)
• Welcome Recondo to the Waystar Family (Waystar)
• EHR Errors Continue to Threaten Patient Safety (NextGate)
• Key Benchmarks for Process Improvement & Success (EClinicalWorks)
• Collaboration Learnings From the PatientPing Chicago Community Summit (PatientPing)
• The Impact of the Opioid Crisis in Post-Acute Care (Netsmart)
• Early holiday comes to Southfield family through Bike-a-Thon (OpenText)
• How data-driven patient access can eliminate healthcare denials (Experian Health)
• Top Revenue Cycle Tools to Implement at Your Urgent Care Center (PatientBond)
• Holiday Arma-BILL-o’s: 5 Ideas for a Festive Holiday Healthcare Billing Experience (Patientco)
• 4 Reasons Patients Cancel Appointments at the Last Minute (Relatient)
• Methodist Le Bonheur Healthcare CISO Steve Crocker on identity governance and cybersecurity (SailPoint)
• Between the lines: Supporting women with diabetes (StayWell)
• Migrating to Epic, Cerner, Meditech? The Value of Utilizing One Vendor to Assist with All Aspects of Your EHR Migration (Summit Healthcare)
• Forces of Change: The Industry Responds to the Call for Prescription Price Transparency (Surescripts)
• TUG robot alerts are the remedy for missed medication delivers at UConn Health. (Voalte)
• 4 Common Rehab Therapy Documentation Mistakes (WebPT)

Contacts

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

Weekender 12/6/19

Weekly News Recap

• Premier is reported to be working with bankers in seeking a sale of the company.
• Waystar acquires Recondo.
• John Halamka, MD announces that he will become president of Mayo Clinic Platform in January.
• Agfa is negotiating the sale of its Europe-focused healthcare and imaging IT business to Italy-based clinical software vendor Dedalus for more than $1 billion.
• Cerner names Amazon Web Services as its preferred cloud, AI, and machine learning provider.
• A server problem causes Dexcom’s continuous glucose monitor to stop sending messages and alerts for several days.
• T-System experiences downtime from an apparent ransomware attack.
• Amazon Web Services unveils a healthcare transcription service for software developers.

Best Reader Comments

You don’t want the company distracted by a shiny new thing while the core competency is getting less attention. So it’s often not a question of “Oh, hey, let’s just do this other thing too.” If you were in a perfect world with an arbitrarily large number of qualified people to take on the job, then moving into these peripheral areas would be a no-brainer. In reality the value gained from the distraction needs to be more than the cost of the distraction. The technical economic term for this is opportunity cost. (TH)

We doctors should stop thinking about EHR as a “special thing.” It is just a tool to get the job done. I can ask the same questions that you asked about paper and pen documentation system and probably add a few more about accessibility across locations, storage challenges, etc. Why is no one complaining about that system of records and why was it not part of so-called “physician burnout?” The reason I believe, is that we all learnt how to use it during our training and accepted it as part of life. Rules of the game changed in the last decade and we need to get on with the program. (EHR is just a tool)

This should drive home the reality that the investor class isn’t comprised of smart people, just people who knew each other or went to the same universities and have consistently promoted and hired each other into positions of authority without any demonstrated qualifications. (HIT Girl)

If the digital companies would have seriously and thoroughly tested their products with MANY physicians and not only one SME, then maybe the EHRs of today wouldn’t have been the monstrosities that they are. (Been there)

I still can’t believe institutions like Goldman make these horrible investments. Between Outcome Health and Theranos, you’d think the investors involved would at some point ask some healthcare industry experts whether these companies were viable enough to pass the sniff tests. Readers on this site have called out the charade for both before. (Elizabeth H. H. Holmes)

The billing methodology in this country has gone totally out of control. Unfortunately, I’m in the middle of a medical situation and the last EOBs made me laugh. For a CT scan with and without contrast, the billed amount was $18K, allowable $18K, amount paid $400, patient due amount $0. How stupid is a system that allows this? If I didn’t have insurance and the provider wasn’t in the network, I’m sure they would have tried to collect the $18K. (David Pomerance)

The moral of the Outcomes Health story is that if you f*ck over @GoldmanSachs & friends for $500m you go to jail. But if you ARE @GoldmanSachs & friends and you f*ck over the US taxpayer to the tune of $62bn, we will hand over the money and allow you to keep doing it. (Matthew Holt)

While I’m (mostly) never delighted when a person loses his/her job, all David Duvall MBA, MPH needs to do is open up about 50 hospital leadership websites and then another 50 HIT vendor leadership pages and tell me where the discrimination lies. I promise you it isn’t against middle-aged white guys. (ellemennopee)

Watercooler Talk Tidbits

The publicly traded owner of North Tampa Behavioral Health (FL) confirms that it has reassigned the facility’s 31-year-old CEO after a newspaper’s investigative report found that he had no healthcare experience and was formerly a quarterback for a pro football team’s practice squad. A company spokesperson said it’s not unusual to recruit hospital CEOs from other industries and the attributes of B. J. Coleman  include “team leadership, situational analysis, and sound decision-making.” Inspectors found that under his leadership, just four of the 96 employees who performed lab work had proper training. The kitchen’s lead cook was covering as director of dietary services even though he wasn’t qualified, so the kitchen ignored special diet requirements and sent trays containing silverware to suicidal patients.

A Tennessee neurologist files a $25,000 defamation lawsuit against a woman who wrote a scathing Yelp review saying that he threw a tantrum when she took out her phone to record her father’s visit. She says she deleted the recording at the doctor’s request even though state law does not prohibit such recording, after which a clinic employee called her to say that phones aren’t allowed in the office. Also named in the suit is the son of the woman’s friend, who overheard her talking about it and posted a negative review on Google. Meanwhile, the negative Yelp reviews are piling up as idiots from several states who admit that they just read the online story, calling the doctor a “filthy animal” and a “nasty immigrant who is suing a real American.”

Kaiser Permanente uses text messaging to encourage 11,000 of its members to sign up for California’s CalFresh supplemental nutrition program. Kaiser didn’t have access to income data to help  choose which of its 9 million patients might benefit, so it used a census-derived “neighborhood deprivation index.”

A CMS analysis finds that the US spent more $1.2 trillion on hospitals in 2018, representing one-third of all healthcare spending. 

NICU nurses at Brookwood Baptist Medical Center (AL) dress up newborns to celebrate their first Thanksgiving.

In Case You Missed It

• News 12/6/19
• EPtalk by Dr. Jayne 12/5/19
• HIStalk Interviews Amanda Hansen, President, AdvancedMD
• News 12/4/19
• Curbside Consult with Dr. Jayne 12/2/19
• HIStalk Interviews Michelle O’Connor, President, Meditech
• Monday Morning Update 12/2/19

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Morning Headlines 12/6/19

Premier considers sale with banks

Premier is reportedly arranging talks with several potential acquirers in seeking a sale of the company.

Stephanie Reel to retire as chief information officer of university, health system

Stephanie Reel, CIO/vice provost for IT at Johns Hopkins University and SVP/CIO of Johns Hopkins Medicine, will retire on July 1, 2020 after a 30-year Hopkins career.

Former Outcome Health employees plead not guilty to felony charges in alleged $1 billion scheme to defraud pharma clients

Two former Outcome Health analysts plead not guilty to charges of felony conspiracy to commit wire fraud.

VA launches National Artificial Intelligence

The VA establishes the National Artificial Intelligence Institute to research and develop AI solutions that will improve healthcare for veterans.

News 12/6/19

Top News

RCM vendor Waystar acquires Recondo Technology, which specializes in automated revenue cycle software and services.

Reader Comments

From Foundational Confused: “Re: non-profit hospital donations. You’ve said that sending money to them is a terrible use of it. How do you personally differentiate between a foundation doing good versus one just burning money?” I like supporting organizations that truly need the money and will put it to good use for a directly connected social mission. Health systems stretch the definition of non-profit (and certainly that of a charity) with million-dollar executives, vast real estate holdings, and a can’t-miss business model that allows them to charge high prices and stifle competition on the backs of people in need, not to mention that they are so adept at raking in cash that they, themselves donate to other non-profits. My paltry donation would pale to the amount of money they can print via cranking out via high patient charges and collections. I would rather help a smaller, struggling non-profit that doesn’t have the luxury of sticking it to Medicare and insurers, whose mission is in danger of disappearing without outside help and that doesn’t employ mahogany wings full of power-broking suits who spend their day plotting deeper dives into the healthcare cookie jar (I say that while acknowledging the irony that I’ve been part of that particular problem for a long time). My personal donation choices are animal rescue and sanctuary organizations, food banks, Donors Choose, and Salvation Army, where a few hundred dollars can really make a direct difference instead of covering maybe one hour of the HR VP’s time.

