Monday Morning Update 6/4/18

Top News

The Illinois Procurement Policy Board rejects Cerner’s challenge of the seven-year, $62 million Epic contract signed by University of Illinois Hospital and Health Sciences System.

The board had previously recommended cancelling the contract and letting the state executive ethics commission render an opinion based on Cerner’s complaint that its bid was lower, that it wasn’t allowed to demonstrate its product, and that the selection involvement of Impact Advisors created a conflict of interest since that consulting firm also offers Epic implementation and staffing assistance.

The procurement board realized that Epic had not been offered a chance to request its own hearing, and after listening to arguments from both companies, declined to pursue the matter further and will let the contract stand.

UIC executives said when Cerner filed its protest in December 2017 that it has had problems with Cerner as a current customer, that it has failed twice in trying to roll out Cerner ambulatory due to Cerner-admitted performance problems, and that Cerner failed its technical review and was therefore excluded from demonstrating per state procurement law.

UIC’s Epic project will replace systems from Cerner and Allscripts.

Reader Comments

From Norway José: “Re: Cerner in central Norway. It seems they’ve pulled out, assuming the translation is correct. Wonder if this is a sign of things to come as they turn their attention and resources to the VA?” The Health Center Norway RHF article says that Epic will get the contract after Cerner pulls out for unstated reasons.

From You Don’t Need a Weatherman: “Re: referrals. Interesting timing in light of the Steward case.” A case before the US Supreme Court regarding how antitrust laws are enforced may change how courts look at anti-steering provisions. The case involves credit card companies, but if the Supreme Court upholds a lower court’s decision, hospitals and insurers would be allowed to include anti-referral rules in their contracts. The AMA argues that physicians would be unable to send patients to out-of-network specialists even when they believe it’s in the patient’s best interest. 

From PitVIper: “Re: provider data. Humana, Aetna, UnitedHealthcare, ONC, SureScripts, VA, and other organizations got together and defined an industry roadmap to address issues in provider data.” A CAQH-convened group develops “An Industry Roadmap for Provider Data” in hopes of reducing the inefficiency created by inaccurate provider data. The groups involved will declare a commitment to the vision, form a governance structure, define an initial dataset and standards, engage regulators, and begin measuring impact.

HIStalk Announcements and Requests

More than 80 percent of poll respondents had a negative reaction to Cerner President Zane Burke’s labeling the DoD’s negative internal report on the MHS Genesis pilot sites as “fake news” that was influenced by an unnamed competitor in unnamed ways.

New poll to your right or here: who is most responsible for high US healthcare costs? Next week I’ll compare the new results from the same poll I ran a couple of years ago.

I received too few entries to last week’s question, so here’s one last try. I should note that I’m not looking only for negative answers with these questions even those are often in the majority.

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

Following through on my long-ago promise to a reader to also recognize companies that have chosen not to renew their sponsorship, I’ll say thanks and goodbye to these companies that have left the HIStalk building since January 1:

• Conduent
• Dynamic Computing Services
• Ellis & Adams
• Encore Health Resources (acquired by Emids)
• Harris Healthcare (although it has added a sponsorship for its QuadraMed EMPI business)
• Haystack Informatics
• Healthlink Advisors
• Infor
• InMediata
• Lifepoint Informatics
• Protenus
• Sphere 3
• UltraLinq

Welcome to new HIStalk Platinum Sponsor Ciox Health. The Alpharetta, GA-based company facilities and manages the movement of health information with the industry’s broadest provider network, deploying capabilities in release of information, record retrieval, health information management, audit management, coding services and education, imaging services, clinical abstraction, and oncology data management. The company has 40 years of HIM experience and provides services to 60 percent of US hospitals, 16,000 physician practices, and 100 health plans. It manages 40 million requests for health information each year and complies with rigorous standards to ensure privacy and security. The company manages health information to support continuity of care, patient access to data, and reimbursement improvement. Thanks to Ciox Health for supporting HIStalk.

Here’s a Ciox Health intro video I found on YouTube.

I paid $65 to run the HIStalk email list through a third-party email validation tool that performs a deep dive into each subscriber’s email service. No wonder people say they aren’t getting my emails – a big chunk of company servers don’t let them through because of anti-spam systems, incorrectly configured servers, and readers who entered their email address wrong. At least I feel better telling people that the problem is on their end, not mine.

I also learned this by accident – if you export your LinkedIn connections from the Privacy menu, you’ll get an Excel file that includes every one of your contacts along with their job title, employer, email address, and connection date.

Thanks to the long-time readers who sent nice thoughts about HIStalk’s 15th birthday, some of whom were reading way back in my first lonely, fumbling year of 2003 (it’s still lonely and fumbling, but I accept it more readily).

Listening: new from Black Thought, aka Tariq Trotter, the genius co-founder and performer of The Roots. The lyrics are simultaneously angry, crude, and poetic: “Picture my daughter drinkin’ water with a sign; say ‘for colored girls,’ I ain’t talkin’ Ntozake Shange; Who said it’s cynical? I was a king and general; Rich in every resource, precious metal and mineral; Before the devil entered the land of the plentiful.” Lyrics are undervalued now that music is dominated by good looks, slick dance moves, and computer-enhanced songs written by someone other than the singer, but check out his freestyle rap from December to hear what Shakespeare might sound like if he were born 46 years ago in Philadelphia to parents who were separately murdered by the time he was 16.

I just finished reading the Theranos book “Bad Blood: Secrets and Lies in a Silicon Valley Startup.” Book report to follow.

Webinars

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Sales

• Boulder Community Hospital (CO) chooses Epic.

Decisions

• Cumberland Memorial Hospital (WI) will replace Evident with Athenahealth on August 1.
• Caldwell Memorial Hospital (LA) switched from Healthland to Evident in September 2017.
• Faulkton Area Medical Center (SD) will replace Healthland with Cerner on June 25.

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

People

Curt Thornton (Capsule) joins Quantros as SVP of sales.

Intelligent Medical Objects hires Ann Barnes (MedData) as CEO. She replaces co-founder Frank Naeymi-Rad, PhD, MS, MBA, who will continue as board chair and will add the role of chief innovator.

Announcements and Implementations

Amazon Web Services announces GA of Amazon Neptune, a graph database that allows developers to query relationships to power social networks, recommendation engines, fraud detection, and drug discovery. A life sciences startup is using it to study disease by connecting genomics, pathology, neurochemistry, and device and patient clinical data.

A new KLAS report on HIT assessment and strategic planning finds that Cumberland and EMids Technologies (the former Encore Health Resources) are more consistent in exceeding client expectations; Impact Advisors and Chartis Groups excel at delivering high-quality outcomes across a large number of clients and projects; Nordic is the highest overall performer; and Accenture finishes worst as clients report less value obtained. The report highlights Nordic and Deloitte for thought leadership.

Other

A University of Michigan poll finds that half of older adults have set up a patient portal, with those aged 65-80 who haven’t done so saying they aren’t comfortable with technology while those 50-64 say their biggest barrier is that they just haven’t bothered. Respondents gave portals a slight edge in their ability to understand the information they’re given, but telephone contact with the practice won for the ability to explain what they need and also with the hope of getting a faster response.

In England, The Daily Telegraph looks at the digital revolution in healthcare, giving kudos to Epic-powered alerts for quickly detecting and treating sepsis at Cambridge University Hospital’s NHS Foundation Trust, where 80 percent of newly diagnosed sepsis patients are being given antibiotics within one hour. It also mentions the Pediatric Early Warning Score for escalating peds issues quickly. The article also quotes Eric Topol, MD, who is reviewing an NHS technology review and who predicts the end of expensive “hotel hospitals” as patients are increasingly monitored at home.

Australia’s new, $2 billion Royal Adelaide Hospital is spending an annualized $2 million to store and deliver paper medical records after the incoming new government pauses its Allscripts rollout. The health minister says the EPAS project is “hundreds of millions of dollars over budget and years behind schedule.”

A small poll finds that 88 percent of Americans aged 40 and over would be comfortable receiving care via telemedicine, although half worry that care could be of lower quality.

A tiny new study finds that doctors can predict which patients will do well on chemotherapy by looking at activity data from their fitness trackers. Those who are non-sedentary more than 60 hours per week seem to require fewer hospitalizations and ED visits.

Newly published research finds that many cancer patients could safely skip chemo and surgery without affecting their survival, including eliminating chemotherapy after surgery for early-stage breast cancer. 

Baylor St. Luke’s Medical Center (TX) temporarily suspends its heart transplant program following publication of investigative reports calling out patient deaths and surgeon turnover. Meanwhile, the hospital’s chief of staff says in a Houston Chronicle opinion piece that “these journalists will need to have a contingency plan to go to Europe or maybe the Cayman Islands” if they need cardiac care after the authors noted the high death rates of heart surgeon Bud Frazier, MD even though the hospital itself had found problems with his work years ago.

Apple announces Digital Health, which despite the name, is an app to help consumers wean themselves off their electronic devices by limiting their time online. Google has introduced a similar feature in its Android operating system that records the time spent within each app and allows the user to set time limits.

In France, two doctors face disciplinary action after getting into a fistfight in an OR after an anesthesiologist complains about having to work after 4:00 p.m. because the urologist’s case ran over. The anesthesiologist says the urologist threw a bottle of Betadine in his face, with the latter then going after the urologist with surgical scissors. They continued their fracas in the OR dressing room afterward, when the urologist is alleged to have smacked the anesthesiologist in the face with his computer bag, shattering his eye socket and requiring a month-long recovery.

Sponsor Updates

• Pivot Point Consulting’s Seattle team volunteers at the Hopelink food bank.
• Netsmart will exhibit at the NAPHSIS – Vital Records Annual Conference June 4 in Miami.
• Datica lists its milestones attained as it reaches its fifth anniversary.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Epic Michigan User Group Conference June 5 in Ypsilanti.
• OmniSys will exhibit at PioneerRx Connect June 7-10 in Nashville.
• Meditech will host  its 5.x/6.0 Revenue Cycle Summit June 26-27 and 6.1/Expanse Revenue Cycle Summit June 28-29, both in Foxborough, MA.   
• Quadramed will exhibit at the CHIA Convention and Exhibit June 3-6 in San Diego.
• Wisconsin Health News features Redox CEO Luke Bonney.
• Nordic reports that its score of 98.1 on KLAS’s “HIT Assessment & Strategic Planning 2018” report is the highest of all companies mentioned.
• WebPT announces the speaker lineup for its annual Ascend Summit September 28-29 in Phoenix, AZ.
• Access joins Athenahealth’s More Disruption Please program.
• Philips Wellcentive publishes a white paper titled “Is there a business case for value-based care?”
• ZappRx achieves HITRUST CSF Certification.
• The SSI Group earns certification under the HHS Optimization Program Pilot of Administrative Simplification.

