Monday Morning Update 2/5/18

Top News

The Economist reviews the number of prescription-only digital health apps that have earned FDA approval or could so more quickly under FDA’s new pre-certification program.

Apps are being approved to actually treat conditions – either alone or in combination with a drug – but investors are watching to see how companies fare since the “who pays” question hasn’t been answered and nobody’s sure how a patients will react to being given an app instead of a pill.

Pear Therapeutics won FDA approval in September 2017 for its ReSet app for substance abuse treatment. Its pipeline includes apps for schizophrenia and post-traumatic stress disorder. The Boston-based company, founded by neuroscientist Corey McCann, MD, PhD, raised $50 million in a Series B funding round last month that increased its total to $70 million.

Reader Comments

From Eloquent Rascal: “Re: Apple Health Records. Does it display any information that patients can’t already see in their EHR portal? Can patients change the information?” A source tells me that, so far anyway, the patient’s phone will show consumers nothing that they can’t already see on the patient portal. Patients can apparently change or hide information, which makes their phone-stored information of limited use to clinicians who may not trust it.

HIStalk Announcements and Requests

My poll tool doesn’t calculate percentages like you might expect when allowing multiple choices, but it’s safe to say that most respondents use their phones for health-related activities. Relatively few, however, use the information contained on it during their provider visit, view their progress notes via OpenNotes (although that obviously requires their hospital to participate), or seek out a video visit.

New poll to your right or here: if you’re going to the HIMSS conference, why?

I received a few responses to What I Wish I’d Known Before … Bringing an Ambulatory EHR Live. Let’s hear what you have to say about the reader-recommended topic of taking a software sales job.

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

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Acquisitions, Funding, Business, and Stock

From the Athenahealth earnings call following positive quarterly results that sent shares up 14 percent Friday:

• CEO Jonathan Bush says the company is seeing a post-HITECH “sugar low” as overall buying demand slacks off. Bookings for the fiscal year didn’t meet the company’s goal.
• The company will change its software release schedule to three times per year following disappointing customer retention numbers.
• 62 hospitals are fully live on its inpatient system.
• 40 percent of customers are exchanging patient records via CommonWell and Carequality. Bush says the they can see hospital CCD information on an application tab, but the next steps involve extracting the most useful information and then developing APIs to allow users to interact directly with a hospital’s EHR.
• The company’s main strategy will be to deepen the number of services offered to mitigate the “micro aggressions against the practice of medicine” and to emphasize its network’s capabilities rather than assuming that offering the best EHR or PM will create demand.
• Bush says the previously “clunky” single, integrated view of inpatient and outpatient patient records view is improving as the company hopes to avoid being “boxed out” in being replaced by a single integrated system such as Epic or Cerner.
• Epocrates continues to turn in poor numbers, although it’s no longer being positioned as a standalone product but instead as a dashboard for other Athenahealth offerings.
• The company spent a lot of money and annoyed doctors as it fought to get a significant share of HITECH-driven business, but now it is transitioning to more thoughtful product offerings.  
• Bush says MACRA and MIPS won’t drive sales since practices “get the check something like two years after you make the move and the check is smaller than cable bill.”
• Bush says high-deductible insurance has pushed patients to defer services until later in the year when they’ve met their deductible, with providers and their vendors facing lean first quarters as the new normal.

Sales

In England, Plymouth Hospitals NHS Trust joins the global health research network of TriNetX.

Decisions

• Adirondack Medical Center Saranac Lake (NY) went live with Meditech in November 2017.
• St. Luke’s Gnaden Huetten campus (PA) will switch from Cerner to Epic in June 2018.
• St. Vincent Hospital (PA) will replace McKesson with Epic in February 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

Investment syndicate AngelMD hires industry long-timer Michael Raymer (Perspectum Diagnostics) as chief strategy officer.

Government and Politics

A GAO report finds that federal and state governments are spending $10 billion for assisted living services for Medicaid beneficiaries without much oversight or quality monitoring. It concludes that CMS has provided unclear guidance, Congress has not established standards, and states haven’t tracked cases involving neglect or abuse.

Other

Hospitals are being overwhelmed with record-breaking numbers of flu-related ED visits and admissions, to the point that Lehigh Valley Hospital-Cedar Crest (PA) erected a MASH-style “surge tent” in its ED parking lot to hold overflows. Patients housed there who didn’t get a flu shot told the New York Times reporter some bizarre theories that “heard” (meaning that they cluelessly read on Facebook):

• When offered a Tamiflu prescription, “No, I heard it causes hallucinations. I heard about a lady whose daughter got Tamiflu and tried to kill her.”
• “I hear the [flu] shot gives you flu.”
• “I heard you can get Alzheimer’s from it — that there’s mercury in it, and it goes to your brain.”
• “I heard it’s a government plot for population control.”
• “As a family, we don’t get it,” an apt description from a man convinced that he got the flu more often in years when he got a flu shot.

Canada’s Royal Canadian Mounted Police reverses its decision to require officers to file an Access to Information Act to get copies of their own medical records after being overwhelmed by requests and complaints about delays. The 30,000-employee RCMP has 65 people working in its access-to-information and privacy office, which scanned 1.2 million pages of documents last year. Documents requested under the Access to Information Act have to be printed from their electronic original and shipped to the access and privacy office in Ottawa, where they are then scanned back in. 

An NHS surgeon who claimed in a job interview to have performed over 50 solo keyhole surgeries vs. his real-life total of six says he didn’t understand the question and instead gave a “guesstimate.” He got the job after submitted a fraudulently completed surgery logbook, but was investigated after a high incidence of post-surgical complications and death. He’s been found guilty of fraud.

Sponsor Updates

• T-System will provide its T-Sheets flu templates to EDs and urgent care centers at no charge.
• Santa Rosa Consulting adds e-learning capabilities to its Meditech offerings.
• Surescripts will exhibit at the NACDS Regional Chain Conference February 4-7 in Fort Lauderdale, FL.

Blog Posts

• 5 Buzzwords I’m Banning from Meetings in 2018 (Salesforce)
• Successful interventions, positive outcomes: understanding the impact of social determinants of health (Medecision)
• Understanding how HIPAA Impacts Text and Email Communication (Solutionreach)
• Be Prepared: The Importance of Investing in Business Continuity During Unplanned Network and EHR Downtimes (Summit Healthcare)
• The Importance of Vendor Selection in Legacy (Leidos Health)
• How Blockchain Could Revolutionize the Healthcare Industry (Conduent Health)

Contacts

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

What I Wish I’d Known Before … Bringing an Ambulatory EHR Live

That technical dress rehearsal issues would get ignored or not addressed before the go-live. Wasn’t that the point of the TDR?

I wish I knew ahead of time that the EHR vendor outsourced their support to a third party. This arrangement created speed bumps to getting real support answers relayed from the EHR vendor through the support vendor.

I wish I knew how effective running a mock clinic was for training providers, especially physicians. An EHR analysts plays the role of a mock patient and gets checked in, roomed by the MA or nurse, seen by the doctor, and checks out. Ideally, the provider completes common orders, does a note, and charges. Any system problems can be caught by the analyst and a trainer can be at the elbow of each users. It is a little labor intense, but the clinics come back up to full speed much sooner. We had one ophthalmologist seeing 87 patients a day within one week of go live. His partners that didn’t do the mock clinic took weeks to get back up to full speed.

To what degree provider productivity would be negatively impacted and how that would impact the productivity-based comp plans of physicians and administrators. There’s a reason CIOs have a hard time surviving an EHR implementation, first among them messing with peoples’ pay checks.

How to generate sincere engagement for the implementation with the clinicians and staff as beneficial to their patients and care delivery. And helping all to make the project not just about the billing.

We learned after the CIOs and people allowed in the room had chosen Epic just because, that all non-Epic apps that were to integrate into the EMR had to have a test environment, or else integration was denied. Even apps with fewer than five users. Go-live was pushed back months, there no budget for this, and rebuilding non-Epic apps took time away from learning and building the actual future EMR and getting certified.

Focusing on optimizing physician workflows and making them as efficient as possible is absolutely important, but the same amount of effort must be made for the other roles on the ambulatory clinical care team: nurses (especially nurse triage), medical assistants, in-house laboratory and radiology, as well as all other ancillary services provided by the practice. Ensuring that the physicians are happy should not come at the expense of everyone else in the practice.

Weekender 2/2/18

Weekly News Recap

• Advocate Health Care announces that it will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care.
• A Nextgov review finds that the VA wasted $2 billion on three failed EHR projects from 2011-2016, adding the cost of the abandoned HealthVet effort to the GAO’s estimate of $1.1 billion.
• Epic issues a rare press release to tout “One Virtual System Worldwide,” which allow Epic-using sites to communicate electronically, perform patient data searches, and schedule patient appointments with other Epic sites.
• Amazon, Berkshire Hathaway, and JPMorgan Chase create an independent company to reduce their employee healthcare costs in unspecified ways.
• A GAO report urges the Coast Guard to make an EHR decision following its failed $60 million attempt to go live on Epic that left it working with paper records, with some members of Congress questioning why the USCG doesn’t follow the lead of the DoD and VA and implement Cerner.
• Digital advertising vendor Outcome Health announces that its two co-founders will leave their executive roles and will take board positions as part of the company’s settlement with investors who say they were defrauded by inflated advertising performance claims .
• Allscripts restores access to its hosted systems more than a week after a ransomware attack.
• The Best in KLAS 2018 report is released.

Best Reader Comments

Syntactic structure and semantic context: MHS Genesis has both. They also have the  largest HIT project budget in history and the full attention of the world’s largest HIT vendor. And yet, they have no connection to any of that vendor’s other sites. No connection to CommonWell. No connection to Carequality. What they do have – after coming a year late out of the gate – is a read-only viewer connection to the VA that you have to open in a separate app. Why does every five-doc clinic on Athena go live connected to Carequality, but the $5b flagship goes live with NOTHING? Vaporware. (Vaporware?)