From Party On: “Re: HIStalk reception at HIMSS20. Wondering how to obtain an invite and which evening it will occur.” The tenth and final HIStalkapalooza was at HIMSS17, I’m sorry to say. Maybe we can all schedule a time during HIMSS20 week to simultaneously reminisce by watching the video of that final evening with Party on the Moon and several hundred industry kindred spirits. 

Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre to present your own

Acquisitions, Funding, Business, and Stock

Premier is reportedly arranging talks with several potential acquirers in seeking a sale of the company, with reports of its interest sending share price and trading volume up this week.

Clinical surveillance and data visualization company Decisio Health closes a $13 million Series B funding round.

Sales

• Seminole Hospital District in Texas will implement CPSI subsidiary American HealthTech’s post-acute EHR at Memorial Health Care Center.
• In England, Birmingham and Solihull Mental Health NHS Foundation Trust chooses Hyland Healthcare’s OnBase content services software.
• Integris Health (OK) and Woman’s Hospital (LA) select Health Catalyst’s Corus Suite of patient, departmental, and equipment utilization and cost analytics.
• Cleveland Clinic London will use Vocera’s care team communication and workflow technology when it opens in 2021.
• In California, Natividad and the Monterey County Health Department will implement NextGate’s Enterprise Master Patient Index across its 19 clinics and other agencies.
• American Oncology Network selects PatientPoint’s patient and provider engagement solutions for its community oncology practice network.

People

Stephanie Reel, CIO/vice provost for IT at Johns Hopkins University and SVP/CIO of Johns Hopkins Medicine, will retire on July 1, 2020 after a 30-year Hopkins career. She says that she’s channeling Elton John in announcing her “Love Mondays World Tour” and sent me her Thanksgiving letter that outlines her future plans to enjoy family, travel, life in general, and a move from Baltimore after 25 years to Falls Church, VA. Few CIOs have had her tenure and breadth of IT responsibility over one of the country’s highest-ranked health systems as well as its correspondingly highly-ranked university through the impressive growth of both as an unfailingly steady hand on the IT tiller. I’m not saying I “know” her personally, but a couple of interviews and some private conversations about personal issues in which she was generous with her time and offers to assist make her #1 in my book.

Change Healthcare EVP/CIO Alex Choy will retire early next year.

Cletis Earle (Kaleida Health) joins Penn State Health and Penn State College of Medicine as SVP/CIO.

John Halamka, MD will join Mayo Clinic (MN) as president of its Mayo Clinic Platform, an initiative he describes as a “portfolio of new digital platform businesses focused on transforming health by leveraging artificial intelligence, the internet of things, and an ecosystem of partners for Mayo Clinic.” Halamka has spent the past 25 years in various positions, including CIO at Beth Israel Deaconess Medical Center in Boston, now part of Beth Israel Lahey Health.

Patient transfer solution vendor Central Logic promotes Barry Dennis, RN, MBA to the newly created position of SVP of clinical operations.

Google co-founders Larry Page and Sergey Brin will step down from their respective roles within parent company Alphabet as part of management streamlining that will see Google CEO Sundar Pichai take on the additional role of Alphabet CEO.

Announcements and Implementations

PatientPing enhances its collaboration network with Callouts (sharing member information with point-of-care providers using multiple EHRs) and Spotlights (a performance dashboard for readmissions, hospital utilization, and post-acute network management).

PMD makes patient-to-provider messaging and multi-provider group messaging with patients available through its app’s secure messaging capabilities.

Kindred Healthcare (KY) implements Netsmart’s Referral Manager software across its 70 LTAC hospitals.

A Surescripts report finds that the use of EHR-integrated prescription price tools more than doubled in 2019, also noting that prescriptions represent 17% of spending on goods and services that are provided directly to patients and are projected to increase 6.3% per year.

A KLAS report on ERP implementation consulting finds that among software vendors, every Infor consulting services client that was contacted is dissatisfied because the company’s consultants don’t understand the software or how to apply change management. PwC earns high marks from clients; KPMG performs well and Deloitte poorly on Workday and Oracle implementations; and for Infor implementation work, ROI Healthcare Solutions delivers high value while Avaap delivers strong outcomes.

Government and Politics

The American Hospital Association and other hospital groups file a lawsuit challenging HHS’s proposed requirement for hospitals to publicly post confidential pricing information. The plaintiffs say that disclosure of negotiated insurer charges would confuse patients about their out-of-pocket costs, adding that the rule is unlawful anyway because it exceeds CMS’s authority. 

Other

Physician services firm TeamHealth, which was acquired by investment firm Blackstone for $6.1 billion in early 2017, tells the Senate that it didn’t send surprise, out-of-network ED bills to thousands of patients in 2017 to generate revenue – their real purpose was to pressure insurers into signing more lucrative contracts. It also says that most of the public griping about balance billing comes from patients who don’t understand their coverage and mistake their co-pay, co-insurance, or deductible as a balance billing. The company suggests that Congress require insurers to immediately pay out-of-network providers at 125% the average allowed amount; require them to send the provider a check for the full amount that includes patient responsibility and then let the insurer rather than the provider collect the patient’s portion; cap ED patient cost-sharing at $1,000; and offer arbitration for dispute resolution.

UC Davis will offer an online course titled “The Health and Wellbeing of Medical Providers,” which will be taught by UC Davis Health Chief Wellness Officer Peter Yellowlees, MD, MBBS (yes, he did earn both degrees years apart even though they are basically equivalent). The 20-CME, $800 course begins on February 24. The course text, “Physician Suicide Cases and Commentaries,” was written by the instructor.

Cerner loses a $600,000 lawsuit that was brought by an air ambulance company after Cerner’s health plan refused to pay for a toddler’s air ambulance transportation after initially authorizing it.

In Australia, a women is sentenced to 25 months in prison for falsifying her application for a high-paying government CIO role. She lied about her education and work experience, gave herself a glowing recommendation in posing by telephone as a former employer, and used a supermodel’s photo as her LinkedIn headshot. Her attorney blames her actions on being “off with the pixies” due to stopping her weight loss drug.

Sponsor Updates

• Ensocare will exhibit at the National Veterans Small Business Engagement December 9-11 in Nashville.
• First Databank’s Meducation medication adherence solution wins Cerner’s first Open Developer Experience Program Member Adoption Award.
• Glytec will exhibit at the IHI National Forum December 8-11 in Orlando.
• EClinicalWorks publishes a new customer success story, “Compass Medical: Growing a Practice, Saving Lives.”
• Gartner has recognized InterSystems as a leader in its “2019 Gartner Magic Quadrant for Operational Database Management Systems.”
• Kyruus Executive Assistant and Office Manager Lisa Marie Rosson Guidi wins the Spirit Award from The Admin Awards.
• PCare leverages cybersecurity services from By Light Professional IT Services as it pursues HITRUST certification.
• PatientPing adds enhanced member information sharing capabilities and real-time network utilization dashboards to its enterprise care collaboration technology.

Blog Posts

• Advancing the medical imaging field with cloud-based solutions at RSNA (Google Cloud)
• Top 3 Ways to Identify Root Cause of Poor Performance Issues in Your Citrix or VMware Horizon Deployment (Goliath Technologies)
• The Art of Maintaining Prescription Renewal Protocols (Healthfinch)
• 6 signs of a quality EHR optimization partner (Nordic)
• You can’t spell radiology without AI (Hyland)
• Social Determinants of Health: Data Drives Lasting Health Improvements (Imat Solutions)
• Data Conversion Scope Best Practice (Impact Advisors)
• Value sets: Supporting the goals of outcomes-based care (Intelligent Medical Objects)
• Integrated Robotic Process Automation – The Fastest Growing Trend in Healthcare Technology (Summit Healthcare)

Contacts

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

EPtalk by Dr. Jayne 12/5/19

A recent NEJM Catalyst piece looks at the role of physician gender when looking at EHR usability and clinician burnout. Researchers at the University of California San Francisco found that female physicians created longer notes, addressed a higher percentage of patient contacts within 24 hours, and spent more after-hours time using the EHR than their male counterparts. Female users were also more likely to use copy/paste and other tools to make documentation more efficient, but spent more time in the EHR. These factors may explain a higher rate of female physician burnout when looking specifically at EHR use. The study was fairly broad, looking at over 1,300 physicians across nearly 90 specialties. It looked at various six-week time periods over the course of a year.

