The 20 Most Important Health IT Takeaways of 2017

1. Hospital Consolidation Ran Amok, Benefiting Cerner and Epic

The big are getting bigger and more profitable among both health systems and their technology vendors. The resulting rip-and-replace projects are offsetting the first wave of post-Meaningful Use demand slack-off. That trend will continue as health systems use their favorable billing rules to acquire not only medical practices, but nursing homes. The industry marches toward a few multi-state, legally non-profit but hugely profitable operators controlling their freshly expanded markets.

The EHR vendor market has consolidated into:

1. Epic and Cerner for US inpatient, as Epic announced plans to move down-market with a less-expensive basic system and Cerner held its advantage among large health systems that are contemplating merging into mega-systems.
2. Epic for health system-connected private practices.
3. Meditech for small health systems and those in Canada.
4. CPSI for cash-strapped rural and safety net hospitals.
5. Allscripts for hospitals in Australia and Europe, with newly acquired Paragon remaining an unknown.

2. Ambulatory Vendors Faced Reduced Post-MU Demand

Most practices that want an EHR already have one, and even some of those are being forced to displace their preferred system after being acquired by big health systems using Epic and Cerner. Ambulatory EHR vendors face several negative market pressures: complaints about poor usability and interoperability, technologically outdated products that still have to be maintained and enhanced, and lack of demand. The Department of Justice’s $155 million False Claims Act settlement with EClinicalWorks could portend similar charges against its competitors.

The bright spot for ambulatory EHR vendors is revenue cycle services (which they are well equipped to provide) and population health management technology (which they are not).

3. Value-Based Care Sounded Good, But Had Minimal Impact

Everybody likes the idea of paying for value instead of services performed — until they look at the work required and the potential profit lost. Heads in the beds and butts in the waiting room seats will continue to be the main driver as long as Medicare keeps paying for them.

4. The Press Exposed Questionable Business Practices

Theranos, Outcome Health, and NantHealth had their bubbles burst by dogged investigative reporting. Those exposés will likely continue as the shrinking journalism industry finds that those stories sell.

5. ONC Was Mostly Irrelevant

Much of the work around hot topics such as interoperability, EHR safety, and cybersecurity happened outside of ONC’s sphere of influence as it faced personnel changes and threatened budget cutbacks in a vastly different political environment.

6. The VA Rushed to Judgment

The VA — pushed by the White House to choose Cerner with the general thesis that running the same system as the VA will be good for veterans — announced to Congress that it will quickly sign a VistA-replacing Cerner no-bid contract despite unanswered questions around cost, DoD interoperability, and information exchange with the community-based providers that serve veterans.

The VA’s contract signing deadline of November was missed as Congress failed to move the VA’s money around to fund the deal, with the resulting extended timeline allowing Congress to pressure the VA into developing an actual plan on interoperability outside the federal government’s walls.

7. New Inpatient EHR Entrants Quickly Hit a Wall

The inpatient aspirations of EClinicalWorks and Athenahealth were dampened not only by complexity, the market’s preference for broad and mature product suites, and entrenched competition, but also by a DOJ settlement and activist investor pressure, respectively. ECW remained characteristically quiet, but the cost-cutting and executive-shedding Athenahealth was reduced to publicly sparring with CPSI over the decisions of tiny hospitals instead of with Epic over the large ones.

8. Allscripts and Greenway Announced Plans to Streamline Their Ambulatory EHR Portfolios

Both companies said they will develop a single system to replace their multiple aging ones.

9. Drug Companies Suddenly Became Interested in EHR Data That Technology Allowed Them To Obtain

Pharma needs to justify high drug prices and analyzing individual patient outcomes is one way to do that. They also found value in performing virtual clinical studies, recruiting clinical trials participants, and detecting adverse effects.

10. AI Hype Became Rampant as IBM Watson Health Turned Into a Marketing Term

Already-inflated expectations for artificial intelligence and machine learning expanded further, but the lack of results from IBM Watson Health, the paucity of transparency on exactly what Watson is doing and how, and Watson’s high-profile failure at MD Anderson encouraged moderating expectations even as Google and other technology firms look for healthcare nails to pound with their profitable hammers.

11. FHIR, APIs, and the CommonWell-Carequality Linkage Decreased Interoperability Barriers In Meeting The Minimal Market Demand For It

It predictably turned out that technology wasn’t the biggest barrier in exchanging patient information with competitors – it was that providers are fiercely protective of their business. Interoperability always works when demand exists, such as among multiple hospitals and practices within the same health system.

Providers will make interoperability happen quickly only if their profits depend on it. Perhaps the “data blocking” standard should be applied to health systems that manage to exchange information with disparate systems only within their own organization.

12. Population Health Management Presented Promise Without Many Definitive Results

Population health management and its associated technologies are an inherently good thing to patients, but the business model is marginal and slipping as the federal government steers the reimbursement ship back to fee-for-service. Implementation models vary widely, it’s early to publish definitive results, and providers whose profit comes from traditional services show reluctance to kill their golden goose. The track record of innovation whose only benefit is to patients is unfortunately poor.

13. The Federal Government’s Anti-ACA Efforts Threatened Provider Incomes

The federal government’s efforts to kill the ACA without an alternative in place will increase the number of uninsured patients who will still show up in the ED knowing they won’t be turned away, putting pressure on health system bottom lines that look great now only because their non-operational investments are killing it in a booming stock market.

The disrupted risk pool will continue to hamper insurers and the lack of political will to address exorbitant US healthcare charges guarantees that healthcare will be a mess for a long time except for deep-pockets consumers who can afford boutique care.

14. Big Companies Once Again Showed Their Health IT Short Attention Spans

McKesson sold out and GE mulled its healthcare IT exit as both companies chased the next shiny object in the face of sliding profits. Historical precedents are ample that buying health IT products from a company whose toes are dipped in other industries – especially if, as is nearly always the case, they turn out to be crappy health IT vendors — will nearly always leave customers stuck with a far-worse product turfed off hastily to a new owner at a devalued fire sale price.

15. Potential New Entrants Like CVS and Amazon Worried Health Systems As Hopeful Consumers Cheered

Health systems realized that despite the political clout that allowed them to become the default but questionably well-suited profiteer for everything from oncology practices to population health management, the market is becoming attractive to potential competitions such as CVS and Amazon that are not burdened by inefficiency and consumer indifference. The question of “who owns the patient” is valid, even if insulting to the patient who shouldn’t be “owned” by anyone.

16.  Cyberattacks Mostly Spared Hospitals, But Hit For-Profit Company Bottom Lines Hard

WannaCry and NotPetya malware caused temporary disruption of the operations of a handful of US hospitals, but publicly traded Merck and Nuance took big but temporary financial hits due to crippled operations.

17. The Federal Government Chased the Tip of the Healthcare Fraud Iceberg

Medicare’s pay-and-chase practices have created a ton of fraud and a few ounces of penalties that haven’t deterred the large number of scammers who make fortunes working the system’s many holes. A few high-profile settlements and prosecutions showed the risk to criminals, but the reward remains infinitely larger and the risk of actually serving prison time is minimal.

18. HIMSS Kept Getting Bigger

Cash-flush HIMSS has to spend its vendor-provided money somewhere, with competing publications and conferences topping its acquisition list and increasingly making it the all-controlling industry voice.

19. Technology Did Little to Improve the Opioid Crisis

Doctor-shopper databases have done little to improve the opioid situation, which remains a people rather than a technology problem due to user demand, doctor willingness to supply it due to questionable prescribing practices and sometimes outright fraud, and the ever-growing and ever-cheapening illegal drug supply that is happy to take up the slack if legal prescribing declines. Continuing demand with reduced supply does little except to raise prices and encourage customers to seek out more dangerous alternatives.

20. Digital Health Had a Few Bright Spots Among Unproven Apps

Consumer health apps and platforms continue to seem like good ideas even in the absence of evidence that they positively impact outcomes, they have minimal mainstream uptake outside of the quantified selves, and providers show no interest in looking at piles of self-captured information (especially when they aren’t being paid to do so) that provides little basis for intervention.

Patient engagement technologies offer promise in improving outcomes for a narrow subset of consumers, although definitive proof is mostly lacking. Technology vendors see the market opportunity in under-diagnosis, the extent and societal health value of which is questionable.

As an uplifting New Year’s bonus for “year in review” honors, I look back at the best health IT-related video ever created. The “Hamilton”-inspired production of Mary Washington Healthcare (VA) was appropriate to its location, magnificently written and performed by its employees, and reflective of the aspirations of a hospital implementing a new EHR.

Morning Headlines 12/29/17

State’s $44.3M health data system ‘at a crossroads,’ study says

A review of Vermont’s statewide HIE finds financial and administrative issues and an erosion of end user confidence.

CMS Appears to Forbid All Forms of Text Messaging

A health law firm reports that CMS has been issuing warnings hospitals that any form of texting PHI is unacceptable, even through secure text messaging applications. UPDATE: only ordering via text message is prohibited, as confirmed with CMS.