Does Epic get to define the word “Interoperability?” It seems like the only thing they have an interest in doing is “INTRA-operability,” which is why they were passed over by DoD. It seems to be a roadblock ahead in innovation for them and I think some folks are really starting to notice. (Cheez Whiz Liz)

Would you rather but all those rolls of digital duct tape and the people to string it together, or have it done for you with no special effort? They [Epic] have been working on this stuff for years, since before I left. I don’t think any other vendor has put in that effort. Back then, it was also free. Not sure whether that’s still true. (Ex Epic)

Sequoia: passing CCDAs in a point-to-point manner does not seem to me to very disruptive approach. (Bobby)

Touting same-vender interoperability seems spectacularly uninteresting … We already have the complete syntactic structure for healthcare data and we have the full range of semantic context determined to give it appropriate meaning. What we need are the vendors to stop making the use of these well thought out and excellent protocols too costly to utilize, which they only do to continue to enforce their monopoly over patient and other clinical and revenue cycle data. (Bill)

Epic doing all of this work to connect between Epic customers is a lot more easy to accomplish since you can build in the functionality, control requirements, and control the message process / processing. If they were to try to do this for the industry, it’d be damn near impossible without buy in from all of the EMR vendors, let alone take multiple times longer. Epic communicating with Epic is a great first start and certainly leads the way in actually accomplishing something. Someone needs to pull the Band-Aid. (Johnny B)

I’ll take leadership by DOING SOMETHING over leadership-by-PowerPoint any day (I’m looking at you, CommonWell). My observation is that industries advance by someone going first and executing better, not by everybody agreeing on a lowest common denominator. (Vaporware?)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. A in Texas, who is rebuilding her relocated classroom following Hurricane Harvey and asked for lap desks for her fifth graders. She reports, “Now students can choose where they work, and they become more interested and invested in the learning happening in our classroom. I firmly believe my students have a greater impact of learning when they feel in control and have a voice in how they learn.”

Nashville Public Radio profiles the open source HIV care app developed for the Kenyan Ministry of Health by Martin C. Were, MD, MS, assistant professor of biomedical informatics at Vanderbilt University. Were, who is originally from Kenya, says there’s lessons learned there that make sense for the US, which like Kenya has areas that are isolated or that have low educational levels.

In England, a group led by physicist Stephen Hawkings wins a judicial review of Health Secretary Jeremy Hunt’s proposal to reform NHS by putting all of an area’s NHS bodies under an ACO with a single budget, which Hawkings calls “back-door privatization.”

India’s government announces a plan to offer free healthcare to half a billion of its poorest residents. The government, which made the announcement in advance of next year’s elections, says the program will create hundreds of thousands of jobs. The coverage would allow patients to seek care in private hospitals instead of in poorly-run government ones. Public health experts question spending so much on hospitals instead of preventive care, noting that poor people are mostly dying of conditions caused by water and air pollution, malnutrition, poor sanitation, and substandard housing.

The Onion weighs in on Amazon’s healthcare ambitions.

In Case You Missed It

• News 2/2/18
• EPtalk by Dr. Jayne 2/1/18
• Readers Write: How IT Professionals Can Work More Effectively with Physicians
• CIO Unplugged 1/31/18
• HIStalk Interviews Niki Buchanan, PHM Business Leader, Philips Wellcentive
• News 1/31/18
• Curbside Consult with Dr. Jayne 1/29/18
• HIStalk Interviews Jonathan Baran, CEO, Healthfinch
• Monday Morning Update 1/29/18
• Tips for HIMSS Exhibitors
• What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based System

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 2/2/18

Five breaches add up to millions in settlement costs for entity that failed to heed HIPAA’s risk analysis and risk management rules

Fresenius Medical Care North America will pay $3.5 million to settle HIPAA violations related to five separate breach incidents that happened in early 2012.

Advocate Health Care replaces Cerner and Allscripts with Epic

Advocate Health Care (IL) will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care, a move that will create the country’s 10th-largest health system.

Yale New Haven Hospital launches new Capacity Command Center

Yale New Haven Hospital (CT) works with Epic to design a Capacity Command Center that uses dashboards to display real-time insight into patient volume, staffing, and environmental services.

CDC director denies she resigned due to tobacco stock buy

Former CDC Director Brenda Fitzgerald, MD denies that she resigned because of newly uncovered tobacco stock sales and instead attributes her resignation to a tangled web of financial conflicts — including investments in Greenway Health – that she couldn’t get out of easily.

News 2/2/18

Top News

Advocate Health Care will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care, as speculated here ever since the merger – which will create the country’s 10th-largest health system — was announced in December 2017.

Advocate SVP/CIO Bobbie Byrne, MD, MBA said in a statement, “This transition will allow for better interoperability throughout our entire geographic region, benefiting patients through a seamless, integrated approach. We are confident this single-platform EHR will be a nimble, long-term solution that can be continually adapted and developed as technology advances to keep us on the leading edge.”

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Acquisitions, Funding, Business, and Stock

Athenahealth reports Q4 results: revenue up 14 percent, EPS $1.11 vs. $0.62, beating expectations for both. Shares rose moderately in after-hours trading following the announcement.

McKesson announces Q3 results: revenue up 7 percent, adjusted EPS $3.41 vs. $3.04, beating expectations for both.

Meditech announces Q4 results: revenue up 11 percent, EPS $0.83 vs. $0.33. For the fiscal year, revenue increased 4 percent and net income rose 6 percent, although the December 2017 tax law changes reduced the company’s fiscal year taxes from $29 million to $19 million and thus heavily contributed to the increased earnings. Both numbers reverse a two-year downward trend. Product revenue jumped 21 percent year-over-year as service revenue dropped slightly.

Voalte gains $15 million in new capital from Silicon Valley Bank, bringing the 10 year-old company’s funding to just under $70 million.

Navicure and Zirmed name their newly merged companies Waystar.

Sales

Mineral Community Hospital (MT) replaces its four year-old NextGen system with Athenahealth.

Marshall Browning Hospital (IL) selects CloudWave’s OpSus Backup service.

Martin County Hospital District (TX) chooses Cerner, delivered via the company’s CommunityWorks hosted model.

North Carolina will become the 45th state to implement Appriss Health’s PMP InterConnect platform to share prescription drug monitoring program data across state lines.

In UAE, VPS Healthcare will implement the Tasy EMR from Philips. I’ve never heard of it, but Googling suggests that Philips acquired the Latin American-focused EHR in 2010 and started rolling it out in Europe last year.

People

William Gish (Cerner) joins Voalte as COO.

DocuTap names Robert Rueckl (Edementum) CFO and Jared Linsby (PointClear Solutions) SVP of sales.

Vibrent Health names James Wade, MD (Inova Schar Cancer Institute) CMIO.

Allscripts promotes interim CFO Dennis Olis to the permanent position.

PatientPoint hires Dan Owens (EVerifile) as CTO, Scott Schemmel (Ciner Resources) a EVP of IT, and promotes Kimberly Thiess to COO.

Announcements and Implementations

In Saudi Arabia, Johns Hopkins Aramco Healthcare goes live on Epic.

Government and Politics

Former CDC Director Brenda Fitzgerald, MD denies that she resigned because of newly uncovered tobacco stock sales and instead attributes her resignation to a tangled web of financial conflicts — including investments in Greenway Health – that she couldn’t get out of easily.

Technology

Yale New Haven Hospital (CT) works with Epic to design a Capacity Command Center that uses dashboards to display real-time insight into patient volume, staffing, and environmental services.

Privacy and Security

Fresenius Medical Care North America will pay $3.5 million to settle HIPAA violations related to five separate breach incidents that happened in early 2012. HHS OCR found problems that include failure to conduct a risk assessment, improperly disclosing PHI, failing to develop policies to address security incidents, and improper movement of PHI-containing hardware and media.

Other

Analysis verifies that 5 percent people who are commercially insured account for 53 percent of healthcare spending, but it’s not the same people year after year – 61 percent of them moved off the top spender list from 2014 to 2015. The takeaway: consumers who buy crappy health insurance (or none at all) because they think they’re healthy might get a big financial surprise, especially as ACA changes allow policies to be sold without pre-existing condition coverage or with newly reinstated lifetime caps.

CHIME decides to pick up the federal government’s slack and create an opioid task force that will attempt to come up with solutions to the opioid epidemic using the expertise of its members and their access to data. Some  might wonder if this is a PR push similar to its National Patient ID Challenge, which CHIME decided to shut down last year for lack of viable entries.

Pediatrician Bryan Vartabedian, MD says even Silicon Valley couldn’t create an EHR that doctors wouldn’t hate because “it’s less about design and more of what’s required of doctors.”

Sponsor Updates

• Medicomp Systems will host Medicomp U 2018 May 21-24 in Reston, VA.
• NCQA certifies ZeOmega’s Jiva population health management solution for 10 HEDIS 2018 measures.
• Premier awards Agfa Healthcare an enterprise imaging agreement.
• Forrester cites Liaison Technologies as a “Strong Performer” in operational intelligence for B2B integration.
• Nordic will exhibit at the HIMSS Wisconsin Dairyland Event February 8 in Madison, WI.
• PatientSafe Solutions exhibits at the San Diego Health IT Summit February 1-2 in San Diego.
• The American Heart Association/American Stroke Association and Nordic help University of Colorado Health and Saint Francis Hospital – both Epic sites –  optimize quality measure reporting for stroke patients using the ASA’s Get with Guidelines-Stroke program.
• Spok publishes a case study describing how Woman’s Hospital (LA) overcame logistical and communications challenges caused by record flooding to manage a 27 percent increase in call volume and to track physicians down using secure messaging.
• Bernoulli Health profiles company highlights in 2017.
• InterSystems announces GA of its Iris Data Platform for transaction processing and analytics.

Blog Posts

• Health IT Day declared at the Georgia State Capitol (Liaison Technologies)
• 3 Questions with Chris Longhurst, CIO at UC San Diego Health (Optimum Healthcare IT)
• If Your Healthcare Organization is Only Using Mobile for Text and Voice, Then Your Mobile Strategy Needs an Update (LifeImage)
• Improving Communication in a Nursing Home for Residents & Staff (LiveProcess)
• How Meditech fulfills the AMA’s 8 EHR Usability Principles (Meditech)
• Avoiding Patient Billing Disasters (Navicure)
• Netsmart Talks Post-Acute Legislative and Policy Advocacy with Home Care and Long-Term Care Associations (Netsmart)
• Who should maintain the EHR problem list? (Nordic)
• The Connected Clinician: How to Receive Pages on Your Smartphone, PHI on Your Pager, and More (Spok)
• Physician Burnout? See how Speech Recognition Can Help! (NVoq)
• Highlights from the MUSE Executive Institute 2018 (Parallon Technology Solutions)
• Four Questions Series: Todd Cozzens, Co-Founder & Managing Partner at Leerink Transformation Partners, PatientPing Board Member (PatientPing)

Contacts

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

EPtalk by Dr. Jayne 2/1/18

Lots of chatter among my clinical colleagues about two main topics: Amazon getting deeper into the health space and the State of the Union address.

