Monday Morning Update 3/26/18

Top News

Israel will spend $287 million to make the health data of its 9 million citizens available to researchers and private companies for work on preventive medicine and personalized medicine projects, Prime Minister Benjamin Netanyahu announced Sunday.

Most citizens of Israel belong to HMOs, whose EHRs will provide the electronic patient data to the government unless they opt out.

Concerns have already been expressed about patient confidentiality and whether the billions of dollars Israel could charge drug companies for using the data will trigger higher drug prices.

Reader Comments

From Imaginary Lover: “Re: Dr. Jayne’s comments about SteadyMD’s CEO declining to comment on its SEC-reported funding. It’s unusual, but understandable. Funding comes at a cost that includes loss of control and dilution (sometimes massive) of previous shareholders. The co-founder and CEO who declined to comment was probably a major shareholder before this infusion, but maybe not afterwards. New funding may save a company from certain death (bankruptcy) but can be the beginning of another kind of sickness – now the company has to pull a rabbit out of the hat for the new investors in short order to give them a return. If it can’t, investors may pull the plug or fire the CEO. The fellow who invested his time, sweat, money, and lifeblood is taking on risk and losing equity, all in one fell swoop. Trying to act like the belle of the ball in those circumstances must be a challenge. I feel for the guy.” I enjoyed the wit, warmth, and insight of this comment so much that I’ve asked the author to consider making further contributions. Sometimes you just read something that elicits a “I want to hear more from you” response.

HIStalk Announcements and Requests

Not only do we have much work to do in delivering a “comprehensive health record,” we can’t even agree on how far along we are. Reader comments note health system data hoarding, the lack of semantic standards needed to make exchanged data useful, and health systems that don’t fully populate what could be a complete medical record.

New poll to your right or here: what online sources have you used in choosing a doctor? I always pair up my insurer’s director with Healthgrades and haven’t used any of the other sources I listed.

Responses to “What I Wish I’d Known Before … Being Admitted to a Hospital or Being Seen in the ED” suggest that while hospitals provide many of us with our living, our experience as patients in them is frustrating and sometimes dangerous. One bizarre example: a hospital insisted on giving a newly-admitted patient the meal that the room’s since-discharged previous occupant had ordered (a fruit cup), so the famished poll respondent ordered a nice dinner on discharge day so the next patient wouldn’t starve.

Let’s hear from folks who have retired or downsized their careers – what do you wish you’d known?

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Regulators approve the merger of Advocate Health Care and Aurora Health Care that will create the country’s 10th-largest non-profit health system upon closing next week. Advocate Aurora Health will have 27 hospitals, 3,300 employed physicians, 70,000 employees, and annual revenue of $11 billion. The organizations predict that synergy will support the always-promised, never-delivered goal of higher quality and lower cost.

Wolters Kluwer completes its acquisition of 16-employee medical student learning platform vendor Firecracker.

Sales

USC’s Keck School of Medicine joins the global health research network of TriNetX.

Decisions

• MultiCare Deaconess Hospital (WA) will go live with Epic in summer 2018.

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

The analytics-powered insurer that is being created in a joint venture between Sutter Health and Aetna hires Steve Wigginton (Valence Health) as CEO. Evolent Health acquired Valence Health for $219 million in October 2016, after which it replaced Valence’s CEO Andy Eckert with Wigginton, then Evolent’s chief development officer. 

Culbert Healthcare Solutions hires Wayne Thompson (Mount Nittany Health) as executive consultant.

Announcements and Implementations

Alex Scarlat, MD publishes “Medical Information Extraction & Analysis: From Zero to Hero with a Bit of SQL and a Real-life Database.” It gives clinicians an introduction to SQL using hands-on exercises running against a de-identified ICU patient database from BIDMC. It also helps IT folks understand the data elements that interest clinicians.

I also noticed when looking up Alex’s book on Amazon that Springer has published a review and self-assessment for the ABPM’s clinical informatics board exam. I can’t vouch for the ultimate outcome of improving test scores in return for your $125, but the material looks solid, the writing is meaty, and the sample test looks darned hard. The other available review book ($129) has just three Amazon reviews, but one titled “Not fit for sale” raises a red flag in noting that “clinical” is misspelled on the book’s spine.

Government and Politics

The federal government’s spending bill leaves ONC’s annual budget unchanged at $60 million – at least through September – instead of being reduced to $38 million as requested by the White House.

In Canada, New Brunswick offers a $2,500 bonus to doctors who start using its provincial EHR, hoping to entice the 400 of its 750 physicians who haven’t transitioned off paper charts to do so. The EHR was implemented in 2012. 

A surgeon in England believes that the Syrian military hacked his laptop to determine which hospital he was helping with video surgery consultations as featured on a BBC program, after which suspected warplanes destroyed the hospital with a bunker-busting bomb. A security expert suggests creating a VPN connection for secure laptops, but the surgeon has since stopped offering video help to doctors in war-torn areas.

Other

Harvard Business Review describes Mayo Clinic’s effort to reduce ICU clinician overload caused by a never-ending stream of data. They’re using “ambient intelligence” in applying NASA methods to identify clinicians whose workload requires them to filter vital information from data clutter, identifying the 60 data elements that are important for taking quick action. The end result was an EHR-connected, rules-based, color-coded dashboard that saves an ICU clinician an hour each day while improving outcomes and reducing costs. Mayo has licensed the technology to Ambient Clinical Analytics.

A North Carolina state legislator who used her background as a nurse to sponsor several health-related bills isn’t a nurse after all. The state’s Board of Nursing orders Beverly Boswell – whose only healthcare background is as a phlebotomist – to remove her claims of being a nurse from her website, which Boswell says was due to a campaign volunteer’s error. However, video shows her telling an audience in 2014 that her background includes “providing nursing skills and medical care.” The Republican lawmaker earned more attention last week when she called a school outside her district after believing a fake news report saying that students were being required to walk out to protest gun violence, posting on Facebook afterward, “So the students that were eating Tide Pods last week run your school this week?”

An addiction publication profiles OpenBeds, software developed by Johns Hopkins medical school faculty member Nishi Rawat, MD. Indianapolis social workers are using it to find available space in opioid addiction treatment facilities.

In China, a media company tells a woman applying for a live-streaming job that her appearance is “far from that of an Internet celebrity,” advising her to have cosmetic facial surgery at their expense. An employee went to the hospital with her on the day of surgery and told her she would need to borrow the $6,300 cost from an online loan company and would be reimbursed afterward. She wasn’t, and she was let go because she still didn’t meet appearance standards. She is suing the company. Such financing is called a “face loan” in China, where would-be Internet stars with poor credit histories often find themselves unable to pay the money back.

Vince and Elise pored over health IT vendor financial filings to name their Top 10 hospital system vendors by annual revenue. Most are unsurprising and the Top 3 hold a giant chunk of the total, but let’s hear it for those #7-10 companies that get less attention as significant players – Harris Healthcare, Medhost, and Cantata Health. Vince notes that Meditech is back in growth mode after four years of declining revenue and also observes that none of today’s top five vendors were on his 1998 version of the list at all. It’s pretty interesting that it took just 20 years for acquisitions (some of them ill-advised and three involving Allscripts buying its way into today’s Top 5) to decimate all of the 1998 Top 10 other than Meditech and CPSI. 

This is fantastic: a Columbia University surgery resident dryly analyzes the accuracy of ED and OR scenes from several dozen movies and TV shows in a  video that has earned 1.6 million YouTube views in barely more than a week. One of her many quotable lines involves her observation of Dr. House running around the OR in street clothes: “In real life, that guy would have been tackled by about six tiny perioperative nurses far before he got to the operating room.” She compares surgery to her hobby of running marathons: “You have to be a masochistic glutton for punishment with obsessive compulsive tendencies.”

Weird News Andy confidently labels this honey of a story as T63.442A, “toxic effect of venom of bees, intentional self-harm, initial encounter.” A woman dies of an allergic reaction caused by a bee sting intentionally administered in a cosmetic procedure called “apitherapy” that has been lauded by anti-medical Hollywood goofball Gwyneth Paltrow. WNA consulted the primary literature in noting the line, “after getting bee venom therapy from an unlicensed apitherapist in South Korea,”which he takes to mean that South Korea has actual, licensed apitherapists. He extends the nomenclature to counselors for software developers in suggesting that they call themselves “APItherapists.”

Sponsor Updates

• QuadraMed celebrates Health Information Professionals Week.

Blog Posts

• New R^ Data Model: Provider (Redox)
• Three Easy Steps to Increase Business Value (Salesforce)
• Outlook for 2018 Healthcare Trends: Value-Based Care and the ACA (The SSI Group)
• Progress of Interconnected Patient Care as Learned from Disaster Recovery Efforts (Summit Healthcare)
• HIMSS18 Wrap-Up: Key Takeaways for Payers and Providers (Medecision)
• Clinical Communication Moves to the Forefront (Voalte)
• A Fun Twist to Vocera Badge Voice Commands (Vocera)
• Referrals Run Dry: How Consolidation is Impacting PT Practice Revenue (WebPT)
• New certification furthers quality mission (Philips Wellcentive)

Contacts

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

What I Wish I’d Known Before … Being Admitted to a Hospital or Being Seen in the ED

How much my ambulance / ED / hospital bill would be for a three-day emergency admission at an academic medical center in Tokyo. Being an American, I spent much of that time stressing about how much it would cost me, assuming I’d be presented with the usual five-digits-or-worse sums we get slammed with in the US. Turns out I didn’t need to stress out so much The ambulance ride was free, courtesy of Japan’s taxpayers. The ED workup, including tons of labs and imaging orders plus the three-day stay, ended up being about $2,000. I expected at least one more digit on that number. The standard of care and facilities was actually better than what I’ve seen at most US hospitals. A good reminder of just how absurdly out of hand healthcare costs in America are by comparison. In related good news, my employer’s surprisingly generous health insurance plan reimbursed the full cost, no questions asked, probably because it was way cheaper than paying for a comparable situation here at home.

