Morning Headlines 7/11/18

Ingenious Med Announces Nimesh Shah as New CEO

Nimesh Shah (McKesson) replaces Joe Marabito as CEO of Ingenious Med.

Children’s Mercy faces class action lawsuit over data breach affecting thousands

Children’s Mercy Hospital (MO) faces another data breach-related lawsuit, this time pertaining to an email phishing scam that potentially exposed the data of 63,000 individuals.

Layoffs likely ahead at Henry Schein in latest move

Analysts predict health IT company Henry Schein, which recently spun off its animal health business, will downsize after a regulatory filing hints at plans to increase efficiencies.

News 7/11/18

Top News

Cerner will partner with value-based care services operator Lumeris to create a combined VBC technology product to be called Maestro Advantage. Lumeris will also adopt Cerner’s HealtheIntent platform.

Cerner will make a $266 million investment Lumeris, acquiring a minority share.

Reader Comments

From You Dubbed: “Re: UW Medicine’s EHR project. You shouldn’t have included the link from your reader since other sites used it without listing HIStalk as a source.” That happens quite a bit when I run insider-reported news that competing sites have to pretend they discovered on their own even though the source is obvious due to timing and the link (or lack of a link). I don’t mind that they do it, but I do mind that they intentionally don’t give credit, which I would unfailingly do. The most head-scratching commentary was added by the 2017 journalism graduate of Becker’s, who ill-advisedly went off script in pondering to a stated CIO audience, “UW Medicine has not revealed whether it will build its own system or select an EHR vendor for the $180 million effort,” missing the obvious points that (a) no health system has built an EHR in many years; (b) the project budget clearly indicates the line item involved with buying the unnamed vendor’s product; and (c) the rollout will start in a few months.

From Blank Cheque: “Re: HIT family tree. Looking for the graphic depiction you ran.” The most recent version I have of the thoroughly researched and incredibly complex document that was created by Constantine Davides (now a managing director at investor relations firm Westwicke Partners) is from 2015. From which I shall extract this trivia question: what was the former high-flying point-of-care patient safety technology vendor that Cerner acquired for just $11 million in 2005? You might also want to consult Vince Ciotti’s HIS-tory, which I believe had similar depictions.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Medical practice technology vendor AdvancedMD acquires competitor NueMD, which offers practice management and billing applications that include clearinghouse capabilities.

Verity Health System (CA) is looking for a buyer of some or all of its six hospitals, hoping to “address challenges our hospitals face after a decade of deferred maintenance, poor payor contracts, and increasing costs.” Patrick Soon-Shiong’s NantWorks bought a majority interest in the health system last July from its hedge fund owner, which retained a minority share and provided additional funding. That announcement touted the health system’s access to new technologies such as the ones NantWorks sells. Shortly after the announcement, Verity moved to implement Sunrise from Allscripts, of which Soon-Shiong was also an investor, a move so embarrassingly self-serving that the Allscripts sales announcement declined to refer to Verity by name. 

Population health management technology vendor Arcadia opens a Pittsburgh office, where it will add 30 software engineering jobs by the end of the year.

Sales

• Catholic Health Initiatives chooses CTG to implement Epic in its Chattanooga, TN region.
• Non-profit Manifest MedEx adds two large California medical groups and Stanford Health Care to its network that provides real-time patient encounter notification and a display of aggregated patient data. CEO Claudia Williams and Chief of Staff Erica Galvez previously worked for ONC on interoperability.
• Avera Health (SD) will implement PeriGen’s PeriWatch labor analysis software in its birthing units and will add the full PeriGen suite that includes its fetal monitoring solution. 
• Nova Scotia Health Authority chooses Corepoint’s integration engine for province-wide interoperability for its One Person One Record initiative.

People

Ingenious Med hires Nimesh Shah (McKesson) as CEO. He replaces Joe Marabito, who was hired for the CEO job in September 2016.

Announcements and Implementations

State of Alaska hospitals can view view prescription drug monitoring program information at the point of care via Collective Medical’s network and platform, which also allows providers to identify their highest-need patients in real time and collaborate to meet their needs. Collective’s system is endorsed as a best practice for emergency medicine by ACEP, whose state chapter was involved in the rollout.

KLAS introduces high-mindshare precision medicine vendors in a new report that will be followed in Q4 by a more detailed version that will include customer opinions.

InstaMed makes its External Payment Page Integration available in Epic’s App Orchard, allowing sites to create a seamless, secure online payment experience without requiring them to store credit card and bank payment information.

Government and Politics

In England, Secretary of State for Health and Social Care Jeremy Hunt replaces the resigned Boris Johnson as foreign secretary. Taking over Hunt’s job in a flurry of Brexit-related resignations is culture secretary Matt Hancock, a 39-year-old former economist and technologist. 

The White House eliminates most of the remaining CMS funding for navigators who help people sign up for Affordable Care Act policies, also requiring groups who apply for navigator grants to pitch short-term and association health plans that offer cheaper but less comprehensive coverage, charge sicker people higher premiums, and exclude pre-existing conditions.

Other

Drug users are monitoring their post-ingestion heart rates on their fitness trackers and posting screen shots on Reddit and other sites to show the effects of what they took. A quantified selfer reports, “Drugs are the only reason I wear a Fitbit. I want an early warning system for when my heart’s going to explode.” Experts warn that this is a really bad idea given the inaccuracy of the devices and maybe for taking potentially deadly drugs in the first place.

More interesting claims from Tennessee’s lawsuit against OxyContin maker Purdue Pharma:

• The company’s sales reps, none of whom were medical professionals, were told to claim medical expertise and to focus their sales efforts on overworked, lesser-trained doctors
• The company paid to create noble-sounding advocacy groups that called the opioid epidemic as a “psuedoaddiction” that could be prevented by prescribing higher doses to eliminate addiction symptoms
• Reps were ordered to keep selling to doctors known to be running cash-for-pills operation and whose patients were dying of overdoses
• Purdue Pharma specifically targeted military veterans as opioid patients with a campaign called “Exit Wounds”
• The company’s tagline was to “sell hope in a bottle” and it urged reps to “always be closing”

A woman with a family history of cancer celebrates her 23andMe BRCA1/2 breast cancer genetic test results that showed no variants, only to receive hospital results four weeks later indicating that the company’s less-than-thorough testing missed the fact that she’s genetically at risk. 23andMe’s fine print indicates that it tests only the most common genetic variants. The woman will have her breasts and ovaries removed this month to reduce her 70 percent chance of getting cancer.  