The Amazon topic definitely got a lot more traction, namely because of comments that the Amazon, Berkshire Hathaway, and JPMorgan Chase venture would be “free from profit-making incentives and constraints.” Many physicians blame the current healthcare crisis not only on hospitals trying to make a buck, but on payer executives focused on shareholder profits and their own career advancement. Healthcare industry stocks declined, including Express Scripts, CVS Health, and UnitedHealth Group.

The new company was also quoted as planning to center on “technology solutions that will provide US employees and their families with simplified, high-quality, and transparent healthcare at a reasonable cost.” There is an incredible amount of waste in our healthcare system, with estimates of up to 35 percent lost through several categories. Don Berwick broke the categories down in his 2012 piece on “Eliminating Waste in US Health Care” and I don’t know that they’ve changed significantly since then:

• Clinical waste (14 percent). Could be improved with high-quality care, use of cost-effective treatments, or standardization of best practices.
• Administrative complexity (9 percent). Could be improved through standardization of billing and collections, credentialing, and compliance.
• Fraud and abuse (7 percent). Payments for services not provided or billed by deception.
• Excessive prices (5 percent). Could be improved by tying prices to efficiency, outcomes, or fair profit.

There are some interesting findings in those numbers. Many of the laypeople I encounter assume that the entire problem with healthcare is with excessive prices, because they see the prices that hospitals and healthcare providers charge and the dramatic reductions through allowable charges and other adjustments. The higher “list” prices are often billed directly to patients without insurance if they don’t know to specifically request a cash price or adjustment.

Health-related businesses should be able to earn a fair profit, I don’t dispute that, but then there are the stories of price gouging, particularly in the drug industry. There are games that manufacturers play, such as purchasing a generic and finding a way to get a new patent so they can raise prices and control the market. Then there are unconscionable acts, such as grossly inflating the prices of medications that cost modest amounts to produce.

Those sources of waste, even coupled with the nefarious category of fraud and abuse, still pale in comparison to the losses via administrative complexity and clinical waste. I spent a good chunk of my clinical day trying to talk patients out of treatments they don’t need even though they think they do because they heard about them on TV or read about them in an article about “things your doctor doesn’t want you to know.” I also watch patients pay urgent care prices for treatments that should be performed in the primary care office, where they can’t get an appointment because we have a serious shortage of primary physicians in our community. I watch our practice spend incredible amounts of money on the billing and collections process, dealing with rejections, denials, and other attempts by payers not to actually pay. We experience these things on a daily basis while we work with patients who lack the resources to get the care they need. I can’t help but think the disconnect between waste and need contributes to the burnout that many of us feel.

When we hear that someone as upright as Warren Buffett wants to get into the fray, we can’t help but be hopeful. And despite what one may think about Amazon and their takeover of the marketplace, the company does seem to get things done and provide excellent service, which people crave. And when it sounds like they’re going to try to take down payers, which many of us find cocky and distasteful, that makes it even better.

The devil is in the details with an endeavor like this one, and it remains to be seen if they can make a difference where others have not been successful, or where they have failed to appreciate the complexity of healthcare economics.

Failure to grasp the complexity of healthcare leads us to the State of the Union address, where much was promised. Addressing drug prices will be a priority, with lowered costs and improved access to breakthrough drugs. Anytime someone talks about breakthrough drugs, many of us are skeptical – precision medicine sounds sexy, but the costs are substantial. The real savings may lie in figuring out to incent manufacturers of generic drugs and reducing the need for drugs through prevention and lifestyle change.

The State of the Union address also covered “right-to-try” legislation that would expand access for patients with terminal conditions so they can try experimental drugs that have not been approved by the FDA. It’s dramatic to talk about patients going “from country to country to seek a cure,” but in reality, the number of patients impacted by this would be much smaller than the number of patients who could benefit from basic, affordable healthcare. In some circles, right-to-try”is spoken of as cruel since treatments themselves may cause suffering with little promise of improvement. I’ve seen my colleagues in hospice care in tears while they care for patients and their families who have been given false hope.

The speech also touched on the need to address widespread opioid misuse. Since my practice just began a groundbreaking partnership with our local sheriff’s office to try to better support opioid addicts as they attempt rehab, I’m all for efforts to stop this serious epidemic. I don’t see big increases in government funding in the future, however. That’s one reason why our practice started this new protocol – addicts in our area have a high risk of relapsing before they can even make it to rehab because there are so few rehab beds available, and those that are open come with a great cost. We help bridge patients through opioid withdrawal while they try to stop using during their wait. The strategy has worked in other communities and we’re happy to bring our resources to bear.

There’s a lot going on in the industry today and frankly it’s been refreshing to hear providers talk about something other than how much they hate their EHRs and how much they think they’ve been meaningfully abused. I’m interested to hear what non-providers think about these recent developments.

Ready for Amazon to get in our business? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/1/18

Veterans Affairs Wasted Closer to $2 Billion On Failed IT Projects

Public and private audits reveal that the VA spent nearly $2 billion on three failed EHR projects between 2001 and 2016 – a sobering statistic in light of the department’s impending contract with Cerner, valued at $10 billion.

US public health chief quits over financial conflicts

CDC Director Brenda Fitzgerald, MD resigns after reports surface she purchased stocks in a Japanese tobacco company after taking the helm.

CHIME Kicks Off Opioid Task Force with Inaugural Meeting in DC

CHIME creates an opioid task force that will leverage the expertise of its members and their access to data to identify best practices and develop protocols to prevent, identify, and treat opioid abuse.

Readers Write: How IT Professionals Can Work More Effectively with Physicians

How IT Professionals Can Work More Effectively with Physicians
By Stephen Fiehler

Stephen Fiehler is IS service leader for imaging and interventional services at Stanford Children’s Health in Palo Alto, CA.

Be Agile – Work Around Their Schedule

Stop inviting orthopedic surgeons to your order set review meeting from 2:00 to 3:00 p.m. on Wednesday at your offsite IT department building. That is not a good use of their time. And good luck getting them to log in and pay attention to your GoToMeeting from 10:00 to 11:00 a.m. on Thursday.

Some electrophysiologists I work with are only available at the hospital at 7:00 a.m. on Tuesdays or Thursdays. I get there at 6:45 a.m. and have everything ready to go when they walk in the room so we can get through as much content as possible. The best time to meet with an invasive cardiologist is in the control room between cases. When I need to validate new content with them, I wear scrubs and work from a desk in the control room for half a day to get a cumulative 30 minutes of their time. This way, if cases run late, they can get home to their family at 8:00 p.m. instead of 9:00.

As long as I have my laptop, my charger, and an Internet connection, I can be productive from any location that works best for the physicians. Their time is more valuable than mine. The more time I take them away from patient care is less revenue for the hospital and fewer kids getting the medical treatment they need.

There are physicians that have the bandwidth to spend more time with us on our projects, but it is imperative that we not expect it from them.

Be Brief – Keep Your Emails Short and Concise

Review your emails to physicians before sending them. You could probably communicate as much, if not more, with half the words.

When I was at Epic, one of the veteran members on the Radiant team had a message on his Intranet profile instructing co-workers to make emails short enough that they could be completely read from the Inbox screen of the iOS Mail app. Any longer, and you could assume he would not read or reply.

If an email has to be long, bold or highlight your main points or questions. Most physicians have little time to read their email. Show them you value their time and increase the likelihood that they will read or reply to your message by keeping it concise. Writing shorter emails helps you waste less of your own time as well.

Also, use screenshots with pointers or highlighted icons when appropriate. They might not know what a “toolbar menu item” or a “print group” is.

Be Service-Minded – Do Not Forget IT is a Service Department

The biggest mistake a healthcare IT professional can make is forgetting that we are a service department. The providers, staff, and operations are our customers. It is our job to provide them with the tools they need to deliver the best patient care possible. That is why the IT department exists.

Given the complexity of our applications, integration, and infrastructure, it is tempting to forget that we are not the main show. Whether we like it or not, we are the trainers, equipment managers, and first-down marker holders, whereas the providers are the quarterbacks, wide receivers, and running backs.

By focusing on providing the best service possible, you will implement better products and produce happier customers. At the end of the day, we want to be effective and to have a positive impact on the organization. The best way to do that is through being service-minded.

CIO Unplugged 1/31/18

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

First Days

This is the third of a four-part series on key considerations and action items during your first 120 days in a new job.

They say the typical executive will switch positions 5-7 times during his or her career. How can you ensure a smooth and effective transition? This series is intended to compliment what others have written over the years with some fresh perspective. This post will begin where the last left.

Below are some ideas to consider from Day 31 – Day 60. A shout out to several peers whose experiences are reflected below.

Wayfinding

By this time, you should no longer need a GPS to find your way around campus. You are becoming familiar with the organizational culture and building foundations of trust with key leaders and team. You can now move to the next phase.

Meet and Greet

Continue your campaign to hit the ground listening. If you have already met with the primary leaders and influencers, meet with their direct reports. At the end of each week, look for key themes and opportunities and share with your team. Determine which challenges to pursue. Always close the loop with a handwritten note and share what action you are taking, if applicable. Remember, you have to build trust and confidence in you.

Extra: Publish key discoveries and the status of the action items to solve uncovered issues.

Vendors

By this time, the vendor community knows you are the new leader and how to reach you. Preserve your time. Unless something is on fire, resist the temptation to spend time with vendors until later. I believe in vendors as partners and I am a strong advocate of collaborative relationships that serve the best interest of the new organization. It is generally not a day 31-60 task. I will discuss leveraging vendors as partners in the next First Days blog.

Extra: Vendors interested in your success will provide invaluable organizational insights.

Assimilation Acceleration

Progressive organizations will have formal assimilation programs. Dive in head first. Take advantage of all programs offered. Assimilation is a process to help you identify any blind spots you might have as you immerse yourself in the new culture. It’s critical to receive feedback from peers and direct reports. Some of the feedback may hurt, but listen and learn.

Extra: If there is no assimilation program, work with your HR and develop one.

Coaching

Many organizations will offer formal coaching programs. Again, take full advantage of all resources offered aimed at helping you successfully transition in your new role. Leaders covet opportunities to enhance their abilities. If your organization does not offer coaching, ask for it. Asking for help is not a weakness, it is a strength. Arrogance stifles potential.

Extra: Interview potential coaches and go with the one who appears most unafraid to get in your face.

Present Often

Now is a good time to make yourself available to your organization so they can know you deeper and ask questions. Send invitations to all your management and offer to speak at their next team meeting. Make it a goal to make yourself available to all the smaller management teams in your division. Town Hall events are important, but the smaller the audience, the bigger opportunity for engagement.

Extra: Arrange a tour of different work areas so you can increase the odds of one-to-one interaction.