1. In the Emergency Department, even though I confirmed with the reception-triage nurse that my physician earlier had called into the ED to discuss my condition and to refer me to the ED and hospital, my medical record, under referring physician, listed SELF-REFERRED.

2. For the next 5 1/2 hours, while I was waiting for a decision to be made about my painful condition and hopeful admission to the hospital, two or three of my “neighbors” in the Emergency Department room were seen and admitted to the hospital. In addition, an Emergency Department staff nurse who complained of flu onset was immediately admitted to the hospital in an available pediatric bed.

3. After another three hours, finally a call was made to the gastroenterologist on call, a Fellow. She never came to see me. I was told by the attending Emergency Department physician 1) that GF did not think I needed to be admitted; 2) that except for requiring a blood transfusion, which would be risky, I was “healthy” and I should be discharged home.

4. Three days later (after the weekend), when I appeared for a rescheduled Clinic appointment, I was immediately admitted to the hospital with intractable diarrhea, failure to thrive, iron deficiency anemia, and a urinary tract infection. I remained in the hospital for TEN days.

5. After discharge, ONLY one day later, the home health nurse, my referring physician, and the on-call hospital physician advised me to return to the ED so I could be readmitted to the hospital.

6. This time in the ED, an NG tube was placed down my throat. From the time I received the NG tube to the time I was finally re-admitted to the hospital, eight and a half hours transpired! I was told that the reason for this intolerable delay was that the Medicine and Surgery Department physicians could not determine what was really wrong with me, and so they argued back and forth about which service should admit me!

Information about your condition and treatment will be verbally communicated to you regardless of your ability to comprehend or retain it due to pain and medication. And your care is overseen by a series of non-employee hospitalists that come and go, leaving nothing but a bill and an 800 number where you can leave a message but never hear back.

Upon discharge, you will be given a paper prescription for three days of medication and instructions to contact your PCP that wont be able to see you for a week.

Within three weeks, the bills for out-of network providers that you don’t remember seeing begin to arrive and will continue to arrive over the next year.

The only coordination of care that exists is what you personally enforce so take notes as best as you can keep copies of what little information is shared with you.

I took my wife to the ED late at night one time. After a thorough examination of her condition (ectopic pregnancy / ruptured fallopian) and in consultation with her OB practice’s on-call physician, the ER team decided to wait for my wife’s personal OB to come in for his morning rounds to see her. So they admitted her, without really consulting us and considering any alternative options, for the few hours until he came in and could get prepped for emergency surgery. She had a private room for all of about four hours, but of course that resulted in a significantly larger bill. I wish we had known more about this plan and had an opportunity to weigh in on the admission decision.

My wife was admitted following a skating fall and a early evening broken wrist. The ED did not tell us that a doctor would not be available to set the break until the morning, when we could have gone to a nearby hospital and had it done right away.

Admitted after about twelve hours in the ER bay (not too much of a complaint, they’re a busy hospital) to a room shared with a women with an altered mental state who rang the nurse call button about once every half hour.

I was brought a hospital gown and trousers, which were left folded on a chair that was past the end of my bed. I was hooked up to an IV on one side, and a heart monitor on the other, so I couldn’t even crawl to the end of my bed to try and reach for them.

The main light in the room was a bright overhead fluorescent light that spanned the width of the room, directly over the head of both patient beds, meaning that every time they checked on her in the middle of the night, they turned on a light that shone through my eyelids.

Eventually they stopped turning it off altogether, so I had to try and sleep with a pillow over my eyes, while hooked up to a drip and a heart monitor.

Similar experience with meals: I was moved to a new room that was “private” (until the next patient moved in) and when dinner came around it was a fruit cup and nothing else.

• “That’s what you ordered.”
• “I didn’t order anything, I just got here.”
• “That’s what the last person in this bed ordered.”
• “They were discharged, they aren’t here to eat their dinner. I am.”

The nurse felt really bad for me and rustled up something a little more substantial, but the total lack of coordination and apparently awareness that beds turn over was startling. I made sure to order a nice full meal before I was discharged so that whoever came after me got at least something they could eat.

Being provided instructions by the nurse on how to make my own bed with new linens. I don’t know what to make of that. On the one hand, nurses aren’t maids, so it seems weird to be churlish that the nurse wouldn’t be making a bed, but on the other hand it definitely seems weird to ask a patient (who is still hooked up to a heparin drip with a heart monitor in the gown pocket) to do it.

I wish I had known that just because nurses don’t get technology doesn’t mean they can’t give you excellent care. At the time I was doing desktop support at a hospital and went to the ED with a particularly virulent GI bug. Due to a combination of factors, they decided to admit me after six hours in the ED. I went to the floor where I felt the nurses were particularly incompetent based on the interactions I had had with them about their computers. The care I got was wonderful and I was incredibly grateful and humbled.

The difference between being admitted and being observed.

That the hospitalists may not be in my insurance plan and I don’t really get to choose the one that will see me.

That the doctor treating me while at an in-network hospital was actually out of network. Then that HDHP out-of-network charge single-handedly emptied my HSA for co-pay and co-insurance.

Even though the wait at the ED seemed shorter than at urgent care, by the time you add in waiting around for the doctor to get results and then actually share them with you, it ends up equaling out, except from a money perspective. ED is definitely more expensive.

As CIO, I was shocked at how folks taking care of me used the systems we had deployed. In discussion with them, it turned out their training was not adequate or they were told “this is how we do it.” What disappointed me most was that my staff was well aware of it and had done nothing to improve the situation, including giving management a heads up. Turning that around took a long time.

I’m probably not a very good person to answer this one, but I honestly felt very prepared for my inpatient surgery a few years ago. I owe this to a pre-op surgery instruction program I attended which was hosted at the hospital a month or so before the actual day of surgery. My doctor and his staff were also very organized and on top of their processes before the day. I had all my questions answered, fears allayed, and was pretty ready to go on D-Day. In fact, my care while at the hospital was so good, I almost didn’t want to come home. Yep, I know, this sounds like a paid advertisement. But I think it was my own initiative to educate myself and the the doctors’ / hospital’s efforts to plan how to educate patients to be ready.

Weekender 3/23/18

Weekly News Recap

• A comment made by a member of the House Appropriations Committee suggests that the VA’s cost to implement Cerner will be at least $16 billion, of which Cerner as prime contractor will be paid $10 billion.
• RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy, accusing former executives of falsifying its financials and blaming the high debt it took on to fund acquisitions.
• Former Vice-President Joe Biden calls for HHS to cite providers for data blocking if they fail to give patients their information electronically within 24 hours of their request.
• A New York Times article says the NIH’s $1.4 billion “All of Us” data collection project that hopes to enroll 1 million people is moving slowly, spending a lot of money, mired in the challenge of harvesting information from disparate EHRs, and facing the reality that the US doesn’t have enough DNA sequencing machines to handle the load.
• The IPO of Siemens Healthineers in Germany raises $5.2 billion.

Best Reader Comments

HIMSS is a necessary evil. From my perspective (i.e. for my role/life) it’s overly focused on “hospitals” and “information technology” (I get that’s a feature, not a bug – this was, after all, the Hospital Management Systems Society). Not every problem in healthcare is going to be solved using software in a hospital. Most of them are probably not. But every year, in rolls HIMSS with big booths from the heavy-iron hospital vendors (Epic, Cerner, Meditech, et al.) looking to meet with CIOs who are focused on incremental improvements to ancient and inadequate systems. All of the “education” sessions at HIMSS are some combination of hopelessly in the weeds and a veiled pitch for a piece of software that I don’t really want to buy. I really don’t need to sit in some nosebleed seats to hear Peyton Manning or Magic Johnson tell me something about healthcare. The best part of HIMSS is the Mos Eisley Cantina that is the basement or adjunct hall where HIStalk usually camps out. In those 10×10 booths are the dreamers and builders who might really be the next big thing. HIMSS has to exist, real work does get done there, but it’s really pretty deep in the machinery of the healthcare system. Will HLTH be different? I don’t know, but I’m willing to give it a shot. (Debtor)

Do we really mean data? Most of what I see in motion, even with interoperability initiatives and FHIR APIs, are records — which is to say, documents and text representing the documentation of care, mostly in a legal medical record sense. As a clinician, I can say that, no doubt, this information has use and value, especially compared with the alternative. Still, it is far from computable. Biden’s interest in data sets shows he is reaching for the latter, and I am beginning to think the lack of distinction is really a problem, expectations-wise. Hopefully, ongoing progress in natural language processing (is the language really that natural?) will save us (by which I mean, me, the clinician) from fixing it, by becoming even more of a data entry worker. (Randy Bak)

Orwellian Aeron chair: If sitting is the new smoking, I’m sure this exercise motivator will have some real health benefits. Perhaps a little electroshock to get us up and about on a regular basis? I’m looking forward to Weird News Andy’s updates covering the exhaust analysis feature: colon cancer screening, dietary recommendations, etc. (Another Dave)

Epic, Athena, Allscripts, NextGen, Cerner, and others are all doing the same thing – they have open APIs, but make it very difficult to get approved to access data. (Annon)

I agree that it’s unfair and irresponsible to lay this [social determinants of health] at the feet of physicians. They certainly aren’t in control of all the economic and social factors that inform the health of this country, but its equally unfair to point the finger at patients themselves as if all the external circumstances that impact them (housing, job, food access, sexism, racism, homophobia, you name it) are 100 percent in their control, as well. (HIT GIrl)

I work in an IT department of a large IDN. The physician salaries and perks are obscene. We talk about all “waste” in health dollars, but I would like to see all these hospital costs out in open and distinguish between the costs borne by the hospital for conducting the tests and costs due to physician salaries / payments. Looking at what goes on in our system, physician compensation is the biggest elephant in the room. (IT Guy)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. C in Utah, who asked for science books for her Friday morning STEAM lessons. She reports, “We have been so excited to open our boxes and find high-interest books for our third graders. Our class is excited to start planning our projects to demonstrate their understanding of a major science standard in third grade: interactions between living and non-living things. We have already started looking through our books. The kids can’t put them down!”

