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Tips for HIMSS Exhibitors

January 27, 2018 News Comments Off on Tips for HIMSS Exhibitors

Every year I get several emails asking me to repost the “HIMSS vendor rules” that I’ve rattled off a few times over several years. The problem is that I’ve never made an exhaustive list or committed to maintaining it – it was just a series of stream of consciousness complaints about sloppy exhibitor practices that frustrated me as an attendee. I often called out undisciplined booth staffers who turned an expensive HIMSS exhibit into “the world’s most expensive telephone booth.”

I decided to try to recapture some of those thoughts in one place after I received recent requests for “the list” now that HIMSS is fast approaching. Here’s what I came up with. Send me your additions, especially if you – unlike me – have worked a booth and have a non-attendee viewpoint that I lack.

My conclusion is this. HIMSS exhibition costs are among a company’s most significant investments (especially for small companies) and the cost/revenue meters are running every minute that the exhibit hall is open. Don’t spend a fortune on exhibiting without a plan.


Pre-HIMSS Preparation

Define success goals. What is your company trying to get out of exhibiting? Is it X number of leads or contacts per hour? Doing X number of demos? Just staying hello to existing customers? Getting rid of all the optimistically ordered crappy swag and going to parties? Everyone working the booth should know what the company hopes to gain from their exhibit hall presence and how their contribution to those outcomes will be measured.

Develop two conversations that every booth staffer must demonstrate: a 10-second elevator pitch covering the problem the company solves and a two-minute version for those who seem interested after hearing the shorter spiel. The wording is as important as any marketing message since it will be repeated hundreds of times in the high-stakes exhibitor game, so get it right and make sure everyone can deliver it well. Trade show messaging is different than any other form of contact with customers and prospects, so don’t let staffers – even the salespeople – wing it.

Define how to qualify a visitor as a prospect and the actions that will ensue – disengagement if they aren’t, deeper engagement if they are. It’s OK to break off a conversation with sincere thanks for stopping by and a goodbye handshake. For chattier non-prospects who don’t take the hint, define a “rescue me” hand signal triggers the appearance of a profusely apologizing co-worker who reminds you that you have a fictitious previously scheduled visitor waiting.

Create a plan for getting even hot prospects in and out of the booth within 10 minutes of saying hello. Don’t waste their time and yours by trying to wear them down into signing a contract right there on the show floor. It’s fine if they want to stick around afterward, but the plan should address what needs to happen within that 10-minute window to make it a success. Then move on to other prospects.

The 10-minute model visit should include who else needs to be brought in or how handoff to another booth staffer with specific knowledge or skills will take place. Nobody likes being walked all over the booth while you’re hunting for someone who turns out to be in an impromptu company meeting.

Perform role-playing to make sure everyone is on the same page for all likely situations (snooping competitors, reporters looking for a story, loudly complaining customers, newly sold customers looking for validation, or attendees asking about job opportunities). Don’t use the “X number of dollars per hour” booth time stage for rehearsal. 

Define dress expectations. Company shirts? Suits? Specific colors? Don’t leave it up to the discretion of staffers. Casual is fine unless the company sells abstract services rather than a physical product, in which case more formal dress might be appropriate in conveying success and strength.

Define clearly what your company does on your booth. Second- and third-tier vendors sometimes don’t realize that most of us don’t know who they are or what they do. Say so clearly on booth materials so encourage attendees to veer off their determined path to check your booth out.

Set up a quiet cocktail party or dinner – at the appropriate cost level for your intended audience and potential benefit – and offer promising prospects who drop by the booth an invitation. Don’t just hand them out en masse or try to arrange something at the last minute. The only negative is that attendees come with fully-loaded schedules, so maybe a nearby lunch would be a good substitute. HIMSS Bistro works great, is inexpensive, offers healthy options, and is located just off the show floor.

If you plan to offer giveaways, consider fun items for the attendee to bring home to their children.


Booth Layout

Use high-top tables and stools that encourage qualified prospects to move into one-on-one conversations, but not so comfortable that visitors and booth staff sprawl on them because their feet are tired.

Instead of swag giveaways that encourage trick-or-treat behavior from people who aren’t really prospects anyway, offer coffee, juice, soda, and water. Place it in a comfortable seating area free of barriers, but assign someone to work that area and strike up conversations, giving the evil eye to people from other companies trying to freeload.

Bring enough people to handle, but not overwhelm, visitors. That’s based on booth size and in-booth activities. A 10×10 booth will seem overloaded if there’s more than a couple of people working since the visitor might not have a place to stand or sit, while an oversized but understaffed exhibit feels dead or leaves visitors unacknowledged. Have backups readily available that can be summoned when needed but free to do other work nearby while waiting.


Choosing Booth Staff

Don’t assign booth duty as reward or punishment. Define the individual roles and choose for them the best people who actually want to work the show. Enthusiasm wins.

Rotate booth staff frequently to keep energy levels up.

Strive for diversity and make sure the male and female staffers don’t huddle around each other like a middle school dance.

Assign some non-management technologists or non-sales subject matter experts to be available for bonding with their prospect peers and for answering questions without resorting to salesperson bluffing. However, don’t let them interact with visitors without having a more people-facing handler managing the process.

Don’t choose smokers. The inevitable scent will turn off many attendees and those folks will require frequent smoke breaks that someone else will have to cover.

It is perfectly fine for a small company to hire contract booth staff, even if they are chosen primarily because of appearance (rightly or wrongly, attractive booth staff often deliver better results). However, those contractors should be educated in advance about the company, its solutions, and how to make a quick handoff to an expert after the initial contact. Obviously they should dress appropriately and be prepared to interact professionally with high-level visitors. Provocatively-clad “booth babes” are never, ever a good idea for the HIMSS conference.

Assign a single person to be in charge of the entire booth and the people working in it at all times. Like the on-duty restaurant manager, their job is to keep staffers motivated, make sure they follow the plan, provide help when needed, and intervene in a “good cop” kind of way when needed. That person is the boss of everyone during exhibit hall hours, even of other employees who outrank them.

The CEO should be present in the booth for at least part of the time, and not just chatting with cronies on an isolated couch. Assign them a handler who will facilitate an introduction to good prospects but who will protect them from being bothered otherwise. Unlike other booth staff, the CEO should be in full-out executive suit/dress mode to convey their position of authority and to make a good impression on prospects and passersby. The CEO may well be the company’s best relationship builder and closer, so use them wisely. Admit it – when you walk by the booths of Epic or Athenahealth, you are slyly looking around to see if Judy Faulkner or Jonathan Bush are there.


Preparing the Booth Staff

Put out a specific schedule with who will be where, including breaks off the show floor for bathroom visits, lunch, checking voice mail, etc.

Map out who will stand where and what responsibilities they have.

Put friendly, gregarious people on the booth’s perimeter. They don’t have to be experts – they are like a barker whose job it is to get people comfortable enough to cross into the carpeted space. They should be quick to make eye contact, greet the person by name, and move them into the next phase (watching a demo, getting literature, etc.) The aisles around the booth are the most important real estate in the exhibit hall and getting prospects to leave them to enter the booth is the most important objective.

Give everyone a list of known customer attendees (culled from the HIMSS registration list) so they can be greeted warmly and personally instead of being pitched unknowingly as a stranger.


Before the Hall Opens

Relieve booth staffers of all other responsibilities. Leave them free and energized to complete the expensive project you started when you bought a booth.

Confiscate the phones of everyone who is working the booth.

Do a booth staffer huddle 10 minutes before the hall opens to make sure that everyone is dressed neatly (no bagel debris lodged between their teeth), their phones have been surrendered, everybody knows about the day’s special activities or presentations, and their energy level has been elevated just before the doors open. It’s really embarrassing to have your people sitting around drinking wake-up coffee and comparing notes about last night’s wild party as prospects are walking by.


When the Show Floor Is Open

Make it an inviolable rule – enforced by the booth manager — that people working in the booth cannot sit, talk to each other (unless trying to get a visitor’s question answered), use their phones, or eat. Do those things away from the booth. Prospects will move on if they feel they’re invading the space of those on duty. No exceptions, and if you didn’t free up their time so they can focus on visitors, shame on you.

Keep the trash cans emptied and handbags and luggage out of sight. That seems minor, but it makes an impression.

Always have a greeter working the aisle. They need to hand off quickly and get back to their greeting job.

Remember that even when booth staffers are away from the booth, they’re still wearing a nametag identifying their employer, so business-appropriate behavior is mandatory. Save the swearing, romantic recruitment, calls to headhunters, and product and co-worker gripes for a different setting. Or, at least tell them to flip their badges over so nobody who is overhearing knows who they are.

Resist the urge to let folks bail out early because there’s no foot traffic. Some C-level decision-makers intentionally use slow exhibit hall hours to seek information without the frenzy.

Use the time before the exhibit hall opens and closes, as well as the slow last day of the exhibits, to cruise the hall looking for opportunities to partner, acquire, or hire. Many companies find that they get more value from their interactions with other vendors than with prospects, often outside of their own booth.

As the show winds down, find similar but non-competing vendors and offer to share leads.


Managing the Visitor Encounter

The greeter should turn the visitor over quickly and smoothly to someone else so they can keep working the perimeter.

Ask the visitor if it’s OK to scan their badge. Not only to capture their information, but to keep them in the booth a few seconds longer while both parties decide how interested they are.

Engage in a friendly manner with demo shoulder-surfers. They probably aren’t trying to steal trade secrets but rather are just avoiding wasting their time and yours with premature engagement. It’s certainly OK to say hello and ask if they need any help.

Don’t disparage competitors. It will sound like sour grapes.

Define the documentation that should result from a visitor visit – badge scan, business card, or information sheet? Capture the conversation so that any follow-up is seamless – what are their organization’s problems or who should follow up?

Don’t assume that a visitor’s job title disqualifies them as a decision-maker. Provider organizations often make decisions that start with a lower-level department employee who is sent out to fact-find.

Don’t assume that consulting company attendees aren’t worth talking to. They are probably looking for products they can recommend to their clients or looking for partnership opportunities.


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What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based System

You still have to work at the application’s care and feeding – you can’t just “dump it in the cloud” and expect all the problems to go away. Some of them will, but not as many as you think.


The Internet gets slow and breaks more often than you think, especially when vital services are at the other end. Downtime procedures are even more important.


Do the research to figure out what all the pieces you will or might need are. Once you’ve done the big deal, you have very little pricing leverage until you have big money to commit again. Example: a full-copy test environment. With one well-known CRM vendor, those environments are priced as a percentage of total licensed product. That makes sense in a way, because a full copy is just that — a full copy. However, that also means that the cost of the environment goes up when you add more products or add-ons to your list of licensed things.