Live Healthy

More than ever, take care of yourself as a person. Leading is hard, but leading in a new job is harder. If you moved geographically, then the level of difficulty is increased exponentially. Eat clean, eat healthy. Drink in moderation, if at all. Get rest. You will be tempted to get up early and stay up late working, but the ROI is negative over time. Progressive companies often correlate healthcare benefit costs with live-healthy attributes, which provide additional incentive.

Extra: Share with friends and family your live-healthy goals so they can encourage you and hold you accountable.

The Why

You were hired into your role to bring about change. People will more readily follow leaders with a change agenda if they understand the why. As you formulate your go-forward strategy with your team, make sure everyone can articulate the why. Why do we need to change? Why is it important? Why should we change? Make sure the why is easily articulated and inspiring.

Extra: Ensure your manager is agreeable to and understands the why as well.

The Team – Gaps

If you have engaged deeply, you should be in the forming and storming stages. You may already know what gaps are in the team. This is not a bad thing. To think that there will always be this perfect match of new leader coming into an existing team is a fairytale. If there are gaps, identify them and fill them.

Extra: Engage the team in any new hire decisions, including full veto power over candidates.

The Team – Fit

If someone is a bad fit, address it quickly. Both you and the individual know it already, even if unspoken. It is likely the team also knows it. The worst thing you can do is to let it continue. It is bad for the individual involved, the team, you, and the organization. A bad fit does not mean a bad person or poor performer. It just means that there is probably a better fit for that person elsewhere. Sometimes it can be a fundamental philosophical difference that can’t be transcended. Sometimes it is a severe personality clash.

Extra: Be an advocate for that individual and assist him or her in their transition.

The Team – Develop

“Everything rises and falls on leadership” (Maxwell). Invest everything possible in developing your team. The ROI on developing engaged people interested in improving is immeasurable. The dividends pay out continuously. Take advantage of HR programs and supplement generously with IT specific programs.

Extra: Create complimentary opportunities that you can curate internally to increase your people development reach.

The Next 30 Days

While you are beginning to settle in and better understand your role, in Days 61-90, you lay out the strategy and begin execution. I’ll review some key considerations and takeaways in the next post.

Feedback

What other considerations and action items should leaders consider in their second month of a new role?

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

HIStalk Interviews Niki Buchanan, PHM Business Leader, Philips Wellcentive

Niki Buchanan is PHM business leader of Philips Wellcentive of Alpharetta, GA.

Tell me about yourself and the company.

I am the PHM leader for Philips Wellcentive. I have been in healthcare IT for over 15 years. I came from the EMR world and have done implementations in a clinical setting. I’m an Epic-certified consultant and have spent time with at other EMRs throughout my healthcare experience.

Philips Wellcentive is focused on value-based care and population health management. We believe we have the tools and the capabilities across our broad business to help healthcare outcomes, help our customers reduce cost, and look at that on a patient population basis.

How would you describe the population health management technology market and Philips Wellcentive’s place in it?

My gosh, it’s so positive. There continue to be opportunities for organizations such as ourselves to leverage what’s happening, both from a legislative perspective and industry and compliance perspective.

Value-based care is here to stay. There are so many initiatives in Congress, on the Hill, as well as happening within the commercial payer organizations that are continuing to drive the opportunity for us to improve clinical quality in our healthcare settings, look at what we’re seeing as far as costs go, and help reduce those costs. But still striving towards quality as well as expanding our views beyond the fee-for-service mentality towards bundled payments and opportunities where we control the costs, but we still provide that high quality of service.

I am very excited about what 2018 has to offer us. When you look back on 2017, all of the data is coming out about how many ACOs formed last year, how many of them chose and opted into extended contracts with Advance Payment Models, and how many are looking to do Advanced Payment Models, specifically around ACOs. We’re heading into our first year of MACRA and MIPS reporting. Now we’re pivoting and evolving even more towards opportunities with value-based care. We see it as a continual business transformation opportunity, not just for our customers, but for everyone in healthcare to drive the change and the effective change we’re looking for to improve patient quality, experience, and reduce costs.

What are the primary technology components of population health management and what does Philips Wellcentive offer?

We tend to base our decisions and our strategy on partnerships that we have in the industry, specifically KLAS. KLAS says you should be evaluating your pop health partner or your value-based care partner upon six driving factors.

When you look at the Philips portfolio and the opportunities that we have to help our customers consume value-based care, it starts with the most simple of simple. We’ve got the data aggregation tools, the data analytics tools. You can do advanced insight and reporting, which meets all of those basic compliance and governmental regulation type submission programs.

We expand into even more analytics and opportunities to do proactive outreach, proactive care coordination. We provide opportunities and tool sets that allow our customers to do chronic care management, which is new in the value-based care world. Opportunities exist to do that care coordination and care outreach and get reimbursed for it, which is the key with value-based care.

So many of the organizations we’re working with are trying to figure out how to maximize their fee-for-service opportunities through wellness visits, get-healthy visits, well checks, etc. Yet at the same time, they’re balancing risk in some of these ACO or Advance Payment Model contracts with their insurers. We believe you need tools that help you with the financial side as well as that care and care coordination or clinical side.

KLAS also added the criteria in the past two years that says that if you are focused on value-based care and improvement for patients and clinicians, then you need engagement tools that allow the clinicians and the patients to have communication beyond the regular hospital walls, beyond their primary care visit, beyond their specialist visit. You need to have communication opportunities between these two entities because they are the driving force of healthcare.

We believe we have the right patient monitoring tools as well as the right partners. American Well is a great example of that, to enable us to bring the technology, software, and the patient experience even closer to the healthcare system.

Philips acquired Wellcentive about 18 months ago, explaining that it was a good fit with its other businesses, such as telehealth and home monitoring. What’s the vision for tying those businesses together?

We continue to progress through our strategy on that very front. Bringing the businesses together, the various groups you mentioned, is an exact reflection of how we see the market going in order to support customers with these value-based care contracts.

We have strong initiatives on the Hill right now, where we’re hoping and advocating that providers can be continually reimbursed for the telemonitoring opportunities and these patient monitoring opportunities. We see that as a direct reflection not only of the tools we provide, but that opportunity to engage the patient beyond the clinical setting. If providers can’t be reimbursed specifically for those fee-for-service visits, or a limitation of fee-for-service visits, they need alternate ways to not get negatively impacted, but yet still provide the same level of care as before.

Bringing together Philips Wellcentive, bringing together our hospital-to-home, ambulatory business, and even other components within our organization to allow us to expand and deliver medication management within the home, collect that data, and bring that back into our system and EMRs. We see these all as a continual part of our strategy for tackling all areas of value-based care and pop health management.

Philips confirmed layoffs in the population health management business to me a few weeks back, with the spokesperson explaining that it was due to “the dynamic nature of the population health management business.” What forces are in play that required changing the workforce?

There are always opportunities for us, whenever we’re revisiting our strategy, to stay focused on what’s important for our business. That opportunity for us is always in gaining our efficiencies as well as aligning our strategy toward what our customers need. We are pleased with the strategy that we’re rolling out in 2018. We see us as having all the components we need to be successful. I appreciate that you’ve covered that topic with our PR department. Obviously, they’re the ones to provide the standard response to that.

Philips recently announced several acquisitions, with the one that seemed most relevant to me being VitalHealth and its outcomes measurement. How does that fit?

We see it as absolutely critical and pivotal to our business in both the European market and the Asian market. VitalHealth is well known, with a great customer base. They’re a creative group of individuals, now part of our larger pop health strategy. Yes, we absolutely see it a part of our key business going forward. There will be opportunities for the market to hear more about them at HIMSS this year as well. We’re excited to be able to expand the global footprint and meet our customer’s demands and needs across the globe with having this acquisition and this new family member as a part of our business.

Does Apple Health Records have a place in population health management, or is it only of consumer interest?

Oh gosh, isn’t it exciting? I love the age we’re living in right now. It feels like every day I wake up and there’s a new article about some consumer-driven business that is having a positive impact on healthcare. Yes, I absolutely think there’s a place for that kind of innovation and technology. I see organizations such as ours, Philips, being able to capitalize and partner with these types of entities.

Pop health 10 years ago was a strategy in and of itself that was segmented by healthcare organizations. It is a business transformation opportunity now, and it’s being visited and seen that way over and over again in the market. I get excited at the CVS mergers and the new ways of thinking about bringing people in for their yearly immunizations, because this is the opportunity. If we’re able to leverage consumerism at this level and at this scale across North America, and of course the globe, we’re going to allow providers, when they have the patient in the office, to practice to the top of their license. They don’t have to worry about all the routine things that occur for a patient every year.

When I think of the impact of EMRs, I spent a career helping set them up across different organizations. I love the fact that there’s a digital record — for me, for you, for patients across the country — that reflects the care that they have received. But I love that we’re taking that data out of the patient record now and we’re deciding on proactive opportunities for caring for them. We’re pivoting away from sick, we’re pivoting towards well care, which is a hugely opportunity for all of us. In addition, because our providers and our clinicians are now used to using an EMR, there is the opportunity for data aggregators such as Philips Wellcentive to take that same information and display it back at the clinician’s fingertips in their EMR.

We are opening up our partnerships. We are opening up our technology. We’ve always had an open platform, but we’re doing so in a strategic way this year to say, do you want to keep your clinicians working in their EMR? We have the data you need for them to make some clinical decisions while the patient is in your office. Let us take care of that for you. Let us create the technology and merge with the technologies out there so that you have banners or pop-ups that tell you what you need to do at the point of care. Don’t worry about how the data got there — just know that it’s valid, it’s clinically relevant, and it’s the right data at the right time. I’m excited about the future there.

The term “population health management” sounds a bit paternalistic, something providers do to faceless groups of patients because they get paid to check boxes when electronically prompted to do so. Does a conflict exist between what providers want to offer and what consumers would like to have?

Absolutely. I don’t think “conflict” is the word I would use. I see it as a coming together. I’m a patient. I’m a consumer. It drives me insane that I have to make a physical phone call to be able to get in and have the care that I want available. I have a son who has been through many medical treatments over the years. The opportunity to get online and schedule a visit, a follow-up visit, for him, to be able to do all that online or from my smartphone seems like the most logical thing, and the way the consumerism market and expectation is driving towards.

Does it put it in conflict with some of our older, established technologies in healthcare? Maybe. But, with innovative companies like Philips and others that are out there, we should be able to build simple tools, simple applications, that allow all that robust technology that we already have in house to simply get connected. When you talk about consumerism, I immediately think it’s all about connectedness. It’s all about us having access to seamless care and opportunities for us to interact even more so with our providers in the way that makes the most sense for us. Granted, I’m a 45-something year old person, I love my iPhone, and what I’m saying may not play well for a 70-year-old or a 17-year-old. But the whole idea around access, patient engagement, and me — where I am at my stage of life — being able to interact with my well care, my sick care for my children, it just makes perfect sense to me. I think we’re all on the right path. We just need to do it better together.

