Readers Write: I Am More Than My Specialty: Physician Burnout and Individualism

I Am More Than My Specialty: Physician Burnout and Individualism
By Erin Jospe, MD

Erin Jospe, MD is chief medical officer of Kyruus of Boston, MA.

While physician burnout is garnering more attention with a steady generation of articles and books both academic and lay, we have yet to see improvements despite our awareness of the problem. We have become facile at recognizing the symptoms of exhaustion, detachment, cynicism, and inefficiency as the hallmarks of burnout, but no better at treating the underlying causes.

Per Medscape, no specialty was spared an increase in self-reported burnout symptoms between 2013 and 2017, [1] and the prevalence is unsettling at almost 60 percent in some fields. [2] While there is no silver bullet for burnout, within their professional work environments, recognizing physicians as individuals and giving them the means to convey their unique areas of expertise to patients, fellow providers, and others within the health system can go a long way in paving a path to higher satisfaction and engagement.

We are equally aware of the downstream ramifications of physician burnout as we are of the symptoms, with repeated studies demonstrating the negative impact on patient safety, quality of care, and the patient experience. With the refocusing of the context of care upon the mission to improve patient lives, in 2007 the “Triple Aim” reminded us of the importance of how individual patients experience care. In the 10 years since, there has been a paradigm shift in respecting the individual patient as having unique needs and values that must be addressed to achieve better health.

Physician burnout directly undermines our ability to deliver on this promise and has worsened in the same 10 years. It was innovative to say we needed to acknowledge the humanity of our patients to deliver better care, to recognize the individual and not view them as interchangeable with every other patient. And yet by creating a delivery system that only recognizes the humanity of those needing care and not of the care providers, we sully the sacredness of that patient-provider relationship and create the same negative environment of disrespect that results in so much dissatisfaction among both providers and their patients.

Though we rightly strive to see and address the individual needs of the patient, there is a widespread sense that physicians themselves are interchangeable. This is no less disrespectful than perceiving patients as such. As a physician, I am far more than my specialty,  as are my colleagues. Yes, I have an expertise, and with it comes an expectation of an established skill set and standards of care. But I have a style, manner, and experience that is my own. I have defined niches of interest and excellence that make me better suited to the needs of some patients.

When given no means, no vocabulary, no voice with which to articulate that which is unique to a physician, we do a disservice to the individual physician and to the community of patients and other providers who would seek them out. Our health systems and networks of physicians are growing exponentially larger, but with it, our awareness of individual contributors diminishes. We no longer have connections with one another as physicians and no insight as to where unique strengths and gifts might exist among us.

In the face of an exploding fund of medical knowledge, we cannot deny the necessity of understanding where unique expertise — and not just specialty — lives. It is hard to enough for physicians to acknowledge the deficiencies in our knowledge base. Providing no means by which to uncover who within our community might help only furthers a tendency toward emotional and mental exhaustion.

Addressing burnout at an individual physician level is often too little, too late. Resiliency is important, but in and of itself, resiliency does not change the environment for which it is necessary, and too often will be insufficient to treat or prevent burnout.

Instead, consider the systemic and holistic organizational contributions to the environment which are causal. Rather than address the individual’s propensity to burnout, address the individual. Allow them to be acknowledged and appreciated as uniquely individual contributors. Give them the means to indicate to their networks what their clinical areas of focus are beyond merely specialty / subspecialty. Provide them with teams aligned in their mission to act in concert as exceptional people in the care of exceptional people. Facilitate their understanding of the excellence that exists within the community of providers.

Failure to do so diminishes the joy and satisfaction of relational patient care by converting those interactions into the merely transactional. Though not a panacea for physician burnout, we need to address the anonymity of our providers if we are to do justice to the promise of prioritizing the patient experience.

[1] Medscape Lifestyle Report 2017

[2] AMA, “Report reveals severity of burnout by specialty,” Jan. 31, 2017.