They seem to track their application only up to the point where it leaves their data center or Cloud Source. Anything else between their address and my user location is left up to me to figure out if there is a problem with the application and my users. We have had to go to other third-party products to get the health of the Internet between the SaaS source and our end users. Yet they (the SaaS source) blame our internal network setup for any end response issues at play. Very tired of hearing “none of our other users are having that problem” when the problem lies in the health of the general Internet and not our last mile.


Was the solution architecture design for the Web and cloud, or was it client-server front-ended by Citrix?


If it’s your first time down this path, your internal HIPAA team or legal may end up having no idea what to do with it based on their standard vetting process. You might have to take additional time in the implementation for back and forth with the vendor to while they jump through whatever hoops are placed in the way to get a green light to implement or even sign a contract.


I’ll have to pay to get my data back.


The importance of not just a DR plan, but a business continuity plan. You are not in control of when down applications will be available, but you still have patients to care for and business functions that must continue. Always have a plan and have it readily available for staff.


You won’t necessarily have full access to the database or software maintenance tools. Ask in advance and put a plan in place on how when data will be accessed / software changes will be completed.


You will spend a lot of time explaining your business operations. Analysts go from those making configuration changes to someone who needs to partner and fully understand business processes and operations. Vendors will not successfully function as your systems analysts.


This was 15 years ago. I wish we had known the true cost of going to the cloud. Verizon charged us a ton to install a redundant pathway to the Internet after questioning why we wanted to do such a silly thing.


Wish I’d required more detail in how my data will be turned over to me at contract termination. Our outgoing ambulatory EMR vendor refuses to hand over our contractually mandated export until the day *after* our account is turned off, giving us zero opportunity for smooth migration to the new vendor.


I wish we better understood and negotiated standard maintenance windows and patch load times for production issues. We sometimes have to wait weeks for patches and get a nine-hour window, any time during which the system could be brought down to install the patch. I also wish we had better prepared ourselves for the challenges of offshore support. They only want to talk via the ticket system and you have to try hard to get them on the phone or a WebEx. It really exposed now poor our internal support was since every issue required going through this painful process with the vendor support.


Weekender 1/26/18

January 26, 2018 News Comments Off on Weekender 1/26/18

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Weekly News Recap

  • Apple announces Health Records, which will allow IPhone users to collect and store information from the EHRs of participating providers.
  • Executives of Practice Fusion will reap millions when the company is turned over to Allscripts for $100 million vs. a one-time self-valuation of $1.5 billion.
  • Allscripts Professional EHR/PM users experienced prolonged outages as the company struggled to recover from last week’s ransomware attack.
  • The CEO of Hancock Health (IN) explains why he decided to pay a hacker’s demanded $55,000 ransom.
  • Microsoft retires HealthVault Insights.
  • Former pharma executive Alex Azar is confirmed as HHS secretary.
  • North Carolina health systems Novant and Wake Forest Baptist Health allow patients to combine their Epic MyChart information into a single view.
  • Open source EHR vendor OpenMRS receives a $1 million donation from a philanthropy organization started by one of its patch contributors.

Best Reader Comments

Can the patient manually add info to their file? Can they choose which info they want to share? Could they hide diagnoses, medications, etc.? I would think providers would be skeptical about the completeness and accuracy of patient-provided info. (Kermit)

How will Apple market this app to Epic MyChart users? Positives: Can likely have info from multiple providers in one location instead of pulling up MyChart accounts from each provider. Negatives: I didn’t see any patient access or billing topics and no provider messaging. So, user would still need to access MyChart to view upcoming visits, manage appts,. make payments, complete forms/questionnaires, update demographics, start an E-Visit. (Lynn Geren)

This is no surprise to many of us. I have been commenting here for years that PF was inflating (lying about?) its number of users. This is just a continuation of that pattern. (Numbers skeptic)

Epic actually created this initiative with Apple. 10 of the 13 sites involved are Epic sites and each of them will tell you Epic supported them in this endeavor. Epic has had Lucy and VDT and full access for Open Notes sites for a very very long time. (Nope)

I’m not sure I get what Novant and Wake have done. Happy Together is baked into Epic with the most recent version. The patient controls the joining of the MyChart instances across provider instances. Sounds more like marketing to me. (Defiant)

There are lots of after-market solutions for downtime EMRs and “lite” charts like the one Dr. Jayne described, and these often will pay for themselves after just once downtime. It’s a smart investment. (Cosmos)

A T&A implementation is perhaps the most complex project an organization undertakes for many of the reasons stated in the post. The main reason is that management is unaware or does not acknowledge the varying pay practices across their organizations. They underestimate the implications of these practices and are unprepared to deal with them during a T&A project. It is not unusual to find that these practices are costing organizations millions of dollars a year, year after year. I ask clients, are you prepared to pay everyone to policy? (Alan Bateman)

You can’t get comfortable and coast [in your current job]. If you do, you’ll wake up one morning and find yourself out the door when least expected. (HIS Junkie)

Both on purpose and unintentionally, as organizations seek out better solutions and question massive spend, bids can tilt towards the current vendor or away from it. As information is gathered across the organization, departments seek out wants and nice-to-haves framed against the current system. Often this leaves the current vendor in an unfair position, but just as often, the new vendor simply and smartly addressed weaknesses of competitors.(Don’t think twice it’s alright)


Watercooler Talk Tidbits

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HIStalk readers funded the DonorsChoose teacher grant request of Ms. T from the South Bronx of New York asked for 50 STEM take-home self-exploration kits covering everything from solar mechanics to tin can robots for her middle schoolers. She reports, “Since the kits are self-contained, they can read and follow directions and carry out the various experiments on their own. They will then demonstrate their experiments for the class on Monday. This will give them an opportunity to show what they have learned. They will be the expert as they field questions from their peers. Some students are shy about making presentations. This will give them another opportunity to develop and practice their public speaking skills.”

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A NEJM opinion piece on physician burnout describes a University of Colorado team-based family medicine ambulatory care model redesign called APEX that has dropped clinician burnout rates from 53 percent to 13 percent, improved vaccination and referral rates, and reduced patient wait times. Provider productivity improvements made it cost-neutral. The patient’s visit starts with a medical assistant who gathers data, reconciles meds, lays out the visit, and identifies preventive care opportunities before the physician or PA enters the exam room. The MA stays in the room to document the visit, and after the clinician leaves, works on patient education and health coaching. The medical director says pre-APEX exam rooms were like “texting while driving,” but now the computer doesn’t intrude between clinician and patient, allowing the clinician to focus on synthesizing data, performing the physical exam, and making medical decisions without distraction.

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A Los Angeles TV station’s investigation finds that up to 25 percent of reviews on Google, Facebook, and Yelp – including those for healthcare professionals such as dentists – are fake. A Beverly Hills dentist says he’s puzzled at several glowing reviews featuring reviewers whose profile photos feature images of minor TV celebrities, stock photos, or those of random people. I suspect that the dentist is in fact quite familiar with phony review services offered cheaply on Fiverr and other sites  – why would anyone post glowing fake reviews otherwise?

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The non-profit, invitation-only Healthcare Innovators Professional Society (HIPS) for chief innovation officers and chief strategy officers launches from Texas Medical Center. Memorial Hermann CIO and Chief Strategy Officer David Bradshaw said that as a founding member, he’s looking forward to networking “without the chaos and scale of other major healthcare societies and conferences.” Membership is limited to 33 people and is not only free, it also covers the full cost of attending HIPS-related events, the first of which will be October 2-4 in Houston. I admire that the provided lunches feature Houston-specialty food by Goode Co BBQ and Lupe Tortilla.

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A newspaper reviews the bizarre patient cases that have been reported in BMJ Case Reports. They include:

  • A man who nearly blinded himself by mistaking Super Glue for eye drops
  • A woman with Crohn’s disease symptoms that were being caused by pieces of a Heinz plastic container lodged in her intestines
  • A woman’s suspected eye lesion that turned out to be Christmas card glitter
  • A heavy smoker’s suspected lung cancer that was actually part of a toy set that had been lodged in his lung since he was seven years old

In Case You Missed It


Get Involved


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Comments Off on Weekender 1/26/18

Morning Headlines 1/26/18

January 25, 2018 Headlines Comments Off on Morning Headlines 1/26/18

Utah’s Intermountain Healthcare is shedding thousands of workers in scheduling and billing, saying it will save $70 million

Intermountain Healthcare will transfer 2,300 billing employees to its revenue cycle vendor R1 RCM, expecting to save $70 million in the next three years.

Lenexa health software company acquires Medicare claims business

Mediware Information Systems acquires RCM company MedTranDirect for an undisclosed sum.

The Cyber Attack – From the POV of the CEO

Hancock Health (IN) President and CEO Steve Long breaks down its recent ransomware attack.

Governor Cuomo Announces Transformation of the Health Care System in Brooklyn

One Brooklyn Health (NY) will use a $700 million investment from the state for technology and facility improvements to its three hospitals, plus the creation of a 32-facility ambulatory network.

Comments Off on Morning Headlines 1/26/18

News 1/26/18

January 25, 2018 News 3 Comments

Top News

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CNBC sheds light on the millions of dollars that Practice Fusion’s executives will reap when the company’s fire sale to Allscripts at 1/15 of its one-time, self-assessed value is completed.

Practice Fusion stakeholders say they were misled by an executive team that was touting a a bright future even as growth was stalling, founder and CEO Ryan Howard was fired, headcount was slashed, and the company had pitched itself to 40 potential buyers starting in November 2015, receiving bids at just $50-225 million for the company that had valued itself at $1.5 billion in early 2016. A group of employees is trying to assemble enough voting shares to remove the payouts to the executives.

Allscripts was the original bidder at $225 million, but backed out when EClinicalWorks was hit by a $155 million settlement related to falsifying EHR certification testing results. Allscripts came back with its offer of $100 million in cash, which Practice Fusion accepted on January 8.


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.

Here’s the video from this week’s Versus webinar titled ““Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.”


Acquisitions, Funding, Business, and Stock

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Mediware Information Systems acquires RCM company MedTranDirect for an undisclosed sum.

Change Healthcare retains the exclusive right to license commercial data to WebMD Health Corp. It seems there was some legal disagreement over which company had the rights to sell de-identified data to third parties after the parent company of both businesses sold them off.

Audacious Inquiry takes in its first outside investment, with Baltimore-based ABS Capital Partners buying an unspecified stake.