The authors suggested that healthcare organizations could do a better job reducing EHR burden overall, including creating clear expectations for EHR use and timeliness of patient contacts. I’d go further to suggest that they look at the FTE support staff in various practices and whether the physician to staff ratios are equal.

I’ve seen several practices in my recent travels that relatively understaffed some physicians (both male and female) despite equal productivity. Staffing ratios there depended more on physician personality and the fact that some providers demanded more support staff, where others were more likely to pitch in and do staff-level work or didn’t want to rock the boat asking for more help. Although the study controlled for staffing, my experience in non-research environments is that staffing can be highly variable.

Other teams have also looked at this issue. A recent JAMIA article looked at usability and gender, along with age, professional role, and years of experience. Among intensive care physicians, they identified “significant gender-based differences in perceived EHR workload stress, satisfaction, and usability – corresponding to objective patterns in EHR efficiency.” Drawing conclusions based on gender can often create friction among clinicians, but I’m glad they’re looking at the problem.

I’ve been on several vendor webinars this week and have experienced sessions spanning the range of good, bad, and downright ugly. For those of you who have to deliver webinars, I have some tips.

First, make sure you have your content fleshed out ahead of time. You don’t have to write a full word-by-word script, but you need to know what you are planning to say. On the other hand, if you struggle with impromptu speaking or have a tendency to go off track, write a script. Whatever you do, please do not simply read the slides to the audience. You’ll lose them in a flash. If you use a script, practice reading it in a conversational way, not like a robot.

Second, check your slides for visual appeal. Text should not be too bulky in content or too small in font. Use visuals to convey your ideas along with your word track and it will be more memorable to the audience. If you’re including polls for the audience, please show the results as you go – don’t just grab the data for your own marketing purposes. Attendees often want to understand how they compare to others on the call – whether they’re ahead of the game or trending the same as other organizations.

Last, make sure any photos used during introductions are professional or appropriate to the audience. Your hair should be combed, at a minimum, and it would be nice if the background was uncluttered and the lighting was good. Under no circumstances should you crop yourself out of a group wedding photo (yes, I saw this).

Mr. H already mentioned this article about physicians and tech staff clashing at digital health companies. Having been a physician working in digital health including with vendors, I wanted to add my two cents.

The article makes the point that clinical and product teams are “at odds,” which I have definitely seen. I’ve also seen teams where everyone works well together and drives the solution forward because they have a mutual understanding of each other’s experience, goals, and priorities. One of the biggest barriers to successful collaboration is the presence of preconceived notions about the members of the team. If tech team members have had previous negative experiences with physicians, they’re likely to make assumptions based on those experiences. Similarly, physicians may not understand the roles and processes of various tech team members or how an agile process works. Getting everyone in the same room to learn about each other and how they need to work together is a start.

Another barrier I’ve seen is lack of structure – inconsistent sign-off processes that may not fully explain how requirements or other work product should be flowing through the organization and lack of defined processes for clinical and other subject matter experts to provide their feedback. That can result in unpleasant shocks at the end of the process when clinical folks are presented with workflows that aren’t going to work, but could have been better engineered if the clinician input was at a better place in the process.

Physicians also need to have a common framework for how they’re going to make decisions around clinical content. Is the company striving to be evidence-based, or is customer satisfaction or sales the lead driving factor? These elements aren’t mutually exclusive, but there has to be a common goal or physicians may be in conflict with each other. This goes back to governance, including team charters and product charters that make sure everyone is working towards common goals and there is clarity about how decisions need to be made, or how to handle when physicians or other clinical SMEs are not in agreement.

This isn’t just a clinical issue. I’ve seen the same problems in other areas of the healthcare IT industry, whether it’s revenue cycle, billing, patient engagement, etc. Everyone needs to understand the role that team members play and needs to respect the roles and knowledge of others on the team or there is going to be conflict. This goes back to leadership. If the individuals in charge don’t buy into this concept of mutual respect, and either team feels like it’s being marginalized or attacked, the effort is not going to be successful.

Do you have clinicians who are part of your development organization? What advice can you offer? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Amanda Hansen, President, AdvancedMD

Amanda Hansen is president of AdvancedMD of South Jordan, UT.

Tell me about yourself and the company.

I started in the position of president of AdvancedMD in June. It represents my 15th role within the organization over the past 13 years. AdvancedMD provides integrated workflow solutions and services to more than 35,000 physicians and providers in the ambulatory market.

How is that market changing?

We are in a replacement market. We sign a couple of hundred clients per month. The new clients we’re signing are on their second or their third EHR, so they are much more selective. Where historically with EHR it was about meeting regulation and Meaningful Use and driving towards that compliance, now it’s more about usability and workflow. Doctors don’t want a solution that is going to interrupt their workflow and add significant labor and administrative work on the back end.

The need for systems to be integrated and fully connected, that all-in-one, has definitely evolved over the past several years. Specialty-specific clinical records are more prevalent within certain subsets. You get a lot of benefit from having everything connected and working well together.

Is it fair for clinicians to say that the EHR causes burnout?

I do think it’s fair. It is necessary to have EHRs and the data structure and the storage of the information. Hopefully over time we’ll be driving more towards a patient-controlled health record in addition to the clinical records from the physician, and having those work in tandem.

But when you look at the demographic in healthcare, somewhere around 50 to 55% of physicians are over 50 years old. In that segment, it has driven some degree of burnout. The millennial generation, the generation that is rising now, grew up with all this technology at  their fingertips, so those types of physicians and providers are excited about the technology. I think it’s more of a generational issue than additional work that has driven burnout.

How are consumer expectations changing with regard to how technology can allow them to interact with their providers in ways that are convenient for them?

We spend a lot of time thinking about this and building strategies. The consumerism of healthcare is here to stay. I’m the perfect demographic to talk about it. I don’t have a primary care physician. My husband and I have three kids and we have an established pediatrician that we go to. But if I get sick, I go to urgent care. I want the same thing. I want an app that I can use. I want to do telehealth or do a telemedicine visit. I want that immediate gratification, that instantaneous response and result. In the healthcare IT space specifically, vendors have to put more resources on having those mobile applications.

Even at AdvancedMD, historically we’ve focused on patient engagement. But the patient engagement we focused on was more driven about how to help physicians engage with their patients, not to help patients engage with their physicians. We need to flip the switch. It has to be patient centralized, where everything drives from that patient and how they interact with their doctors.

With my pediatrician for my kids, we got a patient portal login. We never used it because it was really complicated. We couldn’t remember it. It was dual authentication, just very complicated. Whereas if I get a simple text message that says, go ahead and fill out this consent form and confirm your visit, I’m much more likely to do that than I am to remember some login. It puts pressure on the vendors to make sure that they’re delivering technology in a way that patients want to consume it.

How should interoperability work optimally when a patient’s records are scattered over multiple providers and there’s no PCP to collect and manage all their information in one place?

This is a huge opportunity. This is the secret sauce to making healthcare IT great, being able to have that interoperability and the connectivity. To make it successful, it has to shift from a clinical record from the physician to a clinical record from the physician that the patient can take with them always. This is something that I’m passionate about.

My dad was a type1 diabetic. He got diabetes when he was 20 months old. He passed away about two and a half years ago after two kidney transplants, two pancreas transplants, thousands of dialysis appointments, and a complete loss of vision. He was a modern day health miracle in many ways. He passed away when he was 60. It’s important to me because my mom would take him to doctor’s appointments and she would literally have to bring a binder of his health information with her everywhere they went. It had the prescription history, his conditions, his ailments, the procedures that had been done. It limited the ability of his physicians – specialists, primary care, mental health, behavioral health — to focus on his care at that moment because they were so focused on what had happened historically.

With FHIR and all the standards that are coming out in interoperability and accessibility of information, it really needs to be a record that is controlled by the patient. It doesn’t mean the patient is the only person inputting information we want. There’s a reason doctors go to medical school. We want it to have that flavor and we want it to be certified in the right way, but the patient should be able to take that information with them. What’s missing in healthcare IT is that patient. Companies are trying to address it, like Apple with the Apple Health Records app, and if you’re on an Epic system, you can get your medical record history. It’s something to assemble all of those records into one place that the patient can take with them

Why hasn’t the Health Record Bank concept taken hold?