Blog Posts

• How an Integrated System Can Work For Your Emergency Department. (Santa Rosa Consulting)
• Prior Authorization Software Benefits Patients and Providers (The SSI Group)
• Next Generation Healthcare Consumer Marketing Requires an Advanced Targeting Methodology (SymphonyRM)
• You don’t know what you don’t know. (Voalte)
• Reducing Alarm Fatigue and Interruptions: Clinicians See a Bigger Problem than IT Does (Vocera)
• Why corporate values fail to resonate (and how to make sure yours do) (Nordic)
• The State of Rehab Therapy in 2018 (WebPT)
• Clinical Process Improvement & Innovation in Care Delivery at #HIMSS18 (LogicStream Health)
• ED Utilization: Addressing the Ongoing Industry Challenge (Medecision)
• How one hospital prepared for the new home health conditions of participation (Meditech)
• Strong Physician and IT Collaboration Drive Organization Success (Medicomp Systems)
• Tending Your RCM Garden (Navicure/Waystar)
• Enhancing Autism Services Through Technology (Netsmart)
• Four Questions Series: Alex Binder, VP of Visiting Physician Services, Visiting Nurse Association Health Group (PatientPing)
• Are paperless bills suppressing your patient payments? (Patientco)
• PokitDok joins Hyperledger (PokitDok)

Contacts

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

Weed’s Legacy

Weed’s Legacy
By Robert D. Lafsky, MD

Robert D. Lafsky is a gastroenterologist in Virginia.

It’s been a year since Dr. Lawrence Weed passed on at 93. He got a mention in HIStalk and a longer obituary in the New York Times, where he’s credited as a major innovator in the organization and computerization of medical records.

He was. But reading his later work, one has to doubt that Weed would have been happy with the Times statement about his Problem Oriented Medical Record, that “two of its features have become nearly universal in health care: the compiling of problem lists and the SOAP system for writing out notes in a patient chart.” 

Oh sure, you can look at the average EMR chart these days and see a “problem list” and SOAP designations on at least some of  the progress notes. But do the problem lists reflect the sort of organized rigorous thinking and aggressive pruning he advocated as necessary to keeping them useful?

Not very often. Especially after several admissions, a hospital patient’s list has a long string of overlapping, duplicative, or clearly unnecessary subordinate “problems.” It’s of little use to anybody. And are the SOAP notes problem-specific and do they clearly divide up the information as intended and point toward action?

Don’t get me started. Let’s just say that if we revived Dr. Weed and turned him loose with a current day EMR and gave him an hour at the lectern, his critical dissection and ridicule of the clinical work therein would be strikingly similar to what he does in his famous video from 1971.

The key concept underlying the Weed scheme was that one doctor brain couldn’t hold enough information to organize information and make good decisions about a patient. The process needs a more systematic and documented approach. 

As obvious as that may sound to readers here, medical giants walked the Earth 50 years ago, and a Big Ego telling other Big Egos — especially specialists — that their egos were too big didn’t always go over so well. But there was a more fundamental problem and Weed had to deal with it.

The original Weed system made sense dealing with the management of known and established problems, but the “unknown unknown,” the diagnosis problem, was the flaw in the scheme. I saw this myself when I started practice as a specialist in the early 1980s in a then-hotbed of Weed methodology — a small hospital with young family practitioners trained on the POMR concept.

What I saw repeatedly as a consultant was that no amount of dogged problem list maintenance could get you to see that problems 1, 3, and 5 were actually components of a single syndromic diagnosis. You just had to know that. And in those days, without sufficient training in the field in question, the light bulb never went off over your head.

Actually that light bulb method is still what we’re doing, but Weed spent his later career working on a computerized improvement. A trained interviewer (not necessarily a physician) would work with the patient and the records to input extremely granular information in a neutral fashion, avoiding the leading questions that the current heuristic system requires. The computer would then go to work applying a series of “knowledge couplers,” what I believe would be considered an expert system in current terminology, to generate a complete list of diagnostic possibilities. Only after that would a physician start dealing with the case and sort out the problems in light of that information.

How did that work out? You can read Weed’s book for a very full discussion of his later views. But the business of the ensuing business enterprise is a checkered story. Here’s an article from 2002 about his system and its fate. Suffice it to say that this was not a system that took over the world.  

Is Weed doomed to be an obscure historical figure in medical history at best and a minimally successful software developer at worst? I’ve had conversations with very highly-placed medical people who had never even heard of him. But it’s hard to look at the current morale problem in medicine and not see him as a prophetic visionary. Every week or so, I see two or three “burnout” articles or videos, mainly focusing on the current EMR experience. Everybody complains that they now have two jobs, data entry and actual thinking, or at least trying to make the light bulb turn on.

Will a Weed-like diagnostic system take over eventually and automate the light bulb? The problem is it’s going to take a lot more time and disruption to get something like that working and working well.   

But in smaller but still important ways, Weed’s legacy can and should come into play right now. The Weed argument would be that this burnout crisis was foreseeable, a result of medicine never controlling the data design process in the first place. And we never developed an ethos that requires that everyone have the individual discipline to actually contribute value to structured data with rigorous truthfulness, regardless of specialty orientation. And then to rely on what’s in there, or if necessary, correct it. 

In particular, although specialists are necessary, they have special duty in a shared hospital EMR environment to pay attention to what’s in the data tables and not just churn out unstructured and often contradictory text reports. Detail management is hard but critical, and although details span a range of importance, failure (say, to get a fresh and confirmed cancer diagnosis on the problem list before discharge) should be considered somewhat above the misdemeanor level.  

The burnout crisis reflects a pervasive sense that medicine has lost its autonomy to business and IT interests. But a key Weed-based insight is that we can’t start to get it back without taking more responsibility for what’s gone wrong.

Weed can be seen to offer a tough but fair path off of the beachhead we seem to be stuck on. The profession as a whole can regain autonomy, but the individuals in it have to give up some of individual ego-tripping many in it have enjoyed for too long.

There’s great potential for a better software environment in the future. Weed’s legacy will be more clear to everyone in the future. Right now, we have to pitch in now to work better with what we have.

Weekender 6/1/18

Weekly News Recap

• France-based Withings buys back the consumer digital health business it sold to Nokia two years ago and will restore the brand to the market
• Providence St. Joseph Health modifies its EHR to store patient advance directives and display them to clinicians during care events
• IBM reportedly lays off a significant number of employees of its Watson Health business
• Orion Health lays off 177 employees and is rumored to be pursuing a sale of some or all of the company with unnamed parties
• Personal injury lawyers in Philadelphia are buying geofencing-powered advertising campaigns to identify smartphone users who are in hospital EDs and so they can solicit lawsuit business afterward

Best Reader Comments

Zane: HISsie 2018 nomination + a lock on “Biggest Sore Winner” in a one-horse race. (Another Dave)

Why is it that every time IBM announces another quarterly loss (is this the 25th or 26th consecutive quarter?) that the people who have been busting their tails for years are the ones who unceremoniously get let go while the people in leadership continue to collect their massive salaries and are pretty much immune to any excision-related actions? (Genteel Giant)

Are there really so few women or people of color who making newsworthy HIT career moves? (ellemennopee87)

Keeping current on industry trends is smart, and I think writing thoughts and trends down in your own words (versus just skimming) industry news, if even just a couple sentences a day or even per week, is a good way to stay current. (Kallie)

Practice Fusion is a little clunky in some areas, very slick in others, but the great thing about it is that it’s continually improving. Someone there really cares about users and keeps making the little refinements that make the physician’s day easier. Hopefully, whoever they are, they’ll stick around after the Allscripts acquisition! We’re paying the $100/provider/month for now and we’ll see how it goes. (Dr. Herzenstube)

Is Sutter claiming that there were not any adverse events due to all records of all patients having gone black in one fell swoop? Did any patients die from the delays in care? (Sandi Green)

Watercooler Talk Tidbits

Reader donations funded a three-day academic camping trip in the Santa Monica Mountains for Ms. V’s fifth grade class in urban Los Angeles. She reports, “The project made a world of difference in the lives of so many students such that they are able to have the resources that they need in order to be able to succeed in a natural learning environment. Going to fifth grade camp has been such an incredible experience for my students, not only for learning academic science standards, but also for learning how to work together. For some of the students, it’s the first time that they’ve ever spent the night away from their parents, and it’s truly special to be able to share this with them and their friends.”

In Canada, a Nova Scotia doctor says it’s not fair that the province has singled him out for enforcing its “no new EMRs” policy as it tries to implement a big-picture system in a project started years ago. He says he’s the only one of 15 orthopedic surgeons who is stuck using a paper-based system since his peers ignored the ban and implemented EMRs.

A private addiction hospital in Scotland opens a rehab program for people addicted to trading cryptocurrencies, mostly young males and casino workers. 

Documentary filmmaker Ken Burns gives Mayo Clinic a preview of scenes from the upcoming film he executive produced titled “The Mayo Clinic: Faith, Hope, Science.” It will air on PBS in September.

HBO Documentary Films is creating a film covering the rise and fall of Theranos.

A drug company rep who struggled to push its Subsys fast-acting fentanyl spray that costs $25,000 per prescription because patients were “already addicts” was told to literally beg pain management doctors to prescribe its drug, according to a newly unsealed whistleblower lawsuit. Salespeople report taking doctors to strip clubs and shooting ranges, posing as medical practice office staff to convince insurers to cover the prescriptions, and hiring a male doctor’s girlfriend once he agreed to “turn on the Subsys switch.” The former rep says her employer, Insys Therapeutics, hired a former stripper and escort service manager as a sales executive, along with another rep who was described by her boss as being “dumb as rocks” but willing to have sex with doctors. He described the ideal candidate for an open drug rep position: “A doctor’s girlfriend, son, or daughter. Banging a doctor, that would be perfect.” The company reportedly also developed a script to push reps into selling the drug for off-label uses and used a mail-order pharmacy that didn’t question prescriptions for excessive doses and quantities.

A small study of doctors in two safety net hospitals finds that providing emergency-only hemodialysis to undocumented immigrants contributes to the physicians’ professional burnout due to: (a) seeing patients needlessly suffer and die for non-medical reasons; (b) their lack of control over the treatment criteria; (c) the moral distress that results from seeing care decisions made for non-medical reasons and only after gaming the system; and (d) being inspired for advocacy. 