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Allscripts is apparently still struggling to bring Professional EHR and PM back to normal following last week’s ransomware attack, with reports that some customers can’t access the system through the desktop application. The company also warns that the restored system might be slow and suggests that customers use the mobile solution when possible. Analytics Platform and Clinical Data Warehouse are still down.


Sales

Major Health Partners (IN) will implement Meditech Web EHR.

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Mee Memorial Hospital (CA) chooses Cerner Millennium under the CommunityWorks cloud deployment model. The hospital has the best tagline in history: “At Mee, it’s all about you!”


Announcements and Implementations

Intermountain Healthcare will transfer 2,300 billing employees to its revenue cycle vendor R1 RCM, expecting to save $70 million in the next three years even though the employees will keep their pay rate, health insurance, and tenure at Intermountain. The health system’s COO, questioned by employees worried that the company will outsource its IT operations that include its Cerner system, says Intermountain has not yet made any IT decisions but needs to manage its costs. 


Technology

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Apple announces new beta functionality within its Health app that will let patients at a dozen partner hospitals view their medical records on their IPhones. Participating EHR vendors include Epic, Cerner, and Athenahealth. More detail and insider reports here.

ZeOmega adds Change Healthcare’s InterQual Connect authorization connectivity and medical review service to its Jiva population health management software.


Government and Politics

The VA will use data, analytics, technology, and best practices from CMS to combat fraud and abuse within its programs.

One Brooklyn Health (NY) will use a $700 million investment from the state’s Vital Brooklyn plan for technology and facility improvements to its three hospitals, plus the creation of a 32-facility ambulatory network. Technology upgrades in the $70 million range will include development and installation of a system-wide EHR.


Privacy and Security

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The CEO of Hancock Health (IN) provides details of its recent ransomware attack:

  • The hospital believes the hackers were members of an Eastern Europe criminal group.
  • They obtained (by unstated means) the login credentials of one of the IT department’s hardware vendors.
  • The hackers then attacked a server at the hospital’s backup site.
  • To stop the ransomware’s spread, the IT department had to immediately shut down all network and PC hardware, not easy since the attack was launched in the evening when many PC-using employees had left for the day.
  • The hospital decided to pay the $55,000 ransom when it found no good way to remove the encrypted files and replace them with backup copies because the connection between the backup and live sites was compromised by the ransomware. They later found that the backup files had also been corrupted by the ransomware, which would have required paying the ransom in any case.
  • Employees struggled to figure out how to buy Bitcoin, but once they paid the ransom, the hackers restored the system quickly.

Other

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Healthcare Growth Partners publishes its semi-annual market review, with these interesting points:

  • 36 percent of poll respondents (C-level company execs and investors) say health IT is in a bubble vs. 29 percent in 2015.
  • The health IT market needs to grow 7-13 percent annually to support the current rate of investment.
  • The market pushes companies to balance the long-term value creation caused by serving customers while catering to investors who expect them to innovate using buzzword-worthy technologies such as AI and blockchain.
  • The most actively sought acquisitions are in population health and analytics, RCM technology and services, payer services, and infrastructure technology. Hospitals as a target market led the way by far.
  • The most important acquisition characteristics are growth trajectory and recurring revenue, while strong management finished last.
  • Most executives say the regulatory impact of the Trump administration won’t affect their company’s performance or acquisition strategy.
  • 2017 saw zero health IT IPOs following nine, eight, and five, respectively, from 2014 to 2016.

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Cabell Huntington Hospital (WV) donates $35,000 to Tri-State STEM+M School, with its VP/CIO Dennis Lee (right) making a classroom visit along with the hospital’s CEO.


Sponsor Updates

  • Lightbeam Health Solutions publishes a new patient impact story featuring Mohawk Industries, “Breast Cancer Early Detection.”
  • MedData will exhibit at the ASA Practice Management meeting January 27-29 in New Orleans.
  • Medecision will host its annual Liberation conference March 27-29 in Dallas.
  • Major Health Partners (IN) will implement Meditech’s Web EHR.
  • Netsmart will exhibit at the NY Coalition for Behavioral Health Annual Conference February 1 in New York City.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Society for Maternal-Fetal Medicine’s Annual Pregnancy Meeting January 31-February 3 in Dallas.
  • Infor will launch a cost analytics and accounting tool for providers this summer.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 1/25/18

January 25, 2018 Dr. Jayne 1 Comment

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The hot topic of conversation around the physician lounge this morning was the Apple announcement about integrating EHR records into its Health app beginning with the iOS 11.3 beta. My physician colleagues are almost universally iPhone users, with many having Apple watches. There are some big-name hospitals and health centers involved, including Johns Hopkins Medicine, Rush University Medical Center, and Cedars-Sinai. There are a number of tantalizing articles about the solution, promising that records from different organizations will be integrated into a single view. It sounds largely like C-CDA data, including allergies, medications, diagnoses / problems, immunizations, lab results, procedures, and vitals. I didn’t see any mention of visit notes or diagnostic testing reports.

Apple’s COO Jeff Williams said that, “By empowering customers to see their overall health, we hope to help customers better understand their health and help them lead healthier lives.” Speaking as a clinician, there’s a significant leap between viewing data elements and truly understanding how they relate to overall health. It will be interesting to see how Apple displays laboratory results, including flagging and trending – it’s hard to tell from the screenshots I’ve seen. Hopefully they’ll integrate educational resources either from the patient portals they’re pulling data from or from other reputable sources.

I agree that having health data on your iPhone might be a tool to make people aware of what’s in their medical charts, but many patients are going to need time with a clinician, health coach, or other health advocate to make sense of some of it. Clinicians beware: many more patients may be seeing their data, so it’s time to get those diagnoses and medication lists cleaned up.

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Just when you think things can’t get any wilder with CMS, some portion of a rule or requirement jumps up to remind you there is always something more mind-numbingly tedious on the horizon for clinicians. This time it’s the CMS Patient Relationship Categories and Codes, created under the CMS Quality Payment Program. Although CMS frequently says it aims to “minimize the burden of participation” and to enhance “clinician experience through flexible and transparent program design and interactions with easy-to-use program tools,” they always seem to come up with something that adds clicks to our workflows with questionable return on investment.

Flying in under the MACRA radar was a subsection on “Collaborating with the Physician, Practitioner, and Other Stakeholder Communities to Improve Resource User Measurement,” which mandates the creation and use of new sets of codes to be attached to claims. There are care episode and patient condition groups and codes, along with patient relationship categories and codes designed to enable attribution of patients and episodes of care to clinicians acting in different roles. This all boils down to helping further assess the cost of care.

The MACRA legislation requires CMS to create a process with clinician and other stakeholders to review proposed codes. The draft list of patient relationship categories and codes was posted on the CMS website in April 2016 and opened to public comment. Clinicians were to be categorized based on their relationship to the patient. Initially there were five groups of clinicians in three relationship categories, broken down by whether they were acute or continuing care, whether they were primary or specialty care, or whether a consulting provider was involved.

Additional comments were solicited in December 2016 with an update to the categories:

i. Continuous/Broad relationship, namely primary care providers in continuity

ii. Continuous / Focused relationship, namely subspecialists caring for chronic conditions

iii. Episodic / Broad relationship, including physicians caring for a broad spectrum of conditions for a short period, such as hospitalists

iv. Episodic / Focused relationship, including specialists caring for time-limited conditions

v. Only as ordered by another clinician, including reading radiologists

The codes were to be operationalized using CPT modifiers, and discussions are ongoing as far as how clinicians should be preparing to use them on Medicare claims. Originally the codes were supposed to be mandated on claims after January 1, 2018, but I’ve heard very little about them until recently. The last update I could find from CMS was from November 2017 and it notes that use of the codes is voluntary, with CMS saying “We anticipate that there will be a learning curve with respect to the use of these modifiers, and we will work with clinicians to ensure their proper use.”

I’m not finding a lot of communication from CMS about the codes to help me with my learning curve, but there’s always a possibility I missed it among the dozens if not hundreds of requirements that physicians are trying to keep track of. I also haven’t received any communication from my EHR vendor as far as classes to learn the workflow to apply the codes and they’re usually very much on top of things like this. Even Google didn’t bring back many current results for something that supposedly went into use less than a month ago.

Regardless, I think many physicians have become so inundated with requirements, reporting, and regulations that they start to tune things out. I’ll have to start keeping an eye out for additional instructions. As an urgent care physician in a market that’s short on primary care physicians, I tend to perform services that fall into all of the categories. We’ll have to see when our EHR is ready to handle the new codes and what the real implementation timeline looks like.

I’m heading to the clinical trenches for the next three days, in a state with some of the highest influenza rates in the nation. Normally I truly look forward to my patient care days, but I’m dreading this schedule block a bit. I’ll be doing all the handwashing and cough-avoidance that I can and am considering spending the day with a mask on. It’s not an ideal way to see patients, but when 60 percent of the patients coming through the door are there because of flu-like symptoms, it might be worth the inconvenience. We’ve had several of our physicians and quite a few staff end up with the flu, and the recovery times have been long.

Here’s to staying healthy as long as you can, or at least until the influenza surge breaks. Got flu? Email me.

Email Dr. Jayne.

Insider Report: Apple Brings Provider Medical Records Into the IPhone

January 25, 2018 News 3 Comments

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Apple announced Wednesday an update to the IPhone’s IOS 11.3 beta that will allow consumers to view their EHR information from one or more participating providers within Apple’s existing Health app. I spoke to insiders at some of the beta sites to get more information.

Participating Beta Sites

The initial sites involved are:

Johns Hopkins Medicine (Epic)
Cedars-Sinai (Epic)
Penn Medicine (Epic)
Geisinger Health System (Epic)
UC San Diego Health (Epic)
UNC Health Care (Epic)
Rush University Medical Center (Epic)
Dignity Health (Cerner)
Ochsner Health System (Epic)
MedStar Health (Cerner)
OhioHealth (Epic)
Cerner Healthe Clinic (Cerner)

What Patients See

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Patients will be able to view information extracted from the provider’s EHR that includes their allergies, conditions, immunizations, lab results, medications, vital signs, and procedures. The encrypted information is stored on the user’s IPhone rather than on Apple’s servers. Apple will not be able to see the information unless the user gives their permission.

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The EHR-to-Apple connection goes beyond the extraction of patient-downloaded C-CDA documents, which Apple Health already supports (pictured above). Apple Health Records retrieves discrete data directly from the EHR using HL7’s Argonaut FHIR standard, triggered by the user’s interaction with Health Records.