We also funded the request of Ms. A, who asked for an air quality meter for a project her fifth grade class in Pennsylvania is doing. She says, “Students are taking turns taking home the air quality meters every three or four days. They have found enough places in their own home to check air quality from the attic to the bathroom to their stinky brother’s room to the basement. Students are recording their results in science notebooks that they take home with the books, but when they come back to school, they transfer their data to a shared spreadsheet. The kids love looking at the results. I can’t wait until everyone has had a chance to take the meters home. Then we can really explore what the numbers mean, and I can teach the students how to create graphs using Google Sheets.”

Listening: the cover of “Zombie” by otherwise forgettable metal band Bad Wolves, which while missing the seething Irish anger of the original by the Cranberries and its late singer Dolores O’Riordan, offsets it with searing guitars. O’Riordan died the day she was scheduled to perform the vocals with the band on the recording, so they released it her honor instead. Speaking of angry political songs of that era on SNL, there’s the prophetic sneering thrash of 1989’s “Rockin’ in the Free World” by Neil Young. But arguably the most discomforting social protest song ever was Billie Holiday’s 1939 “Strange Fruit.” Switching to something new, there’s a just-released album from hard rock band Dorothy.

Our booth neighbor down in the basement of HIMSS18 was integration platform vendor MuleSoft. Some of their self-absorbed sales guys were kind of rude to Lorre and Brianne, but maybe they knew what was coming —  Salesforce just bought the company for $6.5 billion.

ProPublica reports that IBM – panicked by competition from more nimble and often global competitors and its own failure to execute – has intentionally ditched its older, higher-paid workers to replace them with cheaper newbies and offshore workers while breaking US age discrimination laws or using loopholes to avoid them. Techniques include:

• Laying off older workers in telling them that their skills were outdated, but then hiring them as contractors at a lower rate
• Encouraging laid off employees to apply for other company jobs, but telling managers not to hire them
• Requiring laid off employees to pursue age discrimination complaints via private arbitration rather than lawsuits
• Using employee privacy as an excuse for not publishing legally required layoff lists that would allow those employees to see how many of those laid off were older
• Labeling layoffs as retirement even when the employee refused to acknowledge it as such
• Using what IBM called “lift and shift” to lay off US employees and send their work offshore, causing IBM to now have more employees in India than in the US

Meanwhile, Bloomberg says that GE sent former CEO Jeff Immelt packing with millions of dollars in parting gifts but has reduced benefits to employees and retirees in an attempt to make its financial numbers look better. Example: the company changed its pay schedule to push the final paycheck of 2016 to a week later, improving its year-end cash flow position; it implemented an “unlimited vacation day” policy that also means it doesn’t have to pay out the unused days as severance; and it replaced merit raises with bonuses tied to unstated objectives. The article notes, “GE has lost more than $100 billion in market value since CEO Jeff Immelt announced his retirement in June, and not because anyone misses him.”

A sharp Vox opinion piece observes that Facebook is like casinos, cigarette manufacturers, and companies that sell alcoholic beverages – it makes most of its massive profit from addicts who feel depressed and lonely and are therefore less healthy after using its product. It concludes that Facebook is “optimized for fakeness” in deliberately turning news consumption into a confirmation bias machine even as it kills off the business model of real news sources.

Researchers find that a substantial portion of Americans – even those with health insurance – take a big financial hit after being hospitalized. A significant number of those patients never return to work, are disabled, or require unpaid recovery time. A health economist questions whether health insurance is enough to to protect people from significant income loss, as other countries also offer wage insurance, mandatory paid sick leave, and disability insurance.

Drug companies are merrily jacking up prices even as the White House claims that it will intervene, as 20 drugs had price increases of over 200 percent since January 2017. Leading the pack was skin cream SynerDerm, whose price has increased 1,500 percent. Its main ingredients: water and vegetable oil.

In Case You Missed It

• News 3/23/18
• EPtalk by Dr. Jayne 3/22/18
• Readers Write: I Am More Than My Specialty: Physician Burnout and Individualism
• Readers Write: Continuous Clinical Surveillance: An Idea Whose Time Has Come
• Readers Write: Analytics Optimization: Doing What It Takes
• CIO Unplugged 3/21/18
• News 3/21/18
• Curbside Consult with Dr. Jayne 3/19/18
• Monday Morning Update 3/19/18

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)
• 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 3/23/18

HHS official who approved Tom Price’s flights resigns

John Bardis, the former MedAssets founder who as HHS assistant secretary of administration signed off on the charter flights of long-time friend HHS Secretary Tom Price, resigns effective April 6.

Finger Lakes Health: ‘Minimal patient impact’ from cyber attack

Finger Lakes Health (NY) is still recovering from a ransomware attack over the weekend that forced it to revert to paper-based processes and EHR backups.

The Yelping of the American Doctor

The threat of a negative patient Yelp review holds more sway with physicians than educational campaigns encouraging them to reduce unnecessary prescribing of antibiotics.

News 3/23/18

Top News

John Bardis, the former MedAssets founder who as HHS assistant secretary of administration signed off on the charter flights of long-time friend HHS Secretary Tom Price, resigns effective April 6. He says he always intended to serve just one year. Bardis’s responsibilities include the HHS CIO office.

Second in command in HHS to Bardis — and presumably the frontrunner to replace him in overseeing HHS HR, the CIO office, and Equal Opportunity compliance — is former technology executive and Trump campaign worker Jon Cordova, who just completed his two-week HHS suspension for his pre-election social media posts.

The Facebook posts written or shared by Cordova include calling Hillary Clinton a “slimy trailer trash huckster;” accusing the Clinton Foundation of paying Gold Star parent Khizr Khan to criticize Trump; making up sex scandal stories about Senator Ted Cruz; and sharing a doctored photo of a black man holding a sign reading, “No mother should have to fear for her son’s life every time he robs a store.”

Reader Comments

From Cowtown: “Re: Microsoft’s March 15 copyright infringement lawsuit brought against Community Health Systems. Microsoft alleges that CHS stalled software audits for years and intentionally under-reported SQL Server usage by claiming only one-sixth of the production footprint. Maybe that’s not surprising when your CIO is Manish Shah, who was fired in 2002 from EMC for making his sales quota by falsifying invoices.” Shah joined CHS in 2013 after spending time at Aurora Health Care and no time in prison since he was never charged with a crime as far as I can tell and thus has never admitted guilt. I don’t have access to the filings to see what Microsoft is claiming.

From Clara Barton: “Re: the attached news item. This, apparently, is still a thing.” Indeed it is. An RN who presumably forgot to lock her car the night before wakes up to find her nursing license, laptop, and thumb drive with PHI on it missing.

HIStalk Announcements and Requests

Please tell me what you wish you’d known before being admitted to a hospital or seen in the ED. I’ve spent only one night in a hospital and that was a waste of time since nothing turned out to be wrong with me, but what I wish I’d known (not that it would have helped except as incentive to go elsewhere) is:

• That the ED person who reassured me that the hospital has only private rooms was either misinformed or lying since I was placed in a room with a guy who sounded like he was on death’s door.
• That I would lie for hours in the ED waiting for a bed, only to find when I got there that I had just missed dinner and nothing would be available to eat until breakfast. This was after being told that I missed lunch in the ED, being offered only apple juice instead.
• That I would be awakened all night by loud employees in the hall and by frequent vital sign and IV checks.
• That every med I received was late and some were never administered at all, including one that the ED insisted afterward was important.
• That the hospital would steadfastly refuse to give me an electronic copy of my information after my visit — they said they weren’t required to and would only give electronic information to doctors, not patients — and that my OCR complaint would be dismissed with no action taken against the hospital.

Welcome to new HIStalk Gold Sponsor OmniSys. The Dallas-based company offers innovative solutions for retail, outpatient hospital, and independent pharmacies. Products include an omni-channel patient communications platform; revenue cycle management for immunizations, DME, and prescriptions; patient engagement programs; and consumer engagement analytics. The company also provides domain expertise, market insight gained from serving 25,000 pharmacies, and proprietary SaaS technology that integrates with customer workflow. The company’s rules-driven OmniLink engagement platform improves vaccination rates, therapy adherence, and post-encounter follow-up, while its Fusion-Rx provides all-channel refill and pick-up reminders, manages refill requests, and offers an inbound IVR with automated attendant and voicemail. CEO John King is an industry long-timer going back nearly 30 years, starting with Shared Medical Systems. Thanks to OmniSys for supporting HIStalk.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

This seems to hit a lot of timely trends. SteadyMD raises $2.5 million for its online, concierge primary care practice. It runs eight practices, most of which are specialized (bodybuilding, LGBTQ, triathlon, etc.), but one of the practices addresses general health. SteadyMD patients meet their new PCP in a one-hour video visit, after which the company collects and stores all their medical records and makes the doctor available at any time via text messaging, phone calls, or video appointments. Membership costs $79 per month. The company says its doctors can prescribe, but doesn’t provide details of how that works.

Sales

• Washington Regional Medical Center (AR) selects Streamline Health’s cloud-based, automated pre-bill coding analysis technology.
• The Wyoming Department of Health chooses Medicity to power a statewide HIE that it hopes to eventually connect to that of neighboring states of Colorado and South Dakota, which also use Medicity.

People

Glytec names Ed Furlong (Kyruus) COO.

Robert Redfield, MD will become director of the CDC. A 20-year veteran of the US Army Medical Corps, Redfield has spent the majority of his career on HIV/AIDS research and clinical care.

Privacy and Security

Finger Lakes Health (NY) is still recovering from a ransomware attack over the weekend that forced it to revert to paper-based processes and EHR backups.