Do you have any final thoughts?

Everything in the industry is going our way right now. Everything in healthcare, everything as far as policy, everything as far as reporting, it is all aligning. The planets are aligning and we have spent so many years as a business planning for this coming together, this tsunami of value-based care that’s on its way.

We feel like we are well positioned to help our customers, prospects, and partners leverage the tools and the data they have to make the right decisions, provide the best care, be efficient around their costs, and strategically plan the business transformation that they’re undergoing. So many are new to risk and risk contracts. We are helping, in partnership, prepare them for that next level of risk, their ACO or MACRA Year 2 reporting. We are excited and we feel like we’ve got everything in the portfolio we need, as well as the partnerships, to be successful in 2018 and meet our customers and our prospects where they are.

Morning Headlines 1/31/18

Epic Interoperability Creates One Virtual System Worldwide

Epic announces new functionality that includes components called Come Together (gathering data), Happy Together (presenting data from multiple sites in MyChart), and Working Together (allowing users to take action across Epic-using organizations).

Amazon, Berkshire Hathaway and JPMorgan Chase & Co. to partner on US employee healthcare

Amazon, Berkshire Hathaway, and JPMorgan will create an independent company to provide healthcare services to their 1.2 million employees that will be “free from profit-making incentives and constraints.”

Coast Guard considers EHR partnership with DoD, VA

After seven years and $60 million, Coast Guard officials announce they will consider moving medical documentation to Cerner-powered MHS Genesis after a botched attempt at implementing Epic.

Dell is considering a sale to VMware in what may be tech’s biggest deal ever

Dell may undertake a reverse merge with publicly traded VMware – of which it already owns 80 percent – to allow Dell to become publicly traded without running a separate IPO.

News 1/31/18

Top News

Epic issues a rare press release to tout “One Virtual System Worldwide,” new functionality that includes components called Come Together (gathering data), Happy Together (presenting data from multiple sites in MyChart), and Working Together (allowing users to take action across Epic-using organizations). 

Epic sites using Working Together can:

• View thumbnail images from other Epic sites, which when clicked will retrieve a reference-quality image.
• Book appointments with another Epic site to which a patient is being referred.
• Allow clinicians to communicate via secure messaging across Epic sites.
• Search for both discrete and free-text data across Epic sites.
• Schedule teleheath visits with other Epic sites.

Future plans include the ability to: (a) check for duplicate imaging and lab orders across sites; and (b) schedule referred patients directly at the new, Epic-using site.

The announcement also notes that Epic sites can exchange 415 discrete data elements vs. the government-required 56.

Reader Comments

From Portal Data Download Blues: “Re: patient portals. Apple’s Health Records has drawn attention to patient portal data, but providers and EHR vendors aren’t great at keeping those running despite collecting Meaningful Use dollars. The download function of University of Washington’s MyChart hasn’t been working for weeks. Either it’s not popular or there are too many obstacles to getting the data. Probably both.”

From WorryWart: “Re: hackers demanding bitcoin. Looks like that practice has started without health records. It’s scary to think about emails starting with, ‘We know you have a mental health condition – deposit two bitcoin or we release it.’ Could be the end of bitcoin itself.” The FBI warns of a surge in emails that start with, “I’ve got an order to kill you” but then offer to cancel the hit for $2,800 in bitcoin.

From Potential Voter: “Re: the HISsies awards. How can folks vote?” I directly sent ballots to the 13,000 or so people who have signed up for HIStalk email updates. Those ballots are tied to their email addresses, limiting votes to one per reader in preventing ballot box stuffing (SurveyMonkey is brilliant and — as far as I know, unique — in offering that option inexpensively). Those emails went out Monday night and around 700 ballots have been completed as I write this. So far, the majority’s vote matches my own in 14 of 16 categories.

HIStalk Announcements and Requests

What do you wish you’d known before bringing an ambulatory EHR live? Take a few seconds to tell me to increase your enjoyment of reading the collective recap later this week.

I’m anxious to load up on Cerner shares and maybe some Adobe given the obvious analytical prowess and overall attention to accuracy by this PhD-claiming editor, who offers on the side his services described as, “Enhance you’re allowing to compose me to edit and alter your archive for the standard linguistic and expressive blunders that we all make.” I shall hazard a guess – supported by a lack of LinkedIn contact information for Dr. Editor – that his American-sounding name wasn’t any more parentally assigned than that of an unintelligible, far-away call center rep claiming to be “Chuck” or “Wayne.”

USA Today’s technology columnist bangs out a quick story, “I tried Apple’s improved Health app. Here’s what I found,” that buries a critical point about his Health Records test drive 15 paragraphs down: “Since none of the 12 health institutions are in my back yard or store my data, I could only go so far in testing the updated app.” Translation: all he did was navigate to the Health Records login screen.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Acquisitions, Funding, Business, and Stock

Amazon, Berkshire Hathaway, and JPMorgan will create an independent company to provide healthcare services to their 1.2 million employees that will be “free from profit-making incentives and constraints.” Warren Buffett referred to healthcare in the announcement as “a hungry tapeworm on the American economy,” Amazon’s Jeff Bezos said that “reducing healthcare’s burden on the economy while improving outcomes for employees and their families would be worth the effort,” and JPMorgan Chase CEO Jamie Dimon said the company will create solutions that not only benefit employees, but “potentially, all Americans.” That’s nearly $200 billion of net worth talking. Skeptics note that big businesses have tried and failed in the past to band together to force provider costs down, but healthcare-related stocks still led the market sharply down Tuesday after the announcement.

The HCI Group acquires Meditech consulting firm Infinity HIT.

Spain-based blood products vendor Grifols invests $98 million for a 51 percent stake in MedKeeper, which sells hospital pharmacy software for IV compounding, medication tracking, cart management, and unit inspections.

Harris Healthcare moves Canada-focused Emerald Health Information Systems from its sister company MediSolution to Harris Healthcare Clinical Solutions, where it will join its EHR, clinical documentation, medication management, and acuity-based staffing products.

Dell may undertake a reverse merge with publicly traded VMware – of which it already owns 80 percent, gained in its $67 billion merger with EMC in 2015 – to allow Dell to become publicly traded without running a separate IPO. It would be the biggest merger in tech history, allowing Dell’s shareholders to reap the benefits of the merger and helping Dell pay down its $50 billion in debt. VMware’s growth has slowed as customers move from running data centers with virtual servers to cloud-based systems.

Sales

In England, East Lancashire Hospitals NHS Trust chooses Cerner Millennium. 

Crawford Memorial Hospital (IL) chooses Cerner under its CommunityWorks hosted model.

Peterson Regional Medical Center (TX) adds Access’s web-based Passport Registration and Passport Clinical to its existing electronic forms and signatures implementation.

HCR ManorCare will roll out PatientPing’s care coordination platform to its 500 post-acute and long-term care facilities.

Washington University School of Medicine (MO) signs a partnership agreement with Israel-based MDClone to aggregate research data from BJC HealthCare in the company’s the first deal outside of Israel. The 25-employee MDClone was founded in March 2016 by Ziv Ofek, who started dbMotion and sold it to Allscripts for $235 million in 2013.

People

Influence Health promotes CTO Rupen Patel to CEO. He replaces Mike Nolte, who will leave the company.

Christopher Maiona, MD (Team Health) joins PatientKeeper as chief medical officer.

Announcements and Implementations

Highlights from “Best in KLAS 2018”:

• Acute care EMR, large hospital/IDN: Epic
• Community HIS: Meditech
• EDIS: Wellsoft
• HIE: Epic Care Everywhere
• Laboratory: Epic Beaker
• Ambulatory EMR, large practice: Epic
• Ambulatory EMR, medium practice: Athenahealth
• Ambulatory EMR/practice management / small practice: Aprima
• Practice management, large practice: Epic
• Practice management, medium practice: Athenahealth
• Patient accounting, large hospital: Epic
• Overall software suite: #1 Epic, #2 Meditech, #3 Cerner
• Overall physician practice: #1 Epic, #2 Athenahealth, #3 GE Healthcare
• Overall IT services: #1 Optimum Healthcare IT, #2 Impact Advisors, #3 HCI Group
• Non-US EMR: Cerner

Government and Politics

A GAO report to Congress says the US Coast Guard is placing service members at risk because it went back to paper recordkeeping following its attempt at implementing Epic, which consumed seven years and $60 million (not counting internal and external labor costs) before the project was abandoned in October 2015. USCG retired two legacy systems that Epic was supposed to replace, with project’s failure forcing it back to paper and Microsoft Office applications. USCG had implemented the DoD’s old CHCS system in 2002, but decided the cost of moving to AHLTA in 2009 wasn’t worth it and instead signed a $14 million contract for Epic’s ambulatory EHR. It found during implementation (!!) that several other of its legacy systems were outdated, requiring a project expansion to include another 25 vendors at an additional cost of $56 million. GAO analysts found poor project oversight and still-undocumented lessons learned. The GAO recommends that USCG get moving on deciding what it wants to do given that it launched a procurement process in February 2016 and identified its desired solution in October 2017. USCG responded that it plans to award an EHR contract later this fiscal year. USCG’s health division covers 50,000 service members, retirees, and dependents from its 41 clinics and 125 sick bays (easily depressed taxpayers shouldn’t perform the cost-per-member math of yet another bungled government software project). In a follow-up House committee hearing, Rep. Duncan Hunter (R-CA) pressed USCG to “not waste time and money” and simply choose Cerner as did the DoD and VA, but Rear Admiral Michael Haycock says that while that’s an option USCG is considering, more due diligence is needed before signing a contract.

Iowa’s state senate is reviewing a bill filed by the Board of Pharmacy that would make it illegal for providers to hand-write prescriptions, which worries the state’s medical society, which fears that providers won’t be ready by the the July 1, 2019 compliance date.

Privacy and Security

HHS’s latest cybersecurity newsletter offers cyber extortion tips.

Innovation and Research

HD Medical markets a Bluetooth-connect stethoscope that captures heart sounds as well as EKG waveforms, with FDA approval pending.

Other

A doctor in Canada is suspended for one month for altering the electronic medical record of a patient after she died, modifying several notes to falsely indicate that the patient had refused treatment recommendations.