“It’s interesting,” one provider told me, “that Apple is possibly the most proprietary, closed software and hardware vendor and Epic is sometimes seen as its healthcare equivalent, yet they are connecting using open standards. That’s awesome.”

Patients of Epic-using health systems, for example, log into their MyChart account, retrieve an authorization code, and agree to share it with Apple. They then receive a token. “The process is slick,” a provider told me, adding that the process will likely be further polished and hardened to allow hospitals to onboard more easily. Epic will most likely productize the access method via an App Orchard app.

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Apple’s Motivation

It’s important to note that Apple, unlike consumer medical records competitors such as Google, sells only hardware. Apple doesn’t develop enterprise apps, sell or use patient data, or have ambitions to build or acquire an EHR company. “Their only goal is to sell more IPhones,” a health system source said, adding, “we’re a lot more comfortable working with them than other companies with less-transparent ambitions.” Having direct access to EHR information is a differentiator from Android-based competitors whose market share is increasing over the IPhone.

The IPhone presents more than just a static display. Allergies include severity levels and lab results include the provider’s normal range and an explanation of the results.

I asked an insider about the testing involved and was told that Apple “does real testing, not just the usual hospital user acceptance testing.” That person was also impressed with the depth of health IT expertise that Apple has hired.

Apple’s Gliimpse Acquisition

Apple in mid-2016 acquired startup Gliimpse, which was developing a platform by which consumers could collect and share their health information. That company described itself as, “Gliimpse solved the hardest medical data problem, aggregation plus standardization. Our product collects data from medical portals – without human intervention – combined with self-entered plus wearable info, all shared with others. Through Oauth & APIs, partners can build consumer and analytic apps.” Some of that technology or subject matter expertise presumably found its way into Health Records. Apple is also working on a variety of health sensors.

Apple is losing smartphone market share worldwide, though it leads the industry in profits. It is not likely that an Android phone maker can muster the resources and ecosystem control to develop something similar, although Google may try if it can enlist hospital development partners. Google retired its Google Health app due to lack of adoption after just four years in 2012, before the widespread use of EHRs, interoperability standards, and personal health devices. It ended up being a little-used place for people to manually enter their own health information that was then stuck inside the app.

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What the Mainstream Press is Missing

The mainstream press is dutifully re-wording Apple’s announcement, but is missing some significant but unstated points that will impact the health IT industry.

  • Patients can store information from multiple health systems on their phones, turning themselves into mini-HIEs as they can simply show any other provider their aggregated information. Apple fixes the patient identification issue that plagues HIEs by requiring the patient themselves to establish the connection from the EHR patient portal’s log-on.
  • Apple or a third-party developer could, at some point, add the ability for patients to push their data to a different, non-connected provider in the absence of other available integration in an app-powered form of “sneakernet.”
  • Apple’s use of the FHIR standard gives it the capability to extract any information supported by the FHIR standard and the specific EHR vendor.
  • Apple’s high-profile rollout will not only sell more IPhones, but will also encourage patients to press their providers to offer EHR connectivity to Health Records. It will also increase consumer use of patient portals.
  • Consumers trust Apple and will be encouraged to think of their medical data as their own since it will be in the palms of their hands.
  • App developers can build products that use previously inaccessible patient information, having Apple as a single, reliable data source instead of being hamstrung by a hospital’s EHR vendor and the technical intricacies of FHIR, vocabulary, and data validation.
  • App developers can list their products on Apple’s App Store – as Epic and Cerner do — instead of only in the EHR vendor’s marketplace since they are directly installable by any consumer without prior arrangement, giving those apps a wide audience and easy monetization.
  • Possible apps made possible by Health Records include medication information or cross-checking; further interpretation of lab results; patient education tools based on actual patient data;combining activity data that is already being collected within the existing Apple Health app with newly available provider data; and sifting through real-time information updates to provide alerting of relevant changes. 

    Morning Headlines 1/25/18

    January 24, 2018 Headlines Comments Off on Morning Headlines 1/25/18

    Change Healthcare and WebMD Settle Data Licensing Litigation

    Change Healthcare retains the exclusive right to license commercial data to WebMD.

    Former Drug Industry Executive Will Lead Dept. Of Health And Human Services

    The Senate confirms Alex Azar as HHS Secretary.

    Apple will let you keep your medical records on your iPhone or Apple Watch

    Apple will launch the beta version of a new service in its Health app that gives users the ability to view their medical records. A dozen hospitals and a handful of EHR vendors have signed up to participate.

    Comments Off on Morning Headlines 1/25/18

    HIStalk Interviews Brent Lang, CEO, Vocera

    January 24, 2018 Interviews Comments Off on HIStalk Interviews Brent Lang, CEO, Vocera

    Brent Lang is president and CEO of Vocera of San Jose, CA.

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    Tell me about yourself and the company.

    Vocera Communications makes clinical workflow solutions that simplify and improve the lives of healthcare professionals and patients. We’re focused on enabling hospitals to enhance both quality of care and operational efficiency. That has direct impact on patient satisfaction and caregiver resiliency as well.

    The company has about 600 employees. We did roughly $160 million in revenue last year. I’ve been the president and CEO of Vocera since 2013 and I’ve worked with the company since 2001. I spent the first six years as the VP of marketing and then spent another six years as the president and chief operating officer before taking over as the CEO.

    In terms of my personal background, I have an MBA from Stanford. I have an engineering degree from the University of Michigan. In 1988, I had the privilege of being part of the US Olympic Swimming Team and won a gold medal in the 4×100 freestyle relay in South Korea, which ironically is the location of this year’s Winter Olympics. Thirty years later, it’s returning back to Seoul, South Korea, and I’m really excited and interested to see that.

    Vocera has been around since 2001, the company is publicly traded, and competitors have come and gone in those years. How would you characterize the market and Vocera’s position in it?

    It is an interesting market. It has definitely evolved over time — our offering into the market, how we’ve broadened our solution, and the way the market perceives us. We were the creators of the category, and for a long time, had to educate the market about the value proposition.

    What we’re seeing today is a recognition that clinical communications is a high priority. More and more customers are reaching out to us proactively to help them optimize their data and mobilize their data in the post-Meaningful Use era, where most hospitals have their electronic health record deployed. They’re looking for ways to empower the mobile workers inside their buildings. Getting the right information to the right worker is a real challenge for them.

    We’ve evolved from being more of a pure communications company to being more of a clinical workflow company. Much more software-centric. The clinical relevance of our solution has definitely risen up. As a result of that, the competitive landscape has evolved over the years. Initially, we were replacing pagers and in-building wireless phones. We were replacing a lot of inefficient processes, where people were running the hallway looking for the right person. 

    Today, we’re much more focused around the idea of clinical workflow and how we can empower care providers to be more efficient. Also, how we can reduce the level of burnout or burden on those care providers by giving them the tools that allow them to do their job on a daily basis.

    Have we figured out alarm and event notification?

    It’s definitely still a work in process. Connectivity from all these clinical systems to mobile workers was a Phase I solution that created as many problems as it solved. All the research would indicate that the vast majority of those interruptions and alarms that caregivers are receiving don’t require immediate action.

    A real focus for us is using intelligence, analytics, and rules engines to try to filter out only the most appropriate alarms, alerts, or messages. Then, delivering those only to the most appropriate person. This idea of the interruption fatigue or alarm fatigue that results from being bombarded by all these clinical alarms is a real concern. It has resulted in a high degree of burnout among clinicians.

    For us, the key is pulling situational awareness from the environment. What’s going on with the patient? What’s going on with the care team and their care plan? What’s going on with the other data points that might be accessible from other systems in the hospital? Then, using that to filter out only the most relevant and most urgent messages to be delivered to a particular care provider.

    Is it a market differentiator to offer an enterprise strategy instead of point solutions, multiple devices, or a lot of connectivity points?

    Our approach has always been to try to listen to the pain points of our customers. You may not know this, but when Vocera was originally founded, we were not a healthcare company. We were a solution that could be used across a variety of vertical markets. It was a  function of listening to specific pain points within our customer base that made us more and more focused on the healthcare space.

    As we’ve evolved the product over time, it’s always been driven by, how do we not think of it as a particular technology or a particular point solution, but how do we think of it in terms of solving particular clinical problems or customer problems? Even our sales approach is one of a consultative inquiry, where we actually send out clinicians. These are people who have worked as nurses before they came to work at Vocera. They do a clinical assessment, where they interview people at a customer site to understand what problems are top-of-mind for them. Then we try to apply the solutions to that. 

    We’ve always had this solution mindset. I think the market is evolving in that direction. If you look at some of the more recent analyst reports, they’ve moved away from looking at it in terms of vendors that might only provide text messaging or might only provide integration. The landscape today is around who can deliver a unified platform that enables true collaboration and clinical communication across these different care providers. 

    I view that as validation of the strategy that we’ve been pursuing for the last several years. I think that the rest of the marketplace is recognizing that and realizing that they need to move more in that direction.

    It must have been both a blessing and a curse to have been identified so strongly with the Star Trek Communicator thing early on, and people might still associate Vocera with that communications badge. How do your other services — such as patient experience tools, pre-arrival preparation, follow-up care, and PCP notification of patient hospitalization — fit in your business?

    You’re absolutely right. The Star Trek connection, the uniqueness of the badge, and the iconic nature of the Vocera badge has been both a blessing and a curse over the years. It’s driven a tremendous amount of brand awareness for the company and a tremendous amount of differentiation and uniqueness in terms of our offering. But it does tend to limit people’s perspectives on the value proposition that we’re delivering to marketplace. We have had to invest time and energy over the last several years to educate the marketplace that there’s much, much more to the Vocera platform than just the badge or just voice communication.

    Our goal is to deliver across the care continuum in interacting with patients and care providers. The products that you mentioned — pre-arrival, post-discharge communication, the rounding solution — these are all software solutions that we feel like fit into our vision around enabling the real-time health system. We have to do a better job of informing the marketplace that we have that breadth of solution.

    For us, it’s all about how we can simplify the lives of these care providers and improve patient satisfaction, There’s a variety of ways we can do that, whether it’s clinical communication, secure text messaging, alarms and notifications, patient experience monitoring, or analytics. These are all areas that become part of a unified platform. By tying them together, we’re able to do some exciting things that you wouldn’t be able to do if they were simply just point product solutions.

    Are caregivers changing their work communications expectations because of the apps they use at home?

    It’s certainly raising the expectation, both in terms of their experience on consumer devices as well as their interaction with voice interactions. Things like the Amazon Echo, Siri, and Google Home. When we were first introducing our products 15 years ago, the idea of using speech recognition as a user interface was fairly new and took some getting used to. Today, consumers are very comfortable using speech as a user interface. That has generated a whole new level of interest in our products, because people are more comfortable with that in the rest of their daily lives. Mobile technology is another area that has become more prevalent for all of them.