There could potentially be a role for it. No one cares about a patient’s health as much as that patient. It is like your job, where nobody cares about your career or your progression at an organization more than you do. You have to own that.

Ideally, that the patient would have access to all of their own information and they could carry it with them and be the quarterback for themselves. Some people are in a situation where they can’t do that, and then their caretaker, spouse, family, or loved ones can help drive that. I really believe that it should be patient centralized, because we care about our own health more than any physician or provider is going to.

What is the mechanism of that patient carrying their data around?

That’s the mystery that that we all need to solve. It goes back to your earlier question, which is, can you have some sort of health data bank? We believe in big data. The challenge that we have had with big data so far is it has helped us to understand risk profiles of patients and to segment different patient bases, but it doesn’t create the action plan. If the information can be assimilated, whether it’s through a data bank or something else, that’s great. But the missing link has been what’s done with the information.

We know that 20% of our patient population has a high risk for adult onset diabetes, but outside of that, there’s not anything to link to what those next steps are. It’s tying that data into proactive tools, like our HealthWatcher solution that automates some of that process.

There are hundreds of EHR vendors and healthcare IT solutions. Unless we have some sort of universal health plan where there is only one vendor, then that can’t be the keeper of everything. We have to rely on something else, whether it’s the patient to control their own fate or if there’s some sort of health data bank. But we need to make sure that whatever information is assimilated, that there are action items and automated processes that happen as a result of the information. That’s the missing piece.

Are EHR vendors backing away from offering revenue cycle management services?

There is high demand for revenue cycle management, especially with the increasing complexity of getting reimbursed. Regulation is consistently changing and it makes it more and more challenging for doctors to get paid for the work that they do.

At AdvancedMD, we’ve seen a big influx in our revenue cycle management demand. Kareo recently divested their revenue cycle management business. I don’t believe that was for lack of demand. It seemed that it was more about the financial profile of the organization, where revenue cycle management is a more expensive business. It’s lower margin. With the exception of Kareo, the main vendors that we see day in and day out all have a revenue cycle management offering.

It has helped that providers and physicians want choice. If they want to do their billing themselves, they can use the software. If they want to have someone else do it, we have billing partners, and then we also have our own revenue cycle management division.

What was the strategy behind payments technology vendor Global Payments acquiring AdvancedMD in 2018?

Global Payments is focused on integrated payment solutions. The philosophy is that if they own software companies that have payments integrated within them, customers will be less likely to switch out their payment vendor for an alternative solution. They have, I think, 10 software companies in multiple verticals. Healthcare is a strong vertical, making up almost 20% of the opportunity in the US. We were their first effort in healthcare to have the integrated payment experience.

How do companies build a development schedule around technologies such as AI and voice-powered user interfaces that may be at various points on the hype cycle?

It’s always a balance. Technologists always want to work on the latest, greatest, really cool things. Sometimes those really cool things end up not being practical, or they aren’t something that’s even needed. A customer would rather you move a button or decrease the number of clicks to do a step in their workflow process. You see that more with startup organizations, where they are developing things that they think are really cool and revolutionary and then the adoption becomes much more of a challenge.

We experienced that historically with a couple of solutions that we put out. One of those was a benchmarking solution that we felt really excited about, paired with our analytics solution. What we quickly learned is that 70% of our client base is practices of fewer than five providers, independent practices, and they didn’t really care — even in a really cool way — to benchmark themselves against their competitors.

The most important thing that companies can do is to make sure that they keep the voice of the customer at the forefront. Not only do market research, but solicit those clients, internal and external, to help drive their roadmaps and make decisions on what to invest in and what to build.

What lessons have you learned in being promoted many times within one company instead of following the conventional wisdom that you have to move out to move up?

I’ve had a lot of friends come and go at this organization since I’ve been here. I can’t point to any of them and say that they are in a better position, or better off than I am, for having worked through the inner workings of an organization to drive my way to the position that I’m in today.

The biggest thing that I’ve learned is that moving ahead requires taking the jobs that no one wants to do. I’m sure that physicians, providers, and others in the healthcare space understand that sentiment as well. Sometimes it’s not the glamorous things. Sometimes it’s the ones that seem extremely challenging and difficult, but that propel you forward.

We have a great team assembled at AdvancedMD. I am extremely grateful and humbled for all of the people that I’ve been able to work with in my 13 1/2 years at this company. Nowadays, especially, you don’t see a lot of people who are fiercely loyal in sticking with an organization. It requires your own drive and will to do it. It also requires having mentors and advocates who look for opportunities for you. Lastly, it requires raising your hand to do the jobs that that may seem impossible at the time, but they’re not. Anything is possible.

Do you have any final thoughts?

We are excited and enthused about the opportunity to help propel the consumerization of healthcare forward, focusing on flipping the switch and with the patient being central to patient engagement rather than the physician. That’s through mobile applications and various programs to engage patients to play a more active role in their healthcare experience.

Morning Headlines 12/5/19

Waystar Acquires Recondo Technology, Gains Best in KLAS Patient Access and Business Office Technology

RCM vendor Waystar acquires Recondo Technology, which specializes in automated revenue cycle software and services.

Kalispell hospital sued over data breach

A former patient sues Kalispell Regional Healthcare (MT) for failing to adequately protect his PHI from a ransomware attack that occurred in May.

Houston virtual health care company receives investment from GE for its $13M series B

Virtual care monitoring company Decisio wraps up a $13 million Series B funding round with an investment from GE Healthcare.

ENT and Allergy Associates® Announces the Formation of QMMS USA, LLC

ENT and Allergy Associates (NY) launches QMMS USA to provide its 46 clinics and other practices with billing, practice management, and health IT, among other back-office services.

Morning Headlines 12/4/19

Dr. John Halamka named president of Mayo Clinic Platform

John Halamka, MD will join Mayo Clinic as president of a new initiative that will use technology and data to improve care and extend the clinic’s global reach.

Health System Sues Software Co. For ‘NotPetya’ Cyberattack

Heritage Valley Health System (PA) sues Nuance for negligence that resulted in the system becoming the victim of a ransomware attack in the summer of 2017.

A letter from Larry and Sergey

Google co-founders Larry Page and Sergey Brin will step down from their respective roles within parent company Alphabet as part of management streamlining that will see Google CEO Sundar Pichai take on the additional role of Alphabet CEO.

News 12/4/19

Top News

Amazon Web Services announces the rollout of Amazon Transcribe Medical, a real-time transcription tool that software developers can use to transcribe speech and then send the resulting text to EHRs and other AWS tools such as the Amazon Comprehend Medical language service.

The company is positioning service as a replacement for transcriptionists, scribes, and transcription software.

It’s a “service” only in the technical sense – despite some sites misinterpreting it as a standalone product, it isn’t. Developers will need to build it into their own products and AWS will charge for usage. 

Reader Comments

From Curious: “Re: Meditech. I’ll l be interested to see if MaaS + Expanse can make Meditech competitive with CPSI, which owns the community and price-sensitive hospital market because they do the billing for their clients. Meditech should get into outsourced billing. The margin isn’t great, but they need it to gain new customers. However, no one who works for Meditech in Boston is going to say it since the people who would be hired to do billing aren’t going to work in Boston.”

HIStalk Announcements and Requests

I’m finding that reading Samuel Shem’s “Man’s 4th-Best Hospital” is more of a chore than I anticipated, which is surprising given how much I liked “House of God” (this one is long and heavy-handed with simplistic cynicism), but I’ll probably finish it despite its tiring anti-EHR diatribes. Meanwhile, I’ve purchased Elizabeth Rosenthal’s “An American Sickness,” which I’ve somehow managed not to read since it came out in 2017.

Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre to present your own

Acquisitions, Funding, Business, and Stock

Agfa is negotiating the sale of its Europe-focused healthcare and imaging IT business to Italy-based clinical software vendor Dedalus for more than $1 billion, excluding expected frontrunner CompuGroup Medical. The business includes enterprise imaging, hospital information systems, an enterprise content management solution, and patient engagement tools. It looks like a done deal since the companies have already said they expect it to close in Q2 2020. The business generates around $200 million in annual revenue, so that’s a pretty rich multiple for a company to pay to acquire a slightly larger competitor.