Swallowing a Spy — The Potential Uses of Digital Adherence Monitoring

A NEJM perspective article questions the usefulness of digital medicines, specifically the ingestible sensor manufactured by Proteus Digital Health to track and improve medication adherence. In the article, author Lisa Rosenbaum, MD opines that for digital monitoring to improve adherence rates, “lapses would probably need to reflect pragmatic rather than psychological obstacles, particularly for diseases for which medication taking isn’t associated with relief of symptoms.”

Some Doctors Still Billing Medicare for the Most Complicated, Expensive Office Visits

A ProPublica investigation questions the billing patterns of providers that almost exclusively bill CMS for the most expensive and complex visit type.

News 12/29/17

Top News

A consulting firm’s review of Vermont’s HIE finds that 91 percent of its stakeholders think the state needs such a service, but VHIE is meeting the needs of only 19 percent of them.

VHIE gets 95 percent of its funding from public sources, which raises a sustainability red flag. It has spent $44 million, most of that provided from federal Meaningful Use funds.

The report says data quality is a problem; VHIE’s “cumbersome” opt-in policy has limited enrollment to 20 percent of the state’s population; and most users have view-only access.

The consulting firm recommends that VHIE:

• Provide search capability for extracted portions of the full record of patients
• Allow providers to submit public health reports and registry data
• Implement a master patient index and provider directory that can link patients to providers or ACOs
• Provide quality reports to support data-driven care
• Allow providers to submit Meaningful Use reports directly from their EHRs
• Coordinate with the state’s all-payer claims database to allow analyzing cost at patient and population levels

The HIE is run by Burlington-based Vermont Information Technology Leaders, which agreed with the consultant’s findings. John Evans, VITL president and CEO, will retire on January 1, 2018.

Reader Comments

From Mordecai: “Re: Renaissance Weekend. I received an invitation – have you heard of it?” I haven’t heard of it. According to its website, Renaissance Weekend  — not to be confused with those goofy Renaissance Faires where historically accurate / BDSM attired attendees frequently exclaim “huzzah” and “good morrow” while they waveth a smoked turkey leg in one hand and cell phone in the other — is an invitation-only retreat of diversely accomplished folks who get together to talk about public policy, innovation, science, and other heady topics. I’m interested in hearing from anyone who has attended or was invited. The idea of going someplace fun for brainy discussions is pretty cool, although interested folks would probably need a connection to be invited and a good supply of extroversion to make it worth going. Maybe there’s something similar with bar lowered for the rest of us. I knew a guy once who convened his own retreat sort of thing, where he invited interesting and diverse people to join him for a day (or maybe it was a weekend) of freewheeling, friendly discussion, although I can see that devolving into a beer bust.

HIStalk Announcements and Requests

An anonymous reader’s contribution to DonorsChoose, with matching funds applied from my anonymous vendor executive, fully paid for these teacher projects:

• Science books for Ms. C’s elementary school class in Provo, UT.
• Programmable robots for Ms. M’s elementary school class in Clermont, FL.
• A programmable robot for the Robot Coding Club of Mrs. J’s elementary school class in Cleveland, OH.
• STEAM kits for Mrs. K’s elementary school class in Winnetka, CA.
• A document camera for Mrs. W’s elementary school class in Elm City, NC.
• Six tablets and a printer for Mrs. J’s elementary school class in Forest Park, GA (it tugged at me when she mentioned that three of her students are homeless)
• Math activity centers for Mrs. S’s pre-kindergarten class in Hillsville, VA.

I was working early and funded the projects at around 4 a.m., but the apparently also early-rising Mrs. W got in touch almost immediately to say, “WOW! What a wonderful surprise! I can not thank you enough for your generosity! I am so excited to be able to give all of my students the ability to watch and interact with my daily lessons. This document camera will allow my students to be in the moment as I model lessons. This will also help students to be more engaged. Thank you!”

Webinars

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

Acquisitions, Funding, Business, and Stock

I realized this morning that it has been nearly six months since Neal Patterson died on July 9, at which time Cerner said its longstanding succession plan meant that “the process to select a new CEO is nearing a conclusion.” CFO Marc Naughton said in the October 26 earnings call that the board would “take their time and go through the process in a very careful manner.” Co-founder Cliff Illig remains as chairman and interim CEO. I don’t know how long the average publicly traded company takes to name a permanent CEO, but six months with an interim seems like a long time.

Sales

Shepherd Center (GA) will implement Epic in a Community Connect agreement with Piedmont Healthcare (GA).

People

Kyruus hires Chris Gervais (Threat Stack) as SVP of engineering.

Government and Politics

A health law firm says CMS is warning hospitals that they cannot send patient information by text messaging in any form since secure texting systems are unreliable. That seems unlikely other than for using messaging to transmit orders, which Joint Commission has raised as a potential problem because of the inconsistent workflow involved in entering them into EHR. I’ve reached out to CMS for a response. UPDATE: per the response I received from CMS, my suspicions were correct. Texting patient information among healthcare team members remains OK as long as the platform is secure, while texting patient orders is prohibited in all cases.

A ProPublica report finds that CMS has done little to investigate private practice doctors who nearly always bill at the most complex visit rate. One Alabama doctor coded 95 percent of his visits at the highest intensity vs. 5 percent of his peers, for which Medicare paid $450,000. An expert blames EHRs that assign billing codes based on which boxes are checked, saying, “Those programs tend to upcode.”

Privacy and Security

Systems at Jones Memorial Hospital (NY) go down due to an unspecified cyberattack. Amusing to me is that the hospital is located in Wellsville.

21st Century Oncology will pay a $2.3 million HHS OCR settlement for potential HIPAA violations involving a hacker using remote desktop protocol to penetrate the company’s network SQL database.

Other

The Peoria, IL newspaper describes the planned February 1 complete IT switchover of two hospitals that OSF HealthCare has acquired, which the IT team hopes to complete in just the seven hours between the 12:01 a.m. agreement effective time and the day shift’s start at 7:00 a.m. The OSF team has staged equipment on rolling carts, practiced assembly and testing, labeled 2,000 cables with their destination, and created training videos for non-technical employees and volunteers who will help with the conversion. CTO James Mormann says OSF is considering using its expertise to spin off a new IT system switching business.

Apple apologizes for intentionally slowing down older IPhones that have diminished battery capacity in an attempt to avoid unexpected shutdowns, offering as a mea culpa a price reduction on batteries for the IPhone 6 or newer from the usual $79 price to $29. The company will also provide a battery health meter in an IOS update in early 2018.

The latest Gallup poll of most ethical professions ranks nurses at the top, with doctors and pharmacists coming in at #4 and #5 even as the honesty ranking of pharmacists fell to its lowest score since 1994. Finishing dead last were members of Congress, car salespeople, and lobbyists.

Only a small fraction of Washington doctors are using the state’s prescription drug monitoring program database, leading one legislator to advocate making their participation mandatory. The state medical association blames standalone PDMP software that doesn’t connect to EHRs. Epic integrates with the state’s system, but only one hospital has turned it on. An expert recommends that the state double the PDMP’s technology budget, integrate the system with EHRs, and pay doctors to use it to avoid resistance to yet another unfunded mandate that takes up their time.

A New York Times article notes the new healthcare possibilities of the latest-generation Apple Watch, which connects directly to cellular networks instead of requiring tethering to an IPhone. It mentions the AliveCor KardiaBand for capturing EKGs, but observes that such devices can flood doctors with questionably useful information that they don’t know where to store. The company has responded by developing a software platform for doctors.

A NEJM op-ed piece questions the psychology behind patients who don’t take their prescribed medications and the role of the Proteus “digital pill” that monitors their medication adherence. The physician author says the problem is rarely caused by patients forgetting to take their meds – despite what they tell their doctor – but rather the psychology in acknowledging their mortality. Some snips:

Understanding takes time, and it’s often easier to tell people what to do than explore why they don’t do it. Even having studied the psychological factors driving non-adherence among patients with coronary disease, I often lapse into check-the-box mode with my patients … For those of us who struggle, the most effective adherence booster may be giving doctors and patients the time to explore the beliefs and attributions informing medication behaviors. These conversations can’t happen in a 15-minute visit. Given how little our health care system seems to value such interactions, it’s no wonder that skepticism often greets these new, unproven, and costly technologies. But though this skepticism may be warranted, it may also reflect a fear that the technology is intended to replace our efforts, rather than facilitate them.

A Froedtert Hospital (WI) anesthesiology resident with a history of depression kills himself on Christmas day by barricading himself in the OR, withdrawing fentanyl from the computerized dispensing system under a patient’s name, and administering it to himself.

Contacts

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

EPtalk by Dr. Jayne 12/28/17

I’ve been following the reader comments regarding the recently-opened $1.2 billion Stanford Children’s Hospital. There is plenty of cynicism about whether the expenditure will lead to better outcomes or a healthier community. I see this in my own community with several multi-state health systems competing to have the most beautiful and indulgent facilities, with far less advertising of their actual patient care.