The 40,000 users in Australia of Telstra’s Argus healthcare secure messaging software are notified that their systems are vulnerable to outside attacks since the company always creates the same user account for remote access and then stores its static password in an unsecured text file. Telstra says hackers used the information to penetrate servers via Microsoft’s remote desktop protocol with full administrative access. One person who examined a breached server said it appears that medical information wasn’t stolen, with the hacker’s main interesting appearing to be using the servers to host dating scams and to buy items with stolen credit cards. I suppose Telstra is correct in calling its service “secure” even if its installation of it isn’t.

Other

The threat of a negative patient Yelp review seems to hold more sway with physicians than educational campaigns encouraging them to reduce unnecessary prescribing of antibiotics. Physicians Working Together has launched a petition asking Yelp to remove negative doctor reviews.

Danny Sands, MD, MPH assures his Twitter followers that the above fax from VNA of Boston to his practice announcing its transition from mail to fax is not an early April Fools’ Day joke.

This contraption looks downright frightening, perhaps something that Michael Myers might have created for his Halloween activities as a Shatner mask replacement. I’m willing to bet the mug that the patient is so tightly clasping is filled with either calming tea or spirits.

A survey that asked consumers to name a famous female technology leader resulted in 92 percent drawing a blank and half the remainder naming Siri or Alexa, fueling the fire under the question of why virtual assistant voices are always female.

Sponsor Updates

• Bernoulli Health publishes a new e-book, “Continuous Clinical Surveillance: A Business and Clinical Case for Creating the Foundation for Real-Time Healthcare.”
• Optimum Healthcare IT publishes a new white paper, “Is Healthcare Preparing for a Cyberattack?”
• LogicStream Health releases a new podcast, “Improving care: The role of patients, technology and the art of healing with Archelle Georgiou, MD and Patrick Yoder.”
• MedData will host a job fair March 24 at its office in Grand Rapids, MI.
• Meditech AVP Cathy Turner, RN joins the HIMSS CNO-CNIO Vendor Roundtable as co-chair.
• EClinicalWorks publishes a new customer success story, “World-Class Care in a Small Town,” featuring Pecos Valley Medical Center.
• National Decision Support Co. will exhibit at the National Comprehensive Cancer Network Annual Conference March 22-24 in Orlando.
• Experian Health will exhibit at the MultiState Managed Care Meeting March 28-30 in Atlanta.
• PerfectServe’s Michelle McCleerey presents at the Population Health Colloquium.
• The Chartis Group publishes a new white paper, “Everyone is a Cancer Patient.”

Blog Posts

• Five Key Takeaways From HIMSS18 (Medicity)
• Top 9 Takeaways from HIMSS18 (Spok)
• The Artificial Intelligence Race and How CIOs Can Stay Ahead (Liaison Technologies)
• How finding your champion is key to a successful implementation (Meditech)
• Dissecting the HIMSS Blockchain Buzz (Medicomp Systems)
• The Torch is Passed (Mobile Heartbeat)
• Experts in Home Health Give Thoughts and Advice for 2018 – Part III (Netsmart)
• Regulator Submissions Using Only Meditech (CEHRT) (Parallon Technology Solutions)
• Collaborative onboarding for health information systems: How we help our partners get up to speed (Experian Health)
• Build a Preferred Post-Acute Network in Seven Steps (PatientPing)
• The Song of HIMSS (PatientKeeper)
• The Current State of Paper Record Digitization: How Do We Get From Here to There? (PokitDok)
• How Does Patient Satisfaction Impact Reimbursement? (Access)

Contacts

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

EPtalk by Dr. Jayne 3/22/18

It’s been a wild week of post-HIMSS email madness, with most of the vendors that I asked to “give me a week to recover before we connect” having complied with my request. It’s a new strategy I tried this year and it seems to have worked, although a couple of companies did call or email the first business day after HIMSS.

You have to give them credit for working their leads, but one company’s contacts have bordered on the obnoxious – every two days with escalating language about our need to connect, and by both phone and email. You can bet that I’m not eager to connect with someone who doesn’t understand that people don’t always respond right away and that getting frantic about it isn’t going to build a potential business relationship.

Over the last two weeks, I’ve visited a couple of long-term clients to check in on their strategic planning for the next year. Organizations vary in how good they are at this process. Some that I’ve worked with do an outstanding job, with a major annual planning retreat each year and then quarterly or monthly follow-ups. They’re a joy to work with since they set their dates a year in advance to ensure everyone can attend and that agendas are productive, since they typically pull key provider stakeholders out of productive clinic time to meet their objectives.

Others are pretty bad at it, with last-minute attempts to pull people together and slapdash agendas. The worst don’t do any strategic planning at all and then wind up in a frenzy as they struggle to meet regulatory or other deadlines.

I was contacted by one of these organizations this week, who is looking for last-minute help with clinical quality measures reporting which is due very, very soon, as in “nine days from now” soon. I have a handful of groups reach out to me every year and all are in the same dire straits. One version of the tale of woe has the person who used to be responsible for it leaving the practice, out on medical leave, or something similar. Another version has someone running the reports regularly, but not telling anyone the numbers are bad until the end of the year and it’s too late to correct workflows. When the physicians find out, they go ballistic and I get the call. The third version has a group who knows their numbers are bad and workflows are problematic, but wants someone to “move” the data because it’s all somewhere in the EHR but just not in the right fields for reporting tools to pick it up.

I’ll help the first group as much as I can, but the rest are on their own for this reporting cycle. I’m happy to contract with the latter two to try to remediate them for next year, but I’m not going to tackle their dumpster fire (which incidentally was added to the Merriam-Webster dictionary) this year.

I enjoy reading posts by the rest of the HIStalk team, especially those that mention startups. I was baffled, however, by this piece sent to me by a reader, where startup SteadyMD refused to comment on $2.5 million in funding. Maybe they’re going for an “International Man of Mystery” vibe, but as an industry follower, it seems unusual.

In the “truth is stranger than fiction” category, I ran across this NPR piece about a reporter who had an interesting experience while working on story featuring Theranos. I’ve heard of people going off the rails during an interview, but the alleged pulling of a fire alarm to force the evacuation of a pharmacy and stop the interview is a new one.

April 16 marked Match Day, where tens of thousands of medical students are herded into auditoriums to learn their fate for the next three to five years in front of classmates and loved ones. It’s a variable experience, with some people whooping for joy and others seeing their dreams crushed. Many of us have mixed feelings about it. My medical school had a keg delivered to the auditorium lobby, so you were either celebratory or partially anesthetized by the time the envelopes were handed out.

This year’s Match set a new record, with over 37,000 applicants participating. The match results are always telling as far as physician workforce and the popularity of specialties among US medical school graduates. Programs filling with more than 90 percent US grads: interventional radiology, orthopedic surgery, integrated plastic surgery, radiation oncology, neurological surgery, and otolaryngology. The three main primary care specialties were in the “programs that filled with less than 45 percent US grads” category: family medicine, internal medicine, and primary pediatrics. The fact that US grads don’t want to go into these specialties should be very telling. Congrats to my neighbor who matched in a highly competitive specialty, even though he will be wading through lots of snow for the next six or seven years.

The highlight of my week was being on a conference line today with the funniest hold music I’ve ever heard. UberConference allows account owners to select their hold music, with one of the options being a song about being stuck on hold on a conference line. I’m sure it might have the potential to become annoying, but today it was just what I needed after having spent hours and hours on the phone yesterday. The worst hold music I’ve experienced was a current events news program that unfortunately was giving updates on a mass casualty situation that didn’t set the stage for a productive call, since participants were still in shock from what they had been hearing. The second-worst was music sounded like it was better placed in an adult film.

Apparently I’m not the only person with an interest in hold music, because a quick Internet search brought up several articles. I had forgotten the quirky Cisco default hold music – if you’re looking for an hour-long recording to jog your memory, you can find it here. I got my hopes up for an article that claimed to have 11 recordings of terrible hold music, but the links were broken so I missed out on that particular hall of shame.

Email Dr. Jayne.

Morning Headlines 3/22/18

Trump’s pick to lead CDC both celebrated and censured

HHS Secretary Alex Azar announces that HIV/AIDS researcher and 20-year US Army Medical Corps veteran Robert Redfield, MD will become director of the CDC.

Apple EHR Initiative to Expand API Use?

Apple’s EHR initiative takes root as Cerner announces plans to expand its pilot of the Health Records app from four customer sites to nine, and Athenahealth lobbies for a consumer-friendly appointment calendar interface.

Wyoming Department of Health to improve clinical record sharing

The Wyoming Dept. of Health will partner with Medicity to launch a statewide HIE that it hopes to eventually connect to neighboring HIEs in Colorado and South Dakota.

Readers Write: I Am More Than My Specialty: Physician Burnout and Individualism

I Am More Than My Specialty: Physician Burnout and Individualism
By Erin Jospe, MD

Erin Jospe, MD is chief medical officer of Kyruus of Boston, MA.

While physician burnout is garnering more attention with a steady generation of articles and books both academic and lay, we have yet to see improvements despite our awareness of the problem. We have become facile at recognizing the symptoms of exhaustion, detachment, cynicism, and inefficiency as the hallmarks of burnout, but no better at treating the underlying causes.

Per Medscape, no specialty was spared an increase in self-reported burnout symptoms between 2013 and 2017, [1] and the prevalence is unsettling at almost 60 percent in some fields. [2] While there is no silver bullet for burnout, within their professional work environments, recognizing physicians as individuals and giving them the means to convey their unique areas of expertise to patients, fellow providers, and others within the health system can go a long way in paving a path to higher satisfaction and engagement.

We are equally aware of the downstream ramifications of physician burnout as we are of the symptoms, with repeated studies demonstrating the negative impact on patient safety, quality of care, and the patient experience. With the refocusing of the context of care upon the mission to improve patient lives, in 2007 the “Triple Aim” reminded us of the importance of how individual patients experience care. In the 10 years since, there has been a paradigm shift in respecting the individual patient as having unique needs and values that must be addressed to achieve better health.