Cerner names Amazon Web Services as its preferred cloud, AI, and machine learning provider. You aren’t having déjà vu – Cerner named AWS as its preferred cloud provider in July 2019, so this announcement adds the obvious AI and ML components that will be incorporated into the Cerner Machine Learning Ecosystem for creating and deploying machine learning models. AWS called Cerner a “healthcare and life sciences organization” in the announcement rather than a software vendor, which I guess is slightly accurate since a microscopic part of its business involves running a few workplace clinics. As far as I know, its life sciences work is limited to selling patient EHR data to drug companies. 

Allscripts launches a $200 million private offering of convertible senior notes in a transaction that is far too complex for me to understand. 

An investigative report finds that Amazon’s on-site medical unit contractor Amcare is failing to send injured warehouse employees to outside care providers when needed and is also, per OHSA inspections, using unsupervised EMTs and athletic trainers outside of their allowed scope of their practice. Amcare is authorized to render first aid using EMTs, but OSHA’s investigation of employee complaints found evidence that employees are being refused treatment and their injuries are not always reported per federal law.

Heritage Valley Health System (PA) files suit against Nuance for failing to prevent the 2017 malware attack that the lawsuit claims spread from Nuance to the health system, taking down its computer and biomedical systems.

Sales

• Two health systems in Puerto Rico select Health Gorilla’s interoperability solution.

Announcements and Implementations

Change Healthcare offers providers free access to National Decision Support Company’s CareSelect clinical decision support system that meets Medicare’s PAMA advanced imaging requirements, which take effect on January 1, 2020.

KLAS looks at PACS outside the US, noting that in Europe, Sectra and lesser-known regional vendors are tops at meeting customer expectations; Philips and Agfa are seen as best positioned to address future needs; and Change Healthcare, Fujifilm, GE Healthcare, Philips, and Cerner are frustrating customers with their lack of development. Philips has taken the lead in Canada with the decline of Intelerad and Change Healthcare, while Intelerad and Philips lead performance in Asia and Oceania although satisfaction scores in that region are lower and customers complain about poor vendor support. KLAS concludes that some market leaders are lagging as the market is demanding cloud technology and lighter infrastructure over client-server PACS. 

Government and Politics

FDA will hold a public workshop on the use of AI in radiological imaging February 25-26 on the NIH campus in Bethesda, MD that will also cover potential FDA regulation. A post-event webcast will be available.

Other

Dexcom confirms that its G6 continuous glucose monitor hasn’t sent results and alerts – most of them intended for the parents of children with diabetes who are managing their conditions – since Friday due to a server overload problem. The company, which didn’t notify users until a Saturday morning Facebook post, experienced a similar one-day outage a year ago. Dexcom’s most recent Facebook update, from Monday, says they are back to “near normal performance.” Users complained that the company didn’t issue alerts by other channels such as text message or even its webpage for customers who don’t use social media and didn’t update its support line with a notice that they were experiencing issues, forcing callers to remain on hold for long periods. Shares of the publicly traded company, which has $1 billion in annual revenue, dropped a few percentage points at Monday’s market open but have since rebounded.

Researchers find that the few mental health smartphone apps that have actually undergone clinical trials – 19 trials versus the hundreds of available apps whose efficacy hasn’t been measured — are not effective when used alone. Apps for depression, anxiety, substance use, self-injurious thoughts, sleep problems, depression, alcohol, and smoking aren’t as effective as web-based interventions, possibly because the apps aren’t used as often, interventions might be less effective due to the casual and impromptu nature of smartphone use, and the form factor does not allow simply translating proven, on-site psychotherapy processes to the screen as has been done with web-based apps. The authors warn that ineffective apps may discourage users from seeking interventions that actually work. They recommend that phone apps be designed to take advantage of that platform’s unique capabilities for context sensing, always-on access, prompting, and the ability to perform physiological assessments.

A researcher’s review of anonymized electronic patient records of cardiac arrest patients who were transported by ambulance to Lifespan Health System (RI) finds that at least 11 patients over 2 1/2 years had misplaced breathing tubes, all of whom died. Rhode Island is one of few states that does not limit ET tube placement to paramedics, but a firefighter’s union killed a proposal to bring the state in line with others, declaring to audience applause in a public meeting, “We’re the experts, not doctors who are doing it when they’re in nice ORs or nice ERs with bright lights and a lot of people helping them.” A misplaced ET tube is considered to be a “never event” in emergency medicine since placement can and should be confirmed. Ambulance services, like hospitals, are required to report such mistakes to the state’s health department, but they would be aware of issues only of the hospital notifies them after the fact.

Kaiser Health News looks at rarely useful interruptive medical monitoring alarms, whose most frequent outcome is disturbing patient rest and burning out clinicians who are forced to listen to their insistent clanging all day long. Joint Commission says 85% to 99% of the alarms don’t require clinical intervention. Bed alarm sales jumped in 2008 when CMS decided to stop paying for hospital fall injuries even as CMS later discouraged their use in nursing homes in considering them a “restraint” as residents remained bedridden to keep the alarms quiet. The article observes that alarm proliferation has created a market for clinical alarm management consultants and software vendors who review alarm-capable device settings and install software that reviews the alerts before notifying employees.

HIMSS will “curate” (there’s a trendy millennial word for you) 12-15 digital health startups to pitch investors at the J. P. Morgan Healthcare Conference via its Health 2.0 acquisition, which seemed more appropriate when Health 2.0 was a for-profit company instead of having the non-profit HIMSS choose which companies get in front of potential investors. FYI to HIMSS – it will be 2020 soon, so please fix that date. Also note that the socialism-despising sharks at J.P. Morgan Chase who oversee this investor orgy happily received $25 billion of your tax dollars stay afloat back in 2008, although they had to pay $13 billion for ignoring their own due diligence process in screwing around with mortgage-backed securities. Both numbers are chicken feed to a company whose annual profits are tracking at around $50 billion. Greed is good, at least for the company’s bottom line and for CEO Jamie Dimon, whose net worth is around $2 billion.

The systems of urgent care software vendor T-System are apparently offline, as reported by malware hunters who found evidence of a ransomware attack on its servers. The company’s PR contact didn’t respond to my inquiry and any problems have not been publicly acknowledged, but the company’s website has been down since at least Friday when we last checked. UPDATE: a T-System spokesperson provided this response:

Through proactive monitoring of our systems, last week T-System identified a cybersecurity incident that has temporarily affected the availability of our Advanced Coding System (ACS) services. After learning of the incident, we promptly took relevant systems offline and commenced an investigation with the assistance of external experts who have expertise in the specific type of malware involved in the incident. Over the past few days, we have been working with our internal team and the external experts to restore backups and move back into production the systems that we initially took offline. We are working closely to restore these systems as quickly and safely as possible. Because of our early detection of the incident and our architecture, we do not – at this time – expect the incident to impact unsecured PHI or other personal information. We have been in direct contact with our clients with updates about the incident. The investigation is ongoing.

In Australia, a cancer center’s six-month, small-scale trial of IBM Watson for matching patients to available clinical trials worked well, but the cancer center won’t move ahead pending product improvements and its own EHR implementation.

Weird News Andy channels “Young Frankenstein” in titling this story Abby Normal. A Duke Health surgeon successfully completes the first transplant of a dead donor’s heart into a live patient, a procedure that has been performed for 10 years in the UK and in 619 procedures in last year alone in expanding the potential donor pool. WNA notes that equivalent US numbers would be nearly all of the 3,400 US heart transplants that were performed last year.

Sponsor Updates

• Avaya names Jon Brinton (Mitel Networks)  as VP, North America channel sales.
• Bluetree Network names Florid Sau (City of Hope Medical Center) an executive partner.
• Clinical Architecture will exhibit at the IHI National Forum December 8-11 in Orlando.
• AGS Health is recognized in the top 75 of “India’s Best Workplaces in IT and IT-BPM 2019” based on a rigorous assessment of the company’s fairness, credibility, respect, pride, and camaraderie.
• EPSI announces a new advanced analytics product.
• Hyland Healthcare announces new products and updates at RSNA.
• CoverMyMeds will exhibit at the NG Healthcare Summit December 9-11 in Amelia Island, FL.
• Cumberland Consulting Group will exhibit at the AHIP Consumer Experience & Digital Health Forum December 10-11 in Chicago.