My own hospital experience earlier this year was in a lovely private room with a flat screen TV four times larger than what I have at home, along with on-demand dining in a brand-new hospital wing. It was also accompanied by lackluster nursing care, delayed antibiotics, and failure to use bar-code medication administration systems as required to ensure patient safety. There was also a missing pathology specimen and a weeks-long delay in seeing my discharge summary in their patient portal. At least the hospital in question was spared a penalty under the Hospital-Acquired Condition Reduction Program. 

Although I received belt-and-suspenders prevention against deep vein thrombosis with both heparin injections and pneumatic compression devices, I’m not sure whether it was as effective as my early-morning ambulation, as I got dressed and packed up as quickly as possible to avoid staying any longer than absolutely necessary.

I caught up with some grad school friends who were in town for the holidays. A summary of our get together reads like the opening line of a bad joke — a doctor, a drug rep, and a hospital administrator go into a bar… All of us have worn many different hats over the last two decades, so it was interesting to hear each other’s perspectives on the evolution of Meaningful Use, the current state of this mess we call a healthcare system, and whether physicians are hanging in there or readying themselves to retire or pursue second careers.

I go back and forth in the latter category. Although my work is rewarding when I can help organizations make meaningful change, it can be depressing as frontline primary care groups struggle with trying to deliver more to sicker patients with fewer resources. Although value-based care is supposed to “fix” this, the learning curve can be steep and it’s hard for many organizations to figure out how to spend money they don’t have to make money they may or may not actually receive.

Many of the physicians I work with experience less satisfaction in their work lives than even a few years ago. Some of my former family medicine colleagues have moved into niche practices such as cosmetic treatments and vasectomy reversals. I know already that a couple of my favorite clients are planning to pursue early retirement in 2018. I’m sorry to see them go since they’re not even in their sixties, but given the diminishing returns on their professional labors, they feel backed into a corner.

As solid members of Generation X, we did have some common thoughts on what we think we’ll see in healthcare’s next decade. First, practices, hospitals, and health systems will continue to compete with each other to some degree even when it would make sense to collaborate. We see health systems that refuse to participate in collaborative ventures that would help not only patients but their own bottom line, out of fear of losing control. At least in our respective parts of the country, we don’t see this changing.

Second, there will be continued focus on profitable service lines despite the push to steer patients to enhanced primary care models. Community-based exercise and weight loss programs aren’t profitable, but knee replacements certainly are. It’s challenging for primary care physicians in the trenches to motivate patients for the months and years needed to solidify lifestyle changes (assuming the same provider even continues to be in your network) and the US population will continue to ask for high tech interventions where there is a possibility for a quick win.

There isn’t any excitement around funding the major cultural changes needed to truly transform how we live, what we eat, and how we manage our health, although we will continue to see glimmers of hope with greater patient engagement and patient empowerment.

Third, the cost of healthcare will continue to be a hot button issue. When left with the individual decision of investing in their health through preventive care or to purchase insurance against major health expenses, many people will lack the money to fund those choices. Others will choose to spend their money on other priorities. Since healthcare isn’t going to get any less expensive, this will continue to cause medical bankruptcies and significant hardship. The cycle of unfunded care and cost shifting to insured patients will continue.

As we chatted, we wanted to be hopeful about things such as machine learning, diagnosis algorithms, and predictive analytics, but it’s difficult to support the bluster from the reality in many cases. The next year or so will be very telling for these technologies and I think we’ll get some real data for how they’re going to play on a broader scale.

The reality, though, is that non-sexy interventions such as public health projects and simply getting people to move more and eat less are going to be increasingly important as we continue to try to reduce the burden of chronic disease. I think often of one of my favorite shows “Call the Midwife” and the untapped potential of community health interventions. At least one health system in my city is working towards greater community outreach, establishing new school-based clinics that not only provide healthcare, but serve as food pantries and distribution sites for clothing and other necessities.

Hopefully the New Year will bring continued focus on corporate stewardship as we continue to figure out how to make something sustainable out of dysfunctional systems that seem constantly on the brink of collapse. Healthcare impacts such a great deal of our economy and daily lives, so I was excited to read about a large health system that was willing to look at issues outside their “normal” areas of activity and consider other impacts such as water use, greenhouse gas emissions, and plastic waste. Healthcare organizations employ an increasing percentage of the US workforce and may be uniquely poised to transform workplace culture over the next decade as we evaluate how we care for aging Baby Boomers and whether we will put systems in place to reverse some of the negative health trends we’re seeing.

What challenges do you think we’ll see in the New Year? Is your organization looking to lead change? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/28/17

Federal Exchange Open Enrollment for 2018 coverage, most cost effective saving Americans millions of dollars while improving customer service and access to care

CMS reports that 8.8 million consumers used Healthcare.gov to buy health insurance during this year’s enrollment period, down from 9.2 million last year. CMS spent $10 million on marketing and outreach this year, compared to the $100 million spent last year.

CMS to relax reporting rules for ACOs impacted by hurricanes, fires

CMS publishes an interim final rule adjusting the reporting requirements of the Medicare Shared Savings Program to provide leniency to ACOs that were impacted by natural disasters this year.

Ransomware focus limits healthcare IT progress in 2017

Modern Healthcare looks back on 2017 and concludes that the onslaught of ransomware attacks overshadowed any gains made in health IT this year.

Morning Headlines 12/27/17

RFI — Indian Health Services HIT Modernization

Indian Health Services issues an RFI seeking help developing a health IT modernization strategy as it prepares to migrate away from VistA.

Regional Variation of Computed Tomographic Imaging in the United States and the Risk of Nephrectomy

A study concludes that the overuse of CT scanning correlates with an increase in discovery of unrelated kidney tumors and an uptick in clinically unnecessary kidney surgeries.

Orlando Portale – My Year End Rant

Health IT strategist Orlando Portale calls on health IT evangelists working the speaker circuit to invest time learning how machine learning algorithms work before telling audiences that they will solve health IT’s woes.

News 12/27/17

Top News

The Indian Health Service — which is about to have the VistA rug pulled out from under it as the VA frantically couples with Cerner — issues an RFI looking for help in figuring out how it can “modernize, augment, or replace RPMS legacy health IT systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure.”

IHS’s RPMS is based on VistA.

Reader Comments

From Steve E: “Re: Stanford Children’s Hospital. The $1.2 billion facility is open and it’s impressive, with lots of technology. You should write a piece on it.” The expanded 361-bed building opened December 9. It’s a beautiful facility, as it should be for $3.3 million per bed. We take a different approach in the US in building elaborate campuses for which we all pay with no promises that outcomes will improve. Patient satisfaction scores will rise because of amenities, although those aren’t any better of a predictor of long-term quality of life than impressive lobbies filled with crystal awards. I freely admit my cynicism about our profit-motivated healthcare non-system. 

HIStalk Announcements and Requests

The 82 percent of meeting attendees who sneak looks at their phones are most likely checking email or their calendar, although a few admit to being drawn to non work-related distractions such as news sites, Twitter, Facebook, Instagram, or Snapchat. THB says shiny object fascination is an addiction that can be cured only by confiscating everybody’s phone at the start of a meeting. Bored Amy observes that everybody at her company is so swamped that multi-tasking to keep up with email is mandatory, while MasterBlaster probes deeper into the “just in case you’re needed” meeting invitations where people are just sitting in the room on standby as the core meeting progresses just fine without their involvement.

Too many meetings are held just because they are on a recurring schedule, often bloated with an ever-expanding roster of marginally involved attendees who can’t escape after being added to a single agenda and never removed from the list. There’s also the age-old meeting problems that make participation frustrating: nobody takes charge, there’s no agenda or action items, nobody puts a stop to pontificating and factless chatter, and specific to-do assignments are not made even though it’s assumed that the next meeting will be held on the appointed calendar day. In that regard, self-gratification by phone may be a reasonable defense mechanism. It may be that just getting together without a specific purpose adds value in keeping everyone updated, but the odds aren’t good.

New poll to your right or here: which winter holiday do you consider to be your primary celebration? I’m happy to observe any holiday and I admit that I’m pleased rather than annoyed when someone wishes me Happy Holidays, Happy Kwanzaa, or Happy Anything Else instead of the traditional Merry Christmas — I’ll take all-too-rare best wishes from strangers any way I can get them. “Merry Christmas” is kind of weird anyway, grammatically speaking – when do we use the word “merry” otherwise? As a contrarian, I enjoy wishing people a John Lennon-style “Happy Christmas” just to stir them from their holiday coma with socialistic suspicion.

An anonymous reader sent a donation to DonorsChoose, which with matching funds will provide math materials for the kindergarten class of Mrs. A in Black Creek, NC.

I was binge-watching the engrossing “Halt and Catch Fire” on Netflix when I was struck by this strange but mostly unrelated fact, which I will present as a trivia question that you won’t get right without cheating. In what city was Microsoft founded, the same city in which Amazon’s Jeff Bezos was born?