    Having said that, we still believe that there are some unique requirements for the healthcare environment. In general, it’s very difficult to bring a true consumer device or consumer experience into the healthcare environment.  You’ve got issues associated with security and privacy of patient information. You’ve got cleaning and sterilization issues. You’ve got security on the wireless network standards. You’ve got breakage. Hostile environments are really tough on electronic devices, and most consumer-grade phones have a hard time surviving in the hostile environment.

    Our purpose-built solution has created a large degree of differentiation for us because we’ve solved the problems of how you get a wireless device to roam inside a hospital. How you create the ability to block out background noise so that you can have a clear communication in a very noisy environment. How you can share a device across multiple users while having it be fully encrypted and logged into the highly secure wireless network environment that an enterprise customer has. Those are all examples where the expectations of their daily lives as a consumer influence their technology choices, but to bring it into the enterprise environment, you have to up the game one step further.

    Another example has to do with text messaging itself. Several years ago, there was a feeling that text messaging by itself was going to be a communication solution for hospitals. Today, the market has spoken and made it very clear that while it’s an interesting feature, it is not a complete solution for mission-critical, real-time environments like hospitals delivering acute care. Secure text messaging combined with real-time voice communication, alerting and alarming, and clinical integration are all required to put together a complete solution. 

    The consumer offering tends to be the baseline. To be successful in the enterprise, you have to build upon that and solve for not only the environmental issues, but also the specific workflow challenges associated with a hospital.

    I didn’t realize until recently how widely deployed Vocera is within the VA and DoD. Does their Cerner implementation present any new challenges or opportunities?

    It really doesn’t affect our business directly. We love our federal customers, both in the VA and in the DoD with the military hospitals. They’re great customers for us. They have a tremendous level of loyalty. They’re great users of the product. They drive standardization across their facilities, something that the healthcare industry overall has not necessarily done a great job of and is moving more in that direction. People are recognizing that to drive greater efficiency and better quality outcomes, standardization is a key. The DoD and the VA are leading that effort and have done a great job of standardizing the product.

    We integrate with Cerner. We have a lot of great Cerner customers that are able to send alerts and alarms from the Cerner EHR out to the Vocera clients. The DoD and the VA were very clear that it is important for Cerner and Vocera to work effectively together in that environment. To some extent, it’s another source of great data that can be delivered out to the mobile workers. In fact, the Cerner employees doing the deployment in that environment are going to be wearing Vocera badges during the deployment and rollout of the Cerner EHR.

    What business lessons did you take away from your experience competing in the Olympics?

    Swimming was a big part of my life growing up. Certainly the Olympics was a key accomplishment along that path. But one of the key lessons you learn as a competitive athlete that translates directly to the business world is that life is not a sprint. It’s a marathon. 

    I was a sprinter. I swam on the 400 freestyle relay. I swam the 50 and 100 freestyle. These are races that last less than a minute, but you train for them for 15 years. Even though the glory happens and the media focuses on the 20 seconds or the 50 seconds that you’re in the water, it’s the preparation that goes into that ahead of time. 

    The business world is very similar to that. People focus on an event. They focus on the IPO, the sale of the business, or a big customer win. But success in sports and success in business is about putting in the effort every day. Having the discipline. Having a clear vision of where you’re trying to go with your life or your company and focusing every day on making progress towards that and not letting the day-to-day highs and lows impact your progress towards that end goal.

    Do you have any final thoughts?

    I’m really excited about the market transition that we’re going through. I think in the post-Meaningful Use era, there is an opportunity to transition care delivery across the care continuum and to use technology to not only improve patient satisfaction and patient safety, but also improve the caregiver resiliency. We have a major problem with burnout among nurses and physicians. Technology has been a source of that problem, historically. 

    Vocera is committed to using technology to restore the human connection to healthcare and to enabling care providers to go back to doing what they went to nursing school for in the first place, which is to care for patients. Our employees and our customers are passionate about that. It drives us every day.

    Comments Off on HIStalk Interviews Brent Lang, CEO, Vocera

    Morning Headlines 1/24/18

    January 23, 2018 Headlines 1 Comment

    New Novant Health MyChart Collaboration Improves Access to Health Records for Triad Patients

    In Winston-Salem, NC, Novant and Wake Forest Baptist Health go live on “Happy Together,” in which the Epic MyChart instances of the respective systems are combined into a single patient view.

    Employees at Practice Fusion expected IPO riches, but got nothing as execs pocketed millions

    CNBC dissects the sizeable differences predicted in Practice Fusion employee payouts once the company’s sale to Allscripts is finalized.

    VA, Health and Human Services Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts

    The VA will lean on the data, analytics, technology, and best practices of CMS to combat fraud and abuse within its programs.

    News 1/24/18

    January 23, 2018 News 2 Comments

    Top News

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    Winston-Salem, NC’s two biggest health systems – Novant and Wake Forest Baptist Health – go live on “Happy Together,” in which the Epic MyChart instances of the respective systems are combined into a single patient view.

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    Novant CMIO Keith Griffin, MD said in an announcement, ““Happy Together for MyChart will allow patients to combine data from the two systems into a single view to improve their understanding of medications, lab results, plan of care, and follow-up appointments. It is truly a major step forward towards the goal of patient engagement and elimination of barriers of information and confusion.”

    Novant says it will expand the program to include other Epic-using organizations.


    Reader Comments

    From Finance Guy: “Re: consultants. I switched to corp-to-corp because of the new pass-through tax rules. I think the 20 percent deduction will be big enough to justify the extra hassle. I don’t think most consultants will do it, though even for the extra money. Most are used to the firm holding their hands and are delusional in thinking the firm is looking out for their interests. Corp-to-corps can contribute 20 percent of their net profit to a self-employed 401(k).” I’m fascinated at how people create businesses with themselves as the only employee. I bet that practice ramped up after the ACA came into law and allowed them to buy competitively priced insurance on their own, although those days might be coming to an end. I also read about professional employer organizations, where for a small annual fee a company will permanently hire “your” employees that still work for you, offer whatever benefits (including health insurance available at big-group rates) you’re willing to pay for, and run the entire HR function, all for a single check.

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    From Epic Trainee: “Re: Advocate Health Care. At least 10 people from the long-time Cerner and Allscripts shop were in my Epic Implementation Overview class. New CIO and a merger with Aurora = another Epic shop.” Unverified.

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    From Movin’ On: “Re: bad job situations. Complaining doesn’t get you anywhere – either work with you employer’s leaders to make things better or move on. It’s time when: (a) they don’t offer career growth in your desired area; (b) you have no confidence in leadership or there’s unprofessional or unethical behavior at the top; or (c) personal reasons come up such as not wanting to relocate or travel.” I’ve hung on to jobs that made me miserable at least a couple of times because I was scared of change, it wasn’t a good time to upend my life (hint: it never is), and I secretly worried that I wouldn’t be good enough to compete with a new set of ladder-climbers. The final straw that forced me to move on – for which I was eventually grateful – was differences with a new boss. My conclusion is that unless you are anointed as a fast-tracker early on, your best path at moving up is to move out as the opportunity arises, probably at least every 3-5 promotion-free years unless you plan to live to 150. It’s OK to stay put if the prospect of change is too scary, but you then need to downsize your expectations and find some other source of ego-stroking beyond the company to whom you are unhappily selling the majority of your waking hours. I’m embarrassed when people complain about their jobs because it means they’ve settled for something they don’t like, which suggests a lack of either motivation or ability (I’m experientially jaded having suffered from both). It gets really bad when your occupational frustration, disappointment, and embarrassment bleed over into your family life and you feel personally diminished as a result. ”Spent a lifetime hunched over from the weight of a soul-sapping job” makes a poor epitaph.

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    From Amazon Grace: “Re: Martin Levine, MD’s role at Amazon. They posted a chief medical officer job last April to run their ‘healthcare’ practice’ that was pulled after 24 hours. It wouldn’t surprise me if that’s the role he is filling.” Seems reasonable since his background is regional chief medical officer for the highly regarded Medicare primary care practice of Iora Health. I expect Amazon is paying a big chunk of expense to pay for our overutilized, overpriced healthcare system, so they could be looking at either offering their own employee healthcare service or creating one as a business.

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    From Sarah: “Re: Ingenious Med. Fired CEO Joe Marabito and CRO Phil Spinelli over the weekend.” Unverified, but their bios have been expunged from the company’s executive page despite their unchanged LinkedIn profiles. I reached out to the company but haven’t heard back. Marabito joined the company in September 2016, while Spinelli came on board in April 2017.

    From WorryWart: “Re: ransomware. Have you heard of patients with conditions such as STDs being blackmailed for bitcoin based on leaked PHI?” I haven’t heard of that. It doesn’t seem practical for a hacker – they would have to identify who to go after, limit their efforts to those with assets and fear of exposure, contact them electronically (email addresses are cutting edge to some practices), and come up with a fear-inducing list of people they would contact. I think the greater risk is that someone local – like a provider’s employee – gets the information and recognizes the patient as a rich target, although the threat of serving time under US extortion laws is probably a dissuader. My conclusion: hackers, like lawyers, don’t waste time on shallow pockets.


    HIStalk Announcements and Requests

    Last chance to tell me about ““What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based Application.” Responses are few, which likely marks an untimely demise to the reader-suggested  “What I Wish I’d Known Before …” series that will otherwise be cancelled after only the pilot episode has aired.

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    Need an inexpensive fitness tracker that — beyond the usual counting of steps and calories burned — includes monitors for heart rate, blood pressure, and blood oxygen? I just bought this one for less than $25 and it works great – it even includes an extra band. It’s probably not amazing, but then again, neither is my workout regimen.

    I watched the premiere of “The Resident” on Hulu and it was kind of interesting, but cliche. The idea that hospitals are money-grubbing, faceless corporations led by bean-counters rang somewhat true since I’ve worked for those, but the titular protagonist with the bad-boy facial fuzz and the ability to bond only with patients he just met is a stereotypical cartoon – brilliant, cynical, anti-antiauthority, unaccepting of incompetence, quick to thrust his endless libido at convenient nurses, and full of unconventional medical methods that magically pull patients (sometimes not even his own) back from the brink after they were nearly killed by the dreaded evidence-based medicine, team care, and expert consensus. All we need, apparently, are more world-weary, narcissistic clinical cowboys who think they know more than the entire body of medical literature.


