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News 7/25/18

July 24, 2018 News 7 Comments

Top News

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The Department of Defense will increase its EHR contract ceiling by $1.1 billion in expanding MHS Genesis to cover implementation of Cerner by the Coast Guard. The extra cost will also cover items included in the VA’s contract that were not present in the DoD’s agreement, according to Defense Healthcare Management Systems Program Executive Officer Stacy Cummings.

Cummings added, “A standard electronic health record baseline for the Department of Defense, Department of Veterans Affairs, and US Coast Guard will enable more efficient, highly reliable, safe, and quality care.”

The DoD’s original contract ceiling with lead contractor Leidos was valued at $4.3 billion and a total of $9 billion if all options were exercised.

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The Coast Guard gave up on its attempt to implement Epic in 2015 after running $46 million over budget with no sites live. A GAO investigation blamed poor project management, insufficient governance, inadequate project documentation, lack of testing, and internal staff turnover. The Coast Guard began searching for an alternative to Epic in February 2016, reverting to paper and, according to the GAO, endangering members with convoluted processes.

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Cummings said the Pentagon will publish a second evaluation report by the end of the year, following a scathing internal review from May that concluded that MHS Genesis “is neither operationally effective or operationally suitable” and not capable of managing care delivery.

The DoD also announced that the next four MHS Genesis rollout locations will be Naval Air Station Lemoore, Travis Air Force Base, US Army Health Clinic Presidio of Monterey, and Mountain Home Air Force Base.


Reader Comments

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From FlyOnTheWall: “Re: Allscripts. The company’s investor page proudly boasts in a press release from last year that Rothman Ortho selected Allscripts PM to replace its ‘legacy system.’ Was not that system Allscripts Vision? Nice to see Allscripts getting into the rip-and-replace frenzy of Allscripts solutions, even though they did an RnR of one of their own products.” Unverified, but I believe Rothman was using the old Vision product of Medic / Misys, acquired by Allscripts in 2008. If that’s indeed the case, then I would categorize the announcement as misleading since it’s just swapping one Allscripts product for another, not a brag-worthy displacement of a competitor’s system.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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Identity and access management technology vendor Identity Automation acquires HealthCast, which offers single sign-on and virtual desktop systems for healthcare.

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Former employees of the shuttered CareSync describe the company’s final days to the Hardee County (FL) Board of County Commissioners, saying they were pressured to keep patients of its chronic care management business on the telephone line for at least 20 minutes to qualify them for their monthly Medicare billing. CareSync co-founder and State Rep. Jamie Grant — who served as senior solutions architect and was cleared of ethics violations after charges that he funded the company’s startup by misusing Hardee County development grants – says he hasn’t ruled out suing unnamed parties. Co-founder Travis Bond, who employees said was removed by the board because of poor financial management, says he does not plan to pursue litigation.

Cerner has added half of the 600 Kansas City-based employees it needs for an expansion of its RevWorks and ITWorks outsourcing businesses.

University of Minnesota hopes to license an algorithm created by its medical school researchers that predicts a patient’s one-year mortality risk using EHR data.


People

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DirectTrust hires Scott Stuewe (DataFile Technologies) as president and CEO. He worked for Cerner for 20 years through December 2016.

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Methodist Health System (NE) promotes Kent Sona to VP/CIO.


Announcements and Implementations

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A Reaction Data survey of 250 physicians finds that EHRs, regulatory compliance, and internal bureaucracy contribute most to their burnout, with patients named as the problem only 2 percent of the time. The top wished-for EHR improvements are improved user friendliness, additional dictation or scribe capabilities, and reduced time required.

A Black Book survey finds that two-thirds of hospitals are reconsidering whether the ED information system supplied by their EHR vendor can handle efficient ED workflows and meet consumer expectations, with outsourced ED doctors being the least satisfied due to EHR training gaps, excessive clicking, and difficulty in obtaining outside patient data. ED doctors who were forced to move from a best-of-breed EDIS to an EHR’s ED module say their new system hurts their productivity (90 percent), impedes patient workflows (75 percent), and contributes to medical staff burnout (90 percent). CIOs are mostly at odds with those beliefs, favoring a single source EHR solution. The top-rated best-of-breed EDIS vendor is T-System, followed by Optum Picis and Wellsoft. Cerner, Meditech, and Allscripts were also highly rated by users. The most-desired features of both types of EDIS in order are better mobile deployment, interoperability, and patient satisfaction tools.


Government and Politics

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The Senate confirms Robert Wilkie as VA secretary in a 86-9 vote.

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The National Institutes of Health launches its Google Cloud-powered STRIDES Initiative to allow researchers to analyze large biomedical data sets. Meanwhile, a Google Cloud blog post says that former Cleveland Clinic President and CEO Toby Cosgrove, MD has signed on as an advisor.


Privacy and Security

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A Kaiser Health News report recommends that consumers pay cash for alcohol and cigarettes while bragging about gym memberships on social media since insurers and other groups are using personal information from credit cards and other sources to create individual profiles that are then sold to companies. Buyers include drug manufacturers – which might want to buy a list of men over 50 who are experiencing erectile dysfunction – and insurers that may use the profile to predict lifespan or medication adherence. Even employers can use the information to check for a job candidate’s potential work-affecting and expensive chronic illnesses before hiring them. The article quotes Harvard fellow Adam Tanner, who wrote “Our Bodies, Our Date: How Companies Make Billions Selling Our Medical Records.”


Other

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A small JAMA-published study finds that back-end speech recognition (specifically Nuance’s former EScription product) has a 7 percent error rate when creating dictated notes (operative notes, office notes, and discharge summaries), with some of those errors such as “grown mass” instead of “groin mass” remaining on the chart for weeks or sometimes indefinitely as clinicians either don’t review them promptly or sign them without double checking. The authors recommend that speech recognition errors be submitted for calculating error rates and for creating automated error detection systems.

Banner Health posts a job for CEO of its Tucson campuses just after its corporate VP/CIO announced plans to leave and the local paper published documents from a state investigation into problems with patient care, provider satisfaction, and billing from its Epic-to-Cerner conversion at the former University of Arizona Health Network hospitals in Tucson.

Google’s Nest home automation division is approaching eldercare facilities to use its products for monitoring the wellbeing of residents.

A Stanford University scientist invents a patch that measures cortisol in sweat to detect disease, measure stress, and evaluate sports performance.

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Columbia University’s new Center for Precision Dental Medicine offers RFID tracking of patients and equipment, biofeedback-measured stress levels for quantifying pain, video recording of procedures, and all-digital dental chairs whose six instruments are RFID-enabled for tracking usage and sterilization. They hope to use the resulting data not only to make patients more comfortable, but to analyze provider technique to identify best practices. They also hope to to integrate their systems with EHRs to remove the silos between professions.


Sponsor Updates

  • Ellkay will exhibit at AACC’s Annual Scientific Meeting & Clinical Lab Expo next week in Chicago.
  • Iatric Systems will exhibit at the SHIEC Annual Conference August 19-22.
  • In Ohio, the MetroHealth System and Medical Mutual become the first provider and payer organizations to digitally exchange data and documents with Hyland’s OnBase Mackinac solution.
  • AdvancedMD publishes a new eGuide, “Best Practices to Improve Patient Payments.”
  • Nordic posts a podcast titled “Developing a strategy for your Epic Community Connect program.”
  • Audacious Inquiry names Roxanne Johanning health IT product manager.
  • Arcadia will host a career open house at its Pittsburgh office July 25.
  • CompuGroup Medical will exhibit at AACC July 29-August 2 in Chicago.
  • Divurgent publishes a new white paper, “Medjacking: A Life or Death Issue for Leaders in Connected Healthcare.”

Blog Posts


Contacts

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

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Morning Headlines 7/24/18

July 23, 2018 Headlines No Comments

Senate Confirms Pentagon Official To Head Veterans Affairs Department

The Senate confirms Robert Wilkie as VA secretary in a vote of 86 to 9.

Cerner adds 100 more employees on its way to hiring 600 in KC

Cerner fills half of the 600 positions it announced it would staff as part of its new CernerWorks managed services business.

Theranos Investors, Founder Holmes Resolve Shareholder Suit

Theranos founder Elizabeth Holmes settles a 2016 lawsuit brought by disgruntled shareholders who had indirectly invested in the company through investment funds.

Curbside Consult with Dr. Jayne 7/23/18

July 23, 2018 Dr. Jayne 1 Comment

Every time CMS releases new proposed rules, I feel like the circus has come to town. The most recent offering includes 1,472 pages of bliss and is open for public comment until September 10.

I used to try to read them on my own, but found it too hard to get through them in a timely manner. I’m grateful to the people who have dedicated time to review and summarize them for the rest of us. It seems like most healthcare media outlets are trumpeting the “historic shift” for ambulatory Evaluation & Management (E&M) codes, so I decided to do a little deeper dive myself. Most recent federal proposals trumpet their aim to reduce administrative burdens, so I was curious whether they had truly found the “easy” button.

This document is a double whammy, addressing both the Medicare Physician Fee Schedule and the MACRA Quality Payment Program. There’s a whopping 0.13 percent increase in the fee schedule, which frankly I would rather have had them just keep it static than to try to explain various updates and adjustments. There are new G codes for preventive telehealth services that may be enticing for primary care physicians.

Our enthusiasm is curbed, though, by the continued insistence on EHR support for Appropriate Use Criteria for Advanced Diagnostic Imaging. That’s a measure that has been created, delayed, stayed, and revisited for the last several years and now will start in January 2020, with a year-long testing period but no enforcement. Providers can apply for hardship exceptions if they have poor Internet access, EHR vendor issues, or uncontrollable circumstances. CMS is relaxing a bit in allowing AUC tasks to be performed by ancillary personnel rather than requiring the provider to do the work, so that’s a good thing. It will be interesting to see how much of a difference the use of AUC really makes. In my market, we’re already well trained by commercial payers so that we don’t order tests that aren’t indicated.