Last Week’s Most Interesting News

• A newly submitted House bill would allow clearinghouses to sell patient data.
• Drug overdose deaths cause US life expectancy to drop for the second year in a row.
• Greenway Health files plans to lay off 120 of its Georgia-based employees in moving some functions to Tampa.

Webinars

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

Government and Politics

I was curious about former Rep. John Fleming, MD — appointed early this year to the newly-created ONC position of deputy assistant secretary for health technology reform — since I have heard next to nothing about him. I emailed my ONC contact on Christmas Day and got a quick reply,  which is either admirable or sad that both of us were keeping an eye on work email on the holiday. Fleming is leading workgroups on burden reduction, usability, and quality measures and I see he’s written some “Health IT Buzz” blog posts.

Other

Industry long-timer Orlando Portale says too many self-appointed AI pundits are expounding on a topic they know nothing about, which is unfortunately not uncommon in the “big hat, no cattle” world of health IT:

There remains a great deal of confusion from self-professed digital health evangelists and conference bloviators who don’t grok how AI/machine learning actually works … I suggest learning how to code or teaming with someone who does. Build something, otherwise your prognostications are without merit. To my physician friends on the digital health speaking circuit: AI/machine learning is a science, no different than the courses you had in med school. Treat the field with the same deference … Consider redirecting time wasted on Twitter cutting and pasting articles about other people’s work toward building something useful.

A study finds that excessive CT scanning turns up a lot of unrelated kidney tumors (“incidentalomas”) that are over-treated by removing the kidney, exposing the patient to more harm than benefit. This is yet another example of where our excessively fine-tuned diagnostic capabilities (which are getting more sophisticated by the minute as technology such as AI advances) lead clinicians down an expensive and sometimes patient-endangering rabbit hole. We need proven, affordable prevention and treatment strategies for already-detectable and clinically meaningful conditions, not companies that are anxious to profit from the consumer misconception that new diagnostic capabilities will improve societal health. Only outcomes matter. We could also use one where just being exposed to it carries its own significant danger via medical errors, overtreatment, and a frequent disconnect between science and practice.

Tanmay Bakshi, a 14-year-old IBM Watson programmer, is convinced of the value of AI in healthcare. He’s working on a project to help a disabled woman communicate through a neural network that models her brain. He developed his first IOS app at age nine, has published 150 YouTube videos to teach young people about technology, consults with major corporations, and has delivered keynote and TEDx presentations.

Sponsor Updates

Blog Posts

• Tech Blog: Virtual Desktop Infrastructure – Drivers, Security, Costs and Benefits (Huntzinger Management Group)

Contacts

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

Morning Headlines 12/26/17

Theranos gets $100 million in debt financing to carry it through 2018, with some caveats

Fortress Investment Group, a New York-based private equity firm, issues a $100 million debt financing round to Theranos, subject to hitting product and operational milestones. CEO Elizabeth Holmes reports that the new funding provides the company “sufficient liquidity through 2018.”

Health insurer Oscar nears $1 billion in revenue

Next year, Oscar Health anticipates hitting 250,000 subscribers in New York and California and revenue of $1 billion.

Family doctors call for guaranteed access to EMR data for research and quality improvement

The College of Family Physicians of Canada, along with the Canadian Primary Care Sentinel Surveillance Network and the University of Toronto Practice-Based Research Network, are lobbying against EHR vendors over information blocking tactics that are preventing clinicians from accessing data.

Morning Headlines 12/22/17

Fortified Releases 2018 Horizon Report Detailing Healthcare Cybersecurity

Fortified Health Security releases its 2018 report on cybersecurity in healthcare in which it predicts double-digit increases in breaches and new variants of the WannaCry ransomware attack making rounds.

US life expectancy falls for second straight year — as drug overdoses soar

Life expectancy in the US fell for the second year in a row, the first time life expectancy has dropped two-years in a row since the 1960s. The opioid epidemic claimed 63,000 lives in 2016, a 21 percent year-over-year increase in overdose mortality.

Healthcare Management Consulting 2017

KLAS releases a report analyzing the performance of healthcare management consulting firms.

News 12/22/17

Top News

Despite appearances, Medhost wasn’t hacked this week, the company says. The cyber intruder penetrated Medhost’s domain registrar (not its actual server or site) and then redirected visitors to a new webpage claiming he or she had stolen patient data. The company did a nice job explaining what happened and getting the site restored as quickly as the propagation of the restored DNS allowed.

Lesson learned for anyone running a website: use a complex domain registrar account password and turn on two-factor authentication if they offer it. I changed mine this morning.

Webinars

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

Acquisitions, Funding, Business, and Stock

Silicon Valley, meet Bubble 2.0 (and possibly the need for SEC Oversight Part Zillion): the juice manufacturer behind Long Island Iced Tea changes its name to Long Blockchain Corp. even though it admits that it is only beginning to look at blockchain with the vague idea that it might be something cool. The news sent micro-cap shares soaring 200 percent.

A previously dismissed shareholder rights law firm’s securities class action lawsuit against Quality Systems, Inc. is reversed on appeal, with the law firm claiming that Quality Systems/NextGen touted increasing revenue through February 2012, at which time the CEO sold his shares at a high price just before the company lowered guidance and reported lower net income. Above is the QSII share price chart from January 2012 through today, with QSII (dark blue, down 65 percent) vs. the Nasdaq (light blue, up 147 percent).

Sales

USF Health (FL) chooses Kyruus to help its access center match patients to providers.

People

Nordic promotes Michelle Lichte to EVP of client partnerships.

Gary Gartner, MD, MS (Allscripts) joins NextGen Healthcare as VP of clinical solutions.

Announcements and Implementations

A new KLAS report looks at healthcare management consulting (click the graphic to enlarge).The most-trusted partners of respondents in each consulting firm category (cross-industry, healthcare-specific, focused healthcare-specific) were Deloitte, Premier, and Optum. KLAS hasn’t sent me any report announcements since early 2014, so in checking their site to see how the company has grown, I note that it lists 12 executives and a 24-employee research team.

Government and Politics

A newly submitted House bill would allow clearinghouses to sell patient data in a reincarnation of previous bills that were suggested by lobbyists for Experian, The SSI Group, and Availity. Clearinghouses would not be considered HIPAA business associates or covered entities, and like providers that can use patient data without individual consent under the nebulous umbrella of treatment, payment, and operations, would not be required to seek authorization from patients and would be allowed to charge patients for providing copies of their own data. Unlike providers, they would also be allowed to sell data. Hat tip to Politico for turning this up.

The just-passed tax law will affect non-profits that include health systems, hitting them with a 21 percent excise tax on each salary of $1 million or more among their five highest-compensated employees who don’t provide medical services. Also affected will be universities (because of their highly paid presidents and sports coaches) and religious organizations. Given historical health system indifference to high salaries and the enforceability of existing employment contracts, the most likely outcome is that they will just figure out how to bill insurers and patients more to cover their new cost of doing business.

Privacy and Security

Fortified Health Security’s 2018 cybersecurity report finds that nearly all of its web and network penetration tests allowed access to patient information, while 33 percent of systems could be compromised due to incorrectly configured Citrix, VMware Horizon, and SSL VPNs. A rather shocking 72 percent of networks tested were at risk because of weak passwords. It recommends that organizations:

• Maintain and enforce security policies and procedures.
• Keep an updated inventory of devices that store, process, or transmit electronic PHI.
• Use strong security engineering when rolling out remote access solutions and web applications that store patient information in a SQL database.
• Enforce creation of strong passwords.
• Consider implementing systems data loss prevention, security incident event monitoring, and intrusion detection.
• Encrypt data at rest.
• Don’t get indifferent about patch management even though it’s a never-ending slog.

Technology

Wired magazine covers CareCoach, a $200 per month human-powered, tablet-presented simulated pet avatar that monitors high-need and elderly patients by checking in, offering medication reminders, and providing a bonding experience. It’s a good idea, although the avatar’s synthesized voice and inherent processing delays are hard to overlook.

Apple finally admits what many IPhone users have suspected – iOS intentionally slows down older iPhones. Not to sell users a newer model, but to prevent the old phones from shutting down because of deteriorating battery capacity. The takeaway: consider replacing your battery to speed your phone back up  instead of spending $1,000 on a replacement.

Bloomberg reports that Apple is developing electrocardiogram capability for its Watch in which wearers will touch two fingers from the opposite hand on the watch’s frame, possibly helping detect arrhythmias. Apple is behind since AliveCor’s Kardiaband add-on band for the Apple Watch is already FDA approved to capture EKGs.

Twitter continues to kill off its only virtue — mandatory brevity — by allowing its users to stitch together a string of tweets. I haven’t seen proportionately more user brilliance in the expansion of the 140-character limit to 280, no different when people who just couldn’t bear to edit their magnificent thoughts started attaching pictures of words that would not have fit otherwise.