Physician burnout directly undermines our ability to deliver on this promise and has worsened in the same 10 years. It was innovative to say we needed to acknowledge the humanity of our patients to deliver better care, to recognize the individual and not view them as interchangeable with every other patient. And yet by creating a delivery system that only recognizes the humanity of those needing care and not of the care providers, we sully the sacredness of that patient-provider relationship and create the same negative environment of disrespect that results in so much dissatisfaction among both providers and their patients.

Though we rightly strive to see and address the individual needs of the patient, there is a widespread sense that physicians themselves are interchangeable. This is no less disrespectful than perceiving patients as such. As a physician, I am far more than my specialty,  as are my colleagues. Yes, I have an expertise, and with it comes an expectation of an established skill set and standards of care. But I have a style, manner, and experience that is my own. I have defined niches of interest and excellence that make me better suited to the needs of some patients.

When given no means, no vocabulary, no voice with which to articulate that which is unique to a physician, we do a disservice to the individual physician and to the community of patients and other providers who would seek them out. Our health systems and networks of physicians are growing exponentially larger, but with it, our awareness of individual contributors diminishes. We no longer have connections with one another as physicians and no insight as to where unique strengths and gifts might exist among us.

In the face of an exploding fund of medical knowledge, we cannot deny the necessity of understanding where unique expertise — and not just specialty — lives. It is hard to enough for physicians to acknowledge the deficiencies in our knowledge base. Providing no means by which to uncover who within our community might help only furthers a tendency toward emotional and mental exhaustion.

Addressing burnout at an individual physician level is often too little, too late. Resiliency is important, but in and of itself, resiliency does not change the environment for which it is necessary, and too often will be insufficient to treat or prevent burnout.

Instead, consider the systemic and holistic organizational contributions to the environment which are causal. Rather than address the individual’s propensity to burnout, address the individual. Allow them to be acknowledged and appreciated as uniquely individual contributors. Give them the means to indicate to their networks what their clinical areas of focus are beyond merely specialty / subspecialty. Provide them with teams aligned in their mission to act in concert as exceptional people in the care of exceptional people. Facilitate their understanding of the excellence that exists within the community of providers.

Failure to do so diminishes the joy and satisfaction of relational patient care by converting those interactions into the merely transactional. Though not a panacea for physician burnout, we need to address the anonymity of our providers if we are to do justice to the promise of prioritizing the patient experience.

[1] Medscape Lifestyle Report 2017

[2] AMA, “Report reveals severity of burnout by specialty,” Jan. 31, 2017.

Readers Write: Continuous Clinical Surveillance: An Idea Whose Time Has Come

Continuous Clinical Surveillance: An Idea Whose Time Has Come
By Janet Dillione

Janet Dillione is CEO of Bernoulli Health of Milford, CT.

It’s no secret that the general acuity of hospitalized patients is increasing as the overall US population continues to age (hello, Baby Boomers). Many patients who would have been in an ICU in the past are now found in lower-acuity areas of the hospital. We foresee that the hospital of tomorrow, in terms of monitoring and surveillance capabilities, will need to be more like an enterprise-wide ICU.

A significant problem with such a transformation is that hospitals will not be able to staff their entire facility like an ICU. In most hospitals, there is simply no money to add more staff. Even if there were sufficient funds, doctors and nurses are in short supply. Hospitals will have no choice — they will need new technological tools to help clinicians manage these rising levels of acuity.

One type of technology that holds promise in this regard is continuous clinical surveillance. In contrast to electronic monitoring — which includes observation, measurement, and recording of physiological parameters — continuous clinical surveillance is a systematic, goal-directed process that detects physiological changes in patients early, interprets the clinical implications of those changes, and alerts clinicians so they can intervene rapidly. (1)

Just a few years ago, continuous clinical surveillance would have been impossible because there was no way to integrate data from different monitoring devices, apply analytics to that information in real time, and communicate alerts to physicians and nurses beyond the nearest nurse’s station. But today, medical device data can be aggregated and analyzed in a continuous stream, along with other relevant data such as patient data from the EHR. In addition, many clinicians now carry mobile devices that allow them to be alerted wherever they are.

Early Warning System

A continuous clinical surveillance system uses multivariate rules to analyze a variety of data, including real-time physiological data from monitoring devices, ADT data, and retrospective EHR data. When its surveillance analytics identify trends in a patient’s condition that indicate deterioration, the system sends a “tap on the shoulder” to the clinicians caring for the patient.

For example, opioid-induced respiratory depression accounts for more than half of medication-related deaths in care settings. (2) Periodic physical spot checks by clinical staff can leave patients unmonitored up to 96 percent of the time. (3) By connecting bedside capnographs and pulse oximeters to an analytic platform to detect respiratory depression and instantly alert the right clinicians, continuous surveillance can shorten the interval between a clinically significant change and treatment of the patient’s condition.

A recent study found that compared to traditional patient monitoring and spot checks, continuous clinical surveillance reduced the average amount of time it took for a rapid-response team to be deployed by 291 minutes in one clinical example. In addition, the median length of stay for patients who received continuous surveillance was four days less than that of similar patients who were not surveilled. (4)

Another condition that requires early intervention is severe sepsis, which accounts for more than 250,000 deaths a year in the US. (5) The use of continuous clinical surveillance can help predict whether a patient’s condition is going to get worse over time. By aggregating data from monitoring devices and other sources and applying protocol-driven measures for septicemia detection, a multivariate rules-based analytics engine can identify a potentially deteriorating condition and notify the clinical team.

Reduction in Alarm Fatigue

Repeated false alarms from multiple monitoring devices often cause clinicians to disregard these alerts or arbitrarily widen the alarm parameters. Continuous surveillance can significantly reduce the number of alarms that clinicians receive.

An underlying factor that produces alarm fatigue is that the simplistic threshold limits of physiologic devices — like patient monitors, pulse oximeters, and capnographs — are highly susceptible to false alarms. Optimization of the alarm limits on these devices and silencing of non-actionable alarms is not enough to eliminate this risk. The challenge is achieving a balance between communicating essential patient information while minimizing non-actionable events.

Continuous clinical surveillance solutions that analyze real-time patient data can generate smart alarms. Identifying clinically relevant trends, sustained conditions, reoccurrences, and combinatorial indications may indicate a degraded patient condition prior to the violation of any individual parameter. In addition, clinicians can leverage settings and adjustments data from bedside devices to evaluate adherence to or deviation from evidence-based care plans and best-practice protocols.

In a study done in a large eastern US health system, researchers sought to establish that continuous surveillance could alert clinicians about signs of OIRD more effectively than traditional monitoring devices connected to a nurse’s station without compromising patient safety. The results showed that a continuous surveillance analytic reduced the number of alerts sent to the clinical staff by 99 percent compared to traditional monitoring. No adverse clinical events were missed, and while several patents did receive naloxone to counter OIRD, all patients at risk were identified early enough by the analytic to be aroused and avoid the need for any rapid response team deployment. (6)

Clinical Workflow

When CIOs are considering a continuous clinical surveillance solution, they should look for a platform that fits seamlessly with their institution’s clinical workflow. This is especially important outside the ICU, where the staff-to-patient ratio is lower than in critical care. In these care settings, a solution that can be integrated with their mobile communication platform ensures that alerts will be received on a timely basis.

In addition, the continuous surveillance solution should have an open interoperability standards based architecture that integrates with the hospital’s EHR, clinical data repository, and other applications. Especially in these times, it must support strict security protocols as part of an overall cybersecurity strategy.

Clinicians are beginning to recognize that continuous clinical surveillance can help them deliver better, more consistent, more efficient, and safer patient care. In this respect, it reminds me of the timeframe after publication of the famous IOM report that highlighted the dangers of medication errors in the US healthcare system. Companies scrambled to provide a solution, and when automated medication administration was first introduced, the technology was unimaginably clunky. As many of us remember, COWs left the pastures and moved onto hospital floors.

I had the opportunity to watch clinicians who had significant doubts about bar coding and scanning try these new tools. It only took that first patient where the technology helped them avoid dispensing an incorrect medication to turn a skeptic into an evangelist. They quickly realized their patients were safer because of the new technology. Clinicians will discover that continuous clinical surveillance offers the same type of patient safety benefits.

Eventually, hospitals will use continuous surveillance with acutely ill patients in all care settings. The ability of analytics to interpret objective physiological data in real time and enable clinical intervention for deteriorating patient conditions that could otherwise be missed is just too powerful to ignore.

REFERENCES

1. Giuliano, Karen K. “Improving Patient Safety through the Use of Nursing Surveillance.” AAMI Horizons. Spring 2017, pp 34-43.

2. Overdyk FJ, Carter R, Maddox RR, Callura J, Herrin AE, Henriquez C. Continuous Oximetry / Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During Patient-Controlled Analgesia. Anesth Analg. 2007;105:412-8.

3. Weinger MB and Lee La. No patient shall be harmed by opioid-induced respiratory depression. APSF Newsletter. Fall. 2011. Available at: www.apsf.org/newsletters/html/2011/fall/01_opioid.htm.

4. “Improving Patient Safety through the Use of Nursing Surveillance.”

5. Centers for Disease Control and Prevention, “Data & Reports: Sepsis.” https://www.cdc.gov/sepsis/datareports/index.html

6. Supe D, Baron L, Decker T, Parker K, Venella J, Williams S, Beaton L, Zaleski J. Research: Continuous surveillance of sleep apnea patients in a medical-surgical unit. Biomedical Instrumentation & Technology. May/June 2017; 51(3): 236-251. Available at: http://aami-bit.org/doi/full/10.2345/0899-8205-51.3.236?code=aami-site.

Readers Write: Analytics Optimization: Doing What It Takes

Analytics Optimization: Doing What It Takes
By Lee Milligan, MD

Lee MIlligan, MD is VP/CIO of Asante of Medford, OR and a director of the governing boards of Asante, Oregon ACO, and Propel Health.