A New York gynecologist files a $1 million defamation lawsuit against a patient who gave him bad reviews of her one and only visit. The patient claimed that the doctor’s business practices are “very poor and crooked” on Facebook, Yelp, and doctor review sites after she was stuck with a $427 bill when he billed her insurance for a new-patient visit plus sonogram instead her covered annual exam. The practice says the doctor has to base his clinical decisions on patient need, he always gives new patients a sonogram, and it’s not his job to keep current on the intricacies of every insurance company. The patient claims that after the reviews, the practice publicly posted her entire medical record in retaliation. Dim-witted Yelpers reacted as they always do – they flocked to Yelp to leave their own scathing reviews of the doctor, making sure to include a hefty dose of ethnic insults because he was born in Korea. Scouting Yelp, the woman has also left lengthy, bitter one-star reviews for a dentist (“I don’t know why anyone would put up with this type of abuse”), a professional women’s association (“everything was not explained to me”), a gym (“I suffered a terrible trapezius injury”), and Fedex (“all of their services are a rip off in my opinion”). Maybe doctors need their own version of a doctor-shopper database to share information about patients likely to complain, lie, or sue. Meanwhile, nothing in this story alters my perceived reality that while I use Yelp regularly, it attracts more unintelligent, sour, and writing-challenged users by far than other review sites like Tripadvisor and OpenTable. Yelp desperately needs the ability for readers to filter out the results (and ratings contribution) of users whose reviews are consistently unhelpful or untrustworthy, especially those one-review contributors who are almost certainly company plants.

In Case You Missed It

• News 6/1/18
• EPtalk by Dr. Jayne 5/31/18
• Readers Write: Modern Practice: Automation and Lifestyle Management are Key Drivers for Growth
• HIStalk Interviews Ron Remy, CEO, Mobile Heartbeat
• News 5/30/18
• Monday Morning Update 5/28/18
• What I Wish I’d Known Before … Taking My First Job Managing People

Get Involved

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

Morning Headlines 6/1/18

ClearBridge Investments Sends Letter to Board of Directors of athenahealth Inc.

Athenahealth investor ClearBridge Investments urges the health IT company to launch sale proceedings in light of a “litany of executive turnover, misexecution on several initiatives and persistent downward trajectory of a variety of financial measures.”

Withings will return after buying out Nokia’s health business

Withings will sell the Nokia Health products it re-acquired earlier this year, and relaunch the Withings brand by the end of 2018.

Propeller Health Raises $20 Million, Accelerating Development of Digital Medicines for Respiratory Health and Other Diseases

Propeller Health secures $20 million with help from Aptar Pharma, which will help the company scale its digital therapeutics beyond its core chronic respiratory disease market.

News 6/1/18

Top News

Athenahealth investor ClearBridge Investments jumps on the Elliott Management bandwagon, urging the health IT company to launch sale proceedings in light of a “litany of executive turnover, misexecution on several initiatives and persistent downward trajectory of a variety of financial measures.”

Reader Comments

From Only the Lonely: "Re: Allscripts. Getting ready to drop the bomb on vast swaths of employees. If you have a total of 60 years combining age and number of years with the company, you have been given notice to accept a early retirement package or else. Numbers said to be 500+." Unverified. I can say from past experience that the company won’t comment on personnel actions, so I didn’t bother to ask. The rumored effective date is July 1.

Webinars

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Acquisitions, Funding, Business, and Stock

Withings co-founder Eric Carreel plans to sell the Nokia Health (née Withings) products he re-acquired earlier this year, and to relaunch the Withings brand by the end of 2018. The company still employs 200 at its headquarters in France.

Omada Health becomes the largest Diabetes Prevention Program provider to achieve full recognition status from the CDC. Founded in 2011, the company has raised $126 million to develop and market a technology-based diabetes management program for employers and payers.

Ovulation-tracking wearable company Ava raises $30 million in a Series B round, bringing its total raised to just over $45 million.

Madison, WI-based Propeller Health secures $20 million in a funding round led by Aptar Pharma. With help from Aptar, Propeller Health plans to scale its digital therapeutics beyond its core chronic respiratory disease market.

People

Voalte hires Keith DeYoung (Wolters Kluwer Health) as VP of sales.

Alan Stein, MD (Hewlett-Packard) joins medication risk management technology vendor Tabula Rasa Healthcare as SVP of healthcare analytics.

Announcements and Implementations

After a successful pilot last year during Hurricane Harvey, UTHealth’s (TX) physician group will offer the Babyscripts prenatal remote monitoring app to all of its pregnant patients.

Premier launches a new collaborative to help health systems navigate physician practice acquisitions.

Robin Healthcare announces GA of an Alexa-like device for orthopedics and other specialties that uses machine learning and natural-language processing to capture physician notes and add them to the EHR.

Fitango Health develops care management and patient engagement software for oncologists.

Hyland debuts new enterprise imaging solutions including PACSgear Image Link Encounter Workflow and upgrades to its NilRead enterprise viewer.

Samsung will embed video visit and symptom checker capabilities from Babylon Health within its Health app on Galaxy devices sold in the UK. Babylon, which powers the NHS “GP at Hand” telemedicine service, hopes the deal will propel it beyond British borders should Samsung decide to expand the partnership beyond the UK.

Sales

• Capital Regional Medical Center (MO) selects Infor’s CloudSuite Healthcare and Cloverleaf Clinical Bridge software.

Privacy and Security

Several Aultman Hospital (OH) employees fall prey to an email phishing scam, resulting in a late-March data breach that potentially exposed patient medical record, driver’s license, and Social Security numbers.

Other

This article highlights the blind-like trust consumers put into Ancestry.com’s DNA testing services, despite the secretive nature of what the Utah-based company does with biological samples after it sends customers their ethnicity profiles. Ancestry has expanded its DNA database to include samples from over 5 million people, and won’t reveal where it stores the DNA or how long it will be kept. “Right now they see the benefit as being able to have cocktail-party conversation about their genetic makeup,” says former FDA commissioner Peter Pitts, who now heads up the nonprofit Center for Medicine in the Public Interest. “They aren’t thinking about the risks of giving up their personal information, and the long-term implications.”

A literature review of HIE studies finds that community HIEs do indeed reduce healthcare utilization and associated costs, especially in the areas of duplicate procedures and imaging. The finding contradicts a 2015 study that found few HIE benefits in similar areas.

Laurent Duvernay-Tardif, MD becomes the first active NFL player to graduate from medical school. The Kansas City Chiefs right guard hopes to add his new honorific to the back of his jersey.

A study conducted by researchers at the University of Virginia using software from National Decision Support Co. finds that radiology trainees are more apt to select appropriate imaging studies when aided by clinical decision support technology from within an EHR. CDS utilization in turn helped to reduce unnecessary imaging and related costs.

A KLAS report on HIT assessment and strategic planning recognizes Nordic as the top overall performer.

Weird News Andy points out that high-profile donors don’t guarantee great outcomes: An elderly dementia patient is found dead in the stairwell of the Zuckerberg San Francisco General Hospital’s power plant. The woman had gone missing from a nearby mental health facility 10 days before. The hospital experienced a similar tragedy in 2013, when a patient was found dead in a stairwell two days after being admitted.

Sponsor Updates

• Medicomp Systems publishes a new infographic, “Phoenix Children’s By The Numbers: Enhancing Patient Care, Increasing Physician Productivity, and Saving Big with Medicomp’s Quippe.”
• A.T. Still University of Health Sciences will use Aprima’s EHR as part of its grant-funded falls risk assessment and prevention program for older adults.
• EClinicalWorks will exhibit at Digestive Disease Week 2018 June 2-5 in Washington, DC.
• FormFast will exhibit at the California Health Information Association Convention & Exhibit June 2-6 in San Diego.
• Healthwise will exhibit at the Cerner North Atlantic Regional User Group Meeting June 4-6 in Grantville, PA.
• Impact Advisors promotes Kevin Gately to principal advisor and Molly Ekelof to senior advisor.
• With help from Engage, Island Hospital (WA) wraps up initial implementation of Meditech Expanse.
• Gainsight recognizes Imprivata for customer success excellence.
• In New Zealand, MercyAscot selects the InterSystems TrakCare EHR.
• Mobile Heartbeat VP of Professional Services James Webb will speak at Cisco Live US 2018 on June 13 in Orlando.
• CTG consolidates several of its enterprise information management services into a single solution dubbed EIM Advantage.
• Salesforce invests in Virsys12, a healthcare-focused Salesforce implementation and consulting company.
• Datica celebrates its fifth anniversary as a cloud-based compliance and security company.
• The SSI Group achieves HHS Optimization Program Pilot of Administrative Simplification certification.

Blog Posts

• ADHD and Telemedicine: A Natural Fit (EClinicalWorks)
• Unlock the Code to a Better CDI Program (HCTec)
• Another Trip to the Hospital (Healthfinch)
• 3 Ways Content as a Service Helps You Win at Social Media (Healthwise)
• Don’t ignore encounter-based medical images (Hyland)
• The Walking Gallery – My Sepsis Story (Iatric Systems)
• 5 Secrets to Healthcare Content Marketing Success (Influence Health)
• Crossing the Payer/Provider Chasm – Getting to Shared Risk, Shared Data (InterSystems)
• Laying the Foundation for Enhanced Patient Access: The Importance of Analytics (Kyruus)
• The Real-Time Enterprise is Coming – Are You Ready? (CTG)
• Why corporate values fail to resonate (and how to make sure yours do) (Nordic)

Contacts

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

EPtalk by Dr. Jayne 5/31/18

A reader sent me this piece about an Ohio hospital that added physicians to the emergency department triage process, helping them lower their wait times for patients to be seen by a provider. The headline was attention grabbing, but when you look at their process, basically they started running their triage area like a mini-urgent care, with providers performing H&Ps and ordering tests. They also created a separate waiting room for patients who were waiting for test results. I’m not sure how different this is from creating a “fast track” section of the emergency department or adding an on-campus urgent care or convenient care facility to divert non-emergency cases from the core emergency department. I’m sure it created some interesting flows for documentation, since providers would be using different workflows depending on whether they were working in triage or as traditional emergency department physicians.

When I work with clients who are “stuck” with their EHR projects, I occasionally encounter a physician who has built his own EHR and uses it as the gold standard against which he compares what we’re trying to implement or optimize. (I use the male pronoun intentionally, because I’ve never had a woman physician admit to it.) I’m all for home-based innovation, but I have to draw the line at DIY Gene Editing  which apparently is a thing. Apparently, there are meetups for these biohackers, including “Body Hacking Con” which was held in Austin. After reading how easy it might be to brew up a batch of bioweapons in your bathtub, I’m almost wishing I hadn’t read it. Plausible deniability might be better, after all.