Blog Posts

• #RSNA2019 – Cloud Services for Enterprise Imaging (Agfa Healthcare)
• Arcadia Aggregate 2020 (Arcadia)
• How Our DevOps Team Adopted Agile Practices (Burwood Group)
• Change Readiness: Preparing for Change (Optimum Healthcare IT)
• Patients Don’t Mind Sharing HER Data for Research, But Not Their Entire Medical Record (ChartLogic)
• Collaborative Care Reduces ED Visits & Increases Throughput (Collective Medical)
• The Value of Data Trust in Healthcare Analytics (Dimensional Insight)

Contacts

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

Morning Headlines 12/3/19

Amazon Transcribe Medical – Real-Time Automatic Speech Recognition for Healthcare Customers

AWS unveils a healthcare-focused version of its transcription service for cloud customers that converts dictated medical notes or multi-party conversations to text in real time.

Agfa-Gevaert Group enters into exclusive negotiations for the sale of a part of its HealthCare IT activities to Dedalus Holding S.p.A. – Regulated information

Italy-based Dedalus Holding will acquire Belgium-based Agfa’s health IT business, including its HIS and Integrated Care solutions, in Q2 2020.

Cerner Achieves 500th Patent With Voice-Assisted Technology

Cerner’s 500th patent pertains to voice-assisted technology that captures verbal interactions, then extracts relevant information and presents it on a physician’s mobile device.

Dexcom glitch kept parents of children with diabetes in the dark over their conditions this weekend

Blood glucose monitor maker Dexcom recovers from a server overload that has prevented updates and alerts from reaching users.

Curbside Consult with Dr. Jayne 12/2/19

I’m happy to report that I’ve survived the Thanksgiving holiday despite the intersection of bizarre karmic forces that had me working in the clinic most of the week as well as hosting Thanksgiving Dinner. I worked Black Friday and the weekend as well, so I haven’t fully recovered. Next, I’ll have nearly two weeks free of clinical care, then some scattered shifts before the scheduling gods smack me down again with a five day streak of 12+ hour days before we head into 2020.

I don’t know what our schedulers are thinking at times, but I suspect they’re scheduling around the day-off requests of the full time and higher-ranking physicians. I’ve asked for fewer shifts in the new year, so hopefully I can regain my sanity.

Truthfully, I don’t mind working Black Friday and it’s become a bit of a tradition for me. I’m not much of a shopper and value my sleep too much to be getting up at the crack of dawn to hunt for bargains. Most of the patients who come in are actually sick and it’s a privilege to help them. Many of them put off care because of holiday preparations and having family in town and now they’re in bad shape.

Most of the primary care offices in the area were closed, so their choices were limited. One cardiology office I called had a message that they would be closed until January 2, so either something funny is going on with the practice or they accidentally recycled their Christmas out-of-office message from last year.

We started the day with more than a little trepidation. The team that was on for Thanksgiving noted they had issues with our EHR communicating with our drug dispensing system. They were not able to get it resolved due to lack of holiday support from the tech teams. Fortunately for us it was working, and by noon, we had seen more than twice our usual volume of patients. As soon as we would empty the waiting room, another batch of patients would arrive. It was well after 3 p.m. before any of us were able to sneak off to the kitchen to eat the previous day’s catered leftovers.

I have to say that our leadership understands that well-fueled staffers are happy staffers. They had pizza delivered the day prior to Thanksgiving, a full holiday spread on the day itself, and the random arrival of dozens of tacos and burritos on Black Friday.

The holiday patient mix is always an interesting one. We had several hospital transfers for influenza, pneumonia, and out-of-control diabetes. We saw kidney stones, raging urinary tract infections, and a couple of lacerations that should have been taken care of the day before, except people didn’t know we were open. There were even a couple of people who had a little too much holiday merriment and came in for IV hydration. Strep throat, sinus infections, and plenty of lingering colds rounded out the day.

I was glad to see the severity of illness dropping as the day went on since we were all getting pretty worn out by dinner time. We had a brief surge of people who came in after their shopping was done, which always makes me a little aggravated since they were out spreading germs when they should have been at home with some soup and a vaporizer. The rest of the weekend was a different story, with moments of calm punctuated by anxiety-provoking stroke symptoms, head trauma, and a myocardial infarction that was smoothly transferred to the hospital.

On days like these, I’m grateful for the EHR and the ability to have default documentation that works for patients with similar symptoms. We tweak them as we need to, but it’s still fast, and as long as you’ve personalized your defaults, the notes are of good quality.

Of course, there are always providers who don’t personalize their options, which is how you wind up with visit notes that have exam findings that you’re sure the physician in question didn’t do. Or they don’t use the defaults at all, which leads to slow documentation and plenty of physician frustration. I definitely couldn’t document this fast on paper, even when I worked in an emergency department that used paper templates designed for rapid documentation based on the patient’s presenting issue.

People often ask me why I continue to do as much clinical work as I do. The real answer is that I enjoy it. I enjoy the people I work with and the organization I work for. We have an outstanding workplace culture. Frankly, compared to being a CMIO, it’s like being on vacation. Everyone knows their roles and responsibilities and how to work together as a team, despite the fact that we work with different combinations of people and at different locations all the time.

It’s a fail-fast environment. People who can’t get it done don’t last very long. They give people the tools they need to be successful, and if it’s not a good fit, they’re not going to subject the rest of the team to poor performance. I never played on a select sports team, but I imagine it might feel a bit similar. I’m willing to put up with wacky scheduling in order to stay on a high-performing team.

We no longer have an annual company holiday part  since it has been moved to the spring after flu season is over. But this year, the staff has organized their own get-together. Sometimes people just want to get away from their co-workers at the end of the day, so it’s great being at a place where people like each other enough to want to spend time together. We’ll be bowling the night away along with a “rob your neighbor” gift exchange, which based on the sense of humor held by many of my co-workers, should be highly entertaining.

I was honored to be invited since I don’t think all of the physicians were on the guest list. At least we know that if anyone has too much holiday cheer or sprains something during the “crazy bowl” part of the evening, we’ll be well cared for in the morning.

What does your company do to celebrate the holidays or thank the team for its hard work? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Michelle O’Connor, President, Meditech

Michelle O’Connor is president and chief operating officer of Meditech of Westwood, MA.

Tell me about yourself and the company.

I took over as president about six months ago. I was previously chief operating officer over operations and primarily development. I am now being reintroduced to a great leadership team that is responsible for our customer experience implementation and client services. We are re-engineering how we look at implementation to improve the physician experience and how we can improve customer experience as we continue to service them moving forward.

It is uncommon for companies to move developers into key executive roles, and Meditech is also different in that most of its executives have spent their entire working lives with Meditech. What is the company’s philosophy as the folks who founded the company and worked early in its 50-year history are handing over the reins to the next generation of leadership?

Part of the preparation for me taking over this role has been succession planning, which has been in the works at Meditech for many years. I’ve been in development, but previously I did work in implementation and worked on human resources with our staff management process re-engineering. I’ve done a lot of work with our staff, how we run the company internally and how we operate everything.

Working in development, I get introduced to the customer fairly regularly. Not necessarily in servicing and implementation, but I do work directly with them. That was especially true when we changed to an Agile development world, which I implemented seven or eight years ago when we started Expanse development. We engage our customers directly into the development process.

The plan for me to take over this role has been very well thought out. I’m prepared for what I need to do to take on more responsibility. That doesn’t mean that we don’t still have Hoda Sayed-Friel working more directly with our business partners and our professional services division and Helen Waters working with our marketing and our sales team. Those strengths help balance my role.

How does Meditech do business differently than competitors whose executives come and go from other health IT companies?

The value that Meditech brings to the table is that we look at what we need to do, we set a direction, and we move forward. Who would have thought that our senior VP of product development would have said in around 2010 when tablets came out that, “This is what we need to do in the future. We need to have mobile electronic health records.” We had just purchased LSS Data Systems. 

Because we are a technology company, we stay abreast of healthcare’s needs. We are able to pivot, move, and make decisions that allow us to do the right thing for the healthcare industry. We’ve been in the industry for 50 years. We have a touch on what customers need. By promoting from within, we allow ourselves to grow, evolve, and change to support it.

Meditech provides systems that go beyond core clinical or EHR functionality into modules that support nearly every aspect of a hospital’s operations in a long list of non-clinical departments. How hard is it to provide that breadth of systems?

I started with the revenue cycle product, which taught me the entire system and how things all come together. I look at non-healthcare technology companies and I can’t think of another industry that has to provide the level of service and the amount of functionality that we do. Meditech is one of the only vendors left that does financials. We are competitive with Cerner and Epic in the EHR, pharmacy, and lab space, but we provide financials and general ledger as well. It helps that we have been in business for 50 years.