Jen Gunter, MD writes a hilarious, occasionally profane, and brilliantly scathing recap of her undercover attendance at the “In Goop Health” conference run by Gwyneth Paltrow-owned Goop and the out-there medical claims made by its speakers.

I was initially worried they wouldn’t let me register, but some quick homework told me they had offloaded registration to a third party, so I thought it highly unlikely there was a no-fly list. I did consider that I was just full of myself and they just didn’t care about me attending; however, along the way I received a tip that the Goopsters hate me more than gluten, cow’s milk, and McChemicals combined, so I think they just never thought I would go … There were non-toxic manicures that smelled as bad as regular manicures, some weird facial station that involved a mask that looked like an early prototype from “Phantom of the Opera,” and Sonic Womb music … There was a drink that tasted like the inside of a spa. If you actually rinsed down a spa and put the effluent into bottles, this is what it would taste like. There was also charcoal lemonade. It tasted like lemonade. The guy handing it out said it was good for “toxins.” I explained that charcoal was an antidote for poisoning and that it did not bind toxins and that I was toxin-free. He didn’t care. At “In Goop Health, ” the truth is irrelevant and words are meaningless … The actual content started at 10 a.m. GP (her formal name, no one calls her Gwyneth) was the mistress of ceremonies, and for such a seasoned actress, she said “um” a lot. She looked fine, but up close she looks her age, so there is no magic in Goop skin care products. The glowing twenty-something skin on the magazine covers is just the power of Photoshop.

In India, a hospital visitor dies after accompanying an elderly family member to the MRI room while carrying the patient’s oxygen tank, causing the 32-year-old to be sucked into the MRI machine where he was crushed. I’m guessing that someone offers a magnetic or metal-detecting door sensor that won’t allow anyone to enter an MRI room with metal when the machine is turned on.

Sponsor Updates

• Catholic Health Initiatives implements Summit Healthcare’s Summit Scripting Toolkit for workflow automation.
• ROI Healthcare Solutions publishes an explainer video of its services.
• PatientPing  publishes a case study of how Pioneer Valley Accountable Care used its system to improve care coordination.
• Audacious Inquiry will present at the MDHIMSS Winter Educational Event February 2 in Baltimore.
• Besler releases a new podcast, “The state of value in US healthcare.”
• CoverMyMeds will exhibit at the NACDS Regional Chain Conference February 4-6 in Fort Lauderdale, FL.
• Fundación Valle de Lili Institute becomes the first in Colombia to achieve HIMSS EMRAM Stage 6 following high adoption of Elsevier’s Care Planning solution.
• EClinicalWorks outperforms Allscripts, Athenahealth, Epic, and NextGen in physician satisfaction, according to a Reaction Data report.
• Huntzinger Management Group announces a strategic partnership with Coretek Services.
• Intelligent Medical Objects CEO Frank Naeymi-Rad speaks at Harvard Medical School as part of its clinical informatics lecture series in Boston.
• Kyruus reports record-breaking success in 2017 with almost 400 hospitals now on the ProviderMatch platform.

Blog Posts

• Arab Health Opens Its Doors in Dubai (Agfa HealthCare)
• Halamka, Norwalk to Deliver Keynotes at Aggregate2018 (Arcadia Healthcare Solutions)
• HIPAA Enforcement in 2017: Key learnings from others’ mistakes (Datica)
• Increased Flu Deaths: Teaching Patients About Flu Prevention (CareSync)
• Medication Management of the Future: Connecting the Pharmacist to the Care Team (Casenet)
• Change Healthcare Wins Big at 9th NTC Awards (Change Healthcare)
• How Creating Happy Staff Members Results in Happy Patients (ChartLogic)
• 3 Advantages to Using Simulation in Predictive Analytics (Dimensional Insight)
• Healthcare is Now the Largest Employer in the US (The HCI Group)
• The Secret to Creating the Most Satisfied Patients (Healthwise)
• Meltdown and Spectre Hardware Vulnerabilities – What You Need to Know (Impact Advisors)
• Here’s Looking at You Targeting Tips for Facebook (Influence Health)
• New Year’s Resolutions are Bad for Payment Security (InstaMed)

HIStalk Sponsors Listed in Best in KLAS 2018

Best in KLAS

Aprima: Small-Practice Ambulatory EMR/PM
Casenet: Care Management Solutions (Payer)
Change Healthcare: Payer Quality Analytics
Chartis Group: Financial Improvement Consulting
Health Catalyst: Business Intelligence and Analytics
Impact Advisors: HIT Enterprise Implementation Leadership
Meditech: Community HIS
MModal: Speech Recognition (Front-End EMR)
Navicure: Claims and Clearinghouse (over 20 physicians)
Optimum Healthcare IT: HIT Advisory Services, HIT Implementation Support and Staffing
Recondo: Patient Access
Wellsoft: EDIS

Category Leaders

CenTrak RTLS: Real-Time Location System
Change Healthcare Ansos Staff Scheduling: Nurse and Staff Scheduling
Change Healthcare True View: Health Price Transparency
Clinical Computer Systems Obix Perinatal Data System: Labor and Delivery
Elsevier Care Planning: Clinical Decision Support (Care Plans / Order Sets)
HealthCast eXactAccess QwickAccess: Single Sign-On
Iatric Systems Security Audit Manager: Patient Privacy Monitoring
Impact Advisors: Clinical Optimization, Revenue Cycle Optimization
Meditech C/S and 6.x Patient Accounting: Patient Accounting and Patient Management (Community Hospital)
Nuance Clintegrity Coding: Medical Records Coding
Nuance Clintegrity Quality Solutions: Quality Management
Optimum Healthcare IT: Go-Live Support
ROI Healthcare Solutions: Business Solutions Implementation Services
Salesforce CRM: Customer Relationship Management
Strata Decision Technology StrataJazz Decision Support: Business Decision Support

Overall Software Suite

Medhost: #7
Meditech C/S: #2

Overall Physician Practice Suite

EClinicalWorks: #7

Overall IT Services

CTG: #9
Encore: #5
HCI Group: #3
Impact Advisors: #2
Leidos Health: #7
Nordic: #6
Optimum Healthcare IT: #1
Santa Rosa Consulting: #8

Overall Healthcare Management Consulting

Chartis Group: #3

Non-US Acute Care EMR

InterSystems TrakCare EPR: Middle East
Meditech Enterprise Medical Record 6.x: Canada

Contacts

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

Morning Headlines 1/30/18

Landmark Health Explores Possible Sale

Home healthcare company Landmark Health considers a full or partial sale, possibly giving CEO and shareholder Adam Boehler the opportunity to take on a leadership position at the Center for Medicare and Medicaid Innovation.

Congress inspects Coast Guard EHR fiasco

The House Transportation Committee will try to get to the bottom of why the Coast Guard canceled a $14 million contract with Epic two years ago – a decision that has sent medical personnel back to paper records.

Tyto Care Raises $25M Led by Ping An Global Voyager Fund

Israel-based telemedicine hardware and software vendor Tyto Care raises $25 million with support from China-based Ping An Insurance Group.

Trump wants US Health Secretary to get tough on drug prices, opioids

President Trump and Vice President Pence swear in Alex Azar as HHS Secretary.

Curbside Consult with Dr. Jayne 1/29/18

We talk quite a bit in the health IT world about efficiency strategies such as muscle memory, use of order sets, care plans, and team protocols. Those strategies and solutions are mandatory if you’re going to try to get through a day filled with dozens of patient encounters while keeping your sanity and trying to finish your documentation before you go home.

In my office, the clinical team works in an open area in the center of the clinical suite. Patient rooms, procedure rooms, the laboratory, and radiology areas are wrapped around the outside. In many ways it’s good, because you can see what’s going on with patients – whether they’ve gone to x-ray yet, whether they’re back from the restroom, etc.

In some ways it’s a challenge because you’re always “on stage” when patients walk by on their way to an exam room or another destination. You have to manage your own positive or negative energy in that situation, and avoid scowling at the EHR or expressing your frustration when patients roll in the door 10 minutes before closing time with a chief complaint they’ve had for weeks.

Our practice is a high-touch, high-service environment where we work hard to make patients feel that we appreciate their business and are invested in their well-being. You get used to wishing patients a “feel better” or “thanks for coming in” as they walk by on their way out.

At times, the muscle memory becomes a bit reflexive, though. My staff had some laughs at my expense this weekend. I was heads-down documenting and a couple of patients had gone by with the usual comments – “Thanks for coming in, we’ll call in a few days to check on you” and “Let us know if you’re not getting better” and so on. Another figure headed my way and I was on autopilot as I thanked him for coming in and said that I hope he feels better. He looked at me a little quizzically but smiled. As he went around the corner, my staff erupted in laughter — he was the evening pickup driver from the reference lab and I completely missed his uniform and the fact that I had not seen him in the exam room.

It was a good lesson that sometimes our quest for efficiency can blind us to the details of our day and that we have to stay vigilant to make sure we’re doing the amount of listening, data gathering, and synthesis of information that we really should be doing. Being on auto-pilot is not necessarily a good thing. I’m sure it’s not the first time the lab rep has encountered someone who commented as I did, but it certainly made me think twice about being more attentive as people are walking by the clinical work area.

The weekend was super busy and confirmed that influenza is not yet on the wane. We’ve had to temporarily shut down our online check-in system because of the patient volumes we’re seeing. The automation was allowing large queues to build without the ability to intervene. When we have people arrive at the office instead, we can let them know what the wait time is at their location as well as where the next-closest location with a shorter wait time might be. I have four days to recover before my next clinical shift, and after tonight, I definitely need it.

I’m starting to do my HIMSS planning and happened across this graphic along with encouragement from HIMSS for people to join in order to save on registration. Even with the “member discount,” HIMSS is still an expensive proposition, with some of the more convenient hotels that are close to the convention center being some of the most expensive. I’ve stayed in enough budget hotels that are hike from the convention center to have earned a little splurge this year, which should be good for trying to rest and refresh between the conference and evening activities.

I tried to eyeball the session schedule, partly in response to some teasers in the HIMSS18 Preview edition of Healthcare IT News. Unfortunately, the one session I wanted to put on my calendar was advertised as being on “Wednesday, March 8” which unless I’m missing something, isn’t a date on this year’s calendar. I searched for the session on both Wednesday the 7th and Thursday the 8th and couldn’t find it on either, leading me to believe that perhaps it’s in another space/time dimension.

I’m also starting to put my evening plans together and there are openings in the social schedule. If you are interested in having Team HIStalk drop by your event, send along an invitation. We register anonymously so you won’t know exactly whether Dr. Jayne or anyone else will be in the house, but we’ll be sure to mention your event in our daily HIMSS recap. If your event is open to HIStalk readers, let us know and we’ll include it on HIStalk as we prepare for the big show. I love meeting new people at events and hearing their impression of HIMSS and the industry as a whole. Plus, I’ve got some new dancing shoes and am looking forward to being out on the town.