I recently surveyed a number of large and medium-sized integrated healthcare institutions in the Pacific Northwest with a focus on the analytics experience. I sought to answer one question: how do the operational and clinical end users perceive their experience of requesting and receiving information? I talked to CIOs, CMIOs, and directors of analytics.

Although the conversations touched on many concerns, three themes emerged that I now call the “Three Reporting D’s” – delay, distrust, and dissatisfaction. End users are just not getting what they need to do their jobs on time. Despite the adoption of sparkly analytics software products, the problems continue to fester.

We experienced a similar disconnect a few years back, and have, over the course of three years, re-architected our approach. Although we still have room for improvement, I’d like to share a bit about what we learned and how this reboot has led to a more satisfying end user experience.

We started the internal investigation by looking at the entire end-to-end experience from the customer’s perspective. Using a lean management technique known as value stream mapping, we drew out on a white board all of the steps that a typical end user would experience as they requested information from our analytics team. Surprisingly, this took quite a while and we ran out of white board space.

This was telling. Why does this process include so many steps? It reminded me of the 1990s Windows installations where the customer would continuously have to click “next” to move the process forward.

One of the keys of this lean technique is to identify the steps in the process that add value and eliminate the rest. We got stuck on the definition of value. What is valuable to the end user? When we honestly answered that question, a surprising number of steps were removed.

Next we asked, what’s missing? That question required us to walk in the shoes of our customer, like a doctor’s seeing the world through the patient’s lens. I also had the advantage of two additional frames of reference:

• I personally requested that a report be built for me from scratch using the prior method, and
• I asked the BI developers to CC me on all email communications between them and the customer.

Both experiences unearthed missing fragments, which ultimately informed our strategic BI architecture. Most of the changes we instituted were budget-neutral, process-related improvements. However, I would like to highlight two changes which cost a few bucks that delivered tremendous ROI.

Customer/BI Developer Partnership and Communication

We recognized fairly quickly that these relationships were in need of optimization. First, the customer rarely knows what they want. That’s not to say they can’t make a request. However, they frequently request what they don’t ultimately need or want.

Second, I discovered through those CC’d emails that they are requesting many additional discrete elements, far beyond the initial scope, usually as they learned more about what the information looks like. In other words, they didn’t fully understand what they were looking for and we were unprepared to fully discover with them what they ultimately need.

To plug that hole, we instituted a new position within our team, the clinical data analyst. Something akin to the business analyst in the corporate world, this role is responsible for working directly with the end user to accomplish two goals: (a) to fully understand the ask to detail this in the agreed-upon scope, and (b) to commit the requestor to actively participate in the data development process.

Also, our team of BI developers desired guidance on how they should communicate with our end users. We had naively taken that piece for granted. They requested clear direction on how to frame conversations, how to respond to specific requests that are outside of agreed-upon scope, and how to ask better questions of the initial ask.

Teaching/Training

We surveyed our customers and discovered something astonishing. Many are not using the reports and data that we have delivered. When pressed, it became clear that many did not fully understand the information produced and even fewer understood how to incorporate this data into their workflow to better inform operational decision-making.

We developed a new role as a principal trainer within ITS-Analytics. The goals of this role are twofold: (a) to work directly with end users to assure a full and practical understanding of the delivered information (i.e., how to read the report, what the symbols mean, how to navigate an analytics dashboard, etc.), and (b) to lead our self-service domain. The self-service aspect has significant potential to meet customer’s needs in a rapid, nimble fashion.

Putting it all together, our take-home lesson has been the criticality of performing regular internal assessments in order to verify that we are meeting our customer’s needs—from their point of view—objectively and subjectively.

CIO Unplugged 3/21/18

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

This is my final HIStalk “CIO Unplugged” post.

I began “blogging” 15 years ago as CIO with University Hospitals in Cleveland. It was an internal, interactive SharePoint hosted site. It became an effective tool to engage my team. I shared what was going on with the health system and IT and asked questions to solicit feedback. It worked well, so I adopted the same format at Texas Health.

A member of my team suggested that I share my blog broadly via a national forum. She entered me in a “contest,”submitting samples, Bam! “CIO Unplugged” was born. When the publication folded, Mr. HIStalk picked me up.

It’s a labor of love involving 10 years’ worth of bi-monthly posts on a wide range of topics. I purposely avoided hardcore technology topics since you get plenty of that content already. Harder to find is transparent insight into what at least one CIO thinks about, primarily around life, teamwork, and leadership.

Through the years, I acknowledged many individuals who enabled my professional endeavors. Everyone from parents, siblings, family, friends, managers, teams, and pastors. I will use my final post and give thanks one more time to those who did the real work — my teams, the IT caregivers.

I have the privilege of representing my teams in good and bad, and it is overwhelmingly good. While I received accolades in my journey, it is all about the teams that make things happen. The teams are the individuals who make all the good possible. Saving lives, impacting quality of care, lowering costs, and enabling the fulfillment of organizational goals and missions and visions. Despite attempts to deflect light received onto them, they often remain in the shadows, hidden.

Leaders often forget that without teams, we are nothing. It is all about the teams who work in the trenches. Trenches (cubes, offices, home, etc.) are where real work gets done. Trenches are where sacrifices are made. Trenches are full of unsung heroes. Trenches are where lives are saved.

While we are at conferences, our team is in the trench. While we do interviews, our team is in the trench. While we attend meetings, our team is in the trench. While we write blogs, our team is in the trench. When we vacation, our team is in the trench.

I will end calling out three individuals who serve in the trench. My assistants, who I prefer to refer to as partners.

Carol (2003-2007). My very first partner. Brash and sassy, she had my back. She was strong and never took no for an answer as she opened doors previously closed to enable my success. A pastor’s wife, she prayed for me, and boy, did I need it! Attending her mother’s funeral, Carol surprised all of us with skill and passion playing drums for a 30-minute solo rivaling Neal Peart and John Bonham. Carol helped me become a CIO. Now retired, we connected when I returned to Cleveland and had a good time catching up.

Dedie (2007-2015). I knew the moment we interviewed that Dedie was the one to help me be successful in Texas. A Katrina refugee, Dedie and I hit it off immediately. While she appears much younger, we are both 1980s kids and would easily have been high school buddies. Dedie jumped on a few grenades for me and shielded me. Also a pastor’s wife, she prayed for me daily. I loved visiting her church. I bettered my speaking abilities watching her husband preach. When I divorced, Dedie and Thad walked through the valley with me until I remarried. Our friendship continues today.

Virtual (2015-2017). Having no partner while in NYC reminded me how much I missed having one.

Dara (2017-20XX). It has only been a few months, but I can already tell that we are hand and glove. Dara came from within my organization, so we have a huge head start. She is proactive and stays one step ahead of me. I was overwhelmed recently with presentations and she put together presentation starter sets that cut my creation time in half. Dara creates space in my schedule for reflection and ensures that I take care of myself. We have dined with spouses and have built a firm foundation for many years to come. I hope Dara is my last partner.

To those who served with me in the trenches, thank you. What inspiration, strength, and hope you gave me knowing you were there. You did amazing things. When it all comes down, it is really about you who are serving in the trenches. You are the ones who save lives. You are the ones who make a difference in the lives of caregivers and patients. Silently. Quietly. Hidden. In the trenches.

Thank you, Mr. HIStalk, for having me all these years.

“CIO Unplugged” may continue. Connect with me on LinkedIn to learn more.

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, and Twitter.

Morning Headlines 3/21/18

VA Open Application Programming Interface Pledge Gains Momentum to Shape a New Direction for Health Care

UPMC Chief Innovation Officer Rasu Shrestha, MD, MBA will lead the VA’s API project that was announced at HIMSS18.

Intermountain Healthcare employees brace for more job cuts as Utah’s largest employer readies to ‘adapt or die’

Intermountain Healthcare employees prepare for another round of layoffs as the Utah-based health system continues cost-cutting efforts to remain competitive with disruptors to the healthcare field like Amazon and Google.

VA-Cerner numbers skyrocket

The VA’s Cerner project will cost $16 billion instead of the previously hinted $10 billion, according to comments made in a House Appropriations Committee by Rep. Debbie Wasserman-Schultz (D-FL).

News 3/21/18

Top News

Houston-based RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy and will sell the business due to the servicing costs of the extensive debt it took on to fund its acquisition strategy.

The company says it fired unnamed executives who intentionally misstated its revenue and earnings.

A lawsuit filed in late 2016 claimed that CEO Paul Parmar masterminded a series of fraudulent acquisitions to allow him to falsify revenue numbers while misappropriating cash.

A private investment firm owned by former Blackstone executive Chinh Chu bought the company for $309 million in early 2017.

Reader Comments

From Stern Countenance: “Re: Tronc. Mike Ferro is out as chairman following allegations of inappropriate sexual behavior. Justin Dearborn, one of his cronies from his Merge Healthcare days, will replace him. Ferro was already a jillionaire with the sale of Merge Healthcare to IBM plus he was rich before he joined Tronc. Ferro gets a $15 million consulting contract as a farewell gift. Now Justin gets to be a jillionaire, too. These guys are no dummies when it comes to money, including running Merge into the ground by slashing and burning to make numbers that looked good enough to get IBM to buy the company.” There’s another healthcare connection – Tronc (the former Tribune Publishing) is selling the Los Angeles Times to NantHealth’s Patrick Soon-Shiong for $500 million in cash. I interviewed Justin Dearborn in early 2014; IBM bought Merge Healthcare for $1 billion in mid-2015 to expand its Watson offerings.    