Sponsor Updates

• Solutionreach adds the voice of three patient advocates to its company blog.
• Datica joins the Cloud Native Computing Foundation.
• CRN recognizes Burwood Group’s Joanna Robinson as one of its 2018 Women of the Channel.
• CenTrak expands IoT location and sensing services to Awarepoint customers.
• Change Healthcare introduces Member Healthcare Payments, a consumer payment tool that helps payers display patient financial information in one place

Blog Posts

• Standard or Encrypted Pagers: What’s the Difference and Which Is Best for My Hospital? (Spok)
• 4 Questions with Anna Turman, CEO, Chadron Community Hospital and Health Services (Optimum Healthcare IT)
• Tiny issues can ruin reputations (AdvancedMD)
• From nurse to CEO to AHA chair: Nancy Howell Agee on her improbable rise and the future of value-based care (Advisory Board)
• Imagine if you could … leverage the wealth of your clinical data (Agfa Healthcare)
• A quick intro to optimizing and refreshing your EHR performance (Nordic)
• You Just Can’t Trust Medication Adherence Data – or Can You? (Aprima)
• #TrotForTri4Schools (Bluetree Networks)
• Defining Clinical Surveillance (Bernoulli)
• Tips and lessons learned for a successful clinical EHR implementation (Meditech)
• Best Practices are Best Practices: How Datica Handles Global Compliance (Datica)
• How Contact Center IT Can Help Health Systems Compete for Patients (Burwood Group)
• Clinical Optimization: What Is It and Why Is It Important? (Leidos Health IT)
• How to Navigate an Acquisition While Maintaining Your Company Vision (CarePort Health)
• Defining What is Value-Based Care for Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia (CareVive)
• Moving the Needles on Interoperability Part 1: Taking the First Step – Defining the Most-Needed Data (Casenet)
• The Shrinking EHR Vendor Space (Culbert Healthcare Solutions)
• ERP: Online Focus Group Recap (Divurgent)

Contacts

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

Curbside Consult with Dr. Jayne 7/9/18

I took some time off this week to celebrate my birthday along with our nation’s 242nd. In coming back to the office, I heard some awful stories of fireworks injuries that made me glad I wasn’t working over the holiday.

According to our friends at University of Washington School of Medicine, legal “shell and mortar” fireworks cause the most adult injuries based on data from Harborview Medical Center. Each year, more than 10,000 people seek care for fireworks-related injuries, which doesn’t account for those tending injuries at home. Teens are more prone to injuries from homemade fireworks, and children are at higher risk from injuries from bottle rockets and similar products. More than 90 percent of injuries occur in male patients. Not surprisingly, limb and eye injuries lead the pack, with 37 percent of hand injury patients requiring at least one partial or whole finger or hand amputation. More than 60 percent of patients with eye injuries had permanent vision loss. I hope you had a safe and injury-free Independence Day.

Summer typically brings a boom in trauma for hospitals, which can present challenges when critical drug products are in short supply. My practice is still dealing with intermittent shortages of IV fluids that our distributor indicates are due to manufacturing disruptions following last year’s Hurricane Maria. Basic medications, such as injectable morphine and lidocaine, are also only available in limited quantities and sometimes in sizes that staff members aren’t used to dealing with. When you’re used to drawing up 4mg of morphine from a single vial and now the vial contains 5mg instead, it’s a recipe for medication errors.

We’ve had to redo some of our EHR templates and defaults to address these changes in our drug supplies, which has led to issues with executing orders and quite a lot of read-back and clarification. Generic products such as IV fluids and morphine tend to have low profit margins, narrowing the available sources and increasing the risk of disruption. There have also been some quality-related recalls that can be at least correlated with manufacturers failing to invest in facilities that make these low-margin products.

Drug shortages aren’t something we like to think about in the US, but they can be challenging when a physician has to use an unfamiliar drug because of availability issues. I recently removed an embedded fish hook from a patient’s finger, and rather than having access to quick-acting lidocaine to deliver a nerve block, I had to use a drug with which I was less familiar and which took five times longer for the patient to experience anesthesia after I injected it. It meant more time for the patient to be in pain as well additional time for staff monitoring and disruption in my ability to see patients while I had to keep checking to see if he was numb. A recent survey  from the American College of Emergency Physicians notes that four in 10 physicians surveyed felt patients were negatively impacted by drug shortages. The FDA is trying to ease some of the shortages by allowing damaged products to be sold when they previously would have been recalled – morphine with cracked syringes was allowed onto the market with instructions for physicians to filter the drug before using it.

Speaking of the FDA, mobile app maker Headspace is hoping the agency will approve a prescription app for meditation. It subsidiary, Headspace Health, hopes to submit an application by 2020 and is preparing to launch clinical trials in support of the project. The app aims to help treat a variety of health problems, although the company is keeping mum on which ones due to concerns about competition. While meditation is increasingly popular, the health benefits have not been proven to the degree required by many evidence-based institutions although some studies show impacts on lowering blood pressure, reducing back pain, and improving irritable bowel syndrome. There is even less data on app-guided meditation. I know my Ringly bracelet and its associated app have some meditation features, but I haven’t tried them yet. I do like my singing bowl, however, for bringing calm into my often crazy days.

The Government Accountability Office released a document this summer that looks at the challenges faced by small and rural practices participating in the Merit-based Incentive Payment System (MIPS). The GAO interviewed 23 stakeholders including CMS and Medicaid employees, physician groups, and small/rural practices. Smaller organizations often experience challenges maintaining EHR systems of the quality needed to succeed under MIPS. In my experience, vendors can underestimate the complexity of running a rural health organization, whether it is specifically designated as a Rural Health Clinic by Medicare or is just in a rural area. Small and rural practices typically have fewer employees and are challenged by a smaller hiring pool that may not include potential employees with significant EHR experience.

I’ve worked with my share of rural practices, who often find the travel costs for onsite assistance to be daunting. This makes it difficult to see how their providers are using the system on a daily basis. Having them explain their pain points over a web conference just isn’t the same as following them into the exam room and watching their interactions with the patient and with the computer. It also makes it challenging to figure out causes of performance issues, such as office staffers streaming Netflix in the break room, because you’re not there to see it.

As a small-time consultant, I can get creative with those engagements and am willing to sleep in the hospital call room rather than at a hotel 90 miles away if it helps convince them to bring me onsite so I can roll up my sleeves and really see what is going on. I once stayed with a pediatrician at his home, which had a “mother-in-law” suite that hosted visiting medical students and prospective partners before I arrived on the scene. It was almost like being at a bed and breakfast, although he did ask me to bring a jar of sun-dried tomato spread with me when I arrived “from the city.”

If you’re a consultant or a road warrior, what’s the weirdest place you’ve ever stayed? Leave a comment or email me.

Morning Headlines 7/10/18

AdvancedMD Completes Acquisition of NueMD

EHR and practice management vendor AdvancedMD acquires competitor NueMD for an undisclosed amount.

Verity Health System Announces Exploration of Strategic Options

A little over a year after Patrick Soon-Shiong’s NantWorks buys a controlling interest in Verity Health System, the California-based nonprofit decides to look at selling some or all of its six hospitals.

Cerner and Lumeris Will Launch Offering to Reduce Complexities for Health Systems Delivering Value-Based Care

Cerner and Lumeris develop combined technologies and services aimed at helping health systems succeed with Medicare Advantage programs.

Cass Regional Medical Center hit by ransomware attack

Cass Regional Medical Center (MO) shuts down its Meditech system after discovering a communications and IT data breach Monday morning.

Morning Headlines 7/9/18

UW Medicine Clinical Transformation: Approve Project, Budget, and Internal Lending Program (ILP) Funding

University of Washington Medicine prepares to move to a single EHR in a 30-month, $180 million project.