It’s difficult for vendors to get into healthcare because our customers expect that level of integration. They expect that when you register in the lab system and populate a document that the pathologist reviews that we also drop a charge that goes over to revenue cycle so that your cost accounting system can deal with it and your general ledger can handle it. Then you send out a check for AP to do an overpayment to a patient. That’s totally expected of any of the vendors right now.

What are the biggest changes or trends you’re seeing across health systems?

Of course there is consolidation, but in terms of technology trends, I see providers who need to outsource their IT services through private clouds or what we’re going to be offering as the public cloud. It has become so complex for our organizations to support themselves. It’s a big change for them having public clouds handling the infrastructure and some of the help desk services. That’s one of the reasons we’re getting into the hosting business in offering Meditech as a Service or through Google.

We’re also doing it because of security concerns. Security is a huge risk. How many healthcare systems have been taken down for weeks and months from ransomware, and how did that disruption affect their overall business operations? A CIO recently told me that security is outside the EHR, but I think security is something that we as an EHR vendor have to do, to provide a system that can be highly secure. How can we do that more effectively and more cost-effectively?

We’re seeing a lot of announcements from health IT vendors who are partnering with Amazon, Google, and Microsoft, not just for hosting, but for using their embedded technologies to change the way they design and build their software. How will your relationship with Google change Meditech as a product and as a company?

It has already changed us, to be honest. In January, we’re releasing our first cloud-based product, High Availability Snapshot, where we are providing the ability for a customer to have access to the electronic health record through Google Cloud services. If they get hit with ransomware and their systems are down, they can go directly to the public cloud through a cellular connection and get a snapshot of that patient’s record. They can at least know what was done to the patient prior to their system going down while they recover from their disaster.

We are working on interoperability changes and API changes that will primarily use Google services. In addition, Meditech itself is lifting and shifting – I actually saw that term in a dictionary recently — lifting and shifting our EHR to run on a private cloud or on premise to the public cloud. As we’re doing that, we’re making significant changes to how Meditech systems are architected in order to run in the public cloud.

Our newest app is Expanse Now, which will be coming out early next year. It is voice enabled and it’s a Google services app as well. Creating new apps, building interoperability standards within the cloud services, and re-engineering our entire EHR to run in the cloud are the three primary things that we’re going to be using cloud services for.

How will these cloud services relationships change the health IT competitive landscape?

When we decided to write our product on a tablet and make it mobile, we made a concerted effort to build it based upon web infrastructure and not do direct apps, to allow us to have a cloud-based product working with on-prem. At that particular time, the clouds weren’t ready for us. Our goal was always to get Expanse into the public cloud. Honestly, it’s been a little quicker than I thought it was going to be.

A year ago, Meditech itself moved our entire operations to the cloud. Then we were going to move our EHR into the cloud. We accelerated that. Not only was it something we felt we could do, we found that with our infrastructure, we could do it much more quickly than we originally thought.

Expanse is getting the recognition that it deserves right now. The industry is seeing it as a great mobile platform to run electronic health records and to give our physicians mobility. Our nursing product recently gave them mobility as well. By doing it through the cloud, we’re giving our customers the ability to get there a lot quicker than they might have been able to if they were doing it on-prem.

There’s a lot more hardware and infrastructure needed to run these systems and costs are higher. By providing them through cloud services, we’re able to get them to the customer quickly without the high capital expenditure and to provide it more economically.

You’re sleeping behind enemy lines in being surrounded by a lot of Epic-using big academic medical centers. How would you, as a patient and a competitor, describe the state of interoperability in the Boston area?

You’re asking me a difficult question. I have elderly parents who have been going through the healthcare system pretty regularly over the past year. Interoperability in our industry is not good, the ability to share a record from a physician’s office to a hospital and to be transitioned to a tertiary care center or to a rehab center. We need to do better as an industry.

We believe that through our Traverse interoperability service, through using CommonWell, and by continuing to push upon using interoperability standards, that healthcare can get better if we all play together. We all work well together. We have seen a lot of the industry doing that. You see vendors coming together with CommonWell, Carequality, and things like that to push the standards. I know the government doesn’t think that we’ve been moving fast enough, but we all want to move data along more quickly to make sure that patients can be taken care of more effectively.

One thing you don’t know about me is that I really believe in what we do. Being in the industry for 31 years, we provide a tool that allows caregivers to deliver care to patients. We take that very seriously from a patient safety perspective and from a fiscally responsible perspective.That comes down to who we are as a company and who I am as a person. I truly believe that it doesn’t matter if you’re running Epic, Meditech, Cerner, or Allscripts — everybody has to be able to interoperate. Even if you have two different Epic systems, they still have to interoperate.

Are customers demanding better interoperability and system usability, or have their own internal policies and deployment choices made the EHR what it has become?

A lot of it goes back to the original question. It’s a lack of understanding of the complexity of the healthcare system and the data in which the systems are out there. Vendors are willing to share the data, especially defined data sets. It’s a matter of making sure that healthcare systems themselves understand that they have to share the data. But how difficult is it to share the data when it’s so vast and deep, and what is the actual data that needs to be shared? It’s not debits and credits. It’s not your ATM. It’s a lot more complex than that. If we all continue to work together, we’re going to get through this in the short term.

What population health management technologies are customers using or requesting?

We have a couple of perspectives on population health. There is managing patients that you’re seeing through through our registries within our ambulatory product. We have a robust system for managing the population of patients that you’re seeing. Then there’s the overarching population health, where you’re given the panel of patients that you’re responsible for managing.

We believe that we need to continue to provide the system in which you care for your patients, the system in which you are seeing what care gaps a patient might have, and things like that. But we’re not the insurance company that has the algorithms to figure out which patients are higher at risk. We are using a system called Arcadia to manage that by gathering all the claims, then providing back into the workflows of the caregivers and practice managers what needs to be done to take care of the patients.

Do you have any final thoughts?

After 50 years, Meditech has continued to evolve and change. We are the leading vendor that has been in this industry the longest. We’ve had a number of accolades. We had PCI and we had the first handheld nursing tool. We continue to use technology to move us forward. Expanse is live and people are seeing the difference in delivering care with the mobile platform that we’re providing. They continue to see Meditech provide technology to the delivery of care to provide better service than we’ve ever provided.

Our founder Neil Pappalardo always wraps up all of his conversations with, “The best is yet to come.” I truly do believe that.

Morning Headlines 12/2/19

Qld Health risks patient admin system failure after halting overhaul

In Australia, an auditor’s report warns that Queensland Health’s decision to push back replacement of its 30-year-old corporate information system places it at risk since the system hasn’t been vendor supported since 2015.

‘Black hole’ of medical records contributes to deaths, mistreatment at the border

The Department of Homeland Security’s inadequate software and sloppy paper record-keeping has caused treatment delays and lapses of care for migrants in its custody.

Doctors and techies are clashing at digital health companies, and one start-up exec is seeking a fix

A CNBC report finds that doctors working at digital health companies are sometimes seen as the unwelcome voice of reality in calling out product or company flaws that impact health.

Monday Morning Update 12/2/19

Top News

CNBC’s Chrissy Farr looks at doctors who join digital health companies but then clash with the development side of the house.

Those involved say that doctors are accustomed to making decisions solo rather than being the “token hire” who is expected to rubber stamp developer decisions. They are sometimes seen as the unwelcome voice of reality in calling out product or company flaws that impact health, as “first, do no harm” clashes with “move fast and break things.” 

A diagnostics company CEO “flipped out” when a newly hired doctor questioned the clinical and business wisdom of using staffing company doctors to write testing prescriptions without reviewing patients thoroughly.

A former digital health doctor says she has yet to meet a happy healthcare person in the digital health field.

Developers complain about the black-and-white opinions of doctors who are not used to being challenged, while doctors bristle at the Silicon Valley emphasis on “obsessively delighting” users that doesn’t make sense in medical situations.