EHR vendors take note: the next set of screening questions you add to your product might need to be around your patients’ tax preparation strategies, or lack thereof. The StreetCred program is a partnership between various hospitals and community organizations, including Boston Medical Center, where patients are supported so that they can receive tax benefits and other entitlements that might help reduce the impact of poverty on chronic medical conditions. BMCs program operates through the Department of Pediatrics and ensures that clients receive tax credits for which they qualify along with tax refunds. Families with improved financial stability have lower stress levels and higher participation in care programs than those whose situations might be more tenuous. Yale School of Medicine has a similar program based on the work at BMC.

Kudos to CMS for figuring out new ways to use acronyms to confuse us. The Direct Provider Contracting model is being referred to as DPC, causing confusion with the Direct Primary Care movement. In Direct Primary Care, patients contract directly with a primary care provider (usually a solo physician although some DPC practices are small groups with low overhead) for services and pay a monthly fee. Direct Provider contracting is different, and includes provider networks which receive Medicare funds in an advance-payment scheme, to manage their patients’ care. It’s considered a potential alternative to the Alternative Payment Model (APM) options already out there. MGMA has already voiced concern about this new direct contracting model and its potential negative impact on small groups.

CMS further sullies the acronym soup by referring to these provider networks as CIOs (clinically integrated organizations) which by necessity must include professional, technical, and hospital service components. Medicare would incent patients to participate by offering lower co-pays for patients seeking care within the CIO-created network, which sounds dreadful for anyone who has ever had to deal with an unexpected “out of network” bill. Most billing systems do a mediocre job of handling non-fee-for-service payments, so providers who might want to do this need to be discussing it with their EHR and practice management system vendors as this unfolds. It’s another nail in the coffin of ambulatory-only products since trying to do the cost accounting needed to make this viable becomes tricky when you’re working on multiple systems. I missed the boat on this one since CMS only accepted public comments on it through May 25.

Given our society’s obsession with smartphones, I am always on the lookout for articles discussing how people use them effectively or to their detriment. In my travels, I see more and more people who are so engaged with their phones they create problems for the people around them. On my flight this week, a woman deplaned a few people in front of me and pulled out her phone in the jet bridge. Her forward momentum dropped as she started fiddling with her phone, resulting in the person behind her (who was also fiddling with a phone) smacking into her. Heads up and hands out, people, and be ready to interact with the world around you. Unfortunately, judging by the number of children in the under-13 set who are also face down on phones or tablets, I don’t see any improvement in this over time. The Wall Street Journal covered the topic, discussing CEOs who have tried to address the issue. The statistics are staggering — the average person engages with his or her phone over two hours per day, including during work hours.

I’ve been in meetings were electronics are banned and find it unfortunate mainly because I take verbose meeting notes on my laptop all the time. Taking notes on paper results in lost productivity later as I have to transcribe my notes. I also like to fire off action item emails in real time rather than carry a list of to-dos back to my desk. On the other hand, I’ve watched people openly surf Facebook or play games during meetings and that’s just not acceptable.

Going “no phones” needs to also address the prevalence of smart watches and other notification devices. My clinical office has a “no cell phones” policy in the workplace and surfing the internet is against our code of conduct. Employees aren’t even allowed to have phones in their pockets for emergencies – they are expected to provide their children and loved ones with the office phone number so they can be reached in case of emergency. Although this may sound draconian, it has resulted in more engaged employees who look for tasks to complete in the office or who actually talk to their co-workers rather than head down the social media rabbit hole. Apparently, an upcoming version of the Android system will include a time tracker to help people track their phone use and I have some family members I can’t wait to try it on.

What do you think about smartphone overuse? Are we addicted or just bored? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/31/18

Healthcare startup Qliance files for bankruptcy, lists more than 100 creditors — including CEO’s new company

Membership-based primary care company Qliance Medical Management files for bankruptcy after abruptly shutting its doors last year.

Manhattan Doctor Sues Patient For $1 Million For Posting Negative Reviews Online

Joon Song, MD of New York Robotic Gynecology & Women’s Health sues patient Michelle Levine for $1 million in damages plus legal fees after she posted negative reviews on Healthgrades, Yelp, and Zocdoc.

Next time you buy a TV at Best Buy, you may be also offered health care

Best Buy looks into offering seniors aging-in-place technologies and services as part of a potential push into healthcare.

VA Announces New Acting Secretary, Retirement of Deputy Secretary

VA Chief of Staff Peter O’Rourke takes over as acting VA secretary from Robert Wilkie, who has returned to his position within the DoD while he waits out the VA secretary nomination process.

Readers Write: Modern Practice: Automation and Lifestyle Management are Key Drivers for Growth

Modern Practice: Automation and Lifestyle Management are Key Drivers for Growth
By Arman Samani

Arman Samani is CTO of AdvancedMD of South Jordan, UT.

At the beginning of 2015, I discussed the technologies that would influence the growth of private practices going forward. Enabled by mobile and cloud computing, integrated practice management (PM), electronic health record (EHR), patient relationship management, and actionable analytics, as well as interoperability were top of mind, with the integration of statistics from patient wearables, benchmarking, and actionable alerts as specific technology solutions for private practices to consider.

Some of these technologies have gained traction while others remain a goal to attain. At the same time, innovations have emerged to help private practices not only compete but thrive in the era of consolidation and healthcare reform. Let’s take a look at how providers are using technology and how they may further engage their patients while thriving as businesses.

Cloud- and mobile-enabled technology as foundation of modern practice

Cloud technology has been around for quite some time now, but I’d estimate that more than 50 percent of private practices still use server-based applications. New entrants into the practice market, particularly those with technology-savvy leadership, are definitely embracing the cloud. These new providers are building their practices around all the technology elements I discussed three years ago. Yet even these modern practices must be vigilant and do their due diligence when identifying cloud-based applications to suit their needs. Some vendors offer so called “fake” cloud: a hosted server solution which is not a true shared environment accessible from any device.

Cloud adoption will absolutely continue for practices that are server-based. Understandably, it’s hard to switch a working practice, but we do see them moving to the cloud when their server applications can no longer keep up with the demand of the new generations of patients.

Workflow automation is a must for successful patient engagement

Given today’s consumer-oriented mentality about healthcare, patients want and need an automated process for all interactions with their medical providers.

As a patient, if I am online searching for a physician, I should be able to look at comments on the doctors in my network, schedule an appointment with the one I select either on a desktop or phone, and receive a reminder of that appointment. I should also be able to provide feedback on my visit and experience. This is where innovations such as Google-interfacing reputation management platforms come in to bring patient engagement closer to how retail, services, and other sectors engage with customers. Private practices can manage their online presence like any other business, obtain feedback from patients, and respond to it in a timely manner.

The physician’s office should also be able to check my benefits, manage my wait time, automatically file claims and receive payments, view day/week/month closings, and send out digital statements. None of it is doable in an efficient and patient- and provider-friendly manner without automation.

Securely automating and interconnecting these processes enables providers to avoid some of the mounting costs of doing business while being responsive to the needs of patients and payers. Ideally, providers should have unified, easy-to-use solutions for all parts of their practice, with one workflow, one database, and one log-in, accessible from all major browsers and on multiple devices.

Continuous engagement for lifestyle management

Everyone is excited about the potential of Fitbits and other wearables to deliver real-time patient data that could both engage patients and help their providers optimize treatment. However, we are far from realizing this integration. Even in the value-based care environment, there are no incentives for private practices to adopt the technologies that would help them proactively manage patient lifestyles. Practices are only reimbursed for managing patients from one visit to the next rather than providing continuous care management that has the potential to significantly reduce care costs.

There is plenty of evidence now that factors such as lifestyle (from exercise to diet to work habits) and social determinants of health (where people are born, live, learn, work, play, and age) account for as great, if not greater, portion of outcomes as clinical factors. This is a tremendous opportunity for the industry to enable providers with appropriate reimbursement and technology to improve the health of our country.

On the lifestyle technology front, think about patient reminders to take medications, fill prescriptions, balance food intake, and check in on both physical and mental health-related issues. Such continuous engagement can be accomplished either by pushing lifestyle applications or sending text messages and responding to communications from the patients.

We are seeing this emerging trend with some employers who are betting on preventative care to keep their employees healthy. They negotiate with payers to offer successful wellness programs that are typically popular with employees. By shifting more funds to lifestyle management, we have more opportunities to reduce costs dedicated to chronic care management. I hope that Medicare will begin to cover lifestyle management medicine, with private health insurance companies following suit.

Future is in technology-enabled continuum of care

Change in healthcare technology does not always occur as quickly as we would like, but it is happening now more rapidly than ever. The consumerism of healthcare will continue to grow and technology will grow with it; ideally, ahead of it. Providers should aim to convert everything that is currently done on paper or that involves a phone call to a digital format that is easily accessible to patients. Private practices are advised to adopt cloud-based systems to optimize the patient experience, including online scheduling, telemedicine, and automated reminders for various purposes, providing options previously unavailable to busy consumers. Technology-savvy patients will be looking for providers who offer this continuum of care and payers will begin to recognize its significance.

The government is also well aware of the consumer-focused technology drivers. I believe we will see a greater consistency in telemedicine rules and reimbursements from state to state and payer to payer. I also truly hope that insurers will begin to support lifestyle management services, helping practices expand beyond chronic care management. Practices can demonstrate the return on investment by measuring results of lifestyle programs through benchmarking and share that data with the insurers.

When we can demonstrate that better-managed lifestyles can reduce or prevent chronic conditions, private practices will have greater leverage in negotiating with payers and be able expand their practices with new, state-of-the-art services and technology supporting the shift. It’s time for payers and providers to move from the visit-to-visit viewpoint to one of long-term wellness.

HIStalk Interviews Ron Remy, CEO, Mobile Heartbeat

Ron Remy is CEO of Mobile Heartbeat of Waltham, MA.

Tell me about yourself and the company.

Mobile Heartbeat has been in existence since 2009. The current product was introduced in 2011. It’s my second project working together with the technology team that started the company. I’ve been in technology my whole career. I was an early employee of Sun Microsystems, going all the way back to 1985, so I’ve been in the technology industry for a long time.

Mobile Heartbeat makes a product line called MH-CURE, which is a clinical communications and collaboration product. It’s designed for acute care and affiliated ambulatory facilities of hospitals. It runs on IOS and Android smartphones and is available both on-premise, with servers inside the hospital’s data room, or a cloud offering via our cloud partner, Parallon Technology Solutions.

What do clinicians want from mobile apps other than message exchange?