The one big winner of the Obamacare wars

Politico surmises that never-ending government healthcare changes and resulting uncertainty, especially those driven by the Affordable Care Act, have been a boon for consultants.

Health Insurers Warn of Market Turmoil as Trump Suspends Billions in Payments

The White House suspends the Affordable Care Act’s risk adjustment payments, which without further action will drive more insurers from the market and increase premiums.

Monday Morning Update 7/9/18

Top News

A reader-forwarded committee meeting agenda from University of Washington Medicine dated July 12 indicates that the health system will move to a single EHR in a 30-month, $180 million project.

The health system is using Cerner inpatient at University of Washington Medical Center and Harborview Medical Center, Cerner Soarian at Northwest Hospital, and Epic for ambulatory.

The document doesn’t say which system UW Medicine has chosen, but all of the peer group hospitals mentioned in another document I found online use Epic.

Reader Comments

From Ricardo Researcher: “Re: my journal article. I was hoping you might mention this one on HIStalk.” I’m increasingly frustrated by articles that exist only behind a paywall, which of course is the ridiculous default for peer-reviewed journals that make a fortune by selling access to articles they didn’t themselves write, describing important research work that they didn’t themselves perform, and funded in many cases by taxpayers who aren’t allowed to look at it. It does no good to proudly tweet out links when non-subscribers don’t have access. I usually won’t mention those articles unless the author emails me a copy since I don’t trust someone else’s summary, especially if they don’t have relevant medical or technical background. 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor MDLive. The Sunrise, FL-based virtual care provider has since 2009 offered high-quality, convenient, and cost-efficient virtual care to meet the medical, dermatological, and behavioral health needs of its 25 million members. Consumers, health plans, health systems, and self-insured employers enjoy 24/7/365, anyplace access to its network of board-certified doctors and therapists via mobile app, online, or phone. Health systems can get a free virtual care assessment to learn how the company’s end-to-end virtual care solution reduces readmissions, removes barriers to ongoing care, increases brand loyalty, drives utilization, and optimizes provider schedules. Informatics luminary Lyle Berkowitz, MD (DrLyle) recently joined the company as chief medical officer, EVP of product strategy, and president of its medical group. Thanks to MDLive for supporting HIStalk.

I found this MDLive intro video on YouTube.

Provider poll respondents mostly spend 1-2 work weeks each year attending conferences.

New poll to your right or here, repeating one I did two years ago to see what’s changed since: have you participated in a virtual visit in the past year? Click the poll’s “comments” link after voting to explain why or why not.

Every year I offer a “Summer Doldrums” deal on newly signed sponsorships and webinars to overcome the seasonally-induced vendor siesta that makes me question whether I have slipped into irrelevance. Contact Lorre. Extra points for naming the summer movie depicted above.

The week of July 4 is traditionally one of the slowest for real news and having the holiday fall on a Wednesday encouraged a week-long work slowdown. You will likely not resent the idea of having less to read knowing that while I wrote less, I still covered everything important.

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

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Sales

• Claxton-Hepburn Medical Center (NY) chooses Masimo’s Patient Safety Net remote monitoring solution that will automatically record vital signs in its Meditech system.

Government and Politics

A Politico article notes that never-ending government healthcare changes and resulting uncertainty, especially those driven by the Affordable Care Act, have been a boon for consultants, observing that, “American healthcare has no shortage of saviors. Some have brilliant insights that save lives and trim costs; others mainly generate invoices … Half of Twitter seems to consist of consultants. (The other half is developing health apps, which themselves spawn niche consultants.) They offer marketing, communication and wellness strategies; practice transformation; team-based-care building, revenue maximizing, behavioral health integration, pharmaceutical price-calibrating, and YouTube channels.”

The White House suspends the Affordable Care Act’s risk adjustment payments, which without further action will drive more insurers from the market and increase premiums. The payments to insurance companies, worth billions of dollars per year, discourage them from cherry-picking the healthiest and thus lowest-risk people as customers. CMS cites a recent New Mexico ruling in which a court found that the payment methodology is flawed in favor of large insurers, with the founder of a small, non-profit New Mexico insurer saying the decision will increase competition and reduce prices despite the commonly held perception that it’s just one more way for the Trump administration to sabotage the ACA.

Other

Informatics nurse and analytics guy Brian Norris is looking for responses to this poll. My choice would probably be email since (a) I don’t like getting voice calls, and (b) text messages are harder to manage, although I would also worry that the email would end up in my spam folder as is often the case these days.

Companies trying to attract investors by claiming their systems use artificial intelligence sometimes instead are sometimes using a “pseudo-AI, fake it until you make it” approach where humans are actually doing the work behind the scenes, or as an expert calls it, “prototyping the AI with human beings.” Examples:

• A company whose app converts voicemails into text message ran its service from an offshore call center instead of with technology
• A scheduling app vendor hired people to pretend to be a chatbot
• An expense receipt company admitted that receipts were sometimes entered by humans instead of its “smartscan technology,” sending work to Amazon’s Mechanical Turk crowdsourced labor tool that allowed low-paid workers to read the full information from user-scanned receipts
• Google admits that some third-party apps allow their developers to read user emails to collect advertising information or to refine the logic of their apps

In Australia, a hospital’s handwashing compliance rate drops from 94 percent to 30 percent after it replaces human auditors with an expensive, sink-installed automated surveillance system.

The parents of two unrelated 11-year-old Florida boys struggle to straighten out an insurance company identity mix-up, caused by the boys having the same full name, date of birth, and birth county. Their Social Security numbers are also one digit apart. The insurance company paid claims without questioning why an unrelated child would be covered on a family insurance plan. The parents worry about which child’s medical record would be displayed in an emergency, but are at least happy that both families are reasonable since “we have the most sensitive information about each other’s children.” 

Sponsor Updates

Blog Posts

• The Legal Risks of Paper Informed Consents – Surgeons and Hospitals in the Firing Line (Access)
• Pediatric Patients (and Pediatric EHRs) Must Be Treated Differently (Optimum Healthcare IT)

Contacts

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

Events and Updates

Upcoming Webinars
[wp-rss-aggregator source=”55050″]
Recorded Webinars
[wp-rss-aggregator source=”55059″]
Sponsor Announcements
[wp-rss-aggregator source=”55039″]
Events
[wp-rss-aggregator source=”55053″ limit=”10″]
Jobs
[wp-rss-aggregator source=”55048″]

Weekender 7/6/18

Weekly News Recap

• England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline
• AMIA publishes the inaugural issue of its Gold Open Access journal that will showcase the best informatics research and applications
• UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business and 25 percent of its population health unit
• Rock Health’s midyear funding review says digital health investments are growing and are attracting more experienced investors, but IPO activity is down as companies remain privately held longer
• CNBC reports on “why telemedicine has been such a bust so far”
• T-System President and CEO Roger Davis resigns

Best Reader Comments

For those of us out in the field working with telehealth and its various service lines, we know it is a success. Children and adults are getting the care they desperately need but cannot access, stroke victims live normal lives and when tragedy strikes, and you find yourself in the ICU it is telemedicine that helps get home quicker. Telehealth and telemedicine isn’t a narrow service for treating common complaints and sniffly noses as the writer only references. (Michelle Hager)