Other

Sixty-three thousand drug overdose deaths in 2016 caused US life expectancy to drop for the second year in a row, the first time that has happened since the early 1960s.

A cafeteria worker at Advocate Trinity Hospital (IL) who says “you don’t have to wait until you get rich to help others” spends $5,000 to buy toys for pediatric patients at Advocate Children’s Hospital. In this tenth year of her project, she will donate half the toys to children in Puerto Rico. 

Dilbert, like “The Simpsons,” somehow remains relevant and edgy after many years.

Sponsor Updates

• Protenus publishes its November Breach Barometer.
• Liaison Technologies rolls out a single user interface for access to its Alloy integration and data management platform.
• HealthLoop will integrate its automated care plans and check-ins with patient activity and behavior analytics from Sherbit.
• A new release of Harris Healthcare’s Novus Meds medication reconciliation application offers mobile physician access and embedded drug knowledge, developed with Hunterdon Medical Center (NJ)
• CloudWave employees collect toys for United Way.
• Conduent will open a global technology and innovation hub in Raleigh, NC.
• LogicStream Health publishes a new case study featuring Tampa General Hospital, “Decreasing C.diff Rates Through Appropriate Testing with a Clinical Process Improvement software platform.”
• Mazars USA will donate $100,000 in 2018 to nine charities that will work to fight hunger.

Blog Posts

• InterSystems Healthcare Leadership Conference: Sun, sand and the future of health IT (InterSystems)
• Gunnison Valley Health Significantly Improves Revenue Cycle Time with ABILITY | EASE All-Payer (Ability Network)
• How Will the CVS-Aetna Merger Transform the Patient Care Landscape? (Redox)
• A Data-Inspired Future? You’re Looking at It (Liaison Technologies)
• In Mammography, History Matters (LifeImage)
• How providers can bridge care gaps caused by social determinants of health (Meditech)
• The Relationship between Artificial Intelligence and Healthcare: Why It’s Complicated and Why Robot Doctors Aren’t Our Future (Medicomp Systems)
• Is Your Revenue Cycle Ready for the New Year? (Navicure)
• 3 solutions to easily comply with shifting healthcare laws and regulations (Experian Health)
• Healthcare IT Trends to Watch in 2018 (PokitDok)
• How Will the CVS-Aetna Merger Transform the Patient Care Landscape? (Redox)
• Spread Holiday Cheer with These 6 Salesforce Carols (Salesforce)
• Two Bundled Payment Models Recalled by CMS, Others Still in Effect (The SSI Group)
• Save 15 Hours of Phone Time Each Week (Solutionreach)
• Quality improvement: more than just HEDIS (Verscend Technologies)
• Here’s to a happy, health New Year! (Voalte)
• The power of effective clinical communication (Vocera)
• 13 Benefits of a Pilot Project Before Buying (West Corp.)

Contacts

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

EPtalk by Dr. Jayne 12/21/17

Usually things in the healthcare IT world are relatively slow from Thanksgiving through the early part of the New Year, as vendors save their best efforts for HIMSS. At the same time, hospitals and health systems make sense of new federal regulations and changes to insurance contracts while patients try to figure out new coverage along with new deductibles, networks, and more.

This year, the early November release of CMS updates to the 2018 MACRA Quality Payment Program, along with the Physician Fee Schedule, seem to have energized the provider community to ensure that they understand the rules that they’ll be operating under in 2018. Healthcare organizations are scrambling to make sure they are ready for initiatives such as the Comprehensive Primary Care Plus (CPC+) program and year-long reporting for various quality programs.

On the vendor side, there has been increased activity supporting clients in the above areas. I’ve seen a handful of vendors announcing their required APIs along with their plans to support the transition to new Medicare beneficiary identifiers. Others are highlighting enhancements to CCD exchange.

Compared to the last several years, vendors seem more likely to publicize the changes they’re making to their systems. Where some focus on enhancements and updates, others are increasingly transparent about defect identification and fixes. In the wake of the Department of Justice action against EClinicalWorks, one has to wonder whether vendors are hoping that transparency will save them from potential whistleblower actions or client claims.

In addition to supporting their clients, vendors are well into the pre-HIMSS run-up. They are refining their messaging and getting ready to put their best feet forward as they work to recruit new clients and to retain existing clients who are constantly looking for the next big thing to solve their workflow woes. I’ve heard from several firms that conduct marketing research – they’re looking for physicians to participate in projects that sound like they are being conducted on behalf of EHR vendors. At least two of them seemed to be for new product launches and I hope I’m able to see what companies are planning before we get to the HIMSS exhibit hall.

I had the opportunity to learn about a startup’s product this week and was impressed by what I saw. The company’s founders come from an industry far away from healthcare. Although many “outsider” companies have thought it would be easy to crack the healthcare nut and have received a rude surprise, this group comes from an extremely data-intensive industry and they have a fresh approach. I’m looking forward to seeing how they prepare for HIMSS and whether their approach to patient engagement will play to healthcare purchasers in the way they hope it will.

A reader emailed after my last Curbside Consult that talked about the challenges patients face when trying to figure out prescription pricing and whether they should use their insurance coverage or pay cash for prescriptions from us. He asked if I had ever seen GoodRx. Although it provides real-time information and price comparisons across pharmacies, it has some of the same issues that make patients question whether they should get their medications from us – namely that GoodRx doesn’t run prescriptions through insurance.

For patients who are looking to meet a family deductible or get out of the Medicare donut hole, it’s not going to help with the bigger picture of those expenses unless their payer allows them to submit receipts and credit the cash expenditures towards the deductible. I also failed to mention that our home grown cheat sheet in the office includes data on pharmacy hours, which is indispensable for any patient trying to get their medications filled after 4 p.m. in our area. I haven’t used GoodRx in a while, but will make it a point to give it another go during my next clinical shift.

It will be challenging to predict how the patient cost curve will bend following changes to the provisions of the Affordable Care Act once the current tax legislation makes it through the process. Although supporters are trumpeting the repeal of the individual mandate for insurance coverage, that doesn’t appear to happen immediately and some subsidies will continue. I would expect costs to rise as people opt out of individual coverage, leaving only sicker people in the pool.

Additional challenges will come to families who receive funding for child healthcare through the CHIP program, whose federal funding stopped September 30 and hasn’t been reauthorized. This is a popular program with bipartisan support, and states are running out of reserves with a forecast of half being out of money by the end of January. Alabama is no longer accepting new patients into the program and Colorado and Virginia have told parents to start looking at private insurance options. Of course, there’s also the threat of a government shutdown looming, so when this will all be untangled is anyone’s guess.

For many organizations, this is the time for holiday greetings and service projects. InstaMed launched its “10 Days of Giving” program, running a toy drive for patients at the Children’s Hospital of Philadelphia and delivering 930 toys.

I looked for blurbs from other vendors and was surprised at how little I found on public websites. One vendor detailed their efforts to collect clothing for the earthquake in Haiti in 2010, and another had a corporate philanthropy blog that hadn’t been updated since 2016. A couple of corporate responsibility webpage links returned “page not found” messages.

I know vendors are out there doing good things and would love to report on them. Many hospitals (especially pediatric facilities) have wish lists for gifts in kind and would be happy to receive your donation. My local hospital is looking for not only toys, but things like ear buds and sports team shirts for teen patients. If you’re looking for an opportunity to give, please also consider Mr. H’s Donors Choose program. I’m amazed by the generosity of our readers, and as the daughter of a retired teacher, I know how much those donations mean not only to the students, but to the educators.

I would love nothing more than to have my next piece be full of stories of holiday giving.

Email Dr. Jayne.

Morning Headlines 12/21/17

Important Update: Domain Registrar Account Compromised

Medhost reports that the account used to register its Medhost.com domain was compromised during a cyberattack Tuesday, but assures customers that all internal systems have remained under the company’s control throughout the incident. The company is reiterating that patient information has not been compromised.

Aledade raises $23 million in new funding round

Aledade, the health IT startup founded by former National Coordinator for Health IT Farzad Mostashari, MD, closes a $23 million venture round led by Venrock and Biomatics Capital Partners, bringing its funding total to $97 million since its 2014 launch.

What This Computer Needs Is a Physician Humanism and Artificial Intelligence

A JAMA Viewpoint article is cautiously optimistic about the potential for AI to improve EHR usability, but urges developers to include front-line physicians in the design and deployment of these tools, noting that, “Even though the EMR may serve as an efficient administrative business and billing tool, and even as a powerful research warehouse for clinical data, most EMRs serve their front-line users quite poorly.”

We’re A Bunch of Expensive Financial Clerks

Brent James, MD, Vice President, and Chief Quality Officer for Intermountain Healthcare, imagines a next-generation EHR that lets clinicians pull core clinical and billing functions into their own customized, activity-based workflow designs. He goes on to say “Epic is dead, Cerner is dead, in their current form. It’s only a matter of time.”