    Webinars

    January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

    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

    The state of Kentucky sues McKesson for providing pharmacies with the narcotics its not-being-sued doctors prescribed. Perhaps they should go after Kroger next for selling its overweight people Doritos and Vienna sausages.


    Sales

    Ohio Valley Hospital (PA) selects Parallon Technology Solutions to provide training go-live and support for its implementation of Meditech physician documentation.

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    Doylestown Hospital (PA) chooses the cloud-based EHR of EClinicalWorks for its 169 providers.


    People

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    Release-of-information vendor Ciox Health hires Mike Connolly (PwC) as president of retrieval services and Leke Adesida (Anthem) as SVP/chief compliance officer.

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    Divurgent promotes Liz Keller to VP of client services.

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    Industry long-timer Meg Aranow (SRG Technology) joins Brighton, MA-based urgent care EHR vendor Edaris Health as COO.

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    Henry Ford Health System (MI) hires Paul Browne (Tenet Healthcare) as SVP/CIO.


    Announcements and Implementations

    Colorado’s CORHIO goes live on Medicity’s Community Interchange, which gives clinicians CCDs for making patient care decisions.

    Clinical Computer Systems, Inc. announces Obix as a Service, a cloud-based version of its Perinatal Data System.

    CenTrak adds Bluetooth Low Energy beacon technology to its Enterprise Location Services infrastructure, offering advantages over off-the-shelf beacons that include interoperability, reliability, five-year battery life, and scalability. 

    Four new published studies find that use of Glytec’s EGlycemic Management System improves treatment safety and effectiveness versus paper-based diabetes and insulin management protocols.

    Nuance releases Dragon Medical Practice Edition 4.

    Cleveland Clinic Florida describes its $4,000 per year concierge medicine program as providing “consistent, comprehensive, personalized medical care while cultivating in-depth patient-physical relationships that support patients’ health goals,” “assistance with medical records,” and “always ample time” during office visits. Apparently we rabble who are paying for visits with insurance and cash can’t expect such service.


    Other

    A claims analysis study finds that commercially insured Americans used less healthcare in 2016 than 2015, but rising prices  — especially drug, surgery, and ED costs — drove 2016 spending up more than any of the past five years.

    The corporate communications director of Fairview Health Services walks back the CEO’s pointed criticism of Epic for being anti-innovation, soothing vendor relations with, “Given Epic’s prominence as an electronic health record provider, they are uniquely positioned to support collaboration for innovation in healthcare.” Notice that she didn’t actually say what Epic is or isn’t doing and thus contradict her boss – only that the company is “uniquely positioned.”


    Sponsor Updates

    • AdvancedMD will exhibit at the Expert Roadshow January 24 in Salt Lake City.
    • Arcadia Healthcare Solutions will exhibit at the CCO Oregon Winter Conference & Annual Meeting January 30 in Salem.
    • Dan Dodson, president of Fortified Health Security, appears on an EHealth Radio podcast.
    • Besler releases a new podcast, “Examining the relationship between the concentration of Medicare Advantage plans and premiums.”
    • CoverMyMeds will exhibit at the NorCal HIMSS Innovation Conference & Showcase February 1 in Santa Clara.
    • Bizwomen recognizes CSI Healthcare IT Division President Kate Mays as a Headliner in Technology.
    • EClinicalWorks will exhibit at the 2018 Star Ratings Congress January 29-30 in Scottsdale, AZ.
    • Healthgrades names the recipients of its 2018 Distinguished Hospital Award for Clinical Excellence.
    • Iatric Systems will exhibit at the HCCA Regional Meeting January 26 in Atlanta.
    • Influence Health will exhibit at The Joe Public Summit January 30-31 in New Orleans.
    • Kyruus will exhibit at the GA HFMA Winter Finance Summit January 24 in Atlanta.

    Blog Posts


    Contacts

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

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    Morning Headlines 1/23/18

    January 22, 2018 Headlines Comments Off on Morning Headlines 1/23/18

    Protenus Raises $11M from F-Prime Capital, Kaiser Permanente Ventures

    Baltimore-based Protenus, a developer of AI-powered EHR security tools, raises $11 million in a Series B round that brings its total funding to $19.4 million.

    Microsoft to drop its HealthVault Insights apps

    Microsoft announces it will pull apps associated with its HealthVault Insights research project from app stores. User-generated data will be available via the HealthVault website.

    Health Intelligence Company, Springbuk, Announces $20 Million Series B Round

    Employer-focused health analytics company Springbuk raises $20 million in a funding round led by HealthQuest Capital and Echo Health Ventures.

    USDA Invests in e-Connectivity to Restore Rural Prosperity by Providing Training and Health Care Services

    The USDA awards $23.6 million via its Distance Learning and Telemedicine Grant Program to rural communities in need of broadband equipment.

    Comments Off on Morning Headlines 1/23/18

    Curbside Consult with Dr. Jayne 1/22/18

    January 22, 2018 Dr. Jayne 2 Comments

    I had several people calling me over the last couple of days, wanting to talk about the recent Allscripts ransomware issue. A couple wanted my advice on protecting themselves, even though they use different vendors and have different system configurations. I have some good friends who spend the majority of their time during security risk analysis and white-hat hacking, so was happy to hand them over to the experts. One was a physician liaison at my former hospital, who wondered if I would write a guest column for their newsletter to help community physicians be more aware of the risks of ransomware. Their deadline is a couple of weeks out, so I’m happy to help.

    Another was from a friend who uses Allscripts and wasn’t sure if her practice was impacted or not, so I got to explain the difference between being self-hosted and vendor-hosted. It sounds like her system is self-hosted but connected to vendor-hosted subsystems that have been impacted. For the most part she was just glad that she could see her charts and also glad to have “someone who speaks IT and can translate” available. She had been getting emails from her practice that included language forwarded from Allscripts that didn’t meet the need for understanding.

    I also received a call from a former colleague who now works for a vendor and who “just wanted to catch up.” The call quickly turned into the most glaring example of schadenfreude I’ve seen in a long time. He went on and on about how this is going to be the death knell for Allscripts and how he was going to hit his territory hard and try to make sales. I had to remind him that his company has had its own share of issues, not necessarily with ransomware, but with outages on its own hosting platform.

    There is plenty of quicksand for any vendor to land in, and sometimes I think only dumb luck prevents vendors from falling into the pit. Not to mention, going into a practice that has been impacted by a major outage and trying to sell a replacement system might not be a good idea in the short term. The proverbial corpse isn’t even cold and practices are still down, so a little patience and respect might be in order.

    I have always preferred vendors who sell their products based on their own merits rather than by tearing down their competitors. Trying to make a purchaser feel bad about their current vendor calls into question their past decision-making and isn’t a way to win friends, in my book. Outages aside, every system has flaws and there isn’t one perfect solution out there. For every rock-solid feature, it seems like there’s something clunky hiding in the background to haunt you after you’ve already signed the contract. EHRs aren’t different from any other technology. As features evolve, sometimes they hit the mark and sometimes they don’t. It’s like buying a car – there’s always something you miss from your old car, or something you didn’t find on the test drive that becomes a daily annoyance.

    I feel bad for the hosted physicians who are having to deal with the consequences of the ransomware and are being told to plan to be down on Monday. Although Allscripts is working on a read-only solution, it’s not clear how they’re going to deploy it or what it will include. This should be a wake-up call to physicians and hospitals and a good prompt to review their downtime solutions and maybe even give them a test. At my practice, we have monthly reviews of the downtime process and site leads have to check weekly that their downtime supplies are ready to go, but despite the preparations it’s always at least a minimum level of mayhem when downtime hits. The reality is that although ransomware and hacking get the spotlight, the majority of downtime events have more conventional or mechanical causes.

    I’ve personally been the victim of the guy with the backhoe that cuts the fiber, the guy who accidentally triggers the Halon fire suppression system, and the lady who crashed into the data center and knocked out the electrical transformer. There’s also the winter storm that took down power lines, the system that froze because the server was out of memory, and the person who triggered a giant report to run against the production server in the middle of the day. Any one of those issues can make a system unusable and lead to a downtime event.

    In my career at Big Health System, we had a utility that created a “lite” version of charts each night, sending records for all the patients in my panel to a local desktop. The lite chart basically contained the medication list, allergies, diagnosis list, and six months’ worth of laboratory and radiology data. It didn’t include scanned documents, but was enough to field a patient’s phone call. The utility also sent a “full” version of the chart for each patient scheduled for an appointment in the next 72 hours, which included the lite chart plus six months’ of chart notes and scanned documents from the laboratory, radiology, and consults filing structure. Theoretically, that would be enough to get one through an office visit with enough essential information.

    That solution was great for a network outage but not for a power outage, so we had to make sure we had a fully-charged laptop with either a wireless modem or the ability to tether to a cell phone in the event that we lost power. The belt-and-suspenders coverage provided by this combination served us well through a variety of challenging situations. Of course, we also had a full disaster recovery plan, with distant servers and near-real-time fail-over processes, but thankfully I only had to experience that situation a couple of times.

    Not every practice is fortunate enough to have staff dedicated to ensuring a smooth downtime. Still, you’d think with all the natural disasters we’ve seen in the past two years, that people would be doing a better job of it. I look forward to the day when I no longer hear about a practice whose only downtime preparation includes some photocopied visit note forms and a hope that someone printed a copy of the patient schedule before they went home last night.

    For vendors servicing smaller practices, offering services to help clients put together a solid downtime plan would be great. I’d be interested to hear what vendors offer support for that type of a solution, and what other organizations small practices look to for downtime advice.

    In the short term, however, I’m wishing the best to my colleagues on Allscripts. I hope the outage is short lived and your sanity makes it through mostly intact.

    Have you been impacted by ransomware? Email me.

    Email Dr. Jayne.

    Morning Headlines 1/22/18

    January 21, 2018 Headlines Comments Off on Morning Headlines 1/22/18

    Allscripts Ransomware Update

    In a ransomware update Sunday morning, Allscripts tells customers that Professional EHR and Allscripts PM are being brought back online on a rolling basis; users should plan for their systems to be down Monday. The company will let customers know what if any HIPAA breach reporting is required.

    Amazon just hired a top Seattle doctor who ran a network of health clinics

    Amazon hires Martin Levine, MD (Iora Health) for an unstated role.

    Consent for Release of VA Medical Records

    To ensure medical records are available at the point of care, the VA issues a proposed rule that would allow outside providers to access records through HIEs, bypassing the need for the VA to have a patient’s written consent in hand.