A significant problem that I’ve encountered is that many smaller practices and physicians don’t make plans for what they will do with their paper records when they retire. Regulations vary from state to state, but they are often responsible for maintaining and providing access to patient records for 10 years from the last patient visit and i some cases up to 25 years or more for minor patients. Storing large volumes of paper records for that amount of time is fraught with risk and expense and the records may outlive the physician and become a burden for his or her family. (Greg Mennegar)

Our company provides, as an employee benefit, Dr. on Demand for a $5 payment. It’s been excellent and especially helpful as a first step to determine whether an in-person visit is necessary. They don’t just triage — in many cases, they also diagnose and prescribe, which is a great saving of time and money for us. (Judy Volker)

I don’t know if I’d call the DoD question to Zane a zinger. Kind of “oversight 101.” The response was brilliant in a way, since you can’t perjure yourself if you never answer the question. (Ex Epic)

Watercooler Talk Tidbits

Ms. S reports from North Carolina on the document camera and screen capacitance pens we provided for her second grade class per her DonorsChoose teacher grant request: “The document camera is such a simple yet versatile learning tool, but unfortunately with budget cuts, the math department is not allotted any. This is such a great gift. While the pictures might not have the normal wow factor that most project pictures do, please rest assured that this piece of technology is making a difference in my students’ lives. The ability to see what math skill I am demonstrating on a larger screen is much easier than trying to have all of the kids crowd around me as they try to see. Surprisingly, the styli are a crowd pleaser. They truly love that little added something.”

The Wall Street Journal chides itself for occasionally using clickbait-type headlines, providing lessons for all writers to avoid writing headlines that:

• Try to sound mysterious
• Promise readers a secret they will learn only if they click
• Ask a question, especially one that the article itself may not answer
• Do not match the tone of the story or that don’t assure readers that the story contains the promised details

A Science report finds that drug companies are paying after-the-fact compensation to members of FDA’s advisory committees who recommend whether a drug should be approved, with members who passed initial conflict of interest checks being rewarded afterward with jobs, research grants, and speaking roles. A majority of review committee doctors received at least $10,000 from a drug company whose product they approved, with seven of them earning more than $1 million.

Tennessee’s attorney general unseals details about the state’s lawsuit against OxyContin manufacturer Purdue Pharma, which contains details such as:

• 80 percent of the company’s OxyContin business came from repeat users
• Purdue kept hard-selling doctors who were known to be diverting drugs out of state or whose licenses were restricted due to overprescribing
• The company was warned about overdoses, muggings outside a pharmacy linked to a particular doctor, a high-prescribing clinic that had no medical equipment, a doctor’s waiting room overseen by an armed guard, practices whose parking lots were filled with cars with out-of-state plates, and standing room only waiting rooms.
• Tennessee prescribers ordered 104 million tablets of OxyContin from 2008 to 2017, the majority of them for high doses.

Researchers using MRI confirm our male suspicions that wearing a tie (especially one that is tightly tied with a stylish Windsor knot) restricts blood flow to the brain, which might explain why some of the dimmest people imaginable hold jobs that require their wear. It’s fun to question commonly accepted standards – why should men have to drape decorative cloth around their necks to project sincerity and authority? My observation is that for small to medium companies, guys who wear ties work for guys who do not – I’ve been to investor pitch-a-thons and you could easily tell who had money versus who needed it because the former were dressed like they just left a satisfying lunch at Golden Corral.

Apple celebrates the tenth birthday of its App Store and the impact it has had on developers, mobile-first businesses, gaming, in-app purchases, streaming, and health and wellness.

The author of a biography of martial arts movie star Bruce Lee – who died mysteriously 45 years ago – speculates that he was killed by heatstroke after dubbing dialog for “Enter the Dragon” in a studio whose noisy air conditioning had to be turned off, compounded by the recent removal of his armpit sweat glands to prevent on-screen sweating.

In Case You Missed It

• News 7/6/18
• News 7/4/18
• Curbside Consult with Dr. Jayne 7/2/18
• Readers Write: The Opioid Crisis: Fix the Process, Fix the Problem
• Readers Write: Why It’s Time to Make Clinical Documentation Clinically Valuable
• Readers Write: EHRs Have Not Reduced Paper Usage Yet. Why? And How Do We Change This?
• Monday Morning Update 7/2/18

Get Involved

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

Morning Headlines 7/6/18

New NHS app will make it quicker and easier to access health services

England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline.

Cleveland Clinic Patients Have New Way to Access Personal Health Records

Cleveland Clinic becomes the latest of several dozen health systems to participate in the Apple Health Records beta.

FDA Regulation of Mobile Medical Apps

A JAMA opinion piece by FDA officials describes the agency’s efforts to foster digital health innovation by pre-certifying vendors instead of individual products.

News 7/6/18

Top News

England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline.

The app will also allow users to record their data-sharing, organ donor, and end-of-life care preferences.

Health and Social Care Secretary Jeremy Hunt said of the app, “I want this innovation to mark the death-knell of the 8 a.m. scramble for GP appointments that infuriates so many patients.”

Thursday was the 70th birthday of NHS, formed on July 5, 1948 to bring together all health services under a single organization.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

The investment fund of David Einhorn – a long-time, vocal critic and stock-shorter of Athenahealth that he dismissed as “a business process outsourcer with a very promotional CEO” that stood no chance against Epic – is losing investors as the value of its investments dropped 11 percent from 2014 to 2017 as the S&P 500 rose 38 percent. Einhorn is also shorting Amazon and Netflix, which have gained value, and is long on Brighthouse Financial, whose shares have dropped 31 percent so far this year.

Sales

• In England, NHS Digital awards IBM a three-year contract for cybersecurity services that include vulnerability scanning, threat detection, and threat intelligence.
• Atrium Health (the former Carolinas HealthCare System) chooses Golden Hour’s EMSHIE solution for exchanging patient information with emergency responders.

People

Our Lady of the Lake Regional Medical Center (LA) hires Stephanie Manson, MBA, MS (Franciscan Missionaries of Our Lady Health System) as COO.

Announcements and Implementations

Holzer Health System (OH) goes live on Athenahealth.

Cleveland Clinic joins the list of hospitals that give patients access to their medical records on Apple Health Records. Apple lists more than 60 health systems that are participating in the Health Records beta.

Government and Politics

Politico reports that Cerner hired two former Congressmen as lobbyists for its VA project the day the contract was signed – Jeff Miller (R-FL) and James Moran (D-VA), both employed by McDermott Will & Emery.

Privacy and Security

A former patient information coordinator at UPMC and Allegheny Health Network (PA) is indicted on federal charges involving her retrieval of the information of 111 patients and her disclosure of the information of three of them “with the intent to cause malicious harm” if an unspecified nature. She faces an 11-year prison sentence and a fine of $350,000.

Facebook can continue tracking the browsing habits of people who have deleted their Facebook account, the company confirms, where it obtains information from any site that uses its Like or Share buttons or that runs Facebook ads to nag the former user into returning to Facebook and to serve them ads.