The most important aspect is to know who’s on the care team for each and every patient, as well as the status of those individuals. Particularly in the larger facilities, you may not personally know every member of the team that you’re on. You need to be able to instantly recognize who is the nurse, who is the physical therapist, who is the cardiologist taking care of that patient, You need to know exactly what their status is — online or offline, in the facility or out of the facility — and then be able to communicate to them with a variety of methods — secure text, a phone call, a video chat, or even a page.

All of those are the communications capabilities, but if you don’t know who to contact, whether they’re available, why they are relevant to you, and what their context is, the communication systems aren’t all that impactful.

What kind of outcomes to customers see?

We talk about a value hierarchy. You get started with implementing mobility in smartphones and their applicable software — which includes our class of software, Mobile Heartbeat, as well as your mobile device management software — and your infrastructure to support those. Your wireless network, your servers, your security. Then layer on top of that our software and the smartphones.

The first thing that you need to look at to make sure you’re getting to the Holy Grail, which is better patient outcomes, is the adoption ratio. How many users are on this mobile network that you’re providing? We tend to quote Metcalfe’s law. It’s an interesting telecommunications law that the value of a network is equal to the square of the number of nodes on a network. For a 10-node or a 10-user network, that value is 100. For a 1,000-user network, that value is a million. It’s much more valuable. If you don’t get high adoption rates, if you don’t get a lot of users on your network, the value is relatively low.

Now that you’ve got your adoption rate high, you start looking at how people are communicating with one another. Who is texting who? Who is calling who? How often? You start to analyze those patterns. Why are people communicating with one another? If you know why and when, then you can start optimizing the workflows around that. Take Lean thinking and apply it to your workflow.

One of the greatest learning experiences early on at Mobile Heartbeat is that the number of ancillary staff members — not necessarily just the nurses and doctors — that you’re in communication with on a regular basis is extremely high. If you exclude those people from your mobile network, your mobile program, you’re missing out on some great workflow improvements.

Once you improve your workflows, the best possible thing that you can achieve is higher quality and better patient outcomes. Very few customers are at that point. They’ve not deployed mobility for that long a period of time. But everyone needs to get there. That’s the top of the pyramid — higher quality, better patient outcomes.

How do you go about analyzing that and what kind of insights can you gain from looking at how they’re using the system?

We have a team of three informaticists, nurses with an informatics background, that assists clients in this analysis. A system like ours creates a huge amount of operational data. The first thing to do is to extract that, do some data mining on it, and see what the communication patterns are. Who is calling whom, who is texting whom and when?

The patterns might tell you that there’s a huge amount of texting going on between the nurses and the warehouse, surprisingly. Why is that? Maybe it’s because they are constantly having to track down supplies. They’re always in contact with the warehouse trying to locate something that they need desperately for a patient. Now that you know who’s texting whom, you can look at the rationale behind that and start to optimize that.

The next level of optimization, and we’re just beginning to do that, is to look at using natural language processing to not just look at who’s texting whom, but also look at the actual content of those text messages. You can get some real insight on that.

Let’s go back to that same analogy of the nurse constantly contacting the warehouse for a specific item. Using natural language processing, you know that they’ve been requesting a specific item all the time. If you know it’s a major workflow request, let’s make that item a little bit more available. Maybe stage that item in the nurse’s central station. Now you’re starting to take this communications system and apply it to workflows, to make those workflows more efficient and to raise the quality and the speed of what you’re getting done inside the hospital.

What kind of integration with other systems is offered or beneficial?

Huge. That’s probably the biggest requirement. The most obvious one to get started is to the electronic medical record, specifically the ADT feed coming out of the EMR, to know which patients are in and out of the hospital. That’s a requirement for having a care team directory and a patient list available to your clinicians.

The second is into the nurse call system of the hospital so that nurse call alerts and alarms aren’t randomly sent to the unit, but instead are directed to the correct responder’s smartphone. That’s a requirement of any system like ours.

Integration to the lab information system makes critical lab results available to the clinician. They’re looking at a patient and they want to see exactly what’s going on with their lab results.

Integration to third-party messaging systems. That’s a generic term, but I’ll give you an example of what one of those is. There’s a tremendous amount of effort in predictive analytics around sepsis prevention using patient data and maybe even population health data to predict that a specific patient is going to go into sepsis. The system that does the analytics makes the determination that a specific patient might be a sepsis risk. Now you have to tell somebody to take action. The integration to that third-party system has to come from that system into Mobile Heartbeat and get sent to the correct clinician taking care of that patient. We’re the last-mile delivery for all these third-party messaging systems. That’s an absolutely critical integration that you have to put in place.

To foster that, we’ve built a fairly comprehensive API set. One of those APIs handles incoming messages from third-party systems and directs them to the correct caregiver. That message can have multiple choice responses, so the caregiver, the nurse, the physician gets the message, it pops up on their smartphone, and they can indicate their response and have that go back to the initiating system to take further action. Maybe it kicks off another alert or alarm or another message. All of that integration is a requirement.

Clinicians use to have a belt full of gadgets because each application had its own device. How do you figure out how those applications can coexist on the device that a user is assigned or brings in from home?

Let’s start physical and then go to logical. When we started the company, we realized that the utility belt effect was powerful and we needed to address it. You’d look at a clinician and they might have a pager and two voice-over-IP phones on their belt walking around the facility. The first step was to consolidate all that onto one device. The advent of the smartphone and its capabilities made that, obviously, the perfect device. That’s where most industries that were consolidating any type of telecommunications or communication systems were looking.

We built our software to take advantage of a couple of key features. The first is to use voice-over-IP for inside the facility, so that you’ve got a voice-over-IP phone that is available for making phone calls over the WiFi network.

The second was to take a look at those old-school pagers that everyone wanted to get rid of. They were all wearing them on their belt. They wanted to get rid of the pager, but they couldn’t get rid of the actual paging service, because the workflows that they’ve been using for 15 years required that paging capability. We developed the ability for sending and receiving pages to come directly into our application using the existing pager service.

That was the first level of making this a much more efficient product and getting rid of some of those utility belt things that you’ve seen in years past. We think that trend is going to continue. It’s pretty obvious that people want to use their smartphone.

The second part of that is, early on, we asked clinicians what they wanted to do on the smartphone. The answer really shocked us. It was, I want to do everything on it. I never want to get in front of a workstation again if I don’t have to. Because when I’m in front of a workstation, I’m not with a patient. With my mobile device, I can be with a patient, so I want everything on that.

That led us to enable another API set that we call the InterApp launcher. You can leave Mobile Heartbeat and go directly to another application. No extra login, so you log in once to the system using your Active Directory login. You log in to every application as you move to it and you can pass patient context. For instance, I can leave Mobile Heartbeat, look up the exact same patient in AirStrip, and view the live waveform of that patient seamlessly, just by clicking inside of Mobile Heartbeat. I don’t have to do any manipulation of the new application. That is the next level of integration we see.

Where do you see clinical communication going in the next five years and how will the company be involved?

Apple announced in their recent earnings call that our largest customer just purchased 100,000 IPhones to launch a corporate-wide mobility program throughout all their hospitals. We’re the core software of that mobility program. That is an absolute milestone in the industry, seeing major players announce that they’re going into mobility in a big way. Software to run on those devices, Mobile Heartbeat and others, is a key component to the rationale behind this.

A year ago, we installed our product at Sunrise Medical Center in Las Vegas, Nevada. It’s a good-sized facility one block off the Las Vegas Strip. When the Route 91 Harvest Festival shooting happened in October, 214 of the injured patients made their way the ED of this specific facility via Uber, police car, or with a bystander. We didn’t really know much about it at the time since it happened in the middle of the night here in Boston.

We were a core component of that facility’s ability to triage, treat, and successfully take care of those patients. To get the staff at the right place at the right time. To broadcast out to everybody, both inside and outside the hospital, what needed to get done.

The learning from that is going to be industry-wide. If you do not have a communications platform in place — both physically with phones as well as your network and the software you’re using — then you’re really not prepared for that kind of event. I don’t want to cast doom and gloom, but being prepared for these types of mass casualties in any good-sized facility is something that requires a lot of care and preparation. We believe that the technology that we build is one of the components of being prepared for that.

Our software and our own products are very exciting, but the industry as a whole is just as exciting. We love to see potential clients picking up mobility in any form. We’d obviously love our product to win every single time, but we’re more excited when they make a determination that smartphone technology is the way to go inside their hospitals. It’s a big step forward in healthcare in the United States.

Morning Headlines 5/30/18

Providence St. Joseph Health Helps Ease, Enhance End-Of-Life Care

Providence St. Joseph Health publishes a state-specific online advance directive toolkit and customizes its EHR to store the advance directives of its patients.

IBM’s Watson Health wing left looking poorly after ‘massive’ layoffs

IBM Watson Health reportedly had big layoffs last week, with the “resource action” mostly focused on employees from its big-bet acquisitions Truven, Merge, and Phytel.

Orion Health cuts 177 jobs as more red ink spills

As layoffs mount, reports suggest that New Zealand-based Orion Health is considering selling all or part of the company to unnamed parties.

ResMed to Acquire HEALTHCAREfirst, a Cloud-based Software and Services Provider for Home Health and Hospice Agencies

Home monitoring technology vendor ResMed will acquire HealthcareFirst.

News 5/30/18

Top News

Providence St. Joseph Health publishes a state-specific online advance directive toolkit and customizes its EHR to store the advance directives of its patients.

Patient wishes will be displayed via the EHR — along with goals-of-care conversations — to clinicians. The EHR will also send an alert to the physician if treatments are ordered that conflict with the patient’s desires.

Clinicians will also prescribe videos and other resources to help patients understand their end-of-life options in a partnership with the non-profit foundation ACP Decisions.

The project is being led by the health system’s Institute for Human Caring, which also offers “Get to Know Me” posters that it hopes will “deliver patients from anonymity.” 

The 20 members of the IHC team include technical experts Matthew Gonzales, MD (CMIO), Shahrooz Govahi (data scientist), and Paul Park (senior clinical data analyst).

Reader Comments

From Closed Doors: “Re: [vendor CEO’s name omitted]. Making headlines for attacking his former wife.” Sorry, but this isn’t news despite the reporting tabloid’s eagerness to pass it off as such and lazy parroting of the irrelevant story by other publications. The rag dug up divorce custody documents that are more than 10 years old and pressed the former couple for comments, both of whom admirably said they regret the way their divorce unfolded. Family stuff that has nothing to do with business should be off limits even if you are a public figure. Staying solvent as a newspaper or news site apparently means dumbing down content to the time-wasting drivel that Americans are anxious to read on their phones while sitting on the toilet, which is exactly where this story belongs. At some point your conscience needs to kick in, thus I won’t be part of it.