    Comments Off on Morning Headlines 1/22/18

    Monday Morning Update 1/22/18

    January 21, 2018 News 6 Comments

    Top News

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    From the Allscripts ransomware update Sunday morning:

    • The ransomware attack involved SamSam malware, but not the same strain that took down the systems of Hancock Health.
    • The vulnerability that was exploited wasn’t within the Allscripts application, so self-hosted customers are not at risk.
    • The many services that were taken offline strictly as a precaution have been restored.
    • Professional EHR and Allscripts PM are being brought back online in a rolling basis, but clients should plan for their systems to be down Monday. Allscripts is trying to put together a view-only solution.
    • Clients that have been brought back online are running normally, not on a temporary instance of their system.
    • The malware does not propagate as a worm or via VPN, so client computers will not be infected.
    • The company will let customers know what if any HIPAA breach reporting is required.

    Allscripts hasn’t said how the malware was introduced, but SamSam’s sole method of entry seems to be unpatched installations of JBoss software, for which Red Hat released SamSam-protecting patches nearly two years ago.

    I was mildly amused that to listen in on the Web-based Allscripts ransomware update Sunday morning, I had to install the notoriously buggy and unsecure Flash browser plug-in, which took forever to load, suggested adding other crap software, and required a browser restart. The Allscripts folks on the call noted that several participants couldn’t hear the Flash-powered audio and suggested trying Chrome or Firefox instead of IE/Edge. I was appreciating the potential irony of an anxious doctor dreading an EHR-less Monday morning having his or her home PC infected with Flash-enabled malware while listening to a Flash-required malware update.


    Reader Comments

    From Tired of the Greed: “Re: Optum Ventures. Bought several companies in 2017, including Advisory Board, because UnitedHealth Group was making so much money they wanted to put capital in the marketplace. Tax reform gave them a huge windfall that they will not be sharing with employees. Raises remain in the usual 1 to 1.5 percent range with zero bonuses for most of my department. Yet upper and senior management (all male in my division) will get nice bonuses and who knows what kind of raises. This is an old boys’ network lining its pockets and those of its shareholders on the backs of patients and physicians with cooked-up ways to deny paying for legitimate medical care.” My reactions are as follows:

    • Salary and benefits exist at the intersection of supply and demand. Lack of a mass exodus means employees don’t see better options and thus implicitly accept their employment conditions. I’m sympathetic because a truly fluid employment market means being willing to relocate, travel, or take a less-satisfying job full of uncertainty and family disruption, but it’s a free market both ways.
    • You can easily test your worth to the company by threatening to leave unless you get a promotion or raise, but expect the company to call your bluff. They have a ton of employees, but you have only one job.
    • Don’t expect a company to be “fair.” Lofty vision statements aside, companies (including non-profit hospitals) exist solely to take in more money than they spend since failure to do so means shutting down. Your only hope is that the person you report to is fair.
    • Don’t conflate gender equity with gender-neutral executive entitlement. While it’s true that executive management is dominated by males, it’s probably also true that the suits aren’t secretly doling out perks to their male underlings.
    • Executives are also sometimes clueless about working in a non-executive job. I’ve had to soothe many ruffled feathers when a hospital C-level executive forgot who he (being male in this example) went off script in a department meeting and joked about his bonus being at risk if employees failed to deliver and how he liked the view from his expansive office or the convenience of his reserved parking spot hundreds of yards closer than where we peons jacked up our adrenaline levels first thing every work day jockeying for any available spot. He wasn’t evil, just cluelessly entitled and smug about his executive ascent, which he attributed to his brilliance and work ethic (both questionable given even brief observation). Executives are “Animal House’s” Douglas C. Neidermeyer, while the non-privileged are banished to the couch with Jugdish, Sidney, and Clayton.
    • Companies (and people) do what someone pays them to do. If they’re making money, they are filling a market need, no matter how socially conscionable their actions are. Blame who’s paying them.
    • As cold as it sounds, if you want to control your own future, you have to work for yourself instead of someone else.

    From Party Shoes: “Re: HIStalkapalooza. I read HIStalk religiously every day and haven’t seen the details.” It’s amazing how many people who claim to pore over my every word somehow missed the several times I’ve mentioned that I’m not doing the event this year. TL;DR: no HIStalkapalooza this year.

    From Chuck Roast: “Re: HIStalk. I read your email newsletter every day. Good job!” I stopped putting teaser bullets in the email blast for exactly this reason – people were confused into thinking it was a self-contained email newsletter rather than a single link to the real online thing. Other folks haven’t figured out that the daily headlines are in addition to the usual M-W-F full posts and complain about overlap. My advice has never changed – if you don’t check HIStalk each weekday, you are almost certainly missing something I thought was important. Just click the home page link and read down the page until you hit something you’ve already seen. The email link goes directly to that particular article, so you won’t see the other stuff there from that link.

    From Bitter Pill: “Re: Amazon and Google in healthcare. How could they possibly fail?” In about a million ways, foremost being the error in seeing healthcare as, like every other industry, being driven by consumers who simply require new technology to further empower them with the threat of taking their business elsewhere. Evidence: if patients were empowered consumers, hospitals wouldn’t offer inconvenient parking, 9-5 weekday hours for non-inpatient services, halls full of roaming providers who aren’t in the patient’s insurance network, next-available appointments running weeks into the future, and inflated but incomprehensible bills. Unlike every other market, healthcare is poorly run and consumer-hostile, but full of entrenched players who can easily steamroll any outsider’s efforts to make it better at their expense.


     HIStalk Announcements and Requests

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    Of the 81 percent of poll respondents who don’t trust KLAS’s product rankings, half think the company is biased or caters to paying vendors.

    New poll to your right or here: is Epic an impediment to innovation as Fairview’s CEO says?

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    I received good responses to my post on “What I Wish I’d Known Before … Replacing My Hospital’s Time and Attendance System.” Next up:  “What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based Application.” I made a list of fun future topics, but it will evaporate if few folks participate.


    Webinars

    January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

    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.” Sponsored by Strata Decision Technology. 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

    Three-hospital Astria Health (WA) will implement Cerner under the company’s CommunityWorks hosting program.


    People

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    Amazon hires Martin Levine, MD — a geriatrician and Seattle-area medical director of Medicare primary care practice Iora Health – for an unstated role.


    Other

    Maybe this isn’t new, but I hadn’t noticed. Signing up for any HIMSS18 pre-conference symposium includes the Pre-Conference Plus benefit. You pay for a particular session, attend its opening keynote, but then are free to move around to other symposia during breaks (it would  be interesting to see which sessions send attendees fleeing for the doors). They all cost $350, so there’s no gaming the system by signing up for the cheapest one and then switching. I also noticed that some conference sessions now list “conference supporters” that HIMSS has convinced to spend even more money, removing yet another safe space for non-vendors trying to evade commercial pitches (you knew that was coming when HIMSS started selling escalator advertising). My brilliant ideas – pay the food court vendors to attach flyers to their $13 chicken Caesars or hire one of those Las Vegas stripper card flippers to further clog the seedy sidewalks. 

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    Open source EHR vendor OpenMRS – whose product is used in developing countries – receives a $1 million donation from cryptocurrency philanthropy organization Pineapple Fund (its tagline: “because once you have enough money, money doesn’t matter.”) OpenMRS learned that the person who started that organization had previously  contributed OpenMRS software patches. OpenMRS is a non-profit collaborative led by Regenstrief Institute and Boston-based Partners in Health.


    Sponsor Updates

    • IBM names Salesforce its preferred customer engagement platform for sales and service.
    • Sunquest Information Systems will exhibit at the Precision Medicine World Conference January 22-24 in Mountain View, CA.
    • Huron will exhibit at the Association of Cancer Executives Annual Meeting January 28 in Portland.
    • Conduent will exhibit at the Middle Tennessee Antimicrobial Stewardship Symposium January 26 in Nashville.

    Blog Posts


    Contacts

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

    125x125_2nd_Circle

    What I Wish I’d Known Before … Replacing My Hospital’s Time and Attendance System

    That our hospital’s Time and Attendance policies were not being applied throughout the organization equitably in all departments.  We found a lot of departments that were providing extra incentive pay to nurses in order to boost their salaries. Other departments were making up their own on-call pay programs for their personnel.


    That employees were getting around showing up late by not punching in and then later stating that the system must not have worked when they “clocked in.”


    Anything that directly or indirectly to do with payroll is EXTREMELY sensitive. Expect people to freak about any test results that don’t match the result of the existing system in payroll, down to the penny.


    If your facility is non-union, and has been working to stay that way despite onslaughts by SEIU and others, expect to deal with lots of very complex pay premiums. Don’t be surprised if disgruntled employees and/or organizers try to make something sinister out of the system change.


    Place time clocks in areas with enough room to hold all the employees standing around waiting to clock in in the morning and clock out in the afternoon.


    If your internal sponsor is the HR director, make sure that you reassure that person early and often that the system change won’t accidentally result in pay changes.


    Hospital pay rules are more complex than any other industry, sometimes exceeding the capability of non-healthcare specific payroll systems to handle them. It was shocking to find how many departments were running their own unapproved overtime, call time, and bonus programs in direct contradiction to hospital policy. It takes a lot of time and finesse to find these exceptions and then some HR backbone to bring those departments into compliance instead of building rules just for them.


    If your implementation involves installation of hardware, allow lots of time to make it happen. Hospital construction can be very tricky from a permitting standpoint.


    Plan to run tests through month end and end-to-end with payroll to make sure everything is perfect before you agree to a cutover plan.


    Don’t let Procurement sunset the contract with your existing vendor until you are absolutely confident in your cutover dates.


    Policy over technology. Users run in the door and swipe at 8:14:59, then get ready for work, and out the door at 4:45:01.


    Pay attention to the choice of letting employees clock in by telephone and limit that to in-house phones.


    Expect managers to express shock and indignation that it’s their job to review time clock reports against reality. And to look the other way if they’re worried the offending employee might quit over being paid accurately rather than generously.


    I wish we had understood the complexities of overtime, the number of salaried employees that are required to clock-in/clock-out even though their pay doesn’t change (and the frequency with which they forget or delay their swipe), and I wish it was understood exactly how much manual overriding would be needed over the first four payroll cycles to make sure employees were appropriately paid. I also wished we had budgeted for all of the overtime required for staff that were perpetually on call to handle these and other issues during the transition period. In short, I wish we knew everything since what we actually knew was nothing, and our vendor was complicit in helping us fail pretty spectacularly during the process.


    Will employees be able to access accrued PTO in their current paycheck (leaving a zero PTO balance) or will their pay be docked even though they have PTO remaining? This “feature” has to be manually overridden by our HR personnel with management approval.