CIO Unplugged 12/20/17

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

First Days

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

They say the typical executive will switch positions 5-7 times during his or her career. How can you ensure a smooth and effective transition? This series is intended to compliment what others have written over the years with some fresh perspective. In this post, I will start with recommended actions during an oft-ignored time period: the 30 days prior to your start date.

30 Days Prior

After you have celebrated your new role with friends and family, you have to get to work. This is a challenging transition time, as you must first honor your commitments and obligations to your current employer while also carving out time to focus on your pending role. Your primary commitment and loyalty remains with your current employer. However, if you can find some time to invest in your pending gig, it will pay dividends.

Family Time

I recommend incorporating a one-week break between the two roles to reconnect and refresh. This is an important to time to take a break and immerse yourself in family. Starting a new role is an intensive process requiring extensive start-up time. You will only regret the time you didn’t take off.

Corporate Communication

Work closely with your new organization’s corporate communications team to ensure that your internal announcement is pristine. The announcement establishes others’ first impressions of you, so it’s critical to make sure it is on point. Your picture should be in your Sunday school best. Your quote needs to be specific and visionary. Timing can be sensitive. Continue to show respect to your current employer by consulting with them on the timing of the announcement.

Information Gathering

I prefer to enter a new role fully informed and armed with a plan. Leverage your network to learn everything you can about your new employer and role. While gathering information, you have the opportunity to strengthen relationships with your new team.

In my last transition, I was fortunate to have several weekly meetings in advance to have my new team bring me up to speed on everything from politics to history to challenges, strengths, and opportunities. Your vendor network can also provide a complimentary third-party external perspective. The more you know about your pending employer, the more effective you will be and the easier it will be to earn the respect of your team.

Team Communication

Leadership transitions can cause unnecessary anxiety for your direct reports and division. Conducting weekly leadership meetings will go a long way to addressing both. Spend more time sharing on a personal level versus business. Being transparent can accelerate the team development process.

Depending on the culture of the new organization, consider proactive communication to the broader team. You may want to send an email detailing your background and some personal information that they would not otherwise be privy to from the official corporate announcement. If timing works out, an introductory town hall type of speech with Q&A can be helpful. The more you communicate, the more accurate the rumors.

Assessment

Between all the data points collected from interviews, related research, and information-gathering, you should have enough intelligence to make an accurate initial assessment of the organization’s strengths and gaps. Knowing what you are walking into helps to prepare.

For instance, if your new organization is based on agile philosophy, you better get up to speed before you show up. One of my employers embraced servant leadership, so I read everything I could on the topic prior to my first day. Once you have a draft assessment, run through it with your new team and manager to refine. You will need an honest assessment before you can develop an effective plan and recruit for any gaps.

Recruitment

As part of your assessment, you may learn of openings in key positions. You may discover skill gaps that will require you to bring in external talent. Much like football coaches who know that success depends on the teams around them, the successful manager ensures that she has the right leaders around her. Football coaches spend significant time recruiting prospects into open positions or where they require more depth.

This is not a human resources function. It is a leadership function. Begin the recruitment process immediately. This process can take anywhere from 90-180 days, depending on the organization and role, which is why I always encourage immediate action.

Planning

To set yourself up for success, you need to walk into your new role with your validated plan in hand. You have to hit the ground running and listening. Engage your team and have them help you create and execute your plan. This process will provide an additional catalyst for team building. Your staff will feel they’re included in the new direction and will be more engaged in the process.

Share your plan with your manager to make sure it is congruent with their expectations. Once codified, share it with your entire division. This promotes a culture of transparency and accountability. It demonstrates humility and openness.

The Next 30 Days

While the initial plan typically covers the first 90 days, your first 30 days on the job are the most critical. I’ll review some key considerations and takeaways in the next post.

Feedback

What other considerations and action items should leaders consider 30 days prior to the start of a new role?

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

Readers Write: Finding the Elusive Insights to Improve Surgical Outcomes

Finding the Elusive Insights to Improve Surgical Outcomes
By Dennis Kogan

Dennis Kogan, MBA is co-founder and CEO of Caresyntax of Boston, MA.

America’s operating rooms have an international reputation for driving surgical innovation. But they are also the setting for high variation in performance, as evidenced by the fact that 10 percent to 15 percent of patients experience serious post-surgery complications. This means millions of patients are at risk, yet insight into the root causes of performance variation remain an elusive “black box.” In the absence of this understanding, some hospitals cite the uniqueness of its patient cohorts as the primary driver of variation.

That has the unsettling ring of blaming the patient for his or her subsequent complications. Further, it raises the question of whether or not the hospital has a reliable risk stratification methodology for its patient cohorts, and if not, why not? We can predict the reason and it’s a valid one. Risk stratification at scale depends on data insights, and most perioperative data—a full 80 percent of it—is either uncaptured or unstructured.

To establish perioperative best practices, hospitals first need to harness the massive volume of data where actionable insights currently hide. With the convergence of IoT medical technology and healthcare analytics, they finally can.

Significant workflow enhancements can be made, for example, via performance analytics that consume structured preoperative and postoperative data from the EMR, surveys and patient outcome assessments. But real actionability is made possible with the addition of point-of-care data acquired within the operating room itself, largely from various connected medical devices. Combined with structured preoperative and postoperative data, this provides clinicians with both aggregated and granular data visibility. Now enabled with the clinical full picture, clinicians can focus on putting the data into action.

Circling back to risk stratification, let’s take a closer look at how this works. First, providers must document an individual patient’s risk factors. Then, using a validated risk calculator, a personalized risk assessment can be created (and communicated to the patient). Then, it should be included in an aggregation of patient risk assessments. From this collection of data, along with other data sources that include data pulled during the patient’s surgery, automated risk stratification reports can be immediately available for ICU managers to help prioritize and tailor recovery pathways. These reports could also indicate complication risk and compliance percentages versus targeted benchmarks.

All patients are inherently unique, but that doesn’t mean most of the variation in surgical outcomes or costs is unavoidable. In fact, a significant amount of variation can be reduced by meeting targeted benchmarks—say, for reducing infection, readmissions, length of stay, or even amount of pain experienced post-surgery. These benchmarks and best practices can be crystalized after aggregating and analyzing procedure and surgical documentation, such as reports, vital charts, videos, images, and checklists.

One strategy used in operating rooms around the world is to automate the collection and aggregation of operating room video recordings with key procedure data, including some of the above mentioned checklists and vitals data. Advanced technology can also retrieve surgical videos and images from any operating room integration system. Once surgery and vitals are recorded in a synchronized way, the ability now exists to identify and create a standard protocol that can go into a pre- or post-operative brief.

An additional use for this data includes streamlining post-operative report building, especially for payer reporting and internal quality initiatives. While there is a little time left to report 2017 data for the first official year of MACRA MIPS, this will be a continuing need.

Pre-operative risk scoring is sporadic at best, again, due to the lack of an ability to harness the necessary data. But the same data aggregated to create benchmarks and best practices can be used to create robust and highly accurate risk scoring to see what the possible harm could be to a surgical patient. In parallel, protocols also identified from the data can help to mitigate this risk.

In a hypothetical example, perhaps in one hospital more than 11 percent of patients undergoing non-cardiac surgery experience post-op infection. Predictive analytics reveal that the number of times certain thresholds were reached during surgery correlated with outcome measures. Evidence from this research can be incorporated into a decision support system that monitors the patient’s score and sends alerts when care plans are veering off course. Reductions in infections—and corresponding length of stay and readmission—soon follow.

Persistent opacity into root causes of variation is untenable. Quality-based reimbursement programs such as MACRA MIPS rely heavily on analytics of surgical performance, with a full 60 percent weight given to quality. Meanwhile, patients are aging and becoming frailer. This could increase post-surgery complications to an even higher rate than it is now.

Clearly it is time to innovate not just how we perform surgery, but also how we improve performance.

Readers Write: Almost Real, But Not Quite: Synthetic Data and Healthcare

Almost Real, But Not Quite: Synthetic Data and Healthcare
By David Watkins

David Watkins, MS is a data scientist at PCCI in Dallas, TX.

We all want to make clinical prediction faster and better so we can rapidly translate the best models into the best outcomes for patients. At the same time, we know from experience that no organization can single-handedly transform healthcare. Momentous information hidden in data silos across sectors of the healthcare landscape can help demystify the complexities around cost and outcomes in the United States, but lack of transparency and collaboration due to privacy and compliance concerns along data silos have made data access difficult, expensive, and resource-intensive to many innovation designers.

Until recently, the only way to share clinical research data has been de-identification, selectively removing the most sensitive elements so that records can never be traced back to the actual patient. This is a fair compromise, with some important caveats.

With any de-identified data, we are making a tradeoff between confidentiality and richness, and there are several practical approaches spanning that spectrum. The most automated and private method, so-called “Safe Harbor” de-identification, is also the strictest about what elements to remove. Records de-identified in this way can be useful for many research cases, but not time-sensitive predictions, since all date/time fields are reduced to the year only.