Reader Comments

From Jagged Little Pill: “Re: Walgreens. Wasted no time after the story you reported on October 30 about closing many of their owned clinics. It’s curious they didn’t wait until after the holiday rush, when it’s nearly impossible to get into your primary care office. I imagine that the nurse practitioners are running to new jobs as fast as they can.” Retail clinics were the hottest thing going not long ago, and it seemed like a great fit for Walgreens to boost its “health hub” concept by offering medical services. The lesson to learn is that publicly traded companies veer in reactionary fashion from one strategy to the next in a desperate search for quarterly earnings, which are hard for huge companies to find, and Walgreens is considering going private and thus needs to preen its financials to chum the private equity sharks. In the mean time, Walgreens seems happy to lease its back-of-store real estate pop-up style to third-party clinic operators and UnitedHealth Group insurance sales centers while also opening Jenny Craig weight loss centers. Remember, too, that this was the company that jumped with zero due diligence into an ultimately embarrassing Theranos partnership that also vacated its drugstore premises. WBA shares are down 30% in the past year and 13% in the past five. 

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From Holiday Journal Time: “Re: hospital EHR alerts. It’s hard for clinicians to argue that alerts are a huge burden when they spend less than one minute per month on them.” Researchers look at how much time Duke University Health System providers spend dealing with the 75 most common interruptive alerts generated by Epic that represent 95% of the alert total, calculating the on-screen time between alert presentation and dismissal (“dwell time.”) Most alerts were closed within three seconds and providers spent just one minute per month dealing with them, leading the authors to postulate that it’s the interruption that alerts create — rather than the time required to manage them — that contributes to burnout. However, the authors excluded drug-drug and drug-duplicate alerts, which are the most common, because they weren’t able to calculate times. It should also be noted that quickly dismissed alerts aren’t necessarily a good thing – it’s likely that users are just reflexively clicking to get rid of the majority of them that are not helpful while missing the critical ones. I also note the financial success of co-author UCSF Department of Medicine chair Bob Wachter, MD,  whose conflict of interest statement in the article includes book royalties, compensation and stock options for serving on the boards or advisory boards of several companies, a royalty stake in one company, and a consulting arrangement with a startup that pays cash and stock.

HIStalk Announcements and Requests

Two-thirds of poll respondents have had their employment forcibly cancelled, but 61% of them said that their long-term career benefited as a result. HappyCIO lost their executive position in a purge, but used the opportunity to relocate for a move up that had been stymied by excessive contentment. An unexpected layoff three years ago forced nurse informaticist Quilmes Boy to rebuild his resume and rush into ill-suited jobs that weren’t good fits, but he’s happy in a new job now even though it pays less. Michael’s pharma employer was set to lay him off after taking paternity leave but instead transferred a co-worker, but he’s sorry he stuck around given the obvious writing on the wall. Marshall was RIF’ed by new vendors at 55 years of age because he was above an arbitrary Excel-sorted salary row, but he used his contacts and knowledge to recover in a different role. Charles took a common path – his vendor employer laid him off, but he took job in a hospital’s IT department.

New poll to your right or here: Does a patient own the data that a provider has recorded about them? TH made a good devil’s advocate argument last week – it’s true across all industries that you don’t own data that’s about you, and without the interpretation and validation of the provider who captured and recorded it, it’s not worth much (try selling a drug company a worksheet containing a list of your prescriptions and your blood pressure reading history). An extension of that argument might be that if the patient owns it, why can’t they insist that the provider change or delete it? Is having a right to obtain your data necessarily synonymous with owning that data? Is it different than credit scoring companies that know nearly everything about every American and make fortunes selling their most private information freely, giving the subject of that information little control or recourse?

Welcome to new HIStalk Platinum Sponsor AGS Health. The revenue cycle management and business process outsourcing company provides billing, coding, analytics, and data integration solutions to healthcare providers all over the US, with $35 billion in annual managed receivables and 24 million charts coded by 6,000 degreed, certified specialists each year. A large academic medical center decreased its denials inventory by 72% by implementing 70 AGS-recommended front-end coding fixes while saving 40% of its outsourcing coding denial management costs, while another major organization decreased its A/R days by 10% and resolved 85% of aged receivables within six months of working with the company. The company recently named industry long-timer Patrice Wolfe (Medicity) as CEO. Thanks to AGS Health for supporting HIStalk. 

I’m struggling to comprehend while still working down the Thanksgiving leftovers that it’s just over three weeks until Christmas and just 98 days until HIMSS20 kick offs.

Speaking of holidays and HIMSS, it’s that slow time of year in which Lorre can work more closely with prospective HIStalk sponsors than in the crazy January and February that follows, when every company is trying to make themselves heard above the vendor din. I suggested she offer inducements of the wacky variety – (a) giving new sponsors an hour or two of Smokin’ Doc standee time in their HIMSS booth for the surprising number of people who want selfies; and (b) providing extra hand-holding for those 10×10 booth-dwellers who, like us in previous years, are questioning the value of their significant investment for the other 362 days of the year.

Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre to present your own

Acquisitions, Funding, Business, and Stock

Consumer Reports observes that the list price for arthritis drug Humira has jumped 78% in five years, but most of the increase went to the pharmacy benefit manager middlemen (CVS Caremark, Express Scripts, and OptumRx) that took a bigger cut of its $5,174 per month list price. AbbVie generates $20 billion per year in Humira sales, but PBMs are pocketing 40% of its 2019 cost.

People

Analytics technology vendor SymphonyCare hires Brad Case (Estrella Health) as chief strategy officer. He was previously chief development officer for predecessor company Symphony Corporation, which was sold to Influence Health in 2013 and then re-acquired by SymphonyCare’s founder and former CEO Ravi Kalla in 2017.

Todd Helmink (ConnectiveRx) joins secure messaging app vendor QliqSoft as chief revenue officer.

Privacy and Security

Great Plains Health (NE) is taken offline in a ransomware attack, leading it to cancel non-emergency appointments and procedures.

Other

In Australia, an auditor’s report warns that Queensland Health’s decision to push back replacement of its 30-year-old corporate information system – following allegations of conflict of interest within the replacement team — places it at risk since the system hasn’t been vendor supported since 2015. The system was provided by Australia-based ISoft, which sold itself in IBA in 2007 following a newspaper’s disclosure of financial irregularities. A replacement will cost Queensland Health at least $150 million.

Politico reports that the Department of Homeland Security’s inadequate software and sloppy paper record-keeping has caused treatment delays and lapses of care for migrants in its custody. Immigrations and Customs Enforcement announced plans to implement EClinicalWorks in 2014, but advocates complain that ICE’s information isn’t shared with other government agencies and medical providers.

A travel website author visits Arizona-based MedAire, which provides ground-to-sky advice for airline crews who are attending to distressed passengers. It notes that unlike what you see in movies, airlines don’t usually ask whether there’s a doctor on board, preferring to deal with a known factor rather than checking passenger medical credentials or distressing travelers with a public announcement.

Sponsor Updates

• StayWell team members in Daly, CA serve meals at the North Peninsula Food Pantry & Dining Center.
• Zynx Health will exhibit at the Institute for Healthcare Improvement National Forum December 8-11 in Orlando.
• LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference December 2-4 in Houston.
• Health Catalyst will host a patient safety reception at the Institute for Healthcare Improvement December 9 in Orlando.
• NextGate will exhibit at the HIMSS Southern California Chapter 2019 CXO Symposium December 2 in Yorba Linda.
• Netsmart consolidates its Ozark and Springfield offices in Missouri.
• Redox previews its new podcast.
• SymphonyRM publishes a new case study, “Health System Drives 15% Increase in Patient Visits, 380% Annual Wellness Visit Growth.”
• Visage Imaging will exhibit at RSNA December 1-5 in Chicago, where it will demonstrate semantic annotations for Visage 7 as a work in progress.
• The Marketing Trends Podcast features Vocera Chief Marketing Officer Kathy English.

Blog Posts

• OIG Series 7: Utilizing Technology to Share Patient Information (Lightbeam Health Solutions)
• What we can learn by employing students in EHR implementation (Meditech)
• How Many Devices Does It Take to Coordinate Patient Care? (Fewer Than You Might Think) (Mobile Heartbeat)
• Physical Therapy Equipment: What Should Your Practice Have? (MWTherapy)
• Automating patient access to create a better consumer experience (Experian Health)
• Marketing to Consumers Who Shop Around for Healthcare (PatientBond)
• Collaboration Learnings from the PatientPing Chicago Community Summit (PatientPing)
• Giving Thanks: Healthcare Payment Processing Edition (Patientco)
• Technology is a Double-Edged Sword for Physician-to-Physician Communication (PatientKeeper)
• How to Get Hacked This Holiday Season (SailPoint)

Contacts

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