One of my medical school classmates reached out to me over the weekend knowing I’m in touch with the EHR industry. He’s trying to figure out how to attach his practice to the class action suit that was filed against Allscripts, alleging that the company “intentionally, willfully, recklessly, and/or negligently” failed to take precautions to prevent or minimize the recent SamSam ransomware attack. The filing is actually an interesting read and provides a primer on ransomware and previous similar attacks.

I explained to my colleague how a filing is laid out and that the responsible attorney is listed at the end. I’m not sure how serious he is about joining the Class or getting involved, but if he does and provides updates, I’ll certainly pass them along. Allscripts has tens of thousands of physicians using its platforms, but it’s unclear how many of them were on the impacted systems.

Are you ready for a ransomware attack? If not, why? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jonathan Baran, CEO, Healthfinch

Jonathan Baran is co-founder and CEO of Healthfinch of Madison, WI.

Tell me about yourself and the company.

The fundamental problem in healthcare is there is far more work than there are people to do it, particularly to care for patient populations. Healthfinch closes that gap by automating routine work that’s associated with patient care. We accomplish that with software that sits on top of electronic medical record systems.

The company is just under 50 people. About half of those folks are based in Madison, Wisconsin. The remainder are remote all across the country. We have 5,000 physicians on our platform and 1.5 million patients that we interact with in some form or fashion each year.

Do you worry that EHR vendors could add similar functionality to their core product?

A core premise of the business is that the next wave of healthcare IT will be built on top of electronic medical record systems. I started a PhD at the University of Wisconsin on building tools on top of EMRs to automate work back in 2009. At that time, it was particularly crazy to think about building on top of EMRs. It just wasn’t heard of at that point.

There has been a significant change in thinking that we’ve seen across the industry. We like to think of Madison, Wisconsin as ground zero for healthcare IT. Now you’ve seen every single EMR vendor open up and start to support companies that are not directly competing, but are doing ancillary things to improve their functionality. I believe it started with Allscripts and Athena and now Epic is part of the game.

While there’s a whole bunch of things that EMRs do, I think they are coming to the conclusion that there are far more smart people outside their organization than are in it. The more that they open up their platforms to enable people to do cool things on top of it, the better for everyone, their customers and the vendors themselves.

Healthfinch products are offered on the third-party app marketplaces of Allscripts, Athenahealth, and Epic, so you are relying on their openness and ongoing cooperation. What’s the benefit and the challenge of working in those EHR vendor marketplaces?

It’s not always easy. We knew early on that if we wanted to introduce technology to support providers in any way, it was not going be via a separate user interface or something that caused you to get outside of the EMR workflow. It was going have to be contained in the EMR for it to make sense.

We started this company with the premise that if the electronic medical record doesn’t exist, then we don’t exist. We don’t have a standalone system. We only exist in those EMR markets. That puts us in a unique position.

Certainly there have been challenges over the years. There’s been a big shift in thinking from how companies like us integrate. There was a dominant way of thinking a while ago that HL7 gives you everything you need. But when you start thinking about the world in the context that I just proposed, an API-driven approach needs to be much more prevalent for that to become real. There’s been a change in thinking and technology changes that have come along with it. We’ve had to follow that wave.

The market is not used to buying from these marketplaces. There’s a whole bunch of reasons for that. But you’re starting to see vendors promoting openness a lot more, because they understand it as being a key piece to the business moving forward. They need to talk about their innovations, the cool companies that are sitting on top of them that are doing things that are interesting that might not otherwise be possible. That’s creating a lot of market awareness, but people aren’t used to buying in this sort of way.

You’re going to see this follow a similar trajectory to what you’ve seen from other enterprise systems like the Salesforces of the world. It will take a few big proof points to prove this, but they will come. It’s just a matter of time now that the EMR vendors have started to embrace it.

Can you assume that those EHR vendors will promote your product? Do they have the right incentives — i.e., financial — to do so?

At least in our experience, all the EMR vendors have financial incentives in the form of a revenue share that makes them align with your business. From my perspective, that’s good thing. I want them to be financially aligned enough to make sure they’re moving in the same direction.

In terms of how they help, how each EHR thinks about that, you get slightly different responses from their teams. In some cases, it is a direct promotion. Sometimes they identify a customer that has a high need for what we offer, and they say, “You should check out this company XYZ on our marketplace.” That’s awesome. That’s great. That’s a great way for us to get visibility within the market.

In other cases, it’s more indirect. For better or worse, all these marketplaces start as just, “Look at all the companies that we have.” More and more they become embedded into the way that organization thinks about doing business. But that’s a many-year transition for these companies, so for the ones that have been there longer, you see more of it. It’s a progression.

How do you decide which areas are ripe for third-party innovation and how much effort is required to turn that into a product that works across multiple EHRs?

Identifying areas of market need comes down to understanding your end user. How they think about the world and the challenges that they face day-in and day-out. We have a strong perspective of that at Healthfinch, which is that there is far too much routine work that is overwhelming providers and their staff. That is the premise around which we think about the world.

The question is that, within that broad context, what are the specific use cases or pain points that are causing challenge today? I place an emphasis on the term “use case” because far too often, startups in particular go in with solutions that are general. They are referred to as general platforms or general purpose solutions that are pitched as, “We could solve a bunch of problems for you.” But in reality, you need to be selling use cases to your end users because that’s what will resonate.

Really quickly, the challenges become apparent. Then to the broader point of that, translating that to other EMR contexts and specifically within the EMR — that is definitely a big gap that we see. I’ve never worked at Epic or an EMR company. A number of folks in the company now do or have in the past. But the understanding of these rather complex workflows is a big barrier to innovation right now.

Take the broad concept of automating prescription refill requests. That sounds simple on the surface, but once you start digging a couple of layers down, you realize the complexity. It’s not always easy to uncover that complexity. That’s a big challenge that I think a lot of these EMR companies have. How do I take an idea and turn it into something that works at the highest level? But also something that works day-in and day-out with what we know are the challenges of healthcare IT today?

The good news is that the general themes will hold across all EMRs. The same problems you face are pretty consistent between EMRs. But there’s always that little bit of nuance that’s specific to each of them. It’s a challenge, but if you can get in there and figure it out, it represents a competitive barrier for new entrants.

How do you coordinate and test EHR changes and make sure the customer isn’t straddling incompatible releases of their product and yours?

When we are integrating with these EMRs, they are making an either implicit or explicit promise that their integration points are going to hold from version to version. So in most cases, that’s abstracted away from us and not something that Healthfinch has to worry about. We just have to make sure that we are consistently working with the SLAs that we have with those third-party vendors.

That isn’t always the case, though, and it doesn’t always hold true. I can tell you that five years ago, it was much more of a challenge from release to release. We had to double- and triple-check to make sure that wasn’t the case. That has smoothed out considerably over the last couple of years. It has more tried-and-true process associated with it as they’ve become more used to working with third parties.

Some EHR vendors are well known as having zero interest in working with third parties or offering open access points to their product. Can those vendors continue operating by walling themselves off?

I don’t think so. For the last couple of decades, there was certainly an argument to be made for the highly-integrated electronic medical record system that didn’t work with third parties, working strictly within the four walls of that organization. What’s happening now is that healthcare is becoming far too complex for just one company alone to solve all those challenges. To a certain extent, you’re facing the classic innovator’s dilemma. The approach that has allowed you to win in a previous business environment is the same approach that will cause you to fail in the current context if you continue along.

Will there be some holdouts? Sure. Will it be challenging for those folks? Yes. As these open platforms become more prolific, as customers use third parties and see the value and that these companies that are narrowly focused in given niches that can do a lot more than a company that has to build towards a lowest common denominator, as they see those proof points begin to emerge, those third parties are going be important to their business and how they run things. That’s not to say that that change is going happen overnight, but it’s a fundamental tipping point. A lot of the major players have already made that transition, so it’s only a matter of time.

Where is the company in its growth trajectory and where does it go next?

We are still very much in the growth phase, on the heels of some of these app stores that have come into existence. In the case of Epic in particular, it went live in the last quarter and we’ve seen a nice uptick in business associated with that.

For us, it’s the mindset of going out and growing the business in those areas that you identified. We last raised funding a couple years ago. We’ll be doing a little bit more fundraising, but then we’re driving towards building this thing into a big, profitable business moving forward.

Do you have any final thoughts?

I am truly excited about the time that we live in right now in healthcare IT. The type of change that I mentioned at the beginning has only become possible to build because of the introduction and the adoption of these electronic medical record systems. For the first time in the history of the world, we have an opportunity to drive some incredible change for healthcare systems, physicians, and for patients. So much is changing.

We are at this defining point in the industry’s life cycle. I’m excited to see the innovations that come out Healthfinch, obviously, but also in the industry at large. There’s opportunity everywhere to drive significant improvement.

Morning Headlines 1/29/18

Outcome Health’s Update to our Customers

Outcome Health co-founders Rishi Shah and Shradha Agarwal step down from their management roles as part of a settlement with investors who had claimed that the company misled them about its performance.

Allscripts says all services restored after ransomware attack; lawsuit filed over outage

Allscripts says it has restored all systems after its January 18 SamSam ransomware attack. Meanwhile, Surfside Non-Surgical Orthopedics (FL) files a class action complaint against Allscripts, saying the outage caused it to lose revenue and spend money coordinating with patients.

Google is using 46 billion data points to predict the medical outcomes of hospital patients

Google AI researchers publish their work on extracting full EHR data from 215,000 hospitalized patients to successfully predict in-hospital deaths, unplanned readmissions, prolonged stays, and discharge diagnoses.

Monday Morning Update 1/29/18

Top News

Outcome Health’s co-founders – CEO Rishi Shah and President Shradha Agarwal – step down from their management roles as part of a settlement with investors who had claimed that the company misled them about its performance.

Shah and Agarwal will remain on the company’s board as chair and vice-chair, respectively. They will also join Outcome Health’s equity investors and lenders in investing $159 million to improve its technology and customer operations.

Outcome Health will expand its board to include new independent directors and will launch a search for a new CEO. It will also hire an outside firm to audit the performance of its waiting room ad campaigns, which was the subject of an investigative report suggesting that the company had inflated the numbers. Several big-name investors then alleged that the company had defrauded them of $500 million.

A May 2017 fund raise valued Outcome health at nearly $6 billion, with the 31-year-old Shah’s stake worth $3 billion.