The Accountable Care Organization programs received an update, with some measures being retired and a new one added. I didn’t spend too much time on the ACO part of the rule, since it’s expected that CMS will release a separate ACO regulation in the near future. I jumped to the part about outpatient E&M coding, which wasn’t as exciting as I expected. Providers will have the choice to document and code their visits based on the current schemes (formulated in 1995 and 1997) or through either a framework around time and medical necessity, or one around medical decision making. Rather than the distinct charges we have now for visits under the 99202-99205 and 99212-99215 codes, a blended rate is proposed.

Not surprisingly, there is a shift towards the lower end of the range rather than a shift towards the higher end, and for those of us used to performing and documenting high-level visits, it will be a cut. This may be made up for by the reduced documentation requirements, but for providers used to maximizing their use of macros, personal defaults, and templates, the perceived reduction in work isn’t going to make up for a more than 10 percent reduction in payments. If you’re not optimized on your EHR or don’t document efficiently, it may be a boon, but not for every practice.

As far as MACRA, MIPS, and the Quality Payment Program, CMS is just shuffling things around again. Advancing Care Information has been renamed Promoting Interoperability, and additional providers are being invited to the party: physical therapists, occupational therapists, clinical social workers, and clinical psychologists. From a quality perspective, all-cause readmission is being added as a measure for groups. Quality reporting will remain full-year, despite provider groups lobbying for a change.

Quality measures that CMS has identified as ineffective will be dropped, potentially saving physicians $2.3 million. Additional quality measures will be added, including four that address patient-reported outcomes. Reporting for Improvement Activities will be 90 days, however, along with Promoting Interoperability. Use of Certified EHR Technology that complies with the 2015 edition is mandatory. Within the Promoting Interoperability category, new elements are available for Prescription Drug Monitoring Program (PDMP) query, verification of an opioid treatment agreement, and expansion of electronic referral loops by receiving and incorporating information. Vendors will need to incorporate functionality to track and report on these elements, and I suspect that many do not currently have that capability.

Security Risk Analysis remains a required element. I continue to find practices that think that this is somehow the responsibility of their EHR vendor and who don’t understand that it’s the covered entity’s responsibility, with EHR vendor compliance being only one piece of it. Organizations are required to assess how they handle Protected Health Information in a variety of different settings, whether in person, on paper, on the phone, etc. which may or may not have anything to do with the EHR. If you don’t know your organization’s plan for Security Risk Analysis, it might be worth a discussion.

As was true previously, participation in an Advanced Alternate Payment Model such as an Accountable Care Organization means a practice doesn’t have to keep track of all the changes in the Merit-based Incentive Payment System (MIPS) model. The APM track is definitely where CMS wants providers to be, adding a 5 percent bonus for them. CMS is also pushing providers to be ready for programmatic updates on a regular timetable with its move to combine QPP with the Physician Fee Schedule. If this holds, providers can plan for updates to both in July and November instead of playing the waiting game.

Still, each time a new rule or proposed rule comes out, the chatter in the physician lounge increases. In my market, we’ve seen a number of established clinicians opt out of Medicare and even more choose to move to cash-based practices whether they involve retainer / concierge fees or not.

My practice remains firmly opted out of MIPS although we accept Medicare patients without restrictions. It remains to be seen whether there will come a time that the penalties outweigh the extra work that will be required to avoid them. So far, we’re diversified enough that it’s not an issue. As I work with practices that don’t have the luxury of non-participation, I’m thankful for that day a couple of years ago when we disabled the “Meaningful Use Content” checkbox and our lives got quite a bit easier.

Given the published comment period on this proposed rule and the typical CMS schedule, we’ll know in a couple of months whether any parts and pieces will be thrown out or modified. Based on this proposal compared to all the feedback that has been submitted on other proposed rules, I’d bet there aren’t too many material changes.

What is your take on the proposed rule for MPFS and QPP? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeremy Pierotti, CEO, Sansoro Health

July 23, 2018 Interviews No Comments

Jeremy Pierotti is co-founder and CEO of Sansoro Health of Minneapolis, MN.

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Tell me about yourself and the company.

I grew up in Madison, Wisconsin. I went to school out East, then worked in healthcare policy in Washington, DC after college. I then moved to Minnesota for graduate school. Despite promising my wife that we would be here for only two years, that was 1996, and we’ve been here in Minnesota for 22 years.

We started the company in 2014. We knew that the next generation of digital health solutions would require data liquidity. We thought we had an innovative way of providing advanced data exchange between health IT applications. I had no actual skills since I’m not a physician and I can’t code, so when I showed my partners how to move a PowerPoint slide backwards and forwards, they told me I should be CEO.

How widely are APIs being used in healthcare?

We’re seeing them adopted at an accelerating pace. We’re excited by it. I’ve always believed that in healthcare, we adopt treatment technology eagerly and deploy it pretty rapidly. New information technology has been adopted more slowly. But now we are counting on digital health solutions to help us deliver better outcomes with lower costs, higher patient satisfaction, and higher provider satisfaction. Recognition is now widespread that this will happen only with secure, seamless exchange of data between applications. In manufacturing, retail, logistics, and financial services, that’s all done through APIs. We are seeing more rapid adoption of that in healthcare, too.

Do EHR vendors make it easy for customers to integrate their products with those sold by other companies?

To some extent, yes. Most of the major EHR platforms have API or developer programs. Some are more robust than others. It depends on the business strategy of the company and the other demands that are on the company. A lot of regulatory requirements have been placed on EHR vendors over the last 10 years. That has consumed a lot of engineering and product development time within those teams.

Our goal at Sansoro is to provide a universal API so that great developers and great healthcare software companies can write to a single API standard. Then we will handle the nuances of getting the data out and putting the data back into the EMR. As a developer, you don’t have to learn the different APIs and the different integration approaches of each vendor.

I saw you your site that Emissary doesn’t update EHR tables by scripted inserts or updates, but instead uses the vendor’s back-end service to preserve their validation logic. What are the use cases for updating the EHR database and do other methods do direct database updates?

I don’t know whether other companies are doing direct table inserts. Our team is a collection of experienced health IT personnel who know how to create safe application. We’ve all been working with health IT for 20, or 30 years per person. Our approach has been to use the back-end services to make it a safer process. We also get to take advantage of the work that’s already been done by the EHR vendor in terms of the updates.

Examples of what we allow for writing data to the EHR would be discrete observations, documents, and notes. Pretty straightforward stuff, but important. In most provider systems, the EHR is the system of record, so it’s important to get key data into the EHR itself. That’s the operating system for a provider.

Our secret sauce is doing the hard work of mapping the data structures of all of the different EHRs that we support into a unified data model. That’s the holy grail. That’s why we can provide a single API in which an engineer can read data from different vendor platforms and write data back to different vendor platforms without having to know the nuances and differences between those vendor platforms.

What are the most-request API integrations and also the most-desired that aren’t yet available?

We see three common use cases across our customers and prospects.

One is pretty simple. We want to pull patient charts. We typically will have to do an extract, run a database report, or send personnel into the clinic or hospital to print out the chart or print it to a PDF. Being able to pull that chart for quality reviews, medical necessity reviews, and release of information — just being able to pull the basic patient chart — is a standard need and use for our APIs.

The second is for advanced analytics. Basic patient chart information, but with additional information. What clinic or department was this patient in when this procedure was performed? What is the provider’s background? Then combine historical information with real-time information to create a dashboard back to the provider in real time, with insight about the possible best treatment for this patient or how the patient’s condition is improving or deteriorating. Real-time analytics, pulling both historical data and data that’s up to the minute from the EHR or from other data sources to provide those exciting insights for clinicians for administrators.

The third and broadest use case involves workflow improvement. Probably 200,000 prior authorizations are submitted every day in the United States. You print out a bunch of information from the patient’s chart, fill out a prior authorization cover sheet by hand, and fax it into the payer. Then the payer has a person who adjudicates that prior authorization. Often, the the approval will be snail-mailed back to the provider. Not really up to 21st century speeds.

Workflow improvement is using our integration platform to listen for orders, determine if those orders require a prior authorization based on the patient’s insurance, and if so, grab only the data that’s needed from the chart to adjudicate that prior authorization, and then push the approval number back into the patient’s chart. All without any further human intervention. Once the provider places the order in the EHR, the rest happens automatically. That’s a great workflow improvement that saves hours for every prior authorization request.

Another great workflow improvement involves unified communications. Lots of companies provide communications tools that augment the EHR tools, whether it’s Vocera, Voalte, PatientSafe Solutions, or Spok. There’s a pretty good list of vendors that have great tool sets. Enhancing those tool sets to send those messages to the right clinician with appropriate context. Here’s a lab result for the stat order you placed, but in addition to this lab result, we’re going to include the last three results for that same lab test so you can put this result in context. Also, here are the patient’s most recent vital signs and here’s the medication list.

As a provider, you’re not getting a call from the lab with the lab result and then having to log into the EHR to find all that information manually. Instead, it’s delivered to you on your smartphone. As a clinician, that saves you a lot of time and allows you to make a decision faster about the appropriate treatment for that patient.

The FHIR standard is even further entrenched now that Apple is using it to populate Health Records. How does FHIR fit into the overall needs for interoperability?

We believe in a “FHIR and more” approach. Our integration platform, we believe, provides the most complete and comprehensive integration on the market today. But we understand that there’s a role for FHIR.

The challenge with any standards group is that it takes time to develop those standards, and that’s totally understandable. The other thing we’ve seen is that those standards are a paper-based or an electronic specification, but they don’t always get implemented in the same way by each vendor. You can look for a single FHIR resource and find that different vendors implemented it in different ways. You would need a different code base for using the same FHIR resource from one vendor to another.

We believe that FHIR has an important role and Apple has shown that you can do some interesting things with it. We’re working with customers that may be able to use FHIR for some of their needs, but they have other needs as well. We are able to provide APIs that fulfill needs that the FHIR working groups haven’t gotten to yet or that haven’t been deployed by the vendors yet.