From Spurious Emission: “Re: poll. You didn’t offer your reaction to Zane Burke’s claim that the DoD report was competitor-instigated ‘fake news.’” I thought it was one of the stupidest things he could have blurted out on the record. It made the company look belligerently whiny instead of humbly grateful after winning a no-bid, $10 billion government contract. It also invites unflattering comparisons to thin-skinned others who define “fake news” as anything they wish had been kept secret. That plus suing a customer / prospect for voting to replace Cerner with Epic recalls the low points of the increasingly desperate Tullman regime at Allscripts before it was overthrown. I assume Burke was passed over in favor of his new, oddly experienced boss Brent Shafer, which might be a friction point for both sides that would encourage treading cautiously.

From Gene Parmesan: “Re: Cerner. We all assume the unnamed competitor was Epic that Zane was bitching about, but what if it was CliniComp, which sues everybody in sight for threatening its federal government revenue stream?” That’s an interesting thought. I don’t know if CliniComp has enough DoD juice to have had some influence over the MHS Genesis pilot project report. Anyone want to weigh in, or for that matter, to speculate on what the heck Zane was talking about?

From NoHorseInThisRace: “Re: CMS forcing hospitals to publish their charge masters. There actually is one way in which the charge master is immediately relevant and could impact consumer choice if made public – taxes. While no one will actually pay the CM rate even out of pocket, the IRS considers any debt forgiveness as taxable income. Therefore if a low-income consumer who’s likely to receive forgiveness has a choice between two hospitals — one that lists a knee replacement at $18,000 on the CM and one that lists it at $57,000 — the consumer would be well advised to select the former (assuming care metrics are roughly equal). At the end of the day, publishing CM isn’t going to be a cure-all (pun intended) for our cost woes, but it’s a start.”

HIStalk Announcements and Requests

Please sign up again if you’ve stopped getting your HIStalk email updates, which long-time readers report several to me times each week. I’ve noticed that quite a few emails have been suddenly been bouncing back as undeliverable. Rejecting the emails in significant numbers are the mail servers of Allscripts, Athenahealth, the former Carefusion, the former Carolinas Healthcare, Cerner, Epic, HIMSS, Medhost, Medicity, Meditech, and Nuance. There’s no downside to entering your email again if you aren’t sure – you won’t get multiple copies regardless.

Here’s a post-holiday reminder to consider contributing your thoughts to this week’s “Wish I’d known” question. Maybe Zane Burke will chime in.

Sunday will be HIStalk’s 15th birthday, which is hard for me to comprehend. Back in June 2003:

• 50 Cent’s “In da Club” and “21 Questions” topped the charts
• The final episode of “Dawson’s Creek” had just aired
• Martha Stewart was indicted for insider trading
• Most of the useful health IT news came from snail-mailed newsletters like “Inside Healthcare Computing” and “HIS Insider” that were far better than most industry websites then and now
• The HIMSS conference had just been held in San Diego and the short-lived HIMSS Summer Conference was getting underway in Chicago (before one last, hot gasp the next year in Las Vegas)
• Epic reached 800 employees and signed Kaiser Permanente in a $4 billion project just 18 months after it expanded from ambulatory-only to inpatient

I needed a distraction from my unsatisfying health system IT leadership job and decided that jotting down my industry thoughts each day would keep me sharp as I scouted for something better. I finally found that job in mid-2005, after which I decided that I should stop screwing around with HIStalk after two years (and no benefit beyond my own satisfaction) and focus instead on staying employed, which I reconsidered when I realized I had nothing else going on after work anyway. I’m still here as a case study of the “80 percent of success is showing up” model. If you’ve been a reader since 2003, tell me how you found the site and why you’ve spent a significant chunk of your life with me.

Webinars

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Acquisitions, Funding, Business, and Stock

IBM Watson Health reportedly had big layoffs last week, with the “resource action” mostly focused on employees from its big-bet acquisitions Truven, Merge, and Phytel. You would think the machine’s claimed intelligence could have been used to predict the likelihood of acquisition success, but the technology’s capabilities are looking increasingly limited or “man behind the curtain” powered to the point that Ken Jennings must be embarrassed to have been beaten by it on “Jeopardy.”

Home monitoring technology vendor ResMed will acquire HealthcareFirst.

New Zealand-based Orion Health is discussing the sale of all or part of the company with unnamed parties, reports suggest.

Sales

• Adventist Health chooses HCTec to provide Cerner and Epic application managed services for its Oregon hospitals.
• The Medical Center of Southeast Texas (TX) chooses Ascom’s nurse call, smartphones, mobile handsets, and Unite software.

People

Pharmacy management and software vendor PharmaPoint hires Bobby Middleton (McKesson) as VP of product operations.

Benton Barney (Wolters Kluwer Health) joins prescribing decision support vendor RxRevu as SVP of strategic partnerships.

Shaun Priest (Streamline Health) joins Clearwave as chief revenue officer.

Michael Brozino (7th Wave Ventures)  joins IScript as CEO.

Announcements and Implementations

In Canada, South Okanagan General Hospital goes live with DrFirst’s MedHx electronic patient medication history service, integrated with Meditech and British Columbia’s prescription network.

Other

Duke University researchers use artificial intelligence to analyze keystrokes to determine whether a computer user’s slow mouse scrolling and errant clicks might suggest early symptoms of Parkinson’s disease.

Otswego Memorial Hospital (MI) fires an orthopedic surgeon after he is charged with cocaine possession, carrying an unlicensed firearm, and hiring a prostitute online. [insert the obligatory “where do you hide a $20 bill from an orthopedic surgeon” joke here]

The New York Times questions why the US spends so little on public health efforts that often pay for themselves given the massive amount spent on healthcare services, concluding that: (a) companies can’t make money from it; (b) the government focuses on projects that offer more immediate benefits; and (c) people resent being told what to do even when it’s in their best interest.

Craig Hospital (CO) describes its occupational therapy department’s use of adaptive gaming in the rehabilitation programs of patients with brain and spinal cord injuries. The hospital modified game controllers, undertook trials of commercially available adaptive controllers, and used the accessibility features of games – including sip-and-puff devices, voice controllers, and modified buttons – to help patients increase strength, balance, dexterity, and endurance.

AI did a better job than dermatologists in distinguishing malignant melanomas from benign ones, researchers find.

The New York Times says health policy experts are insisting that taxpayers are paying twice for expensive new drugs – once in funding the drug’s development (via NIH grants) and then again when the drug hits the market at prices of up to hundreds of thousands of dollars. NIH did most of the work to develop the cervical cancer vaccine Gardasil and then licensed it to Merck, which sold more than $2 billion worth last year alone.

Sponsor Updates

• DrFirst is exhibiting at MUSE this week.
• Meditech announces that its Physician and CIO Forum will be held October 17-18 in Foxborough, MA.
• Aprima will exhibit at the Association Professional Sleep Societies Annual Meeting June 4-6 in Baltimore.
• Bluetree Network Analytics Specialists Matt Kesler and Erik Sederstrom contribute to the new book, “Clinical Analytics and Data Management for the DNP.”
• Bernoulli Health, Burwood Group, and Centrak will exhibit at the AAMI 2018 Conference & Expo June 1-4 in Long Beach, CA.
• Carevive will present and exhibit at the ASCO Annual Meeting June 1-5 in Chicago.

Blog Posts

• Questions when building your Community Connect Team (Optimum Healthcare IT)
• How one hospital prepared for the new home health conditions of participation (Meditech)
• My Experience as the Patient’s Father (Spok)
• Why You Should Never Buy Business Technology from a Used Car Salesman (And Should Calculate ROI Instead) (Access)
• Best Practices to Improve Patient Payments (AdvancedMD)
• Patients are struggling to make ends meet. Here’s how Boston Medical Center put $3M back in their patients’ pockets. (Advisory Board)
• The Value-Based Care series- Episode #2: Supporting the acquisition (Agfa Healthcare)
• The Dark Myth of the High-Deductible Plan (Arcadia)
• What do these “technical” people do, anyway? (Bluetree Network)
• Digital Health Funding Already Billions in Q1 2018 (Datica)
• 5 Reasons Healthcare Contact Centers Should Embrace Social Media (Burwood Group)
• Mental and Behavioral Health Support for Chronic Disease Patients Means Better Health Outcomes (CareSync)
• What Does It Mean to Be ONC Certified and Why Does It Matter? (ChartLogic)
• Can Appropriate Prescribing Practices Curb the Opioid Crisis? (Clinical Architecture)
• Developing a Quality & Patient Safety (QPS) Program (Culbert Healthcare Solutions)
• Digital Health: Hospitals must keep pace or be exposed to risk, experts say (Direct Consulting Associates)
• Interoperability between Clinical and Claims Data, Standard Supplemental Data, and a (Very) Brief History of Clinical Quality Measurement (Diameter Health)
• Want to Cure Cancer? First Liberate the Data (Dimensional Insight)
• Five Things Urgent Cares Should Know About MIPS (DocuTap)

Contacts

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

Morning Headlines 5/29/18

How I remember my lost military comrades

Former senator, governor, and US Navy Seal Bob Kerrey suggests spending a short time alone to remember those who have been lost and those who lost them.

Me and My Numb Thumb: A Tale of Tech, Texts and Tendons

Doctors are seeing many people with problems caused by thumb overuse in texting.

Next time you buy a TV at Best Buy, you may be also offered health care

Best Buy plans to offer home monitoring technology and services to seniors.

Morning Headlines 5/28/18

Steward Health Care pressured doctors to restrict referrals outside chain, suit says

A doctor files a class action lawsuit against venture capital-owned hospital chain Steward Health Care, claiming he was pressured to refer patients only to other Steward facilities

Emory Healthcare and Sharecare to launch Emory Healthcare Innovation Hub

The health system and digital health vendor, both based in Atlanta, will develop, test, and implement digital health products.

Digital Ambulance Chasers? Law Firms Send Ads To Patients’ Phones Inside ERs

Personal injury lawyers in Philadelphia are using geofencing technology to identify smartphone users who are in hospital EDs, then sending their devices a weeks-long string of “call if you’ve been injured” ads.

Monday Morning Update 5/28/18

Top News

A Massachusetts urologist files a whistle-blower lawsuit against Steward Health Care, claiming that the venture capital-owned hospital operator not only pressured him to refer patients only within the health system, but also strong-armed his patients directly and cancelled their appointments his office had made for them at competing hospitals.

Steward then terminated the surgical privileges of Stephen Zappala, MD, claiming his patient care was substandard.

The company’s attorney said in a court hearing that policies intended to reduce network leakage are common, earning the judge’s contempt for using the “all the other kids are doing it” excuse. He argued that patients were not harmed since the the doctor sent them to the providers he felt were best for them, thus making his whistle-blower claims invalid.