Reader Comments

From Digital Dork: “Re: Apple Health Records. I don’t see why everyone is so excited. Patients can get the same information from their provider’s patient portal. It doesn’t even include OpenNotes.” I’m surprised that the perpetually underperforming health IT industry expected more from Apple’s beta release. The important takeaways are:

• It’s Apple — which has high consumer trust and high adoption rates — connecting via FHIR to EHRs. That’s significant news in itself.
• Patients don’t like and use patient portals all that much. Replacing little-used portals with an IPhone-stored aggregated record is a pretty big deal to consumers.
• Apple can extract and display whatever information the FHIR standard supports. The beta isn’t the end of Health Records development and it’s early to be whining about what it doesn’t do instead of celebrating the fact that Apple was interested enough in patient EHR data to use it as an IPhone differentiator in an increasingly Android world.
• If enough IPhone users want OpenNotes, diagnostic images, or anything else that’s stored in the EHR, they may eventually get it.
• It’s a big deal to give app developers a way to build and sell their products without the permission or participation of EHR vendors.
• Health systems may be overwhelmed with patients wanting their data or demanding that errors they find in it be corrected.

From Apple The InfoBlockers: “Re: Apple Health Records. Your source said they were more comfortable working with Apple, but patients have a right to their data. Why does it bring over a subset of data but not pathology reports, radiology reports, notes, and genomic data? ONC railroaded the public with Meaningful Use that didn’t give patients the full data from their EHR, but this gets the word out about patient-centric interoperability. It also puts to bed excuses by provider / vendor info-blocking consortia like DirectTrust, who have argued that patients can’t participate without in-person identity verification and the Halamka argument that ‘we don’t make patient data available because nobody wants it.’ FHIR is one of the most powerful info-blocking tools out there  and Argonaut in particular is a forum where providers define use cases that work behind the backs of patients. But that game is up since supporting a FHIR interface via a patient portal token means you can support it with any application the patient wants.” It may be that a tiny percentage of patients want to see their entire medical record, and even though there’s always the paternalistic fear that they might apply that information unwisely, I agree it’s their right. However, the average IPhone user is probably more interested in appointments, messaging, and quick access to lab results than second-guessing their pathology notes. Also recall that this is a beta release, a minimum viable product whose development will surely continue if demand exists. The reader observes that only three of the participating health systems use OpenNotes and Health Records doesn’t extract it anyway, so the patient portals of those three Epic sites will offer more information. I’m all for enhancing electronic records access, but what makes me really angry are the extortionate prices health systems charge patients to get even paper copies of their own records, especially when in-house technology makes producing them nearly effortless.

From Madison Ashley: “Re: Apple Health Records. The story in a Madison newspaper says Microsoft has shut down HealthVault just like Google did its Health app in 2011.” It doesn’t say that, only that some of its software has been turned off (it’s referring to the just-retired HealthVault Insights). However, an error-filled article posted on a questionable health IT news site boldly declared that Microsoft has “shut down HealthVault,” only one of many mistakes it cluelessly stated as fact  — HealthVault insights has not been “around since 2007,” HealthVault was never renamed to HealthVaults Insights, and Microsoft hasn’t ended its “mHealth app experiment” (although it might as well). Be careful who you trust for health IT news.

From Bob: “Re: HIMSS exhibitor staff rules. I’ve search endlessly trying to find your rules from a few years ago, such as no talking on cell phones or to each other.” I’ve riffed a few ideas out several times over the years, so since I get asked several times each year right about this time, I started a permanent list. See my “Tips for HIMSS Exhibitors” and send me your additional ideas.

HIStalk Announcements and Requests

It’s a nearly even split on whether Epic is an impediment to innovation. Dev says the risk-averse health systems that spend hundreds of millions of dollars on Epic demand stability and that difficulty of integration is also a factor, adding that organizations can’t continue to wait two years for Epic to implement something and then take another year to run it by their in-house steering committees. Vic says both Epic and Cerner discourage third-party participation in installation, enhancements, and maintenance. Hermanator says its leadership, not the brand of EHR, allows provider organizations to innovate. Ex-Epic says the company’s aversity to PR and marketing mean customers, employees, and the health IT industry are kept in the dark, adding that Epic’s no-acquisition policy runs contrary to Silicon Valley, where everyone wins when side projects or acquisitions can change the world in the right hands.

New poll to your right or here, as a follow-up to the Apple Health Records announcement: which of these activities have you performed on your phone?

Check out the responses to “What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based Application.” After that, please take 60 seconds to weigh in on the new topic, “What I Wish I’d Known Before … Bringing an Ambulatory EHR Live.”

I’ve talked to a few former KLAS employees about how their process works. I would be interested in talking to a couple of additional people just so I get the full picture, all anonymously of course. Contact me.

Listening: Massachusetts-based Speedy Ortiz, which overcomes an obviously limited inventory of talent to create some pretty good grungy rock. They donated their last tour’s proceeds to Girls Rock Camp Foundation. The singer studied math and music for two years before taking a poetry degree from Barnard College. The music is edgy enough to be interesting even when it’s not all that great. There’s also the new album from pastor and songwriter Cory Asbury, who crafts polished and highly listenable worship music.

Welcome to new HIStalk Platinum Sponsor DocuTAP, which I’m sure will interest Dr. Jayne given her not-great EHR experience in her urgent care practice. The Sioux Falls, SD-based company is the industry-leading technology provider for urgent care centers, offering a tablet-based PM/EHR, patient engagement, revenue cycle management, and business intelligence solutions. EHR features include a chart room to track patient wait times and complaints, templates that can be modified per provider and per clinic, automatically generated procedure codes, single-tap order sets, and automated E/M coding. DocuTAP also streamlines occupational medicine and workers’ compensation workflow that includes converting all forms to be filled out electronically and supporting employer-specific fee schedules. It offers connectivity with ACOs, state HIEs, and local hospitals. DocuTAP acquired Clockwise.MD in April 2017, allowing it to offer patient self-scheduling, wait time viewing, text reminders, and automated post-visit surveys. The company provides 24/7 support and offers certified remote hosting. Users benefit from two-minute charting, a $10 per visit revenue increase, and 15-minute shorter wait times. Thanks to DocuTAP for supporting HIStalk.

For those questioning DocuTAP’s two-minute documentation claim, here’s a video showing it in action.

Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Sales

St. Vincent’s Health Australia will expand its use of Vocera’s badge- and smartphone-based communication across its 15 hospitals and 17 senior care facilities.

Perry County Memorial Hospital (MO) chooses Cerner Millennium delivered by the CommunityWorks model.

Four-hospital Alameda Health System (CA) chooses Epic in a $200 million project. The health system nearly went broke following billing struggles after its $77 million implementation of Siemens (now Cerner) Soarian and NextGen in 2011.

Decisions

• North Shore Medical Center (FL) switched from a Medhost EDIS to Cerner in late 2017.
• Stephens County Hospital (GA) will go live with Wellsoft’s EDIS in February 2018.
• Astria Sunnyside Hospital (WA) will switch from Meditech to Cerner in mid-2018.
• Washington County Regional Medical Center (GA) will replace Empower Systems with an inpatient EHR not yet chosen.

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

People

Scott Decker (MDLIVE) joins Homecare Homebase as president.

Announcements and Implementations

Allscripts says it has restored all systems after its January 18 SamSam ransomware attack. Meanwhile, Surfside Non-Surgical Orthopedics (FL) files a class action complaint against Allscripts, saying the outage caused it to lose revenue and spend money coordinating with patient. The practice says the industry has known about SamSam ransomware since March 2016 and Allscripts failed to take reasonable security measures to protect its systems. None of this has affected Allscripts shares, which are up 7.1 percent since the attack vs. the Nasdaq’s 6.13 percent.

A new Reaction Data report asked 133 radiologists and radiology administrators about the potential use of AI in diagnostic imaging. Most respondents say it’s going to a big deal, although practicing radiologists are skeptical. The report notes that folks who say they aren’t all that familiar with AI also responded that it’s important, a case of what Reaction data calls FOMO (fear of missing out). Most respondents say they will implement some form of AI by 2020, while imaging centers surprisingly seem to have fallen far behind hospitals in progress so far. IBM leads in AI mindshare even though nobody reported implementing anything from IBM – most of the progress is in breast imaging and Hologic, GE Healthcare, Google, and ICAD lead the pack.

Privacy and Security

Hackers steal more than $500 million in cryptocurrency from a Tokyo-based digital currency exchange startup.

Other

In England, a newspaper’s report says doctors are being pressured to manipulate patient EHR data to avoid hospital penalties for missing ED treatment time targets. Sources say they are changing admission times, performing phony patient transfers that sometimes makes it hard to find those patients, and discharging and then readmitting patients to restart the clock. NHS standards require patients to be assessed within four hours of entering the ED and to be held no longer than 12 hours before being admitted, although the stopwatch starts only when they are taken to an exam room rather than when they show up, excluding their wait time watching My Lady Her Honour Judy.

Google AI researchers publish (in a non-peer reviewed, non-medical open access journal) their work on extracting full EHR data from 215,000 hospitalized patients (from UCSF and University of Chicago Medicine) to successfully predict in-hospital deaths, unplanned readmissions, prolonged stays, and discharge diagnoses. The authors conclude that analyzing the full EHR with deep learning methods provides predictions that are more accurate than other predictive models that require data harmonizing and a pre-defined statistical model.

A proposed Singapore bill addresses the country’s National EHR (NEHR):

• Providers will contribute the electronic information of all patients to the NEHR.
• The core data set will include the patient profile, events, diagnosis, surgery procedures and notes, discharge summary, medications, lab reports, radiology reports, immunizations, and allergies.
• Patients can opt out, but their information will still go to the NEHR. It will, however, be made invisible to providers.
• Telemedicine will be regulated.

Sponsor Updates

• Sunquest Information Systems will offer several presentations at the Precision Medicine World Conference January 23-24 in Mountain View, CA.
• Surescripts will exhibit at the NACDS Regional Chain Conference February 4-7 in Fort Lauderdale, FL.

Blog Posts

• Urgent Care Trends to Watch in 2018 – The Year of the Patient (DocuTAP)
• 4 Security Tips for the New Year (Salesforce)
• 5 Tips for Dealing with Medical Practice Employee Turnover (Solutionreach)
• Balancing Act: Managing Outcomes and Costs for Medicare & Medicaid Populations (Medecision)
• Can the Healthcare industry get into the Millenial mindset? (TransUnion)
• Bringing doctors into the loop. (Voalte)
• 27 Stats That Show What Consumers Expect from Brand Communication (West)

Contacts

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