There is no “one size fits all” solution for data exchange. We know from our growth over the last few years and from the continued interest that we have from new customers that there’s a demand for FHIR and more.

Do you have any final thoughts?

The next generation of software that will be part of the digital health revolution demands data liquidity. When you have free flow of data, it’s fascinating what you can accomplish.

The easiest analogy that I draw is to the smartphone. As a platform integrating your location and the ability to send messages, the smartphone has enabled whole categories of industries to develop. Take ride-sharing, for example. That never would have been developed.

As we start to break down the barriers among health IT applications and create the ability for them to exchange data, we’re going see a similar explosion in the creativity and innovation around health IT software. We are excited to be able to support that. For all of us, it will mean a better patient experience, lower costs, and better outcomes. That’s what we’re all trying to achieve.

Morning Headlines 7/23/18

July 22, 2018 Headlines No Comments

NHS to receive £487m technology boost

In England, new Health Secretary Matt Hancock pledges his support for NHS modernization and announces $640 million in new technology funding.

Samsam infected thousands of LabCorp systems via brute force RDP

LabCorp is close to fully restoring its systems after they went offline in a July 13 ransomware attack.

Banner Health’s Tucson computer conversion yielded reports of medical errors

Banner Health’s $45 million conversion to Cerner caused medical errors and staff frustration, although hospital officials said delays in patient registration, lab ordering, and medication ordering and delivery didn’t harm patients.

SingHealth’s IT System Target of Cyberattack

Singapore says hackers stole the information of one-fourth of its population, 1.5 million people, in an attack involving its SingHealth clinics.

Monday Morning Update 7/23/18

July 22, 2018 News 5 Comments

Top News

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In England, new Health Secretary Matt Hancock pledges his support for NHS modernization and announces $640 million in new technology funding. He touted virtual visits, barcode tracking, and electronic medication ordering.  


HIStalk Announcements and Requests

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Poll respondents say Epic has the best CEO. HISJunkie says Meditech hasn’t grown, Brent Shafer is too new to judge, and Allscripts is a mess. Tripp Tart voted for Judy Faulkner in admiring her for keeping the company free of shareholder influence. Former Community CIO votes for Howard Messing since he also kept Wall Street out of the picture and is creating company growth again, while Epic’s growth is mostly due to its hospital customers acquiring more facilities.

New poll to your right or here: would you be OK with insurance companies using your harvested social, financial, and lifestyle data to approve and price your medical coverage?


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Decisions

  • Schoolcraft Memorial Hospital (MI) switched from Evident to iSolved HR and payroll software in June.
  • Divine Savior Healthcare (WI) will replace Evident with Athenahealth in fall 2018.
  • Crisp Regional Hospital (GA) will replace Meditech HR with Kronos in 2018.
  • North Country Hospital & Health Center (VT) replaced Allscripts Paragon with Athenahealth in April 2018.

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


People

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Chronic Care Management, Inc. hires two former executives of its defunct competitor CareSync, Gurpreet Singh (CIO) and Marc Gauthier (head of enterprise business development).


Announcements and Implementations

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Publicly traded rural hospital operator LifePoint Health is considering selling itself to a private equity firm for up to $6 billion, with the report sending LifePoint’s shares up 40 percent. LifePoint Health also operates 15 hospitals in partnership with Duke University Health System under the Duke LifePoint Healthcare brand.


Privacy and Security

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LabCorp is close to fully restoring its systems after they went offline in a July 13 ransomware attack. The company’s security team detected the Remote Desktop Protocol attack and stopped it within 50 minutes, but by then, the SamSam ransomware had impacted 7,000 Windows-based systems and 1,900 servers. SamSam took Allscripts down earlier this year, reportedly also using RDP as its vector.

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Members of a private Facebook group for sexual assault survivors find themselves trolled by new users who threaten to post the intimate details they had shared under their real names. The group was apparently created by an anonymous administrator who either had duped the members or whose account was hacked. The report by “Wired” notes a Facebook flaw that allowed this to happen – groups can be created by “pages” that aren’t tied to an individual’s profile, the same way Russian propagandists used the platform before the 2016 elections to keep themselves anonymous. I was going to play around with some Facebook group stuff but decided instead to try Microsoft Teams now that the company is offering a free tier and no longer requires members to use Office 365.

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Singapore says hackers stole the information of one-fourth of its population, 1.5 million people, in an attack involving its SingHealth clinics. The hackers specifically targeted the information of the prime minister in the cyberattack that lasted from June 27, 2018 until it was discovered on July 4. They breached a specific PC and then elevated its account privileges to access the database.


Other

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Epic’s campus is free of cranes for the first time in two decades as the company’s frenetic construction projects wind down, having expanded the campus to handle employee headcount that tripled to 10,000. Epic says that it may another set of buildings next year.

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The local paper reports that Banner Health’s $45 million, October 2017 conversion to Cerner at its acquired Tucson academic medicine locations caused medical errors and staff frustration, although hospital officials said delays in patient registration, lab ordering, and medication ordering and delivery didn’t harm patients. The paper just received heavily redacted records of an Arizona Department of Health Services investigation. Banner says it made 100 improvements to Cerner this year, naming specifically changes in pharmacy processing, oncology administrative activities, and patient records access. The paper notes these items uncovered from various state investigation documents and meetings:

  • The Tucson locations had a smooth transition when they originally implemented Epic, but moving to Cerner “provided fraught for some patients and staff,” with significant problems due to poor implementation planning and training.
  • This was Banner’s first implementation in an academic medical center (the former University of Arizona Health Network) and its Cerner system couldn’t distinguish between a medical resident and an attending doctor.
  • A near-miss infant overdose happened because Cerner was set up to order per-kg weight-based doses, while Epic had been set up as per-gram ordering.
  • Banner’s CFO admitted to state officials last month that it underestimated Cerner’s data center and bandwidth requirements.
  • Banner’s CFO says both revenue and clinical productivity have yet to recover from the Epic-to-Cerner switch nine months ago. He replied to a Regents member who expressed concerns about Banner’s Tucson reputation, “You and me both.”
  • The article notes that Phoenix-based Mayo Clinic Arizona will replace Cerner with Epic on October 6.
  • In other Banner news from Tucson, the health system cancels its nurse Magnet status, where under University of Arizona Medical Center’s ownership in 2003, it became the first Magnet-designated hospital in Arizona. Banner will continue Magnet participation at its Phoenix campus.

AP Stylebook neatly summarizes how publications should use the results of political polls, offering rules that also apply to healthcare IT:

  • The existence of a poll isn’t in itself newsworthy.
  • The poll results should disclose who paid for it, and if the poll was commissioned by an organization that benefits from its results, it is not newsworthy.
  • Polls should include a description of their methodology and a list of the questions asked.
  • The polled group should be randomly selected to make sure that every member of that population has an equal chance of being selected. Online polls are valid only if participants are randomly recruited, while polls of website visitors, a company email list, or Twitter should be avoided.
  • The poll should state its margin of sampling error.
  • Reporting on results from a poll’s subgroup – such as people of a certain age or location – may be meaningless if the sample size is small.

An interesting study finds that telling students to “find your passion” for a career is bad advice since most passions are grown from experience, not discovered. The danger of the “do what you love” argument is that it encourages people to give up too easily and move on to something else if they don’t receive immediate gratification.

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This is where science and public health meet the reality of people who don’t value them or who think they are driven by conspiracies. The parents of 57,000 Texas public school students decline to have them vaccinated in the 2017-2018 school year for non-medical reasons. In a significant jump, some counties saw a 9 percent opt-out rate and nearly half of the parents of students at one Austin private school opted out of giving them vaccinations under the repeatedly scientifically disproven belief that vaccines cause autism and other diseases, with “vaccine choice” being viewed by some as resistance against overly intrusive government. Supporters of Texans for Vaccine Choice are mobilizing political activities, protesting with signs that say “The State Does Not Own My Children” and promoting “informed consent” in publishing anecdotal stories in which parents claim that the medical problems of their children were caused by vaccinations. Obviously their choice affects everyone as vaccines work for entire populations only when enough people receive them to create “herd immunity.”

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A CNBC report notes that a roadblock to digital health company success is that apps always end up recommending that users see their doctors, which people don’t like doing and often can’t afford. That leaves apps as “a funnel or a stopgap rather than a revolution.” A cardiology fellow and digital health founder says, “All the things done well by digital health — they’re simple, fun, visual, with great user experience — are still missing from most clinical visits, so it remains pretty unpleasant to be a patient. To me, this gap gets closed by bringing the clinical experience up to the same standards as our digital health solutions.” That is pretty brilliant insight – imagine frictionlessly summoning a ride on Uber and then having a 2004 Pontiac Aztek show up an hour late with the meter already at $40 and the lost driver refusing to use the GPS.

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Google, Facebook, Microsoft, and Twitter launch an open source Data Transfer Project that allows people to transfer their data from one online service to another (the technical overview is here). Healthcare wasn’t mentioned specifically, but it would be pretty cool if EHR vendors provided a similar capability in allowing patients who are seeing a new doctor to initiate their own transfer of data to the new doctor’s EHR, although questions would then arise about the lack of synchronization capability afterward.


Sponsor Updates

  • Elsevier will offer its StatDX radiology diagnostic decision support tool through MModal’s Fluency for Imaging.
  • Liaison Technologies partners with One Laptop Per Child.
  • Pivot Point Consulting names Matthew Curtain director of business development.
  • Sunquest will host its annual user group conference July 29-August 3 in Scottsdale, AZ.
  • Vocera will exhibit at LeadingAge Florida July 29 in Kissimmee, FL.
  • Mazars USA names Steven Herbst principal, health care consulting group.