At the other extreme, it is possible to share more sensitive and rich data as a “Limited Data Set” to be used for research. Data generated under this standard still contains protected health information and can only be shared between institutions that have signed an agreement governing its use. This model works for long-term research projects, but can require lengthy contracting up front and the data is still locked within partner institutions, too sensitive to share widely.

What’s a novel yet pragmatic solution to ensure that analytics advancement is catalyzed in healthcare industry? We are exploring “synthetic data,” data created from a real data set to reflect its clinical and statistical properties without showing any of the identifying information.

Pioneering work is being done to create synthetic data that is clinically and statistically equivalent to a real data source without recreating any of the original observations. This notion has been around for a while, but its popularity has grown as we’ve seen impressive demonstrations that implement deep learning techniques to generate images and more. If it’s possible to generate endless realistic cat faces, could we also generate patient records to enable transparent, reproducible data science?

The deep learning approach works by setting up two competing networks: a generator that learns to create realistic records and a discriminator that learns to distinguish between real and fake records. As these two networks are trained together, they learn from their mistakes and the quality of the synthesized data improves. Newer approaches even allow us to further constrain the training of these networks to match specific properties of the input data, and to guarantee a designated level of privacy for patients in the training data.

We are investigating state-of-the-art methodologies to evaluate how effective the available techniques are at creating data sets. We are devising strategies for overcoming technology and scientific barriers to open up an easy access realistic data platform to enable an exponential expansion of data-driven solutions in healthcare.

Can synthetic data be used to accelerate clinical research and innovation under strong privacy constraints?

In other data-intensive areas of research, new technologies and practices have enabled a culture of transparency and collaboration that is lacking in clinical prediction. The most impactful models are built on confidential patient records, so sharing data is vanishingly rare. Protecting patient privacy is an essential obligation for researchers, but privacy also creates a bottleneck for fast, open, and broad-based clinical data science. Synthetic data may be a potential solution healthcare has been waiting for.

Morning Headlines 12/20/17

MedHost

EDIS vendor MedHost is the victim of a ransomware attack that brought down its webpage twice on Tuesday. The company has yet to make a public statement about the attack, and its public-facing webpage has since been restored.

Humana, private-equity firms buy Kindred Healthcare for $4 billion

Humana has partnered with two private equity firms to acquire home-health care and long-term care operator Kindred Health for $4 billion.

Health IT Leader Fortifies Tech and Policy Innovation at Dell Medical School

Former National Coordinator for Health IT Karen DeSalvo, MD joins the faculty at the University of Texas Austin’s Dell Medical School where she will serve as a professor in the Division of Primary Care and Value-Based Health.

It’s Official: North Korea Is Behind WannaCry

Republican White House staffer Thomas Bossert pens a Wall Street Journal op-ed publicly attributing the WannaCry cyberattack to North Korea operatives.

News 12/20/17

Top News

Medhost’s public website medhost.com was hacked Tuesday morning, according to a cyber intruder’s message that replaced the company’s usual home page content.

The hacker demanded 2 bitcoin ($37,000), threatening to otherwise “sell the patient data and do a media release regarding the lack of security in a HIPPA [sic] environment.” Medhost offers hosted financial and clinical systems, an emergency department system, a patient portal, and a health and wellness site.

The site had returned to normal by Tuesday afternoon with no acknowledgement of the previous problem on the site or on social media. A Medhost spokesperson did not return my call in which I asked for verification of the hacker’s claim that patient data was exposed.

UPDATE: shortly after the normal home page was restored late Tuesday afternoon, the site was apparently hit again with the “this website has been hacked” message restored.

UPDATE 2: Medhost CISO William Crank reports that the problem has been resolved and no information was compromised:

MEDHOST has full control of the domain, and the restoration of the domain and associated applications has been completed. Depending upon geographic location, sites may already have full access, but it is possible that the DNS restore process could take up to 24 hours to propagate the changes due to TTL. Intermittent application impact may be experienced by end users during that time. MEDHOST wants to reiterate that there is no indication that sensitive information was comprised and the incident didn’t extend beyond the redirection of the MEDHOST DNS to a static site with the message your article referenced. We strive to provide a robust and secure platform for our clients and continue to investigate this incident and its root cause.

Reader Comments

From Athenahealth: “Re: APIs. We have integrations with over 200 innovators and a developer community of 7,000, processing 700 million calls per month. Our single-instance, multi-tenant cloud platform allows a global integration model that allows immediate access to all partners for our clients – where innovators connect once and then are activated at clients with the flip of switch. We agree that talking numbers is interesting, but more so, let’s start to talk about API usability and the downstream impact of API calls.” It’s encouraging that Allscripts, Epic, and now Athenahealth have checked in with big API usage numbers. None of these are surprising – Allscripts (in the form of the acquired Eclipsys) pretty much defined the idea of inpatient systems with “hooks” as we called them in the old days, while Epic and Athenahealth stay current in deploying modern technologies and Athenahealth’s system is based on connectivity. I’m guessing Cerner has impressive numbers although I haven’t seen them.

From Event Attendee: “Re: John Halamka’s installation as Harvard Medical School’s inaugural International Healthcare Innovation Professor of Emergency Medicine. I had the distinct honor of attending and snapped a picture of a few notable CEOs in the room – Jonathan Bush (Athenahealth), Girish Navani (EClinicalWorks), and Hoda Sayed-Friel (Meditech). It’s remarkable that they spent the morning together honoring his lifetime of achievement.”

From Earth Shatterer: “Re: Epic. What exactly is Sonnet?” Sonnet is a streamlined, cheaper, faster-install subset of Epic’s full software suite being developed that will target small hospitals and physician groups, post-acute care facilities, and some international organizations. It will be released in March 2018. Sonnet was announced at HIMSS17 along with Utility, a fast installation program that gets customers live faster with fewer modifications. Epic says Utility implementations started in Q4 2017 (it’s now Epic’s most popular implementation method) and the first Utility-implemented customers will go live in 2018. Judy Faulkner chooses all Epic product names herself and they always contain a subtle reference, in this case with the word “sonnet” as translated from Italian as “little song.” Epic has tried similar rollouts in the past, twice in a partnership with Philips in the early 2000s and another attempt a few years later using the Sonnet name that may have failed because of newly mandated Meaningful Use requirements, but this one seems like a done deal.

From Who Else Remembers?: “Re: selection consultants having a conflict of interest. This is reminiscent of the late 1980s and early 1990s when Arthur Andersen was accused of a similar bias. Back then, the cozy relationship resulted in a string of predictable yet questionable wins for Gerber Alley and Statlan. Anderson would do the selection and inevitably be granted a large advisory and implementation role post award. Notably, Jay Toole and Andersen were crisscrossing the country espousing the virtues of a best-of-breed approach that needed lots of consulting help, for which Andersen was all to eager to offer the brave buyers of these footnotes in HIT history.” It’s a longstanding question of whether consulting firms that sell system services should be asked to help customers choose those same systems, at least without first recusing themselves from earning future business related to the selection. On the other hand, health systems can hire whoever they want and are presumably acting in their best interest. You mentioned Jay Toole, and in tracking him down, I learned that Dearborn Advisors filed Chapter 7 bankruptcy and apparently closed earlier this year. For more about Gerber Alley, see Vince’s HIS-tory.

From Fanny Pacque: “Re: vendor underbidding. Epic underbids (probably to their advantage) relative to their competitors. Implementation services, additional software, etc. always come later and require direct third-party engagement. This is the tick-tock on how you get to projects that go 2-3x over budget. Example: San Francisco Department of Public Health, which is a few months out from choosing Epic and they’re already bidding out voice recognition software, revenue cycle implementation, HIM, and patient outreach. You can see why Allscripts, Cerner, and others might suggest increased transparency on this topic since they provide fully loaded proposals.” San Francisco DPH’s several Epic-related RFPs are here (on the right side of the page as part of RFP 47-2017). I would think a prospect would know to compare apples to apples in choosing a vendor, but sometimes they get so mentally locked in to their favored vendor that they don’t dig deep enough and/or their lack of EHR selection experience makes them unsuited to detect contract land mines.

HIStalk Announcements and Requests

The efficiency of DonorsChoose is always impressive to see – we funded the teacher grant request of Mrs. A in Michigan on December 10 and her students are already using the STEM kits and experiment books we provided just nine days later, as evidenced by the photos above. She reports, “My students and I are so elated that this project was funded. The excitement they showed when we unwrapped the science kits was unprecedented! I wanted to thank you again for your very generous donation. The students are now able to take science out of the science classroom and bring it in to their homes. Not only have you allowed the students to experience science phenomena, you have also allowed their families to as well! Many of my students and their families do not have access to the items that will enable them to perform these experiments and now they do! You have truly helped to create lifelong memories.”