Cerberus Capital’s holdings, other than Steward, include the Albertsons grocery chain, Staples, Avon, and defense contractor DynCorp.

Reader Comments

From Tracking Man: “Re: Awarepoint. The RTLS company has apparently shut down operations. The website is down.” I can only verify that the website is not displaying pages – executive LinkedIn profiles remain unchanged and the 800 sales number still gives a PBX recording. I’ve emailed CEO Tim Roche without a response so far. 

From Communal Well: “Re: pricing transparency. Do you know of any health systems that have taken action on CMS’s FY19 rule requiring them to publish standard prices on the Internet? Do patients understand that charges aren’t the same as patient responsibility?” I don’t think CMS-1694-P has been approved yet and won’t take effect until January 1, 2019 in any case, so I doubt hospitals have done anything. It would require them to publicly post their charge masters, which sounds good only to clueless folks who think CDM prices mean something or that consumers can make constructive use of the information. Hospital charge masters are mostly indecipherable to the public, aren’t relevant to what a given patient or their insurance company will pay, and are not very useful for comparing prices among competitors. The proposed rule also won’t address the ever-increasing problem of hospitals contracting with doctors (ED, anesthesia, radiology, etc.) without requiring them to accept the same insurances, sticking patients with unexpected out-of-network charges from an in-network visit. I’m still not convinced that providers shouldn’t be forced to offer the same published price to any willing party rather than conducting secret negotiations with every insurer.

From OneHITwonder: “Re: Practice Fusion. I created an account many moons ago just to see what all the fuss was about (I’m not even a physician) and received this today.” Practice Fusion users who don’t sign up for a paid plan by June 1, 2018 will be switched to a view-only mode, with their only option being to view, download, or print their patient records. The monthly cost is $99 for a one-clinician practice, which includes three secondary licenses (for clinicians who don’t submit claims) and an unlimited number of unlicensed staff. The Allscripts-owned company says subscribers will get new features such as 2018 MU, MIPS, and ECQM dashboards; enhanced reporting; e-prescribing of controlled substances; and advanced QI tools.

From WebinAren’t: “Re: webinars. Do people still watch them? Some sites don’t get many participants.” We get a good number of registrants in those cases where the presenter listens to my suggestions about a choosing a broadly interesting and non-pitchy topic, a snappy title, a concise write-up, good speakers (preferably not all from the vendor side), and a sign-up form that contains few required fields. I postulate that the no-show rate, at least in our case, is because registrants know we post the full webinar on YouTube for any-time, any-place viewing afterward. Most of our webinars have had at least 200 YouTube views (some have thousands) and our channel has more than 500 subscribers, so some folks certainly are participating.

HIStalk Announcements and Requests

Most poll respondents think Cerner was the VA’s best choice, but they would have advised the VA to wait to see how the DoD’s rollout goes before signing a contract. Cosmos says it’s going to be hard and expensive for the VA and DoD to be simultaneously competing for experts from Cerner and consulting firms, while Matthew Holt thinks it’s the worst time to be buying an EHR because lipsticked, non-cloud based products will be passé in the next 5-10 years and waiting it out on VistA would have been smarter.

New poll to your right or here: What was your reaction to Cerner calling DoD’s analysis of its Cerner pilot sites competitor-aided “fake news?”

Thanks to the thoughtful folks who provided answers to my question of “What I Wish I’d Known Before … Taking My First Job Managing People.”

This week’s question is timely. I’m all ears.

Monday is Memorial Day, set aside to honor those one million US Armed Forces members who died while serving, many of them teenagers whose parents never got to see them grow up. Their sacrifice allows you the luxury of having a fun-filled long weekend free of contemplating that it was made possible by those who made the ultimate sacrifice on your behalf or feeling empathy for the families who experienced their loss, but it would be nice if you did anyway.

Things I learned about the increasingly competitive streaming landscape when playing around with the Roku this weekend, seeking an alternative to the frustratingly clunky, slow Pandora user interface:

• It’s at least a little bit easier to navigate Pandora by installing the Roku app on my Android phone and then using it instead of the remote, especially when typing text (ditto for Netflix)
• Roku competitor Amazon (which sells Fire TV) doesn’t enable Prime Music streaming on its Roku channel, making it pretty much worthless for me as a Prime benefit since I stream only from the Roku since it’s connected my ancient surround sound system with those VCR-type red-yellow-white RCA audio cables
• Spotify has disabled its Roku channel, but it still works on Fire TV

I’ve always wanted an HIStalk theme song like those of podcasts and radio shows, so I was happy that Max Yme wrote and performed a masterful prog rock instrumental for me. You can stream it from the player widget in the right margin of this page or from your player here if you’re in need of background music while reading.

Webinars

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Decisions

• Memorial Hospital (IL) has gone live with Cerner supply chain management.
• Frio Regional Hospital (TX) will switch from Evident to Athenahealth.
• Mary Washington Healthcare (VA) will go live on Epic June 2, replacing Cerner.

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

People

Maine’s HealthInfoNet promotes acting CEO Shaun Alfreds to the permanent position.

Announcements and Implementations

Emory Healthcare (GA) and Sharecare launch an innovation hub for “studying, creating, and implementing digital health technologies.”

Other

You will have to decide if this Politico article is a feel-good story or a depressing look at our healthcare system. A tiny, remote Kansas town turns its struggling hospital into the county’s largest employer after boosting its profitable OB business by recruiting young doctors, obtaining grants to upgrade equipment, and adding luxury birthing suites that took business away from hospitals in neighboring counties. Macroeconomically speaking, is a growing, high-employing health system a positive contributor to a given region?

California’s medical board threatens to rescind the medical license of a 75-year-old Stanford-trained MD and homeopathic doctor who sells $5 “ERemedies,’ prescribed 13-second-long “hissing sounds” that he claims cured 36 of 37 people with malaria within four hours.

Personal injury lawyers in Philadelphia are using geofencing technology to identify smartphone users who are in hospital EDs, then sending their devices a weeks-long string of “call if you’ve been injured” ads.

This is a great tweet.

Contacts

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

What I Wish I’d Known Before … Taking My First Job Managing People

The most fulfilling part of your career can be helping others advance in their careers.

I wish I would have known how good my HR department really was and how well they supported me in being a first-time manager. Every company I have worked for since then has had terrible HR resources and I’m not really sure who they were there to serve. When I had my manager hat on and needed to deal with disruptive employees, they seemed to support the employees. And when I put my employee hat on and complained about MY abusive manager, I was treated terribly. I miss that first team. They were the best.

That I’d spend 80 percent of my time and effort on 20 percent of my staff. That some people feel compelled to give details when calling out sick. That promoting someone would feel so rewarding.

I wish I’d known that managing is dealing with other people’s problems much of the time. Once I came to this realization, it became easier to plan for the kinds of things one must handle. Illness, messy personal situations, child care challenges, addictions, money trouble, and host of other things intrude on the work place and impede people who want to do a good job from being able to focus. Then there are the people who don’t really care about doing a good job. That’s another thing I had to realize. One can assume positive intent from staff, but that works a lot better after a rigorous hiring process has taken place to prevent the people who really don’t care from ever making it in the door. Another important set of lessons has to do with learning how to manage people out of the organization in a humane way. I’ve been on the receiving end enough to know that there are good ways and bad ways to manage someone who isn’t a good fit for their job. It’s still a tough thing to do but knowing how to do it right – setting fair expectations, communicating them clearly and repeatedly, and then holding the individual accountable for their performance – makes it less painful for everyone involved.

I’m in sales and love sales. I wish I had known that I like commissions more than I love managing people before I took my first management job.

That responsibility with no authority is one of the most frustrating situations to be in. If you’re responsible for getting X amount of work done, but you don’t have the people power to do it, management will say “tough cheese”. At one job, I was reduced to working nights and asking relatives to help pick up the slack from my tiny team.

Also, that a lot of people these days want so much more out of work than a paycheck. You have to be a cheerleader, counselor, drill sergeant, and about 16 other things in order to get some people to do their job.

That eventually the confluence of political correctness and regulation would make the real, personal aspect of working relationships a facade that only attempts to mimic human potential.

The skill set for managing people is very different than the skill set to do the work. You are equal parts boss, friend, mentor, confidante, etc. and there’s a fine line between the first item and the others. You will end up dealing with so many more personality and HR issues than you anticipate and you should be prepared to deal with not only workplace issues but people who can be dealing with pretty rough stuff in their personal life. I think many of us who now manage people didn’t know beforehand how much emotional intelligence you will need to be successful.

That other managers that still feel like they need to be a “boss” instead of a “leader” would feel threatened by a true leadership style of management. Although challenging at times, being a leader is highly fulfilling.

We have two ears and one mouth. Use them in proportion. Listen and engage first. Your people can provide you with all the direction you need to be successful.

That there are way more variables to consider than what you think you have learned in college and from observing others. If you don’t have a mentor, find one!

That most of the stuff (AIDS, AIDS hysteria, divorces, affairs, thefts, partner abuse, alcohol and drug addiction, mental health) were not mentioned in my MBA curriculum.

This is a tough one because there are so many things to choose from. I wish I had known that it is OK for a decision not to be universally liked. They will come around. I think also as a business owner I wish I had known how many people are poor personal money managers — save some money, people!

That “managing” people really meant being the parent to a staff of adults and my parental duties included conversations about personal hygiene, basic etiquette, and trying to instill a work ethic in them regarding the need to come to work EVERY day of the week. Also, that my “children’s” feelings would be hurt when I didn’t make it a point to tell them good morning every day. Giving up a management position to become a consultant with no employees working under me was a very good decision!

How to more effectively manage up and outside of my direct reports for an environment that would support productivity without “political” distraction.

If you are being promoted, making the transition from peer to manager is tough. I found the best approach is to be honest and humble.

You are being watched all the time. If your team sees you become anxious / freak out by bad news, they will be anxious. If you walk by someone and don’t respond when they say hi, you could ruin that person’s day. Every action is magnified, good and bad.

Being a manager doesn’t mean you have to know all the answers. You have a team of smart people that are good at their job — you should empower them.

The “my job is to make my manager look good” approach is garbage. My job as the manager is to make it easier for my team to do the job(s) they are really good at.

Managing people is more rewarding for me than being an individual contributor, but the satisfaction from watching your team grow and improve takes a long time. You sometimes have to look harder for the daily and weekly wins to keep yourself going.

Being promoted doesn’t mean you should force everyone into doing their job the way you used to do it. Set the expectations and let each person determine the approach that is best for him or her.