Blog Posts


Contacts

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

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Weekender 7/20/18

July 20, 2018 Weekender No Comments

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Weekly News Recap

  • A survey finds that both consumers and physicians recognize the benefits of virtual care, but few consumers have experienced it and few doctors offer it
  • Tenet Healthcare considers selling its Conifer Health Solutions business for up to $2 billion
  • LabCorp shuts down its nationwide computer network when it detects that a hacker has penetrated it and is trying to access patient records
  • Draft CMS rule changes would make major changes to physician billing, the Quality Payments Program, EHR design in supporting simpler billing requirements, and telehealth coverage
  • The VA creates a committee to oversee its Cerner implement that will be led by ONC Principal Deputy National Coordinator Genevieve Morris

Best Reader Comments

No one is commenting on the CMS announcement, I suppose because no believes they are serious, or capable of executing any part of this grand plan. (DZAMD)

As a former CFO at a university medical center, a ROI of $190m that requires a $180m investment is a no-brainer — that is the people moving ahead with it have no brains! Any project as large and complex as this has at least a 90 percent probability of being 20 percent (or more) over budget. Nor did I see a contingency allowance in the budget which would allow for any mistakes. Given that, I would need to see at least a 50 percent ROI before moving ahead. Good luck UW, you’ll need it. (HISJunkie)

The communication director for BJC needs a communication director for her own messaging. You START the public statement about how bad you feel for the people whose lives you just turned upside down. You don’t bury that sentiment after two lengthy paragraphs about “market forces.” This should be a PR no-brainer in today’s hyper-sensitive environment for businesses who face these tough decisions. (AreUKiddingMe?)

“If I were a CareSync investor.” Apparently CareSync got millions from a local county development fund. That makes the county taxpayers the investors. Good luck to them recouping any money. (Blocked by Gurus)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B, whose classroom is in “one of the most dangerous cities in America” in New Jersey, as she describes it. She asked for puzzles, books, and STEM supplies for her after-school program in which students remain on campus until 6:00 p.m. She reports, “My students were so excited when our After School Fun box arrived! Thank you again for your continued support to our school and specifically my classroom. My students come from a city that will not define their future and it is because of donors like you that make them see the possibility this world has for them!”

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Telehealth vendor Dictum Health’s Virtual Exam Room and VER-Medic are featured in Discovery Channel’s new show “Sharkwrecked,” where paramedics used it to monitor the health of participants at the show’s shooting location in the Bahamas. Producers blew up a boat in the ocean, then left two men floating with sharks for two days to see what happens in simulating a real-life (yet rather far-fetched) situation. Just in case anything in Shark Week sounds like actual science, the network eliminated all doubt by featuring budget-friendly, D-list celebrities like Ronda Rousey and the massive Shaquille O’Neal, whose fear-overcoming shark dive might well trigger tsunami warnings.

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Something I learned about the Chrome browser today after months of pondering instead of simply Googling: yellow lines stacked in the scroll bar show where the most recent search term appears on the page. Remove the search term from the search box and they go away, but otherwise you can scroll to one of the lines and then you’ll see your search term highlighted in yellow in the page text.

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A woman is charged with breaking into Westmoreland Hospital (PA) on two occasions to steal soda, once by guessing the ICU door’s access code to enter its conference room, from which she left with a backpack full of drinks. The woman says she regrets her arrest since it might impact her ability to return to her paralegal studies, explaining, “I was thirsty, and it was really late at night, and there are no convenience stores really in my neighborhood. I just thought I’d get some soda. I didn’t think it was this big deal.”

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British Airways responds to a customer’s tweeted complaint by asking him to provide his personal information “to comply with GDPR,” which the dimwitted customer (among others) does by tweeting it right back at the company and to the world. A security expert baffled at why the company would try to solve problems on Twitter instead of asking the customer to call in. He also notes that British Airways allows customers to check in online only if they disable their browser’s ad blockers, after which it sends their information to many third parties.

In England, a 63-year-old NHS doctor who is upset about his pension investment losses sends messages to his financial advisor threatening to kill himself, then uses a “hire-an-assassin” site on the dark web to order the advisor killed. The National Crime Agency detected his activity while investigating the Chechen Mob’s site, finding that the doctor had chosen the first of four predefined options: kill the man, beat him, set his car on fire, or set his house on fire. The doctor entered the advisor’s address but didn’t pay the $5,000 fee, leading him to plead not guilty of attempting to solicit murder.

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Catholic Health Initiatives collaborates with AHA and Mass General to develop a set of IICD-10 codes that allow providers to document sex and labor exploitation.

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I’m not sure if this is an Amazon success or failure, but the company’s website was so busy in the first few minutes of  this week’s Prime Day that its servers bogged down, forcing IT staff to deploy a stripped-down home page and to shut off international access. The company’s auto-scaling feature apparently also failed, requiring manual server spin-up and the need for “looking at scavenging hardware.” Prime Video was slowed, Alexa experienced outages, and warehouse employees weren’t able to prepare orders. Experts say that Amazon may have a bug in its auto-scaling service, but they nevertheless marvel that all of the Amazon sites remained up despite unprecedented volume. The company’s Sable computational and storage system processed 64 million requests per second under last year’s less-busy Prime Day.

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The 63-year-old chief of cardiothoracic surgery at Jersey City Medical Center (NJ) is commissioned as a US Navy Reserve commander after receiving an age waiver for his in-demand skill. Tyrone Krause, MD, who was sworn in by his Navy ensign daughter, said, “Why don’t I just relax and sit in my back yard and drink some beer? But that’s not my style. I’ve always been on the move. And hopefully I’ll always be on the move.”


In Case You Missed It


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Morning Headlines 7/20/18

July 19, 2018 Headlines 1 Comment

What can health systems do to encourage physicians to embrace virtual care?

A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t had a virtual visit and only 14 percent of doctors offer them.

CEO Gawande’s first task: a road trip to hear firsthand about workers’ health challenges

Atul Gawande, MD — head of the still-unnamed healthcare joint venture among Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies.

Survey: Progress on Patient Safety Slowed by Ineffective Technology, Healthcare Professionals Say

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors.

News 7/20/18

July 19, 2018 News 1 Comment

Top News

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A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t experienced a virtual visit and only 14 percent of doctors offer them.

The most commonly implemented virtual care technologies are email / patient portal consultations, physician-to-physician consultations, and virtual visits. Adoption was in the single digits for remote care management and coaching, remote patient monitoring at home or in other facilities, and integration of wearables.

The factors listed above do not include the big ones that doctors can’t control — reimbursement and licensing. You can bet that they would be quick to offer those services if adequately paid to do so or if per-visit fees were eliminated under value-based care payments and an in-person visit actually cost the practice money.


Reader Comments

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From DisCerner: “Re: Banner Health. CIO Ryan Smith has tendered his resignation and a posting is up for SVP/CIO on Banner’s site.” The job is posted here, although Ryan is still listed as CIO on the company’s executive page. His career was with Intermountain until he joined Banner in October 2013. He was paid $900K in the most recent year. The tax filings also indicate that Cerner was Banner’s third-highest paid independent contractor at $47 million. 

From Email Privilege: “Re: HIPAA. I was emailed a receipt after paying online that included my name, account number, date of birth, and telephone number. Should they not just have the account number and amount paid because of HIPAA?” All of those fields, as well as your email address itself, are elements of PHI. However, your use of the provider’s portal probably could be taken to indicate your consent for communicating by email (I bet that was listed in its terms of service). It’s also not illegal to send PHI by email – HHS’s only requirement is that the provider “apply reasonable safeguards,” of which encryption would be one even though the rule doesn’t specifically require it as far as I know.

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From Avuncular Robert: “Re: McKesson’s outpatient pharmacy point-of-sale system. It’s been down for over 24 hours and their service desk is blaming Amazon Web Services. It is a huge headache – we’ve had to go back to the old cash box process.” I reached out to McKesson, which provided this response:

We are aware of the situation that affected a subset of our customers and impacted their operations for the past 24 hours. Though point-of-sale services were impacted, the dispensing of medication was not affected. We have resolved the issue and have informed customers of next steps. As always, we appreciate our customers’ support and thank them for their patience and cooperation.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor EPSi. The Allscripts-owned, Chesterfield, MO-based company is the industry leader in health system integrated financial decision support, budgeting, and planning. More than 900 US hospitals — including nine of the top 10-rated hospitals, 128 IDNs, and 40 global academic facilities — rely on EPSi for data-driven insight into managing costs and improving their long-range financial performance, as well as addressing requirements created by value-based care, bundled payments, accountable care, and continuum of care. The company’s just-launched, cloud-based RealCost financial decision support and analytics system allows health systems to quickly gain deeper cost insights and empower informed decision-making. Check out case studies from Texas Children’s Hospital, University of Kentucky Healthcare, and UMC Health System. Thanks to EPSi for supporting HIStalk.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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Stat reports that Atul Gawande, MD — head of the still-unnamed healthcare joint venture of Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies. Those conversations will likely fuel the nonprofit’s business plan, which could include a digital primary care solution, according to Mount Sinai Health System Chief Population Health Officer Niyum Gandhi. “I wouldn’t put it past them to … test it on all their employees first before they go broadly to market. I mean, if anybody could do it, it would be them. But they’re going to have to do things that are at national scale, which there just aren’t quick wins on.”

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Tenet Healthcare considers selling its Conifer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion. Tenet hired Goldman Sachs last December to help it divest Conifer as part of a $250 million cost-reduction initiative that it aims to wrap up by year’s end.

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Vyera Pharmaceuticals, known as Turing Pharmaceuticals under the infamous leadership of now-incarcerated pharma bro Martin Shkreli, reports Q1 losses of over $1 million thanks to declining sales of Daraprim, the drug Shkreli infamously raised the price of by over 5,000 percent when he acquired it in 2015. Vyera is considering changing its name to Phoenixus, no doubt in an effort to shed its former association with Shkreli and revitalize slumping sales.


Announcements and Implementations

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NYU Langone Health (NY) implements Omnicell’s automated medication management software and dispensing cabinets at its new inpatient hospital.

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Northwestern Memorial Healthcare (IL) selects HealthSource release-of-information technology from Ciox.

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AdvancedMD releases a redesigned version of its AdvancedInsight financial reporting suite for private medical practices.