From Obsidian: “Re: HLTH conference. Between JPMorgan and HIMSS I’ve seen 100+ billboards and ads for this new conference that’s supposed to be the greatest thing since sliced bread. What do you and your readers know about it?” The conference, taglined as “The Future of Healthcare,” will be held in Las Vegas May 6-9. They expect 2,000 attendees and will offer a smallish exhibit hall. The guy in charge is money guy and conference organizer Jon Weiner, who has zero healthcare experience in advocating for “disruptive innovation.” He has raised $5 million in funding to launch the conference. Among HLTH’s handful of sponsors are Change Healthcare, Optum, and UPMC. The massive roster of 250+ presenters includes the CEOs of Allscripts, Geisinger, 23andMe, Optum Health, Change Healthcare, Sharecare, Intermountain Healthcare, and Athenahealth. HIMSS (and its newly acquired Health 2.0) seems to have most of the bases well covered and JPMorgan is where the money guys and CEOs hang out, so I’m not quite sure how HLTH will convince people to spend another $1,850 registration fee and four days away from work to go back to Las Vegas (assuming most of its attendees will have just returned from HIMSS18). However, I shouldn’t underestimate the willingness of healthcare people to spend their employers’ money on conferences with questionable ROI to anyone except the attendee, who gains validation for getting his or her employer to foot the bill. Readers: are you going, and if so, what’s the draw beyond the HIMSS and JPM conferences?

HIStalk Announcements and Requests

I get excited by two Northern Hemisphere calendar days – the winter solstice on December 21 (after which daylight lasts longer every day through the summer solstice on June 21) and the spring solstice equinox (thanks for the correction) Wednesday, which is when spring officially begins. Actually I should add a third celebrated date that I call the HIMSS solstice, the last day of the HIMSS conference in which the crazy-busy health IT period that starts January 2 ends, replaced by a relatively lazy summer that lasts until Labor Day.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Parachute Health, which offers a durable medical equipment ordering system, raises $5.5 million in a seed funding round.

Sales

• Orlando Health extends its Affinity RCM contract with Harris Healthcare for three years with an additional one-year option.
• Piedmont Healthcare (GA) expands its use of Glytec’s EGlycemic Management System to all of its acute care facilities.
• Partners HealthCare expands its use Kyruus ProviderMatch patient access solutions.
• University of Maryland School of Dentistry will implement DrFirst’s mobility suite to help dentist prescribers meet the state’s July 1, 2018 prescription drug monitoring program mandate.
• Lawrence General Hospital (MA) will implement Meditech’s Expanse EHR.

People

Change Healthcare hires Fredrik Eliasson (CSX) as EVP/CFO.

UPMC Chief Innovation Officer Rasu Shrestha, MD, MBA will lead the VA’s API project that was announced at HIMSS18. The VA’s Lighthouse project involves standards-based data exchange via an open API framework. Organizations that have signed its Open API Pledge are UPMC, BIDMC, Partners HealthCare, Mayo Clinic, Cleveland Clinic, Fairview, Geisinger, Intermountain Healthcare, Jefferson, Rush, and VCU Health.

Steve Weichhand (Avaap) joins Divurgent as VP of professional services.

Charles Tuchinda, MD, MBA is promoted to the newly created role of EVP and deputy group head of Hearst Health and VP of Hearst. He will also continue in his role as president of Hearst-owned First Databank.

Announcements and Implementations

Diameter Health gives its clinical data management users the ability to track user-defined patient populations over time, with a sample use case being a health plan that wants to update its patient list with fresh HIE information on a specific schedule.

Healthcare sharing ministry Medi-Share will use payment processing systems from Liquid Payments. This is interesting mostly because of the business model of Medi-Share, which is run as a ministry but is effectively an insurer since its 375,000 members agree to share their healthcare bills that are discounted via Medi-Share PPO provider agreements. Faith-based plans, which don’t guarantee that they will cover medical bills and sometimes exclude preexisting conditions, require a pastor’s recommendation and the member’s pledge to avoid using drugs, smoking, and behaving immorally. The plans are not regulated.

Clinical Architecture releases Symedical on FHIR, a RESTful API based on the FHIR Terminology Service standard.

Government and Politics

The VA’s Cerner project will cost $16 billion instead of the previously hinted $10 billion, according to comments made in a House Appropriations Committee by Rep. Debbie Wasserman-Schultz (D-FL). Cerner will get $10 billion (which is probably where the earlier figure originated), the VA will spend $4.6 billion on infrastructure improvements, and another $1.2 billion will be budgeted for third-party project management (Booz Allen Hamilton has already been awarded $750 million of that). Another tidbit dropped in a House Committee on Veterans’ Affairs hearing: VA Secretary David Shulkin had planned to announce during his HIMSS keynote that the VA’s contract with Cerner had been finalized, although continuing delays took that topic off the table.

Former VP Joe Biden expands on the Seema Verma-Jared Kushner announcements at HIMSS18 in a Fortune opinion piece, recommending that:

• HHS should cite providers for data blocking if they don’t provide patients with an electronic copy of their EHR information within 24 hours of their request.
• The Center for Medicare and Medicaid Innovation should create a uniform patient data portal for storing and sharing patient information.
• HHS should expand its Sync for Science program in which patients can contribute their medical records to research.
• The National Cancer Institute should create a cancer data trust to hold EHR, diagnostic, genomic, and outcomes data.

The New York Times reviews the NIH’s $1.4 billion project to collect genomic, medical records, blood, and wearables information from one million Americans. The “All of Us” research program – still in beta testing — hopes to uncover new diagnostic and treatment insights, but hasn’t made much progress in its first three years even though its 2017 budget alone was $230 million. Geisinger gave back its $50 million participation grant because endless meetings and conference calls weren’t going anywhere, while Kaiser Permanente felt NIH just wanted its data without its insights so it passed, too. Both organizations are creating similar systems and so is the VA, which is making good progress for a budget of just $250 million over seven years. Researchers also say it’s hard because patient information is scattered across multiple provider EHRs and the US doesn’t have enough DNA sequencing machines to handle the load. 

Other

The US News “top medical schools” for research are Harvard, Johns Hopkins, and NYU, while the top three for primary care are UNC-Chapel Hill, UCSF, and University of Washington.

Epidemiologists are being robbed of their ability to track infectious disease activity by the shutdown of US local newspapers, which provide higher-quality information than social media. 

Sponsor Updates

• Optimum Healthcare IT publishes an infographic titled “The Complex ERP Lifecycle.”
• Aprima will exhibit at the Association of Independent Medical Software Value Added Resellers Annual Conference March 23-24 in San Antonio.
• CoverMyMeds will host TechPint March 22 in Cleveland.
• Nordic publishes a podcast titled “How will transitioning to Nordic’s maintenance and support affect my internal teams? Q&A with Loma Linda University Health.”
• HCTec publishes a new case study, “Outpatient CDI Model Increases Revenue Opportunities and Positions Health System for Future Success.”
• Healthwise will exhibit at the 2018 Midwest ACE User Group Conference March 21-23 in Chicago.
• Image Stream Medical will exhibit at the AORN Global Surgical Conference & Expo March 24-28 in New Orleans.
• Kyruus will exhibit at the Cleveland Health IT Summit

Blog Posts

• Bermuda Hospital Board Deploys Access’s eForms Solution to Enhance Registration and Integrate Patient Documentation with Cerner (Access)
• Common Risks Areas of ERP Implementation (Optimum Healthcare IT)
• Overview of the Current Administration’s Approach to HIT (Datica)
• Consultant’s Corner – Kathi Goovert (Huntzinger Management Group)
• HIMSS 2018: A Universal Agreement to Put Patients First (CarePort Health)
• The 3 Best Alternative, Non-Nursing Jobs for Nurses (CareSync)
• The responsibility of a leader (Meditech)
• Freezer Failure – How to Protect Critical Biomedical Materials (CenTrak)
• Framework for Success: Provider Workflow Optimization Hits New Heights (Crossings Healthcare Solutions)
• Have You Connected Your Patients to their Benefit & Estimate Information on your Organization’s Portal? (Culbert Healthcare Solutions)
• HIMSS 2018 Recap: By the Numbers (Direct Consulting Associates)
• 3 Takeaways from HIMSS18 (Dimensional Insight)
• Value-based Care Trends – What’s on the Horizon in 2018 & Beyond (Divurgent)
• Leaving Las Vegas: FormFast’s Recap of HIMSS18 (FormFast)
• 6 Questions to Ask When Preparing for a Legacy System Requirement (Hayes Management Consulting)
• What Patient Safety Means to Consumers and Hospitals (Healthgrades)
• Improving Patient Experience Through Innovation at HIMSS18 (Healthwise)
• What Works – IT Roadmap Providers Path to Operational Excellence (Huntzinger Management Group)
• Is your organization as healthy as you think? (Hyland)
• A Personal Story of Patient Safety from Impact Advisors’ President (Impact Advisors)
• Putting a Face on Effective Facebook Marketing Methods (Influence Health)
• Payment Device Questions – What Healthcare Organizations Need to Know (InstaMed)
• Health Systems Can Own the Customer Relationship (Docent Health)
• Nine Questions Urgent Cares Should Ask Before Hiring a Collection Agency (DocuTap)

Contacts

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

Morning Headlines 3/20/18

Constellation Healthcare Technologies Files Voluntary Chapter 11 Petitions to Facilitate an Orderly and Efficient Sale Process

Following earnings discrepancies, an executive exodus and investigation for fraud, Constellation Healthcare Technologies files Chapter 11 for several of its subsidiaries.

Joe Biden: To Save and Improve Lives Using Data, Details Matter

Former Vice President and founder of the Biden Cancer Initiative Joe Biden responds to the Trump administration’s MyHealthEData initiative with next steps that include mandating the provision of a patient’s digital health data within 24 hours of treatment.

Trump administration to seek stiffer penalties against drug dealers, reduce opioid prescribing

Trump administration officials share plans to fight the opioid epidemic, including the creation of national PDMP that would flag suspicious prescriptions.

Curbside Consult with Dr. Jayne 3/19/18

Many of the physicians and other health professionals I work with during consulting engagements are suffering from burnout. As I work with troubled organizations, I am finding an increasing number of non-caregivers experiencing symptoms of burnout as well. I’ve recently partnered with an executive coach to work on strategies that we can use to better assist these organizations. It used to be that teams became stressed during times of change or times of institutional uncertainty, but we’re seeing teams that are now under stress all the time. Budgets have been cut, positions have been eliminated, and remaining workers are expected to absorb the work of others regardless of their capacity for additional tasks.