    How difficult is it for employees to enter multiple days off in a row. Do they have to do every single day as a separate entry or is the multiple-entry feature seamless and user-friendly?


    That a focus on staffing workflow impact is equally or more important than the specific technology. That includes integration with upstream and downstream systems.


    Don’t underestimate the creative nature of employees clocking in and out. Before we got wise and changed it, some would stop and clock in and or out at our remote locations (30-45 minutes away) and then drive in to the hospital. We noticed a spike in overtime. Also we noticed an incredible number of time sheet edits by non-management folks who had the authority previously. Their role went away and the authority moved to managers (some of whom argued it wasn’t their job?) Every management level now had to sign off for their areas. The number of edits decreased but it took a long time and a lot of oversight.


    A story about a payroll system. I don’t recall the name but it was a Mom & Pop vendor (Mom was the CEO and Pop was the techie) selected by the HR division. On January 31 with no other option, we had to mask out the SSNs on a couple hundred (or more) printed W-2s, then run them through the printer as blank sheets with a correctly placed SSN cell from Excel. We moved on to a new vendor and the company was gone the next year.


    They were in negotiations to be acquired by a competitor and there equipment would be sunset within the year.


    It’s not the system that causes issues. It’s the clock in/out & OT calculation policies & procedures.


    Weekender 1/19/18

    January 19, 2018 Weekender Comments Off on Weekender 1/19/18

    weekender


    Weekly News Recap

    • Allscripts-hosted EHR and e-prescribing systems go down early Thursday due to a ransomware attack.
    • DoD confirms that its Cerner rollout is on hold not because of problems, but rather according to the original project plan, which called for a comprehensive review of the first four pilot sites that won’t be completed until later in 2018.
    • Change Healthcare acquires National Decision Support Company.
    • Microsoft kills its HealthVault Insight app less than a year after its rollout.
    • Senator Jerry Moran (R-KS) questions the VA’s contract-signing delay with Cerner, asking in a letter to Secretary David Shulkin what he hopes to learn or do differently after digging deeper into Cerner’s interoperability capabilities.
    • The VA’s CIO says its legacy VistA system will need to remain running (and funded) for the 10 years it will take it to fully implement Cerner.
    • Hancock Health (IN) pays the demanded $55,000 ransom to regain access to its systems following a ransomware attack, saying it was a good business decision given the time it would have taken it to restore them from backups.
    • The CEO of Fairview Health Services (MN) calls for a “march on Madison” to demand that Epic encourage innovation by opening up its system and intellectual property management practices.
    • McKesson, 70 percent owner of Change Healthcare, says Change’s IPO could be run this year.

    Best Reader Comments

    Epic’s model does assert the ability to use any IP in App Orchard without compensation or limitation, it’s why the few vendors I’ve spoken to are hesitant to use it. The only reason that they’re considering it is because Epic has a stranglehold on their customers. That atmosphere isn’t really innovation-encouraging. (DrM)

    Amused by the fact that the most engagement an HIStalk post has received in months is due to a hospital executive saying something critical of Epic. Thin skin in Madison. Epic is Big Healthcare. With that kind of company financial success, you are going to have your critics. Comes with the turf, guys. (CheapSeats)

    There’s a world of difference between updating the OS or AV software, where users shouldn’t be affected at all, and updating software that affects of the UI and workflow of knowledge workers. The number of decision-makers involved is an order of magnitude different, and simply understanding the effects of workflow changes can take far more than three months. (DrM)

    So “pace of change and innovation is stifled” and “pace of change in software is too fast”? I’m confused. (Doesn’t compute)

    VA CIO: Expect another 10 years of VistA in facilities during new EHR rollout. This is clear indication of how the VA and government agencies are dysfunctional. There is so much wrong with this it’s hard to decide where to begin. Interoperability issues between systems only being exacerbated over years as patients move from a region on Cerner back to a facility still on VistA. How do you call a system new 10 years after it’s installed in the organization? In 10 years the VA and DOD could be replacing Cerner with another system. (Matt)

    Will this Cerner dust-up with the DoD now give us a real granular discussion on a national level as to what Interoperability really means as far as how much is exchanged, degree of exchange and access, and who is responsible for it ($$$$ from vendors or hospitals paying for the infrastructure)? More realistically, will it force Cerner deeper in to a “commitment” to the CommonWell Health Alliance? Commitment in quotes means a lot of things. Really publicizing how well (and how much) it shares between itself and the other vendors and Epic. Having to commit more resources to it, including education and architecture for their customers and hospitals using other vendors. Perhaps how Cerner has to address this could chip away at the conventional wisdom that eventually you will have to be on either Epic or Cerner. (You might say I’m a dreamer)

    I played Theme Hospital as a child and always thought it was a joke that the hospital systems were out for profit. Now I write EMR software. It was the longest, darkest punchline.(ThemeHospital)

    Epic doesn’t assert ownership over any the apps on their App Orchard or the hundreds and hundreds of third-party apps that work with Epic. Their model is just like Apple. And, if there are literally billions of dollars and so many smart people in Silicon Valley, why didn’t they solve healthcare automation in a hugely, bigly amazingly way by now? They’ve had that money and those smart people for a while. How did a podunk outfit out of Madison Wisconsin get the drop on all of them? Good thing they haven’t found Kansas City yet. Give us a break James. What specific innovation do you feel is being impeded? (What’s with the Fairview guy?)

    Even though Apple could take IP directly from the Apple ecosystem developers, their usual model is to just buy the companies. Same is true for Google and Microsoft. The big guys get the IP in the end, but developers get an exit strategy. Because of Epic’s stance against acquiring, that option isn’t available to Orchard developers. I would be hesitant, too. (Bob)

    I wonder if there should be an EHR feature where patients if they’d like can subscribe to access to their record where they get emailed every time it gets accessed with a note on who accessed it and their role? (AC)

    I’ve stopped believing any story about celebrity doctors saving people on planes unless there’s photographic proof of it happening. Eric Topol figured out it’s a completely unverifiable way of getting extra publicity for whatever device he happens to be talking about at the time, and obviously Oz learned the lesson. My prediction – Oz has a show coming up about the dangers of air travel. Regular doctors respect those peoples’ privacy and don’t go humble-bragging about their clinical acumen. (DrM)


    Parental Leave Policy Responses

    A few folks responded to Allspice’s question about paid leave for new dads, which his company doesn’t offer.

    • Athenahealth – 12 weeks for mom, six weeks for dad.
    • Unnamed health system – no maternity, paternity or family leave. Employees have to use FMLA and cobble together PTO and short-term disability if you’ve given birth. “People always assume that because I work in healthcare, I have great health benefits, and I just respond with a slightly unhinged laugh.”
    • A reader from Canada – leave policy is mandated by the federal government. New moms get a maximum 15 weeks at 55 percent of average compensation, while those caring for a new child get a maximum 35 weeks at 55 percent of earnings (can be shared between parents) or 61 weeks at 33 percent of average earnings.
    • Epic – new moms get 5-8 weeks of short-term disability, then can use PTO to cover the rest of FMLA time up to 12 weeks. They can then come back part-time for another three months, but that’s a problem for those in travel roles. New dads get nothing. “I was back on the road 17 days after the little one was born. They will tell you that they support your time off, but if you have an escalated client, you are responsible for it, period. As a company that preaches about health and doing the right thing, they missed the boat on being progressive on this key area for welcoming a newborn.”
    • Merge Healthcare/IBM – IBM increased the paid time for paternity, maternity, and adoption from six weeks to 12 and even back-granted extra time for new parents.
    • Unnamed health system – women get short-term disability and FMLA (no specific paid maternity leave) and dads get FMLA.
    • Epic – no paid time off, just FMLA.
    • Unnamed health system – introduced a new benefit of two weeks PTO for both parents with a birth or adoption, Previously, dads got PTO/FMLA and moms got short-term disability after a two-week waiting period.
    • Unnamed health system – new dads get nothing outside of FMLA, moms get short-term disability if they give birth and only FMLA if they adopt.
    • WebPT – for birth, surrogacy, adoption, or foster care, no benefit for less than six months of service, two weeks time off for 6-24 months, four weeks for two or more years of service. Employees get two weeks for foster care.

    Watercooler Talk Tidbits

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    Thanks to those impressively credentialed readers who signed up for my Rolodex – I really appreciate it. The link will always be listed at the bottom of the Weekender posts, along with links to other permanent and short-term opportunities to help me out or get involved. It’s heart-warming to see CIOs, other hospital executives, CEOs, technologists, consulting firm executives, and clinicians offer to provide me with occasional guidance and news reaction.

    image image

    HIStalk readers provided science game night activities for the elementary school class of Mrs. S in Mississippi in funding her DonorsChoose teacher grant request. She reports, “Thank you so much for helping my students fall in love with science. It warms a teacher’s heart when they actually want to learn! They were so eager to see the new products that we got to use for our projects. Their favorite one so far has been the Augmented Reality dinosaur project. They just love that they can make it come to life with just the use of an iPad. I cannot wait for my students to use the globe next. That is our next standard in science. They will get to learn all about the seven continents and ‘see’ them just as if they were there.”

    SNAGHTML302e3f62

    The fun folks at Ellkay sent cool swag our way through Lorre. I thought the “15 years” mug was to commemorate HIStalk’s 15th anniversary (this coming June), but I realized in rotating the mug that it refers to Ellkay’s 2002 founding. Inside the cool cardboard container is some Ellkay honey supposedly harvested from bees kept on its roof, and even though I can’t verify its source, it’s still a great marketing idea.

    A few readers let me know they got an error trying to read HIStalk Thursday afternoon. It was actually a good problem if there is such a thing – so many folks jumped on to read my Allscripts ransomware news item (to which kind readers alerted me) that my dedicated, rather high-powered server was overloaded for 30 minutes or so. Thursday didn’t set a readership record since, other than the Allscripts item, I hadn’t published anything except headlines and Dr. Jayne since Tuesday night, but it was still over 11,000 page views in a 24-hour period. Tops of all time was DoD’s Cerner announcement day, July 30, 2015,  when 17,000 folks checked it out and many others weren’t able to get in, leading me to dig out my wallet to beef up the hardware yet again.

    Uber hires a HIPAA-focused lobbying firm for unstated purposes, but possibly related to transporting people to medical appointments or for professionals booking rides for patients.

    “The Resident” premieres on Fox Sunday night following the NFC championship game. It’s apparently cynical and darkly funny in covering healthcare ethical issues, an incompetent surgeon bullying staff to cover up his mistakes, and the never-ending quest by hospitals to boost their bottom lines.


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