Other

A small study finds that adding a second exam room monitor that mirrors the clinician’s EHR screen can be helpful in engaging patients. Patients liked the transparency, not having to look over the clinician’s shoulder in feeling engaged, and having the clinician’s conversation reinforced by seeing their information on the EHR screen. However, they found the EHR user interface, screen-flipping, and on-screen jargon confusing. Clinicians liked the ease of sharing information with patients, but noted that not all patients are interested. They also worry that raising more patient questions would extend visit time. Both groups noted that exam rooms were not well laid out for adding a second monitor.

Epic adds to its quirky campus art collection by buying the old-fashioned carousel and decorations of the recently closed Ella’s Deli of Madison, saying that it was an easy decision to preserve part of the iconic landmark.

In Wales, Assembly member Lee Waters says the country is struggling with NHS’s IT systems, claiming that the unreliability of its Cancer Network Information System Cymru (Canisc) is causing daily problems. BBC says the system is over 20 years old, is not supported by Microsoft, and went down 11 times in a recent four-week period, delaying some chemotherapy and radiation therapy treatments.

A Fortune opinion piece by a venture partner observes that companies are claiming their systems are AI-powered when they are really capable of doing only basic data analysis via pre-programmed logic or plain old algorithms. His investment evaluation checklist for AI-claiming companies is:

• Do their systems get constantly smarter?
• Do they leave a large trail of proprietary data collected from interesting sources?
• Does their technology reduce the need for humans to be involved?
• Do the founders have deep technical understanding of machine learning models and how they can be applied to a large data set?
• Is their AI expertise so deep that they have an extreme advantage over competitors and can they attract the right talent to go after their market?

Independence Day always generates some fireworks-related cautionary tales. A Dayton, OH man who had just purchased fireworks couldn’t wait to light one and throw it out his car window, with his unsuccessful toss igniting his in-car stash and causing an explosion that severely injured him and several people nearby, set off car airbags down the street, and damaged a nearby house. A 21-year-old Maryland man sustains severe hand injuries when he tries to launch an illegal firework from a mortar over his head during a party, not realizing that he was holding the mortar upside down.  A Florida man holding an M80 blows off all his fingers. Another Florida man loses his fingers and eyebrows when a mortar he had modified went off in his hand. Kudos to NFL’er Jason Pierre-Paul, who, as he does annually, posted gruesome photos of his July 4, 2015 fireworks-caused hand injury in warning people to be careful with fireworks (ESPN’s tweeting of a hospital OR schedule to scoop the world on his finger amputation kicked off a privacy firestorm, you may recall). 

Contacts

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

Morning Headlines 7/5/18

A new journal for sharing informatics innovations: introducing JAMIA Open

AMIA publishes the inaugural issue of its Gold Open Access journal that will showcase the best informatics research and applications.

Diagnosing Fractures With AI

A JAMA Network article describes FDA’s approval of Imagen OsteoDetect for diagnosing adult wrist fractures.

Predictive modeling of U.S. health care spending in late life

Medicare claims data analysis finds flaws with the idea that spending 25 percent of in the last 12 months of life is wasteful, instead concluding that deaths are not predictable and patient conditions are rarely defined as hopeless to support reduced spending.

Twitter can’t even celebrate Independence Day without misspelling the hashtag

The US Air Force, the First Lady, and the city of Boston are among the patriotic tweeters who misspell the hashtag as #IndependanceDay, possibly because of Twitter’s autofill feature propagating an earlier error.

Morning Headlines 7/4/18

UK-based Hg to buy Orion Health’s Rhapsody for $205 million

UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business for $138 million USD and will pay another $14 million to acquire a 25 percent share of its population health unit.

2018 Midyear Funding Review: Digital health déjà vu in yet another record breaking half

Rock Health says digital health investments are growing and are attracting more experienced investors, but IPO activity is down as companies remain privately held longer.

150,000 medical records shared against patients’ wishes in data system glitch

NHS Digital blames one of its technology vendors (TPP) for failing to send it patient opt-out requests

Cordova hospital averts loss of internet access

The Alaska critical access avoids its planned closure after a cut in federal broadband subsidies left it with a million-dollar annual bill.

News 7/4/18

Top News

UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business for $138 million and will pay another $14 million to acquire a 25 percent share of its population health unit.

In a complicated transaction, Orion will then reinvest some of the proceeds to buy back equity from the same acquirer, leaving it with 25 percent of Rhapsody and 75 percent of population health. It will use the rest of the money to buy back shares and fund its hospital division.

Orion shares, traded on the New Zealand exchange, rose sharply on the news but are still down 81 percent since the company’s December 2014 IPO.  

Reader Comments

From Gaunt Survivor: “Re: HIStalk ‘like’ buttons. Which items have earned the most votes?” That’s an interesting question since I’ve never looked at the statistics from those little thumbs up/down icons I added to each post and comment, and in fact I didn’t know I could look up historical results. The all-time top three items by net score (likes minus dislikes over the past 18 months since I first turned on voting) are a diverse group:

• Readers Write: A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing
• Book Review: “Bad Blood”
• The Smokin’ Doc Celebrates a Successful HIMSS

From Sprachen: “Re: telemedicine. Some harsh tweets say it was overhyped.” The virtual visit companies have certainly hyped themselves (which is what companies do, especially when they are trying to create a new consumer market) and uptake has been slower than you might expect because of state-specific laws, reimbursement issues, and natural market consolidation. However, there’s no way telemedicine can fail to attract a significant share of some market elements — specifically non-urgent acute issues, mental health, and chronic disease management – because it eliminates the geographical challenges that are caused by irregular provider distribution and challenging physical access. The biggest challenges to telemedicine vendors are (a) they have to market directly to consumers, which is expensive and difficult; and (b) they have to maintain a supply of competent providers who are wiling to conduct video visits at reasonable compensation levels. They have an advantage that both insurers and consumers should find appealing in that they can operate as a de facto national medical practice that is professionally managed to follow sound medical standards defined by policy and procedures and measured by analytics across a broad scale, which could be a lot better than a rogue independent doctor whose practice patterns stray from the accepted. There’s actually a third challenge that sounds worse than it is – it’s not as good as having access to your regular doctor via email or telephone, but most medical practices are eliminating that threat by hiding themselves behind the four walls of their insurance billing factory.

HIStalk Announcements and Requests

Listening: new from The Wild Feathers, which breaks my lifetime-long streak of never recommending a country-rock band. It’s like the Eagles with the annoying parts excised, with remarkable harmonies and enough minor chords to keep me from quickly flipping on. I only wish they would ditch the cliché cowboy hat affectation that is emblematic of Nashville-based artists even though I’ve never seen anyone the South (except for Texas) wear a cowboy hat in public since they have no actual cowboys, especially the kind that work indoors at night miles away from the nearest horse that they couldn’t ride anyway.