Welcome to new HIStalk Platinum Sponsor Ellkay, which brilliantly taglines itself as “Healthcare Data Plumbers.” The Elmwood Park, NJ-based company enables interoperability, providing a data pipeline for 45,000 practices and 500 PM/EHRs and connecting hospitals, practices, labs, payers, HIEs, and ACOs using almost any system. Products include connectivity for diagnostic labs; PM/EHR integration and data migration, lab orders and results interfaces; and ACO/HIE connectivity solutions. Its CareEvolve portal and interfaces provide clinical workflow support between laboratories and the point of care, while hundreds of hospitals have used Ellkay’s data extraction, conversion, and archiving services to decommission legacy systems. Black Book included Ellkay on its list of 2017’s most disruptive health IT companies that have top customer satisfaction scores. The company’s “Our Story” page is the most entertaining and fascinating backgrounder I’ve seen and the story about why they installed beehives on the company roof roped me in completely. Thanks to Ellkay for supporting HIStalk and for entertaining and informing me with an unusually cool website.

Webinars

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

Acquisitions, Funding, Business, and Stock

High-profile Silicon Valley investor Bill Gurley – an early Uber backer whose startup Brighter was just acquired by Cigna – launches Stitch Health, a Slack-like care team coordination and patient engagement platform. The Connect team communication system costs from $6 to $18 per user per month depending on features. Stitch CEO and co-founder Bharat Kilaru is a 2015 Harvard MBA graduate and ran a Nashville clinic for the underserved until 2013.

Pittsburgh-based specialized outpatient clinical documentation vendor Net Health will be acquired by two private equity firms and the company’s management team.

Humana and two private equity firms will acquire home health and long-term care operator Kindred Healthcare for $4 billion, continuing the trend of insurers moving into direct patient care.

A New York Times review of proposed health system mega-mergers contains some interesting quotes:

• “Hospital executives are realizing that someone else, including an insurance company employing the nurse at a walk-in clinic or the doctor at a surgery center, wants to take over their relationship with patients — and the potential revenue that those patients represent.”
• “But many point to the promises of past mergers as reason to doubt whether the hospital mergers allow much more than an ability to demand higher prices from insurers. After the last wave of mergers that took place a few years ago, the hospitals didn’t use that opportunity to bring their costs down.”
• “The challenge cannot be underestimated in asking these massive institutions to come together and change into something radically different. You’re taking a zebra and a zebra … what they want to become is a unicorn.”

Silicon Valley, meet Bubble 2.0: SoftBank will invest up to $300 million in a dog-walking app vendor that has already raised $40 million.

Sales

Mercy Health chooses PatientPing for real-time patient care coordination.

People

Recondo Technology hires Craig Niemiec (AxisPoint Health) as CFO.

Patrick Neil Mescall, PhD (Businessolver) joins VirtualHealth as SVP of channel development.

Former National Coordinator Karen De Salvo, MD, MPH, MSC joins Dell Medical School at the University of Texas at Austin as a professor, with appointments in internal medicine and population health.

Announcements and Implementations

A survey of a few dozen hospital CIOs finds that the biggest jump in deployed mobile strategy components over the next three years will be in critical test result alerts, clinical decision support alerts, and care team assignments. Respondents also indicated that their investment in communications technologies will be slightly more driven by system integration capabilities than by end user needs.

I’ve never heard of CHIME’s 2014 spinoffs AEHIS, AEHIT, and AEHIA – which seem to have been created primarily to help CHIME to lasso new dues-paying members who don’t meet the job qualifications to join CHIME since they aren’t CIOs (security executives, CTOs, and application leaders, respectively) – but for those CHIME members who are interested, they’re waiving dues for 2018. I don’t quite understand why a prominently posted press release on the site of AEHIS (that’s the security group) is “Fujifilm Captures New Customers for its Synapse Enterprise Imaging Solutions,” but then again I don’t usually like providers and vendors sharing an association-provided membership bed even when a logical connection exists. As readers have observed, CHIME is mimicking HIMSS in seemingly trying to get bigger, more vendor-friendly, and more executive-compensating, but its members are apparently OK with that and that’s all that counts.

Government and Politics

Americans say healthcare is the country’s second-biggest problem behind the government, Gallup finds. Healthcare hasn’t been one of the top two problems since 2007, when it finished a distance second to Iraq.

Privacy and Security

White House Homeland Security Advisor Tom Bossert says in a Wall Street Journal op-ed piece that North Korea launched the WannaCry malware attack earlier this year that hit hospitals hard, adding, “Pyongyang will be held accountable.”

A Black Book survey finds that 84 percent of healthcare provider organizations don’t have a chief information security officer, 54 percent don’t conduct cybersecurity risk assessments, and 39 percent don’t perform regular firewall penetration testing. The survey also finds that few boards of directors actively discuss cybersecurity.

Yet another exercise proves that de-identifying patient data doesn’t really work, as a university in Australia (as several have done) matches up a publicly released Australia Medicare database and re-identifies patients by linking their information to other publicly available databases. The Australian government is considering laws that would make re-identifying government data illegal, which is an interesting (and not in a good way) approach.

Other

A reader whose company has nothing to do with healthcare consulting was surprised to have it shortlisted among the “Top 10 Healthcare Consulting Firms 2018,” which comes with a (free) certificate and (not free) interview reprint rights from a magazine called Enterprise Services Outlook. The magazine shares a telephone number and street address with shady magazines (CIO Review and Healthcare Tech Outlook) published by Bangalore-based marketing firm SiliconIndia. I’ve previously noted the hilarious misspelling of HIPAA on the cover of Healthcare Tech Outlook and the fact that its covers always feature males. It has published an article by UC Health CIO Steve Hess (which also appeared word for word in Becker’s Hospital Review under a different UC Health author’s name) and by other health system CIOs like Marc Probst and Dan Waltz who probably don’t even realize who they’re writing for. The magazine invites readers who “skimp” [sic] its questionable vanity content to join its august roster of contributors.

Jenn ran this fun item on HIStalk Practice: an Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own epinephrine and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”

Moxe Health founder and CEO Dan Wilson reads “’Twas the Night Before Go-Live,” an HIT-focused song parody written by Jay Rath. Jay fascinates me because in addition to having spent time with Epic, he’s a former staffer at “The Onion,” a contributor to “Mad” magazine, and has a broad background in theater and radio comedy.

Wendy from Bellin Health (WI) sent a photo of the Epic Willow team’s holiday-decorated cubicle area in the IT department that creatively adds a fireplace inside and a welcome mat out front. The coats inside prompted me to check Green Bay’s weather forecast – Tuesday was to be sunny with a relatively balmy high of 40 degrees and a low of 11, but Christmas will be biting as temps struggle to rise to zero (Fahrenheit, just to be clear).

Sponsor Updates

• The InstaMed team delivers over 900 presents to the Children’s Hospital of Philadelphia.
• Definitive Healthcare adds visual dashboards to its hospital and provider databases.
• Elsevier Clinical Solutions publishes a new white paper, “Build or Buy: Considerations when adding a new Clinical Decision Support System.”
• FormFast publishes a new case study, “East Alabama Medical Center Saves Time and Cuts Costs with FormFast’s Leading Form Design Technology & Services.”
• Healthfinch publishes a new case study featuring Valley Medical Group.
• Data analytics from Arcadia Healthcare Solutions supports a New York Times skin cancer investigation.
• T-System President and CEO is recognized at D CEO’s “Excellence in Healthcare” awards program.
• Besler Consulting releases a new podcast, “Perspectives on the Alex Azar nomination for HHS Secretary.”
• Mphasis Eldorado and Change Healthcare expand their partnership to include integration between Javelina and Change Healthcare’s payment integrity services.

Blog Posts

• 5 Tips for a Consumer Friendly Front Desk (Hayes Management Consulting)
• 6 Resolutions for a Healthier and Happier New Year (Healthgrades)
• The Evolution of Healthcare and Railways (Optimum Healthcare IT)
• eGartner to healthcare provider CIOs: Evaluate biometrics for their most important patient identification use cases (Imprivata)
• The New Healthcare CRM: Moving Beyond Marketing (Influence Health)
• A Look Back: The Top Tips of 2017 (Leidos Health)
• Red Flags You Have a Patient Access Problem (Kyruus)
• MIPS Cost Component – Three Things You Need to Know! (Impact Advisors)
• The Healthcare Platform Advantage: How to Do More With Less (Spok)
• Address All Four Parts of HIPAA Compliance (AdvancedMD)
• Agfa HealthCare proudly supports the UNICEF Emergency Fund (Agfa HealthCare)
• Q4 Industry Report: Shadow IT’s positives and negatives within healthcare (Datica)
• Amazon, CVS and Aetna: Online Medicine and the Future of Healthcare (CareSync)
• Navigate the Penalties & Bonuses of the 2018 MIPS Reporting Year (Chart Logic)
• Celebrating the Holidays with Karson and Make-A-Wish Foundation (CoverMyMeds)
• Embracing the Spirit of Giving (Dynamic Computing Services)
• How Will Artificial Intelligence and Machine Learning Impact Healthcare? (Dimensional Insight)

Contacts

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