The huge impact that my immediate supervisor would have on my ability to carry out my responsibilities.

In my first leadership role (as a chief resident for a busy and intense residency program), I was fortunate to be supervised by people (including the departmentt chair) who were supportive yet gave me a fair amount of authority to make my own decisions (with appropriate consultation). They would back me up if the other residents tried to go higher up the hierarchy behind my back. They were also available without being intrusive and treated me respectfully like a colleague rather than dumping things on me simply because I was lower on the feeding chain. This is not to say that management was easy, but it was doable and possible to do good things (and learn to manage people) with appropriate support and guidance.

That’s in contrast to my current chair, who micromanages, second guesses, makes decisions that affect my division without telling me, frequently changes priorities and directions, and keeps everyone stressed out and on edge. The higher-level administrators see my current chair as smooth and efficient and they accept his finger-pointing and explanations of the reasons for our department’s poor performance. Though I now have 25 years of clinical and leadership experience, I am treated like a scut puppy and supposed to jump when he gives the word. I’m just grateful that this wasn’t my first experience in management or I wouldn’t have attempted it again.

How “the people” would be both the best part and the worst part of my new job.

How hard it is to get rid of poor performers.

How often managers keep poor performers around and don’t let them know they’re poor performers (either because they’re afraid of the conversation or too busy to deal with the performance issue).

How it’s harder to measure your contributions. It’s no longer about how many tickets you close or issues you resolve. It’s how you empower your team and support them and manage their work intake/output.

Weekender 5/25/18

Weekly News Recap

• A KLAS report on hospital EHR market share finds that most new sales in 2017 were to hospitals of under 200 beds, Epic led by far in overall net hospital count change, and CPSI and Allscripts lost more than 30 net hospitals each last year.
• Epic tells the Illinois Procurement Board that no conflict of interest existed in University of Illinois-Chicago’s choice of Epic over Cerner, saying Epic was cheaper, state law required Cerner to be excluded from demonstrating because it scored so poorly, and that the hospital is a customer of both vendors and thus knows what it’s doing in choosing Epic.
• ONC announces an $80,000 contest to entice developers to create apps that will help users identify, record, and report potential health IT safety issues in real time.
• A New York Times article says that hospital EHRs are a “medical records mess” that impede research efforts because of incompatible data formats and the reluctance of health systems to share their patient data.
• The House passes a bill that would require the VA to provide Congress with regular updates on its Cerner project and to notify lawmakers promptly if it experiences contract or schedule changes, milestone delays, bid protests, or data breaches.
• The US Supreme Court sides with Epic and two other companies in finding that mandatory employee arbitration and non-disclosure agreements are enforceable, meaning employees may not organize together to file workplace-related class action lawsuits.
• Cerner President Zane Burke blames an unnamed competitor (presumably Epic) for publicizing negative reports about the DoD’s MHS Genesis project, labeling the resulting coverage as “fake news” in the company’s annual shareholder meeting.
• President Trump says he will will nominate acting VA Secretary Robert Wilkie to the permanent position.

Best Reader Comments

It’s tough to get my head around why Congress would take the time and effort to pass an oversight bill when the oversight already in place is wholesale ignored. Literally days after Genesis’s best efforts are measured as basically failing and late in every aspect, the project is rewarded with a $10b vote of confidence. It’s just an incredibly lazy lack of leadership/stewardship. The word that comes to mind is “laughable,” but to taxpayers and veterans, it’s really not funny. (Vaporware?)

If you read the majority and dissenting opinions, this is clearly the correct decision from a legal standpoint. Unless you’re advocating for judicial activism, which I would hope no one is. To be clear, I think this is a bad thing and gives too much power to corporations, but from a purely legal standpoint as the laws are written, this interpretation is correct. (Former Epic Billing)

It has been no secret that while a good chunk of Epic is liberal leaning, and while Epic — like other EHR vendors — has benefitted from government’s largesse (nothing wrong there) like a good old capitalist organization, it has often chafed at any sort of government regulations of its business or labor practices. Board seat, token compensation, campaign support etc. goes a long way to help politicians forget their principles.(Stolen Supreme Court Seat)

Regarding Cerner’s negative reports about the DoD’s MHS Genesis project as “fake news,” HIStalk pages for the last decade are filled with “news” about health systems tearing out Cerner systems and replacing them with Epic, notably, Mayo, Aurora Health, etc. Was that all fake? I suspect DoD will regret their decision like all those other large (but smaller than DoD) systems dissatisfied with Cerner. (FakeNews)

I guess the logical conclusion to Cerner’s poor initial performance with the federal government is that Epic has moles in the Pentagon leaking information to Politico that is somehow “fake.” (AynRandWasDumb)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request from Ms. W in Georgia, who asked for a programmable robot to launch an after-school STEM Club. She reports, “My students love our new Lego Mindstorm kits. We are incorporating them into our gifted classroom lessons and also into an afternoon STEM Club. They will be used by many students. In the after school program, students are working in groups to build a robot of their choosing. They will also spend several days coding their robots. They are just beginning to learn coding skills, so this is an excellent opportunity for them to improve in this skill. I am working hard to create students who are excellent problem solvers and know how to use critical thinking to work in collaboration with others in groups. Again thank you so much for your generosity! You are making a difference in the lives of my students!”

Waystar donated $1,000 to my DonorsChoose project in honor of a customer attendee of their HIMSS conference event, which when matched by my anonymous vendor executive, fully funded these classroom projects:

• Math manipulatives and calculators for Ms. K’s fifth grade math class in Indianapolis, IN
• Math and science books for Ms. P’s elementary school class in Greenacres, FL
• Math manipulatives for Ms. C’s elementary school class in Norfolk, VA
• Science toys for Ms. W’s headstart class in Philadelphia, PA
• Headphones for Ms. D’s first grade class in Indianapolis, IN
• Guided math materials for Ms. G’s elementary school class in Baytown, TX
• An Apple TV for Ms. V’s elementary school class in Houston, TX
• Lap desks and floor cushions for Ms. T’s kindergarten class in Vista, CA
• Makerspace supplies for Ms. W’s elementary school library in Dawson, MN
• Headphones for Ms. C’s first grade class in Victoria, TX
• Programmable robots for Ms. H’s elementary school class in Atlanta, GA
• STEAM accessories for Ms. G’s preschool class in Russell, KY
• Programmable robots for Ms. R’s elementary school class in Immokalee, FL
• A field trip to University of Maine for Ms. P’s elementary school class in Winterport, ME
• A Chromebook for Ms. M’s elementary school class in Las Vegas, NV

I nearly always choose teachers from schools in low-income areas. As an example, here’s how Ms. M describes her Las Vegas school that’s getting a Chromebook:

I work at a Title I school in a very low-income area in Las Vegas, Nevada. Unfortunately, too many students are homeless (living in cars, shelters, or on the streets). Many students come to school wearing the same clothes all week. Eighty-five percent of our students receive free lunches, all students are provided with free breakfast, and some students qualify to receive bags of food over the weekend to feed them and their families. My school’s diverse population of students come from all over the world and speak a variety of different languages. In fact, many students come to my school hearing English for the first time. Since my students are very underprivileged, they usually do not have access to technology at home. Despite so many hardships, my students are excited about school and eager to learn. I have a passion for teaching and they have a passion for learning. Coming to work doesn’t feel like work at all!

A small group of nurses at Zuckerberg San Francisco General Hospital wants the Facebook CEO’s name removed, saying that Facebook performed unauthorized research in tweaking the news feeds of individual users to see how they reacted and is trying to obtain data-sharing agreements with the American College of Cardiology and other institutions. One nurse says city residents should have a say in the name since they fund most of its operation, while another says the name scares patients. The group suggests naming the hospital after local political activist and drag queen Jose Julio Sarria, who died in 2013 at 90.

A ProPublica report says insurers have no incentive to aggressively negotiate doctor and hospital prices since they just pass the cost through to patients with a profit margin added. It profiles a patient – a former insurance company actuary — who fumed at being stuck with a 10 percent co-pay for a $71,000 partial hip replacement at NYU Langone, which sent him an error-filled bill that neither the hospital nor the insurer would investigate. Medicare would have paid the hospital only $20,000. The hospital, which had a $300 million operating profit in 2017, responded by turning his $7,100 bill over to a collections agency and then sued him, with its attorney saying in court, “The guy doesn’t understand how to read a bill … Didn’t the operation go well? He should feel blessed.”  

Parliament, the 50-year-old funk band best known for late 1970s hits like “Flash Light” and “Aqua Boogie,” releases its first album in 38 years titled “Medicaid Fraud Dogg.” Leader George Clinton says it explores “the inner workings of the corrupt modern American medicinal machine.” Click the above cover of the single “I’m Gon Make U Sick O’ Me” for some sophomoric humor.

Pittsburgh police arrest a man who kept showing up at hospital codes at UPMC Presbyterian (PA), finally caught when employees realize they don’t know the badge-less responder.

In England, the finale of BBC’s “Hospital” documentary series draws national attention to the shortage of ICU beds at Nottingham Queen’s Hospital.

Also in England, an elderly couple is reunited with the car they lost five days before after forgetting where they parked for a hospital appointment. The hospital’s lot was full, so the woman – 79-year-old retired psychiatric nurse Hilda Farmer, who paid for a hospital space before finding there were none – had to park a half hour’s walk away and then couldn’t remember the way back. Her granddaughter’s Facebook appeals led to the car being found. Farmer commented afterward, “Aren’t we lucky to live in a country where an old aged pensioner’s car gets national news coverage? Thank God we live in England.”

In Case You Missed It

• News 5/25/18
• EPtalk by Dr. Jayne 5/24/18
• HIStalk Interviews Michael Abramoff, MD, PhD, President, IDx
• News 5/23/18
• Curbside Consult with Dr. Jayne 5/21/18
• HIStalk Interviews William Bartholomew, Founder, HCTec
• Monday Morning Update 5/21/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
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Morning Headlines 5/25/18

US Hospital EMR Market Share 2018: Small Hospitals Hungry for New Technology

A new KLAS report on hospital EHR market share finds that Cerner gained the most customers overall, but also lost enough to place it behind Epic in net market share change with +29 vs. +46.

Athenahealth issues statement

Elliott Management sends yet another letter pressuring Athenahealth to take its buyout offer seriously. Athenahealth reps have fired back with a letter of their own, stressing that they will take their time in reviewing Elliott’s offer.

ConnectiveRx Acquires The Macaluso Group to Enhance Specialty Product Reimbursement and Customer Support

Prescription affordability and adherence solutions vendor ConnectiveRx acquires The Macaluso Group, a tech-enabled prescription benefits company, for an undisclosed amount.