Healthcare informatics work is becoming more high stakes as systems are more deeply intertwined in care delivery. It’s not just about keeping systems in a state of high availability anymore. Now, healthcare IT teams are expected to monitor clinical quality calculations, enable reporting that has significant financial ramifications, and monitor updates and patches to ensure there are no changes to critical business processes or reporting processes. At one hospital where I have worked, there is no budget for clinical informatics, so the IT team is handling everything from system maintenance to ensuring physician adoption, with little support from medical leadership. The analysts are stressed all the time, caught between a mandate to ensure clinicians use the system properly and not having any authority to actually get the physicians to come to training. The turnover rate in the IT department is high, and leaders don’t seem to understand why people don’t want to stay.

The executive coach I’ve partnered with works with organizations to try to build resilience. The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, or stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” The people we’re working with are adaptable – they’ve watched the evolution of healthcare IT systems and some of them have worked on everything from basic billing systems to complex enterprise applications. They’ve watched the growth of technology at the bedside, and have seen the need for more transparency in the IT organization as the number of departments using technology has grown. They’ve coped their way through the rise of E&M coding, Meaningful Use, MACRA, MIPS, and ACOs.

Even with those changes under their belts, we see people struggling with the day-to-day stressors that impact their work. People are double booked for meetings and more than once I’ve been confronted by a conference call participant who appears to be inattentive who responds by saying he’s on multiple calls. (I still don’t understand how that works, but people do it, so it’s definitely a thing.) Workers are reluctant to take much-needed time off because they don’t have adequate coverage or feel that they’ll be buried when they come back. Others don’t want to burden their coworkers with the extra work that might shift their way if someone takes off. I see IT analysts that are continually frustrated by buggy software and delayed release schedules, who feel it acutely when they can’t deliver solutions to their customers. They’re caught between the vendor and the end user and may feel powerless to remedy the situation.

We’re working with groups in this situation by helping individuals analyze their individual work styles and better understand their own strengths. We help them identify situations they find challenging and develop strategies to work through them. Unfortunately, learning new strategies and figuring out how to incorporate them in the workplace takes time, and already-stressed teams struggle with finding the time to do this type of contemplation and reflective work. It’s often the management level that is feeling the most stress, because they have little control over budgets and priorities but are expected to deliver results regardless. When working with managers, one of the first steps we take is to help them complete a 360-degree evaluation, where they understand how they are seen by supervisors, peers, and direct reports. In one organization, we struggled with even getting the team to find time to respond to the surveys required to complete the evaluations.

There’s a concept that’s referred to in clinical circles called Moral Distress. It’s defined as the state of knowing there is a “right” thing to do but there are institutional constraints present that make it impossible to pursue the correct course of action. We typically talk about this when discussing nursing shortages and clinical staffing issues, when clinicians have to make difficult choices on how they deploy scarce resources. It’s thought that being unable to care for patients properly creates a particular kind of stress that increases the risk of caregivers quitting. A study of nurses performed in 2014 found that 20 percent of nurses surveyed intended to leave their current position due to moral distress.

Although it’s not quite as severe as moral distress at the point of care, we’re starting to see similar levels of stress in the teams that support front-line caregivers. Those support teams feel it acutely when clinical staffers can’t complete tasks or don’t have the technology they need to care for patients. I watched one IT analyst tear up as he tried to help a nurse figure out a documentation issue, when he understood that problems in the EHR were directly responsible for errors in care that negatively impacted a patient. He had reported the issue to his manager previously and they had been working with the vendor to try resolve it, yet he was told to move on to other priorities. He feels personally responsible even though there wasn’t anything he could have done, other than not follow the instructions that his leadership had given him. This isn’t the first time he’s been in a situation where patients were impacted by system issues, and he’s actively pursuing a job outside of healthcare.

As leaders, we need to figure out how to make sure our teams have the resources they need to do their jobs properly and ensure that the ultimate customer, the patient, is taken care of. We’re often between the proverbial rock and a hard place figuring out budgets and staffing while we prioritize projects. Maybe we need to be more forceful at saying no to implementing an on-demand meal ordering platform when our laboratory and radiology orders platforms aren’t at peak performance. Maybe we need fewer 70-inch TVs in patient rooms and more functional desktops and mobile workstations so documentation can occur quickly at the point of care. Maybe we need to stop adding bells and whistles to our systems when we haven’t fully implemented the basics. These are issues that the C-suite deal with regularly as our hospitals try to keep up with the Joneses across town.

I’d be interested to hear from any healthcare IT leaders who are taking a back-to-basics approach and trying to refocus energies on reducing stress while helping workers be more resilient. Have you found the recipe for the secret sauce? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/19/18

Technical glitch and market turmoil overshadow Healthineers IPO

Siemens AG raises $5.2 billion in its Healthineers IPO despite technical glitches that delayed the start of business.

Giving patients control of their health information will help give patients control of their health

CMS Administrator Seema Verma and presidential advisor Jared Kushner reiterate the Trump administration’s commitment to the MyHealthEData initiative.

Amazon is hiring a former FDA official to work on its secretive health tech business

Amazon hires the FDA’s first chief health informatics officer, Taha Kass-Hout (Trinity Health), to head up healthcare project business development on its Grand Challenge team.

Monday Morning Update 3/19/18

Top News

Despite technical problems that delayed business on the German stock exchange by an hour, Siemens AG raises $5.2 billion in its Healthineers IPO. Funds will be used to invest in molecular diagnostics and to acquire US-based health IT startups.

Reader Comments

From Lizzie Borden: “Re: Theranos board and advisors. It looks like at least one member of the infamous company’s scientific advisory board is getting proactive about making sure industry insiders know she’s distanced herself from the company.” The Washington University School of Medicine has indeed assured the media that professor Ann Gronowski left the Theranos board at the end of last year, even though the company’s website still lists her as a member. Sources report that two other advisers still remain on the SAB, which was formed in 2016 to lend credibility to the company’s under-fire efforts.

HIStalk Announcements and Requests

Thanks to those who responded to “What I Wish I’d Known Before … Taking My First Hospital IT Executive Job.” I can’t say I’m surprised at how frequently hospital politics came up.

The next installment of the series is your chance to help future patients and caregivers learn from your past experiences in the hospital or ED.

Meditech was the favorite in a highly unscientific poll that mostly garnered votes from IP addresses associated with the vendors listed.

New poll to your right or here: How far along are EHRs in delivering a "comprehensive health record" that paints a full patient picture?

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Mazars USA opens a new office in Los Angeles.

Decisions

• Tri Valley Health Center (NE) will go live with Meditech on May 1.
• Morristown Medical Center (NJ) will go live with Epic in June.
• Northside Regional Medical Center (OH) will switch from Cerner to Meditech in June.

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

CNBC reports that Amazon has hired Taha Kass-Hout (Trinity Health) to head up healthcare project business development on its Grand Challenge team. Also known as the 1492 Lab, Amazon’s team stealthily launched last year to focus on projects related to medical records management and access, though not much has been heard from them since. Much is being made of the fact that Kass-Hout was the FDA’s first chief health informatics officer.

Announcements and Implementations

In Bermuda, the Hospitals Board integrates eForms from Access with its Cerner EHR at King Edward VII Memorial Hospital and the Mid-Atlantic Wellness Institute.

Medication management vendor DrFirst deploys FDB’s new Opioid Risk Management Module as part of its support of Nebraska’s PDMP. In January, Nebraska became the first state to require tracking of all prescription drugs.

Other

This sounds a bit Big Brotherish to me: Herman Miller introduces a smart office chair that, when paired with its smart desk and app, gives employers insight into how long workers spend at their desks, times of highest productivity, and whether they’ve gone to the restroom or left for the day.

Sponsor Updates

• Parallon announces a reseller agreement with Cerner.
• CommonWell Health TV interviews Redox Chief Customer Officer Devin Soleberg.
• ROI Healthcare Solutions launches the ROI Resource Group.
• Santa Rosa Consulting adds an analytics migration program to its business intelligence and analytics services.
• Philips Wellcentive will exhibit at the Population Health Colloquium March 19-21 in Philadelphia.
• Wolters Kluwer publishes its annual report.
• QuadraMed will celebrate Health Information Professionals Week, March 18-24, by providing HIP swag to any healthcare organization registering for a Lunch-N-Learn by March 30.
• Maryland Lt. Gov. Boyd Rutherford visits DrFirst’s headquarters to learn how the Rockville, MD-based company is fighting the opioid epidemic with Maryland-based partners MedChi, CRISP, and UMSOD.

Blog Posts

• How Healthcare’s Digital Transformation Can Drive Better Patient Engagement (Salesforce)
• Ambulatory Surgery Center Industry Updates and New Analytics Tool (The SSI Group)
• What Keeps a Hospital CIO Up at Night? (Summit Healthcare)
• Next-generation sequencing at scale: Guided variant assessment (Sunquest Information Systems)
• Surescripts Commends Congressional Leadership as EPCS Act Gains Traction in Senate, Following House Bill (Surescripts)
• Healthcare Marketing with HIPAA (SymphonyRM)
• Presumptive Eligibility for Charity Care: The Risk of Presuming Your Hospital is Compliant (TransUnion)
• A Training Revolution: Visage 7 Powers UF Health’s SIMulation (Visage Imaging)
• Close clinical communication gaps and avoid risks. (Voalte)
• Strengthening Patient Safety and Engagement Through System Standards (Vocera)
• A 10-Point Plan for Smart and Secure Electronic Communications with Patients (WebPT)
• Less clicks and more data at the point of care? It’s true. (Philips Wellcentive)
• 4 Pitfalls of Searching the Internet for Health Answers (WiserTogether)

Contacts

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