People

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Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.


Sales

  • Methodist Hospital (KY) selects cloud-based backup and recovery software and services from CloudWave.

Other

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors. A lack of adequate staffing and budget is a close second.


Sponsor Updates

  • Formativ Health is recognized as the Gold Winner in the startup categories of both the CEO World Awards and the Globee Awards
  • RxBenefit Clarity, a prescribing decision support solution developed by CoverMyMeds and RelayHealth Pharmacy Solutions, will be adopted by a dozen health systems that use Epic, Allscripts, and other EHRs.
  • EClinicalWorks Director of Interoperability Strategy and Business Development Tushar Malhotra joins the CommonWell Health Alliance Board of Directors.
  • FormFast and Kyruus will exhibit at the AHA Leadership Summit July 26-28 in San Diego.
  • The Jacksonville Business Journal recognizes The HCI Group as one of the city’s fastest growing companies for the sixth year in a row.
  • Optimum Healthcare IT publishes an infographic ttitled “3 Keys to Change Success.”
  • Impact Advisors promotes April Smith to principal.
  • InterSystems will exhibit at the Defense HIT Symposium July 24-26 in Orlando.
  • CoverMyMeds announces that its RxBenefit Clarity prescribing decision support tool, developed with RelayHealth Pharmacy Solutions, will soon be used by 250,000 providers via new integrations with a dozen EHRs and Epic health systems.

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 7/19/18

July 19, 2018 Dr. Jayne No Comments

Every fall, providers across the country are required to update their ICD-10 codes in order to be compliant for services performed on or after October 1. A quick review of this year’s changes offers some insight about healthcare and culture in the US.

New codes were added for elevated lipoprotein(a), postpartum depression, and newborns affected by maternal use of opioids and other substances. Other codes help document forced labor and sexual exploitation. The one I found most disheartening was Z28.83, Immunization not carried out due to unavailability of vaccine. It’s unfortunate that practices that want to administer vaccinations can’t do so for a variety of reasons – manufacturing shortages, cost of supplies, cost of appropriate storage, and more. Vaccines are one of the most clinically-proven and cost-effective services we can provide, and access should be universal.

I appreciate the book recommendations that readers have been posting in response to my recent Curbside Consult. Bill Gates has also been recommending books over the last eight years, and they’ve been compiled into a list by Quartz.  Many of them address public health issues, including:

  • “Dirt and Disease: Polio before FDR” (Naomi Rogers)
  • “House on Fire: The Fight to Eradicate Smallpox” (William H. Foege)
  • “Infections and Inequalities: The Modern Plagues” (Paul Farmer)
  • “The Fever: How Malaria Has Ruled Humankind for 500,000 Years” (Sonia Shah)
  • “Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver” (Arthur Allen)
  • “The Checklist Manifesto: How to Get Things Right” (Atul Gawande)

As a confirmed Atul Gawande fan-girl, I’ve read the last one, but will add the others to my list for when I need something substantial to counter my summer reading diet of chick-lit.

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I have to admit that I was pulled in by the headline “Pay Bump for PCPs Fails to Drive Medicaid Participation.” Looking at data for 2013 and 2014, when payments increased under the Affordable Care Act, researchers didn’t see an increase in the number of physicians willing to accept Medicaid patients or the number of Medicaid patients seen by the cohort of 20,000 physicians. It should be noted that the boost only took the payments to the Medicare amount, not all the way to the amount paid by commercial insurance carriers. If Medicaid payments were increased to that amount, I think you’d see a boost, but not a tremendous one.

Medicaid patients are some of the most challenging to treat due to concomitant social and resource issues. Providers and their practices spend a large amount of time trying to coordinate care, identify subspecialists who are willing to consult on Medicaid patients, and trying to figure out how to improve outcomes and quality of life while dealing with issues such as unemployment, lack of transportation, low health literacy, poverty, overutilization of emergency services, and more. Providing those additional services costs money, which is one reason (besides low payments) that providers limit their care of Medicaid patients.

The article goes on to mention a possible solution with advanced payment models, including risk-adjusted capitated payments with bonuses for outcomes and cost-control. This would only work if you also provided the other necessary economic and social supports that complex patients need in order to successfully navigate our healthcare system.

In other news, LA Care Health Plan is throwing $31 million at efforts to recruit primary care physicians in a move to reduce physician shortages at safety net clinics that see its 2 million members. LA Care Health Plan is publicly operated and understands that physicians are more likely to choose employment with larger organizations such as health systems rather than opt for the smaller salaries often paid by clinics and health centers. They’re targeting younger physicians through grant programs, medical school scholarships, and loan repayment programs and are intentionally not recruiting physicians already serving in the county or working with underserved populations. Additional moves include salary subsidies, signing bonuses, and payment of relocation costs. The latter two are fairly standard for physicians in a highly sought-after specialty, so it’s a bit surprising that they’re just adding them now.

Focusing on loan repayment doesn’t incentivize some older physicians, who have had theirs paid off for some time. I know quite a few seasoned family physicians who would be willing to move to a more meaningful care environment if the compensation was right. However, when loan repayment comes from grant and other funds, potential employers are not able to compensate with a higher salary for physicians without loans, and the recruiting falls apart. Employers are eager to trumpet “total compensation” except for when employees do the analysis. I have several colleagues who don’t take health benefits from their employer, which is a substantial savings for the organization, but were unsuccessful in negotiating higher salaries to offset the change in the total package. Finding the right physicians will reduce turnover and save them money in the long run, so I wish LA Care Health Plan the best of luck.

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As we swing into another hurricane season, the Food and Drug Administration has formed a Drug Shortages Task Force to address shortages of medically necessary drugs. Our practice is still contending with supply chain issues impacting IV fluids, which manufacturers continue to attribute to Hurricane Maria’s assault on Puerto Rico. We’re also short on local anesthetics, injectable anti-nausea medication, and several injectable antibiotics. It’s nerve-wracking to have to use a drug that you’re not familiar with that is the only available substitute for something you need. I hope they can find some long-term solutions quickly.

This one almost snuck under my radar, but the FDA has given its first approval to a drug for smallpox treatment. Smallpox has been considered eradicated since 1980, and I hope it stays that way. There aren’t any human clinical trials due to the lack of disease, but it has proven effective in animals. It has also been shown to have no severe side effects during human safety tests. The drug has been in development since 2001 and approval went to Siga Technologies, which developed it under a federal contract. Smallpox is a nasty disease, killing a third of those infected. Although research stockpiles remain in Russia as well as at the Centers for Disease Control and Prevention in Atlanta, there is concern that gene hackers could create strains for release. For those of us without the telltale vaccination scars on our arms, it’s a terrifying thought.

What disease do you fear the most? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/19/18

July 18, 2018 Headlines No Comments

UnitedHealth Is Among Suitors Circling Tenet’s Conifer Business

Tenet Healthcare considers selling its Confer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion.

HHS Secretary Azar Announces Senior Advisor for Fourth Departmental Priority

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.

Israel grants $33 million to GE, Medtronic, Change Healthcare to boost R&D

Israel’s Innovation Authority will award $33 million over six years to Change Healthcare, GE Healthcare, and Medtronic as part of a program to attract digital health companies to the country.

HIStalk Interviews Mudit Garg, CEO, Qventus

July 18, 2018 Interviews No Comments

Mudit Garg, MSEE, MBA is co-founder and CEO of Qventus of Mountain View, CA.

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Tell me about yourself and the company.

Qventus is an AI platform. We work with hospitals and health systems to help them manage their day-to-day operations. I’m one of the founders and CEO of the company. My background for the last 10-11 years has been in healthcare operations, specifically in lean process improvement. I’m proud of that. I started a few technology companies and spent time at McKinsey & Company’s healthcare practice. I’m an engineer by background.

How can data and dashboards be made useful to frontline people as they are making operational decisions?

That was one of the biggest prompts to start the company. The first time I walked into a hospital, I was struck by two things. One, how the managers and caregivers did whatever it took to provide care. Second, maybe because they cared so much and because the system was dependent on them doing these heroic acts day after day, the system itself never developed. My perhaps biased view in the beginning was that data could help folks be more prepared and to require fewer of these heroic acts.

We are comfortable in the conference room thinking all we want about dashboards and information, but in the moment when people are busy, nobody has any time to do something about it. Nobody logs into a dashboard. Nobody has time to read through a graph or a report and understand it. That was the earliest insight into the way of using data that we learned from.

We started talking a lot about what was needed in 2013. We said, what makes it so hard in healthcare operations? Typically the answer came back as, half my patients are unscheduled, we don’t know how long they will stay in the hospital, and the resources they will need is unknown. Predicting would be great.

It’s an often-used buzzword, but we started using machine learning tools back in 2013. My co-founder and I both had a background in it. We started predicting.

But we learned that predictions by themselves are sometimes counterproductive. While an average manager doesn’t have time to stare at a dashboard, they also don’t have time to interpret a prediction. A nurse we worked with at that time said, I don’t have time to figure out 30 percent chance do this, 40 percent chance do that. If my GPS said it’s a 30 percent chance to take a left, 40 percent chance take a right, I would toss it out the window. I have more load than I do while I’m driving. Just make it simple.

The goal of the product is not to expose more data, but to take those things that a really good manager would do. A really good manager in an emergency department anticipates. They say, things are getting really bad, I had better have my lab manager start doing X or start prioritizing these things. I had better tell the house supervisor to prioritize some beds. By doing those things two, three, or four hours in advance, they can get ahead of the situation. But that only happens when they have a calm environment where they have the time and capacity to look ahead and solve those problems.

Our product’s goal is to take away that mental load — the data processing, the evaluation of options — and to offer a suggestion in the moment as a message, discussion, or into the workflow in some way.

Hospitals usually have some internal expert they call in when they have a problem, but are lost when that person isn’t available. It would seem that once a hospital has formalized the decision-making process, it would be easier to then enhance it.