It’s the beginning of the July Syndrome, when fresh batches of frightened, newly minted medical residents begin working in US hospitals in scarily defining why we call it the “practice” of medicine. You will be well advised to steer clear for non-emergent needs for the next month or so.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Laid-off IBM Watson Health engineers describe the challenges faced by the company following its expensive acquisition of Phytel, Truven, and Explorys in 2015-2016 in trying (and failing so far) to turn its $15 billion investment into profits:

• Phytel employees thought they would accomplish great things under IBM, but has seen the company lose half its clients and 80 percent of its employees
• IBM halted everything Phytel was doing for the first post-acquisition year as it “bluewashed” the company by making it do things IBM’s way
• Non-technologist IBM leaders tried to create new Watson products from the capabilities of its acquisitions, but didn’t have clear ideas, kept changing their mind, and sketched out products that were impossible to create
• IBM is losing the war to attract AI talent
• Former engineers say IBM is “not anywhere close to injecting AI into the provider space” as the planned new products don’t use AI
• Asking Phytel’s customers what they wanted resulted in their demand to bring back the pre-IBM product

Rock Health’s Midyear Funding Review says:

• Digital health investments continue to grow at a record pace
• Startups are increasingly having their products validated even in a post-Theranos shadow
• Two-thirds of digital health investors have made previous deals in the sector
• M&A activity is down from its 2015 high as companies are staying private longer even when they have raised more than the $136 million average of previous IPOs, instead choosing to be acquired pre-IPO
• Half of the digital health companies acquired so far in 2018 were bought by other digital health companies, although the number overweighted by virtual visit providers that aren’t really technology companies

CNBC notes that e-cigarette maker Juul – whose USB-recharged vaporizer is easily concealable before and during use — is enjoying an 800 percent sales jump and a valuation of $15 billion, even as public health experts warn that while the company claims its products are intended to help adults quit smoking tobacco, many of its users are teens and adults who have never smoked. The company and its knock-off competitors offer nicotine-containing pods in such flavors as apple honeydew, donut cream, and Gummy Bear.

Sales

• University of Mississippi Medical Center chooses Kyruus’s ProviderMatch for Access Centers to allow call center agents to identify the right provider based on a patient’s needs.

Announcements and Implementations

Japan’s first telemedicine intensive program goes live, developed in conjunction with Philips.

Government and Politics

Politico reports that the VA will not continue its Epic-powered MASS scheduling project beyond the pilot stage and will instead use Cerner’s capabilities. The VA ended up spending $28 million of the $624 million contract. However, the publication has since issued a “clarification” that its original report was incorrect, and the VA in fact hasn’t yet decided whether to continue the MASS project.

Privacy and Security

A former peer review coordinator of Memorial Hermann Healthcare System sues the health system, saying it fired her for her refusal to reveal confidential surgery-related information at open meetings.

A developer whose company’s mission-critical monitoring application runs on Google Cloud is dismayed to find his entire site down, shut down hard by Google’s automated systems after “potential suspicious activity” with warnings that the entire site would be deleted within three business days. He reports that Google’s customer chat was offline and no support telephone number was provided – Google requires completing an online form and attaching a scan of the credit card use for payment as well as the holder’s picture ID, requiring him to wake up the company’s CFO in whose name the card was issued. He advises using Amazon Web Services instead, having experienced this problem twice with Google Cloud.

In England, NHS Digital blames one of its technology vendors (TPP) for failing to send it patient opt-out requests, a just-uncovered problem going back to 2015 that has caused the information of 150,000 patients to be shared against their wishes.

Other

Stat profiles Biobot Analytics, whose technology analyzes a city’s wastewater as a “public health observatory” that uses “wastewater epidemiology” to perform population-level, toilet-based studies. The company’s challenge is that cities don’t really want to know (and to have publicized) their incidence of opioid use and it would merely confirm the extent of a problem already known to be extensive.

The New York Times says people are being unnecessarily frightened by false positives after they send information from their consumer genetic tests to third-party analysis companies like Promethease, which looks for health-related mutations in the raw data of companies like 23andMe even though they aren’t certified clinical laboratories. The other (unstated) issue is that like much of today’s sophisticated diagnostic testing, we can recognize and name it without being able to fix it.

This medical versus financial decision repeats itself endlessly every day in the only country where an urgent medical need can leave you broke for the rest of your life.

Cordova Community Medical Center (AK) won’t close after all, despite having warned the community that it would shut its doors on July 1 when it expected to run out of money to pay for the Internet access that its computer systems require. The hospital CEO says the FCC’s cuts to the Rural Healthcare Fund left the hospital to pay for its Internet access in full, leaving it with an accumulated $1 million bill. The hospital didn’t say how it resolved the issue, although the FCC boosted the program’s funding on June 1 to account for inflation, possibly restoring the subsidy that allowed the hospital to receive $80,000 per month worth of broadband services for $1,000.

A Detroit jury awards a 17-year-old girl a $135 million judgment in her malpractice lawsuit against Detroit Medical Center, which she claims botched her spinal surgery when she was 10 and left her with permanent weakness that the hospital says was due to a blood clot.

Reno, NV police arrest a 31-year-old man who was running around a hospital’s public areas wearing scrubs and a doctor’s nametag, although he wasn’t booked for that charge specifically since he didn’t identify himself as a doctor and there’s no law against “just throwing a stethoscope around your neck and walking around.” The charge involved a similar incident at a different hospital in which he came in as a patient and then decided to video himself wearing someone’s scrubs. He has led an interesting life – he had two airplane crash landings in two days after convincing aircraft owners that he was a pilot and potential buyer and needed to take their planes up for test drives, then crashing them. His scrubs in the video carry the name of “Denver Prinz, MD,” suggesting that he might be this guy (Prince Denver of Prussia) who claims to be a prince, a charity CEO, a friend to countless celebrities (“my friend Jeff Bezos, owner of Amazon”), a talented keyboard player (whose fingers aren’t shown and whose body movements clearly don’t match the music), and a pilot of everything from helicopters to stunt planes.

Sponsor Updates

• Waystar (the former Navicure and ZirMed) rolls out its “The All-New Rev Cycle” branding campaign at the HFMA annual conference.

Blog Posts

• The Cost of a Lost Minute in the OR (Access)
• The Top 10 Spokwise Healthcare Blog Posts of All Time (Spok)
• How can Application Managed Services help your organization? [podcast] (Nordic)

Contacts

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

Morning Headlines 7/3/18

VA looks to scrap Epic scheduling contract

Politico reports that the VA will not move forward with its MASS patient scheduling project – powered by Epic — despite recent assurances that a system-wide rollout would be much cheaper and faster than originally estimated, choosing to go with the equivalent Cerner modules instead.

Layoffs at Watson Health Reveal IBM’s Problem With AI

Employees of acquired companies Phytel, Explorys, and Truven are hit hardest by staffing cuts as laid-off IBM engineers claim that former KLAS-topping population health management technology vendor Phytel has lost half its customer base and 80 percent of its employees under IBM’s ownership.

Toolkit: Using Data Analysis To Calculate Opioid Levels and Identify Patients At Risk of Misuse or Overdose

HHS OIG releases a SAS-powered tool that allows health plans to analyze their prescription drug claims data to identify at-risk patients.

Netsmart Finalizes Acquisition of Change Healthcare Home Care and Hospice Solutions

Netsmart completes its acquisition of the solutions formerly owned by McKesson.

Curbside Consult with Dr. Jayne 7/2/18

I received quite a bit of correspondence after my recent piece regarding the CareSync shutdown. I had some pushback about my comments about the risk of working for a startup, where I said, “For people higher in the company who fully understood what it means to be part of a startup, they are likely prepared for such a scenario. For lower-wage workers on the front lines, especially for those living paycheck to paycheck in a relatively tough economy, it’s devastating.”