Absolutely. An excellent manager has to look at data and make sense of it. That depends on that manager’s time. What judgment they apply depends on that manager’s experience. All those things create inconsistencies.

But in that ED example I gave, the system would be saying, it’s Monday after Thanksgiving. The patients in the waiting room are much sicker. Dr. Smith is working and he tends to he tends to order more labs, but our lab is really slow right now. Based on all of this, we will run out of capacity in the next three hours.

Then the hospital can connect those subject matter experts. Gather the lab manager, house supervisor, and charge nurse and say, “Here is something that we see. We suggest you do this.” Let them have a workforce huddle on that discussion topic and do something about it well before the problem becomes bad.

Who would typically serve as the internal champion of that kind of real-time monitoring?

The executive sponsor often ends up being someone like a chief operating officer or a chief nursing officer. But the internal champion often comes from the lean groups in the hospital. They are the ones who have seen the day-to-day problems, are trying to improve them, are trying to build a system around them, and are connected enough to the day-to-day problems. They can be good champions. Oftentimes department heads will see these challenges, such as the medical or nursing director of the ED.

Those are the internal champions who want this to become a part of the system. The executive sponsors typically are the chief operating officer or the chief nursing officer, who are day-to-day focused on these problems and who jump in to help when things don’t go well.

What is the physical and operational manifestation of how your product gets used in a average hospital?

The ideal end state of the product is that there is no physical manifestation. The ideal end state is that it is invisible, like a really good assistant or someone who is helping you have the insight. It just disappears into the background and brings in the right information at the right time. That’s why it is like virtual air traffic control.

The product has three parts. The most important one brings the insight into the moment. It tells you, this patient in room 434 is likely to get admitted. We don’t have an admit order. We probably won’t have one for the next three hours, but let’s start preparing the bed. Or, this patient is likely to leave without being seen, or that we’re going to have a bad situation with this patient. It’s processing these insights in the background and delivering them in the moment — on a Vocera device, on a secure messaging device, or whatever the right mechanism might be.

Our system provides situational awareness, a sort of mission control. It can be in the break rooms or the huddle rooms, where people can have meaningful information displayed to help them understand the situation. Some of these nudges can be shown at that same place.

The last part is being able to understand the data to see where changes need to be made. An average department will get insight in the moment when they need to do something.

As hospitals centralize and and have larger deployments, there is an interesting role to play for a centralized place. In General Stanley A. McChrystal’s book “Team of Teams,” he talks about how the traditional image of command-and-control came to fail. The military started it, but in the most recent war, we struggled with that approach. They had to rebuild it and dismantle the command-and-control approach. He talks about the importance of spreading shared consciousness throughout the frontline people who are experiencing the situation and who have the most knowledge in the moment.

Our job is to spread the context, consciousness, and best knowledge to the people in the moment who are about to make that decision. While there’s a role to play for the central manifestation in escalation and awareness, the ideal situation is one where the information and the shared consciousness is going to the front lines. That’s how our product works.

Your site allows looking up any hospital’s efficiency index as calculated from publicly available information. What metrics might improve in using your system?

Our product is in 60 or 65 hospitals. Patient flow is a big use case — in the ED, inpatient, and OR. Length of stay, as you can imagine, is a really important metric, because it’s one of the most important measures of affordability and survivability for an organization to be profitable on Medicare patients. Length of stay is a big one on the inpatient side.

Length of stay is important in the ED, but so is patient satisfaction. The number of patients who are leaving without being seen is important.

On the operating room side, they look at efficiency — how much time it takes to turn a room, how many of the rooms are being used, whether supplies are being used appropriately, and how well patients are being informed throughout.

Then we have use cases for pharmacy and outpatient clinic access. In pharmacy, how to manage the drug spend. In outpatient access, how can the health system, with the resources it has, provide patients with quick access to care?

These metrics are beneficial regardless of the payment mechanism or the healthcare system’s economic model. As an example, one hospital freed up about a million minutes of patient wait time in their ED when they deployed the system. That helps them provide care to more patients in the community with the same resources. That lowers the cost, helps the hospital, and helps the patients. Regardless of the economic model, it helps both the health system and the patient.

Where do you see the company’s future being?

I grew up in India. We have in the US healthcare system the best clinicians, some of the best equipment, some of the best therapies. What’s holding back the potential of our system is oftentimes is the ability to execute on the processes day-to-day consistently and reliably, without placing an excessive burden on the people who provide it. If we can do that, if we can create a mechanism where it doesn’t take the heroic effort to provide that consistency and reliability, we can do that across every aspect of delivery of care. Whether it’s your experience in the unit, how well informed you are, your billing, or your staffing. Whether its in the emergency centers, in urgent cares, or in outpatient clinics.

My hope is that we can provide the infrastructure to allow for consistent, reliable execution of the clinical practices we know. Managing the logistics around delivery of care so that the human connection, and the calm that we can provide to people while delivering the care, is feasible. That’s my hope. I’m hopeful that we’ll be able to play a meaningful role in bringing that about.

Morning Headlines 7/18/18

July 17, 2018 Headlines 1 Comment

Nashville health-tech company buys data-analytics firm, changes name

PlayMaker CRM acquires post-acute market intelligence and analytics vendor ViaDirect Solutions and renames itself PlayMaker Health.

Promoting Telehealth for Low-Income Consumers

FCC will propose to fund a $100 million “Connected Care Pilot Program” that would promote using telehealth among low-income families and veterans by providing affordable broadband service.

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

Insurers are buying the lifestyle information of hundreds of millions of Americans from data brokers and then running it through algorithms that predict how much that person’s healthcare will cost.

UnitedHealth posts big profit jump but sees room to improve

UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $2.98 vs. $2.32. Its Optum segment booked $1.8 billion in profit on $25 billion in revenue for the quarter.

News 7/18/18

July 17, 2018 News 6 Comments

Top News

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LabCorp shuts down its entire computer network when it detects that a hacker has penetrated its systems and is trying to access patient records.

The company says via an SEC filing that test processing and customer access was limited over the weekend. It will take several days to bring all systems back online, the company says, causing delays in results reporting.

LabCorp hasn’t yet said whether PHI was compromised.

The company does not use Twitter or Facebook, but its LinkedIn profile and its website don’t mention the outage.


Reader Comments

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From Another Allscripts Casualty: “Re: Friday the 13th Allscripts layoff. Our VP used a lot of corporate jargon words like ‘synergy’ and ‘socialize the discussion’ to describe the streamlining process in which basically each manager had to remove one employee slot, even those with teams of just a handful of people. Team managers were notified only 30 minutes before the heads rolled. The cuts were not performance based, so producer worker bees were let go instead of middle layer fat. The McKesson EIS acquisition brought in a lot of overlapping people and I expect another round late this year or early next as more people are trained to be cross-functional. Allscripts is like the mythical Hydra – every time they lop off a head, another acquisition causes 10 more to pop up, and management is never lopping the right heads. I think some of the people at the top have a good idea of where they want to take the company, but the inertia of herding cats keeps them in the same rut.” Unverified. I’m not as confident that the company has a solid, rational strategy other than making undisciplined acquisitions that sometimes work out great (Netsmart, DbMotion) and sometimes just fizzle out quietly. That’s been the strategy all along, but other than a burst of investor enthusiasm that sent shares on a tear in 2000 (peaking then at more than six times today’s share price), it’s been a market-lagging stock that made headlines for mostly the wrong kind of reasons as it also came late to the post-MU EHR consolidation party by finally announcing that it would develop a new product, which is new territory for a company known for buying instead of building. Even with all that acquisition activity, Allscripts has a market cap of $2.2 billion, around 1/10 that of Cerner and one-third of Athenahealth’s market value. It has made some good deals, though – it paid just $185 million to buy the health IT business of a desperate and perpetually HIT-clueless McKesson, then sold off just the content management part to Hyland for up to $235 million.

From Fact Checquer: “Re: Allscripts. You mentioned the new EHR product Avenel. I find no mention of it on the company’s site.” It’s not listed on the physician EHR page with TouchWorks or Professional, but I found by Googling that it has its own site that says “machine learning” a lot and offers only a “contact us for more information” form. 

From Bjorn To Be Wild: “Re: HIStalk theme music. I don’t know when you added it, but I love it. It improved an already wonderful daily morning reading and coffee experience.” I put up the prog rock “HIStalk Theme” a few weeks ago. That musical style isn’t to everyone’s taste, so I’m considering commissioning a light jazz sort of tune for a more mellow experience. It’s surprisingly inexpensive (in the $100 range) to have custom music created to spec.

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From RN Data Maven: “Re: National Guidelines clearinghouse shutdown. A tragic loss of a resource for practitioners to access evidence-based clinical practice guidelines. Fear of evidence-based scientific research or short-sighted funding decisions?” AHRQ says it can’t come up with the $1.2 million to keep the site running and thus took it down this week, but the non-profit ECRI – who managed the site for AHRQ — will bring it back in the fall with enhancements as a fee-based service. Some speculate that the site was doomed once then-Congressman Tom Price, MD (who later became HHS Secretary for a few months) demanded that AHRQ remove a study that was critical of a drug sold by one of his campaign donors.


HIStalk Announcements and Requests

Lorre has a backlog of inquiries for my annual “summer doldrums special” on new sponsorships and webinars, but she would still be happy to chat.

I was thinking today that Karl Marx’s “opiate of the masses” is no longer religion – now it’s actually opiates.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $2.98 vs. $2.32. The company’s UnitedHealthcare insurance business took in $46 billion as membership increased to 49 million people. Its Optum segment, which provides pharmacy benefits management and technology services, booked $1.8 billion in profit on $25 billion in revenue for the quarter. 

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Nashville-based post-acute care CRM software vendor PlayMaker CRM acquires post-acute market intelligence and analytics vendor ViaDirect Solutions and renames itself PlayMaker Health.


Sales

  • CoxHealth (MS) chooses Kyruus to provide a digital provider directory and patient-provider matching technology for its website and call center.
  • Southwest Mississippi Regional Medical Center selects Phoenix Health Systems for outsourced IT management and support.
  • Australia’s Canberra Hospital and University of Canberra Hospital will implement Alcidion’s Electric Patient Journey Board to reduce length of stay and improve patient flow from the ED.

Announcements and Implementations

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Health Catalyst launches a patient safety surveillance system and applies to become an AHRQ-certified Patient Safety Organization (PSO) that can offer clients a litigation-free environment for data analysis. The trigger-based system cost $50 million to develop. The company says EHRs offer limited surveillance capabilities and, unlike a PSO framework, are legally discoverable.

CompuGroup Medical launches its ELVI telehealth product.

Behavioral Health Network of Massachusetts goes live on ZeOmega’s Jiva population health management.


Government and Politics

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NIH Director Francis Collins, MD, PhD pitches IRhythm’s Zio arrhythmia monitoring patch for detecting unknown atrial fibrillation, although noting that while the results may get patients to visit their doctor and begin anticoagulant therapy, its long-term benefit in reducing strokes, ER visits, and hospitalizations remain unproven. Collins concludes that the clinical trial was interesting because high-risk patients were recruited by email, had the patches mailed to them, then mailed them back at the end without having met a researcher face to face. Less exciting is the fact that we have yet another high-powered diagnostic tool to detect diseases that we as a country can’t afford to treat because we refuse to control healthcare costs — those newly ordered anticoagulants cost $15 per tablet, meaning someone will be paying $5,000 per year for the rest of each new patient’s life, although maybe that’s cheaper than treating the subset of them that would have otherwise had strokes.

FCC will propose in its August meeting to fund a $100 million “Connected Care Pilot Program” that would promote using telehealth among low-income families and veterans by providing affordable broadband service. Up to 20 providers that serve low-income populations would receive up to $5 million in funding in partnership with a broadband services provider.


Privacy and Security

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In Canada, home care provider CarePartners is hit by ransomware, with the hackers contacting CBC News with samples of the patient information they have stolen (the samples alone involve 80,000 patients).The cyberintruders, who say they found unpatched software that allowed them to penetrate the systems, are demanding unstated “compensation in exchange for telling them how to fix their security issues and for us to not leak data online.”

Change Healthcare introduces a kill switch for its HealthQX value-based care analytics suite that allows customers to instantly revoke access to their data as long as two of its authorized operators issue the command from separate locations as part of a “bring your own key” capability.


Other

A Quest Diagnostics survey finds that healthcare has made little progress toward value-based care since last year. More than half of health plan executives think physicians don’t have the tools they need to succeed under VBC arrangements, while 61 percent of doctors say their EHR doesn’t contain all the information they need to deliver patient care.

In Australia, 20,000 people opt out of sharing data with its My Health Record online system on the first day of the three-month opt-out period.

Western State Hospital (VA, rebranded from the more memorable Western State Lunatic Asylum) realizes that it hasn’t followed state laws allowing it to destroy the records of patients 10 years after their last date of service, forcing a three-year records review in which a single HIM employee examined 6,000 reels of microfilm dating back to the 1800s. And you thought your job was dull.

A New York Times report notes that rural hospitals are not only closing at alarming rates, they are eliminating OB services to the point that fewer than half of US rural counties still have hospitals that deliver babies. It notes that loss of OB services means that fewer women receive prenatal care due to the time and cost of traveling further, more of them deliver prematurely, infant mortality increases, and EDs deliver babies the best they can.

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This is important as the White House dismantles ACA protections that prohibit insurers (including those who sell through employers) from denying coverage for pre-existing conditions or charging sicker people higher premiums. A ProPublica report finds that insurers are buying the lifestyle information of hundreds of millions of Americans from data brokers that includes race, educational level, TV habits, clothing size, net worth, credit, and social media activity, all of which are run through algorithms that predict how much that person’s healthcare will cost. The article notes that while the information is ostensibly used to manage population health, it could also be applied to premium pricing formulas. Experts say that while insurers can’t blatantly discriminate (at least for now), they have cherry-picked the healthiest people by choosing their geographic coverage based on population data, or as one data salesperson said, “God forbid you live on the wrong street these days.” An excerpt:

[LexisNexis] said it uses 442 non-medical personal attributes to predict a person’s medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people’s cell phone numbers, criminal records, bankruptcies, property records, neighborhood safety, and more. The information is used to predict patients’ health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy, and their stress levels. People who downsize their homes tend to have higher healthcare costs, the company says. As do those whose parents didn’t finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won’t share its methods and hasn’t published the work in peer-reviewed journals.

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In New Zealand, an internal health board report finds that hospital generators failed to kick on after a power line was cut, with battery back-ups having just four minutes of power left when the power came back on. My experience with generators is not reassuring – even with regular testing and fuel monitoring, the switchover always seem to fail. What’s your experience?

In England, a nurse assistant is charged with fraud after submitting timesheets indicating that she had worked 242 shifts in 20 months instead of her actual 10, for which she was overpaid $66,000. She claimed that she thought she was entering the times she was available for work instead of logging her actual time. She had asked her manager to help her, which might have provided yet another clue to the manager that her entries were incorrect. The judge noted that the hospital makes such fraud easy.

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Bizarre: a hospitalized prisoner who eats metal objects such as catheter clamp, thumbtacks, and screws racks up $1 million in medical bills, then is admitted under 24-hour watch to Loyola Medical Center in a stay that has added $500,000 to his tab as taxpayer-funded hospitals try to keep him from being admitted to their facilities and the hospital presses the prison for payment. The prisoner is a 6-foot, seven-inch former basketball player who has previously threatened hospital employees. The sheriff bluntly but accurately explains:

We have a guy right now that has cost us — has cost all the people in this room — close to a million dollars in health bills because he constantly eats the jail. Across the country, the easy thing to do was cut mental health services, and they’ve done it. So people don’t get better. They don’t get treatment. They go to jails and prisons and emergency rooms.

Welcome to a country run by lawyers. In Las Vegas, Mandalay Bay Hotel’s corporate parent MGM Resorts International sues 1,000 concert-goers injured in the Route 91 Harvest festival shooting last year, hoping to force a decision that it can’t be held liable because it hired a security firm that was certified by the Department of Homeland Security for protecting against mass injury. A lawyer representing some of the victims says the company – which also owns the concert venue — is “judge shopping” in trying to push any case into federal instead of state court.


Sponsor Updates

  • PatientKeeper publishes an e-book titled “Attending to Physicians: Why Healthcare Must Focus on Improving Physician Experience” and a video titled “PatientKeeper Charge Rescue Service.”
  • Buffalo Business First profiles Hamish Stewart-Smith, CTG’s managing director of sales for its North American healthcare business unit.
  • Huntzinger Management Consulting Group earns high rankings in the KLAS HIT Assessment & Strategic Planning 2018 report.
  • FDB releases a new video to help people understand how its Opioid Risk Management Module supports safer opioid risk management and prescribing.
  • Divurgent publishes its “Windows 10 Upgrade Benchmark Report.”
  • Optimum Healthcare IT publishes a white paper titled “Change How You Approach Change in Healthcare.”
  • Dimensional Insight VP George Dealy earns CHIME’s CFCHE credential.

Blog Posts


Contacts

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

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Morning Headlines 7/17/18

July 16, 2018 Headlines No Comments

Walmart Names Humana Veteran to Run Its Health and Wellness Unit

Sean Slovenski (Healthways) joins Walmart as SVP of health and wellness.

Cerner to grow Dublin research hub

Cerner will add 50 new R&D jobs at its Dublin hub, home to its IP development team.

Joe Harpaz Joins Modernizing Medicine as President and Chief Operating Officer

Modernizing Medicine brings on Joe Harpaz (Thomson Reuters) as president and COO.

Lab Corp. (LH) Detected Suspicious Activity on its Information Technology Network

LabCorp works to restore full system functionality after detecting suspicious activity on its IT network over the weekend.

Curbside Consult with Dr. Jayne 7/16/18

July 16, 2018 Dr. Jayne 12 Comments

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I’m a voracious reader and enjoy many kinds of literature. I’m part of a book club, largely composed of women in healthcare IT, that meets monthly via Webex to talk about a good read. I see hundreds of manuals, summaries, and business documents come across my desk every year.

Given all these things, I’m a firm believer in the concept that words mean something. Unfortunately, I don’t think this belief is shared by some of our fellow travelers in healthcare IT. We may understand how a claim needs to be properly formulated for it to be paid, or a lab result so it can be delivered through an interface, but sometimes we fall short in the realm of communicating with people.

Almost every end user has complained about user guides or technical manuals at one point in their career. There are hazards in trying to convert a technical process into something that clinical people can follow, or that distracted physicians are willing to sit and read. My first EHR vendor put out a 1,000-page user manual that was nearly unreadable and would rival any piece of federal legislation for its sleep-inducing properties. They blamed its size on the included screenshots, but part of it was the overly-wordy description of a complicated documentation system that was a hybrid between legacy green screens and something more graphical.

My undergraduate institution’s English department has a program in technical writing. I’m surprised they don’t turn out more than the one or two graduates who earn degrees each year because it should be a skill that is in demand.

The language of healthcare itself often gives physicians something to chat about in the physician lounge. “Reimbursement” implies that someone is getting paid back for something  in an amount equal to a previous expenditure. It’s fancier than saying “payment” and tries to mask the transactional nature of the business of healthcare. Many physicians agree that those reimbursements don’t adequately cover the time, effort, supplies, and overhead required in delivering the service, especially when looking at payers such as Medicaid. Can you imagine your HVAC contractor or auto mechanic talking about reimbursement for their time as opposed to just delivering a bill for services rendered?

I also hear physicians complaining about marketing campaigns directed towards them, and there are certainly plenty of those to make fun of. We’ve grown out of having photos of physicians playing golf and fishing as a proxy for the free time that technology solutions are going to give them. Instead we’re depicting them in the office seeing patients, which is where they belong, but that does agree with how physicians see themselves working increasingly long hours. There’s greater emphasis on showing physicians and providers of various demographics, old and young, male and female, and of diverse racial and ethnic backgrounds. Although vendors have done better with some of their pictorial efforts, there are still issues with the words they use.