One correspondent essentially blamed the employees, stating they should have known that working for a startup is risky. I would argue that there were probably a fair number of people who worked there who either didn’t understand that they were working for a startup or didn’t fully understand what kind of risks are inherent in that situation. If you’re a nurse or care coordinator who isn’t as familiar with the healthcare IT space, it might look pretty good. Especially when a company leases a shiny office building and hires a couple hundred workers, people might not register that it’s a startup.

Even in established companies, there can be startup-type projects that put workers in as much jeopardy as they might be with a startup, but it’s not obvious. I watched some of my dearest friends get downsized when their company blew through scores of millions on a project, only to shut it down while the rest of the company went forward in a profitable state.

Another reader commented on the issue of survivor’s guilt:

I read your blog about CareSync today and found myself nodding my head in agreement at most of your points. I’ve been working for a startup company the past couple of years. Prior to that, I held a variety of roles in a different industry, where survivor’s guilt was a daily thing. I can’t tell you how many hundreds of jobs I saw disappear, often for selfish reasons such as protecting the C-suite’s annual bonus. At some point, I had enough and retired and that’s how I ended up in healthcare IT.

There is a huge difference between that industry and healthcare IT. The major players all have negative sales growth, and any growth you see on their quarterly statements comes from expensive acquisitions instead of organic growth. Healthcare IT is experiencing a nice growth curve still since most practices are underserved in my segment. I talk to many different practices weekly and each of them appreciates the help we give them.

The CareSync debacle just highlights the fact that there are people running businesses that they shouldn’t be. Given the amount of funding CareSync received, it is clear to me that they did not have a sustainable business model. The C-suite should have either pivoted or reorganized to a sustainable model. After what happened at Theranos, if I were a CareSync investor, I would be looking into whether or not a crime was committed.

I’m not the legal eagle in the family so I can’t comment about the criminal piece, but these types of examples should give investors pause and encourage them to ask more questions about the businesses they are supporting. I’ve been asked several times to support ventures in a much smaller capacity, from money to labor, mostly because of the personalities involved and their track record for success. Even though I’m a small investor, you have to do due diligence. Just because someone made money in the past in one industry or another doesn’t mean they understand healthcare IT.

I did a deep dive into a company that was courting one of my relatives as an investor, and not only was there really not a market for their product, but how they were approaching it was flawed. It was a bolt-on user interface designed to “improve the EHR experience,” but they were going after it by trying to court major EHR vendors. I gave them a bit of free advice — it’s probably not the best idea to go to a vendor and call their baby ugly. Maybe they’d have a better shot at going after either a regional or specialty-specific user base and getting some grassroots traction then moving up from there and trying to be acquired by a vendor. They ended up cold-calling a bunch of vendors and have gotten exactly nowhere in the last three years.

I also heard from one of my favorite healthcare startup CEOs, whose response made me respect him even more than I already did:

Today’s post is near and dear to me, as it is something I battle every day as an employer in this space, especially in a startup-like environment. I take very seriously the lives I am in control of. I worry greatly about what could happen if bad things happen and I need to make significant cuts. I would have to be a sociopath to not lie awake with that concern as it relates to each client / prospect / lead we are trying to get business and revenue from. If we lose all of our clients, what will I tell the people who rely on our bi-monthly paychecks to feed their families and cover their expenses?

First, I make clear to the entire organization, from board to rank-and-file folks, that everything is subject to change. Even though runway is a great indicator of longevity for overall company success, growth, and existence, that doesn’t mean that there are no risks whatsoever. If projects / prospects don’t come through, certain folks will inevitably face a departure. Fundraising concerns are also a part of it, and with each pitch, it is my job to make sure the health of the company (and therefore the team itself) is well taken care of. Even with revenue, capital, a great plan, and strong leadership, no company is truly protected and no employee is truly safe. It is my job to provide opportunity for folks, protect that opportunity as a condition of their employment, but also be smart and savvy about investment and spend every day. If you come into a company and start counting share price on equity and think it is all rosy, you’ll probably be the first to be shocked if and when things don’t go as planned.

Second, I suggest to employees that not get too whimsical in their spending. I toe a delicate balance, but try to instill in every employee, from executive to intern, the realities that could present themselves and what it would mean to be 180 days without income. This has happened to me earlier in my career, so I can speak from experience — if you aren’t prepared, you will struggle. Saving, being cautious with spending, and being aware of the frailties of life are messages I try to impart during regular check-in with all employees. They don’t teach people these skills. Many assume that the career ladder is a short hike up stairs. Few are aware of what may lie ahead, and it should scare everyone.

Third, I have a separate near-term savings that is a rainy-day fund. Not for purchases, travel, college savings, or retirement, but an account that I fund every month that could carry the family through any immediate challenges that could be faced. Whether it comes with having elderly parents who have poorly prepared for retirement, small children who are likely to need care that may not be covered, or pets that will do absolutely idiotic and expensive damage to themselves and the world around them, I think I have enough liquid capital to get through a rough patch, which took over a decade to stash away. It pains me to think of the things I missed out when I was younger by putting so much money aside, but it makes more and more sense each passing day when I hear stories of friends, neighbors, and colleagues going through career issues that are really scary.

Whether you run a health tech startup, work for one, or are working for a huge health system in any capacity (I have been all three), I think it is important to reflect on your immediate needs in a responsible way. Nothing is guaranteed in life, nothing lasts forever, and getting a heads-up doesn’t normally happen.

I’ve worked with several CEOs who spend money like water and it’s not always clear whether it’s personal money or the company’s money. Knowing my own temperament, I would prefer working for someone who is willing to talk to employees about the possibility of a downturn and his own rainy-day planning rather than talk about his new boat or her condo in Aspen. You may be buying the finest liquor and the best cigars, but how are you doing running the company?

I once worked with a hospital CIO who kept the security camera footage of his house in the Florida Keys running continuously in a window on his desktop, mostly to show off his dock and his boat. The only thing I could think of was how much time he was wasting every day.

My CEO friend went on to hypothesize that perhaps his conservative attitude towards finances comes from being “in healthcare” since we see people who have life-changing medical issues or end up changing their own career plans to care for others. I agree, but also think some of it is also generational, since many people in my age bracket are working under the assumption that Social Security will be a historical footnote by the time we are of retirement age. He went on to close with this:

One last thought on this topic. I don’t think it is specific to healthcare or startups. I just had a friend that works in insurance / re-insurance for the past 25 years get RIF’ed on a random Friday. The entire team of a Fortune 250 company was cut as the company migrates to blockchain. I can laugh about the blockchain part, but the reality is that here is a mid-50s executive who was part of a mass cut of staff unexpectedly. Three kids, mortgage, college for at least one child. How prepared are even the most well-heeled Americans from the unlikely (though statistically incredibly likely) scenario where job goes away and the next one doesn’t seem like it will come too easily?