One of my bigger pet peeves is the overuse of the word “holistic.” Newsflash for marketeers: holistic means something that has parts that are interconnected and that the whole is greater than the sum of the parts. A holistic approach to a problem does not mean providing a laundry list of solutions that a client might want to purchase in order to solve a business problem. Holistic also has a certain connotation in medicine that I think vendors fail to understand. A reference to holistic medicine often implies complementary and alternative therapies, non-western medicine, naturopathy, and other modalities. Depending on the beliefs of the physician you are marketing to, use of the word holistic can either be a blessing or a curse. Beyond that, if your “holistic solution” doesn’t provide any benefit beyond that of its parts, then it’s not holistic and you just look confused about how you are describing your offering.

Other words that have lost their sparkle include innovative, novel, revolutionary, and cutting-edge. Everyone claims that their solutions and offerings fall into these categories, to the point where the words no longer have meaning. I had a rep recently pitching a tabletop lab analyzer machine which was similar to the one we already have in the office. He acted like it was something groundbreaking when there are multiple competitors in the field that offer similar devices. The real difference between his offering and others was the price point, which in his case was a disadvantage. Costing almost twice as much as the nearest competitor might be novel, but the data trying to show it as a better device wasn’t going to swing us into buying 36 of them.

Then there are the folks who are killing us with mostly meaningless buzzwords: artificial intelligence, blockchain, synergy, cloud-based, mobile, virtual reality, and more. I think people assume that if they include one of those words in an email that it means people’s ears will perk up and they will instantly be attentive. I think we’re all hyped out on many of those terms, at least until there is proof that their respective technologies can really make a difference.

Words also have meaning with interpersonal communication. I see far too many emails where people respond rapidly and appear that they may have done so without thinking. It feels like people are so concerned with moving messages out of their email boxes that they’re just flinging information back and forth without proofreading or making sure their responses make sense.

I see emails where someone has asked multiple questions and the response addresses only one of the points, or where it’s clear that someone wasn’t reading for comprehension. There are emails that are full of nonsense words – talking about circling back to review deliverables and determine which items are deal-breakers and the like. I once saw an email about “prioritizing show-stoppers” prior to a go-live. By definition, if they are show-stopping defects, aren’t they all of equal priority since they will bring the go-live to a screeching halt? It was worth a number of laughs, so I can’t make too much fun of it because it made several of us smile.

I’m a firm believer that people who are strong readers are better writers. If you’re responsible for creating content, writing blogs for your company, or preparing user guides and manuals, when is the last time you read something non-work-related? I want to challenge people in those roles to read a good book and see if it changes your frame of mind or if it positively influences your work.

What’s the last good book you’ve read? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Eric McDonald, CEO, DocuTap

July 16, 2018 Interviews 1 Comment

Eric McDonald is founder and CEO of DocuTap of Sioux Falls, SD.

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Tell me about yourself and the company.

My background is computer science and mathematics. I founded the company about 15 years ago. We have created an electronic medical record, practice management system, and strong business analytics solution for the on-demand space. That’s also known as the urgent care space, but it is morphing and changing into more what we call on-demand care.

What does that on-demand marketplace look like and how is it changing?

It has been known historically as the urgent care space. The term “urgent care” gives the impression that the patients’ needs are urgent. But realistically, this space is all about convenience and delivering a service to an on-demand society. Over the last half-decade to a decade, we have become more of an on-demand society. This part of healthcare has realized that and shifted its services to meet those needs. Not just in offering convenience and walk-in services, but also with the services themselves.

Historically, people thought of urgent cares as being urgent only and not offering primary care or other services. But now urgent cares are doing that. We’re seeing this shift to more of on-demand care versus urgent care. We’re seeing pediatricians and primary care docs move into this on-demand space and change their business model. Those things have led DocuTap to recognize that this is broader than just urgent care. It’s about being a technology company focused on on-demand care.

Who owns these on-demand centers? How many of them are operated by health systems?

Historically there has been a division between retail care — CVS’s MinuteClinics — and the tried-and-true urgent cares. In the urgent care world, about 25 percent are owned by health systems, Over the last half-decade, that has shifted by two to three points one way or another, but it hasn’t dramatically changed. You have seen a larger presence by corporations, larger chains like MedExpress, American Family Care, NextCare, or FastMed. Those continue to grow to take a larger percentage, probably 40 percent of the market.

The remaining urgent cares are provider owned. An ER doc decides to throw up a shingle and do it himself, and he’s maybe got one to three clinics. Or primary care docs who have changed their model to be more of an on-demand care as a hybrid between primary and urgent care.

That makes it tough to identify how many urgent cares are out there. Some clinics are primary care during the day, and then from 5:00 until 9:00 p.m., they become an “acute care urgent care.” By definition, it’s probably not an urgent care, but it really is. A number of these facilities are at times acting as an urgent care. You also have clinics or facilities that don’t offer x-rays or do laceration repairs, which are the basics that you would expect to have in urgent care.

The high-end number is about 10,000 urgent cares across the country. If you’re looking at a tried-and-true, pure-play urgent care, it’s probably 7,500 to 8,000 locations. That does not include retail clinics like MinuteClinic, which has been separated from urgent care because of their limited scope of service. They don’t have x-ray. They’re not going to manage a laceration. If you fracture something, they will not be taking care of those needs. But those would be expected in a visit to an urgent care. 

Retail clinics are limited in scope to sore throat, cough, earache, and maybe your flu shot. You got a half a dozen things that are going to be common in retail, which is different from urgent care. Having said that, I believe that will potentially shift over the next five years.

What are the technology needs of an urgent care center?

One of the challenges with a hospital-based system is that they are built to manage every specialty, every service. It’s one solution fits all, which means that it’s going to be clunkier. It’s hard to develop software that works well for every specialty. I learned early on that the best way for the company to be successful is to find one niche and be the best in it. When it comes to urgent care, it’s all about speed. How do you get patients in and out as fast as possible? When all we do is urgent care, it makes that simple.

When you start looking at the additional services that an urgent care needs — such as their revenue cycle management services, like billing services — there are some intricacies with urgent care that a hospital system is going to ignore, which impacts their revenue. We have robust data analytics, and when you’re dealing with consumers, you need to understand some of those consumer trends.

The marketing aspect plays into this. The urgent care space is consumer focused, whereas orthopedics and cardiologists aren’t. The tools that we deliver need to have a consumer play in ways that others don’t. When we talk about patient engagement, it will be very different than an oncologist or an ortho.

What kind of information exchange with other providers is typical for an urgent care center?

Interoperability, where you’re downloading information into the urgent care, is usually less important, because they’re usually acute visits such as for a sore throat or fracture. It’s less important for those providers to be aware of what’s going on. What’s important is that we get the information from this acute visit back into the health system or the mother ship. The most common interface is pushing data from our software back into systems like Epic or Cerner.

Having said that, there are situations where the hospital or health system is willing to let us pull that down as a patient walks in the door, but we wouldn’t ever keep those in sync. We would wait for a patient to walk in and do it on an on-demand basis.

How are urgent cares broadening their services?

One of the biggest buzzwords and the most important item within urgent care is patient experience. At the very onset, being able to remotely register from your phone, put your name in the queue, and wait at home or wherever you need to be instead of in the waiting room. The system will automatically text you when it’s your turn to be seen. You essentially walk right on back. Being able to remotely register and take a picture of your insurance card and driver’s license does it all for you and enhances that experience.

Our clients are embracing those items to enhance the experience. When that patient walks in, they’re going to be able to get in and out of that clinic in probably 40-50 minutes, under an hour for sure. The services that are rendered can be anything from acute-related items — sore throat, earaches, fractures – to proactive preventative items related to their care. Diabetic care, an annual physical, and “primary care lite” services. You’re going to see more moms that are using urgent cares as their pediatricians. Whether it’s pediatric care, primary care lite, or truly urgent fracture-related or lacerations stuff, you’ll see all of those happening within urgent cares.

How do you see the market and your company changing in the next 3-5 years?

We have to be very nimble. We have to assess our clients’ needs every year and shift as quickly as we can and stay ahead of them. That is hard to do because they are also quick and nimble. Many of our clients are backed by venture capital or private equity firms, which means that they’re growing quickly. They’re going to change their business models quickly if needed. It’s a tough niche to be in because it’s constantly changing and it’s changing quickly.

Do you have any final thoughts?

We got lucky. Sometimes people think that it’s crystal ball-ish, but in reality, we picked an amazing niche within healthcare. It will be fun to see how the urgent care space continues to evolve and changes how healthcare is delivered. It will push other specialties to be more consumer focused and to pay more attention to an enhanced patient experience.

Five or 10 years from now, we will look back as a healthcare industry and see that the urgent care space — which will be referenced as on-demand care — has changed how providers interact with their patients. There will be a higher expectation to offer an enhanced patient experience. Patients will have more control than they have had historically. I couldn’t be more proud of the niche we’re in, what it’s doing for healthcare, and DocuTap’s role in it.

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  • Debtor: NantHealth. Or am I too late on that one?...
  • Cosmos: I absolutely love the new email summaries! It lets me skim the news of the day and then dig deeper if I want the full sc...
  • Michael G.: Very well done Dr. Butler! As a healthcare trainer using the Epic system we are actively trying to implement a program t...
  • John: Worked at MIT for a period on biosensors and micro fluidics and found working with blood to be pretty much impossible. B...
  • Vinnie whibbs: Suggest moving link to top of email....
  • Bonny Roberts: I agree with Big Dog. I am over stimulated by the new format: the email subject line and the summary page. I loved the c...
  • Eddie T. Head: Sounds like someone just discovered the mobile format of HIStalk......
  • Dr. Herzenstube: The thing that gets me about the Theranos story was that even at the peak of their hype, everyone I spoke with in the he...

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