The blockchain reference definitely made me chuckle, but it’s a serious topic. If you’ve been “released to the workforce,” what advice do you have to give that you wish you knew before the layoff? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Opioid Crisis: Fix the Process, Fix the Problem

The Opioid Crisis: Fix the Process, Fix the Problem
By Brita Hansen, MD

Brita Hansen, MD is chief medical officer of LogicStream Health of Minneapolis, MN.

As the nation continues to grapple with the overprescribing and misuse of opioids, reaching a solution often feels far out of reach. According to the US Department of Health and Human Services, more than 11 million individuals have been documented as having misused prescription opioids, resulting in an alarming 116 opioid-related deaths daily.

Despite this growing epidemic, provider organizations are uniquely positioned to address a key issue contributing to improper prescribing practices – inefficient clinical processes. Outdated and obsolete clinical processes built into electronic health records (EHRs) can be significant factors driving inappropriate drug utilization and impaired patient safety and quality care.

While the opioid crisis has no single origin point, one contributing factor can be traced back to the early-2000s when the Joint Commission implemented its revised pain management standards in response to the under-treatment of pain that was reported throughout the industry. In turn, many healthcare organizations interpreted these standards as a mandate and began to adopt clinical processes that aggressively treated patients’ acute and chronic pain. This also contributed to the then-growing trend of patients and caregivers equating pain management with medication use, which led to a demand that helped drive the increase in opioid prescriptions, and subsequently, opioid-related abuse and overdoses.

Despite evolving patient expectations and the emergence of new best practices for opioid prescribing, EHRs still lack the ability to appropriately guide clinicians and provide effective decision support during the prescribing process. Further, healthcare organizations also face the challenge of ensuring that clinicians understand and adhere to both general opioid ordering practices and best-practice guidelines. Gaining insight into these clinician’s ordering habits has been a continuous issue, and while clinicians express interest in reviewing and improving their ordering practices, this information is difficult and time-consuming to gather.

In addition to fixing and controlling processes and improving clinician adherence, provider organizations must ensure content in EHRs are continuously and reliably aligned with evidence-based guidelines to enable sustainable opioid therapy. For instance, recently developed treatments limit patients’ exposure to opioids, and instead, provide them with powerful yet non-addictive drugs such as corticosteroid injections for rapid pain relief and local anesthetics used during surgery or physical therapy sessions.

Facing the pressures to curb the country’s misuse of prescription opioids and adhere with rapidly changing prescribing guidelines, many healthcare organizations are increasingly leveraging health IT to encourage and improve the use of evidence-based best practices at the point of care. However, these tools are only as effective as the upstream clinical processes governing them, processes that are too often overlooked in the overall improvement strategy.

The data and trends contained within EHRs provide the key insights needed to optimize, measure, and manage the clinical processes related to opioid prescribing. With this critical information, frontline care teams can target and eliminate obsolete opioid protocols and order sets, thereby helping to improve, standardize, and better control processes and decrease the variability in how opioids are prescribed.

By identifying inefficiencies in workflows and the EHR build that often drive inappropriate prescribing practices, care teams can eliminate these issues. With the right tools, they can also continuously monitor the clinical processes guiding opioid prescribing and ensure they are aligned with current clinical evidence, regulatory requirements, and internal workflow needs. It’s equally imperative to continuously monitor clinician interaction with and adoption of the clinical processes that have been implemented, as various barriers inevitably lead to low compliance with set prescribing standards and protocols among some clinicians. Regular monitoring of opioid ordering enables clinical leaders to identify outliers, address barriers, and deploy appropriate interventions as needed.

To truly address the current opioid epidemic, provider organizations must fix the process to fix the problem, which begins with maintaining upstream improvements to clinical processes guiding opioid prescribing. While these steps may be one part of the nation’s opioid strategy, they remain key to providing healthcare organizations with the proactive support needed to combat the crisis.

Readers Write: Why It’s Time to Make Clinical Documentation Clinically Valuable

Why It’s Time to Make Clinical Documentation Clinically Valuable
By Jay Anders, MD, MS

Jay Anders, MD, MS is chief medical officer of Medicomp Systems of Chantilly, VA.

“I love documenting patient encounters,”said no clinician ever.

Clinical documentation is a time-consuming source of frustration for physicians and nurses, yet a necessary evil for any hospital and health system that wants to keep its doors open and its lights on. Clinical documentation drives the billing process, maintains the details for diagnosis and procedure coding, and provides the required justification for reimbursement.

The whole “billing and getting-paid” stuff is obviously important, but what if we could transform the clinical documentation process to make it more valuable to the physician and the patient? In other words, why not “fix” clinical documentation so that it helps clinicians deliver better patient care?

Consider the typical clinical documentation process for a patient encounter. The doctor sees a patient who, for example, is complaining of an irregular heartbeat. The physician pulls up an arrhythmia template in the EHR and begins documenting the patient’s symptoms. Everything moves along smoothly until the patient mentions that he’s recently been having some pain in his right elbow. And, that his A1C levels have been a little elevated.

Suddenly the documentation process gets a lot more complicated as the physician hunts for template options to document the non arrhythmia-related ailments. After a couple of minutes searching unsuccessfully for the right disease templates, the doctor gives up and decides to dictate the rest of the note.

Because of the inefficiencies of most clinical documentation systems, physicians often resort to dictation. The transcription of dictated notes can be expensive and is prone to error. Furthermore, dictated data is stored in a non-structured format that is more difficult to access at the point of care. This means that physicians may overlook critical details hidden within free text, which in turn can impact the delivery of care. In addition, it’s difficult to analyze data in an unstructured format for quality reporting purposes or for any type of analytics.

Physicians and their patients deserve better. Here are my recommended “fixes” to give clinical documentation more clinical substance for the enhanced delivery of patient care.

Clinically-dynamic, patient-specific documentation

More physicians now have access to disease-specific templates, which give clinicians a great head start in the documentation process and help with the capture of structured data for larger quality improvement initiatives. However, because physicians treat whole patients and not a single disease, clinicians also need documentation tools that are patient-specific and clinically-dynamic.

With a clinically-dynamic documentation platform, physicians can easily pull in clinically relevant items without having to call up multiple templates. In the case of the patient complaining of an irregular heartbeat, a doctor can tap in a few keystrokes and quickly add new issues into the existing document. The documentation workflow is not disrupted and the clinician does not need to dictate any details or enter free text. Everything related to the patient, including the elbow pain and A1c concerns, are merged directly into the same note. Each element is logically linked to the relevant section within the note – the problem list or physical exam, for example – so that physicians can quickly access the precise details at any time.

Capturing patient-specific details for quality initiatives

You may never hear a physician say they love documenting patient encounters, but you may be able to convince them that it’s worth the effort if the finished product facilitates better patient care.

When clinical documentation can be leveraged to advance quality initiatives, physicians are less likely to view the charting process as a time-consuming task that turns doctors into overpaid members of the billing staff. With smarter clinical documentation tools, physicians can track more patient data in real time and capture critical information that feeds analytics systems and performance dashboards. Clinicians can then access population-level information or view specific clinical details in a longitudinal format and gain deeper insights into a patient’s medical status.

It’s time to usher in a new era with clinical documentation. With the right technology and a shift in mindset, we have the opportunity to transform clinical documentation so that it’s not just about coding and billing, but instead a vital tool that enhances the delivery of quality patient care.