Readers Write: Continuous Clinical Surveillance: An Idea Whose Time Has Come

Continuous Clinical Surveillance: An Idea Whose Time Has Come
By Janet Dillione

Janet Dillione is CEO of Bernoulli Health of Milford, CT.

It’s no secret that the general acuity of hospitalized patients is increasing as the overall US population continues to age (hello, Baby Boomers). Many patients who would have been in an ICU in the past are now found in lower-acuity areas of the hospital. We foresee that the hospital of tomorrow, in terms of monitoring and surveillance capabilities, will need to be more like an enterprise-wide ICU.

A significant problem with such a transformation is that hospitals will not be able to staff their entire facility like an ICU. In most hospitals, there is simply no money to add more staff. Even if there were sufficient funds, doctors and nurses are in short supply. Hospitals will have no choice — they will need new technological tools to help clinicians manage these rising levels of acuity.

One type of technology that holds promise in this regard is continuous clinical surveillance. In contrast to electronic monitoring — which includes observation, measurement, and recording of physiological parameters — continuous clinical surveillance is a systematic, goal-directed process that detects physiological changes in patients early, interprets the clinical implications of those changes, and alerts clinicians so they can intervene rapidly. (1)

Just a few years ago, continuous clinical surveillance would have been impossible because there was no way to integrate data from different monitoring devices, apply analytics to that information in real time, and communicate alerts to physicians and nurses beyond the nearest nurse’s station. But today, medical device data can be aggregated and analyzed in a continuous stream, along with other relevant data such as patient data from the EHR. In addition, many clinicians now carry mobile devices that allow them to be alerted wherever they are.

Early Warning System

A continuous clinical surveillance system uses multivariate rules to analyze a variety of data, including real-time physiological data from monitoring devices, ADT data, and retrospective EHR data. When its surveillance analytics identify trends in a patient’s condition that indicate deterioration, the system sends a “tap on the shoulder” to the clinicians caring for the patient.

For example, opioid-induced respiratory depression accounts for more than half of medication-related deaths in care settings. (2) Periodic physical spot checks by clinical staff can leave patients unmonitored up to 96 percent of the time. (3) By connecting bedside capnographs and pulse oximeters to an analytic platform to detect respiratory depression and instantly alert the right clinicians, continuous surveillance can shorten the interval between a clinically significant change and treatment of the patient’s condition.

A recent study found that compared to traditional patient monitoring and spot checks, continuous clinical surveillance reduced the average amount of time it took for a rapid-response team to be deployed by 291 minutes in one clinical example. In addition, the median length of stay for patients who received continuous surveillance was four days less than that of similar patients who were not surveilled. (4)

Another condition that requires early intervention is severe sepsis, which accounts for more than 250,000 deaths a year in the US. (5) The use of continuous clinical surveillance can help predict whether a patient’s condition is going to get worse over time. By aggregating data from monitoring devices and other sources and applying protocol-driven measures for septicemia detection, a multivariate rules-based analytics engine can identify a potentially deteriorating condition and notify the clinical team.

Reduction in Alarm Fatigue

Repeated false alarms from multiple monitoring devices often cause clinicians to disregard these alerts or arbitrarily widen the alarm parameters. Continuous surveillance can significantly reduce the number of alarms that clinicians receive.

An underlying factor that produces alarm fatigue is that the simplistic threshold limits of physiologic devices — like patient monitors, pulse oximeters, and capnographs — are highly susceptible to false alarms. Optimization of the alarm limits on these devices and silencing of non-actionable alarms is not enough to eliminate this risk. The challenge is achieving a balance between communicating essential patient information while minimizing non-actionable events.

Continuous clinical surveillance solutions that analyze real-time patient data can generate smart alarms. Identifying clinically relevant trends, sustained conditions, reoccurrences, and combinatorial indications may indicate a degraded patient condition prior to the violation of any individual parameter. In addition, clinicians can leverage settings and adjustments data from bedside devices to evaluate adherence to or deviation from evidence-based care plans and best-practice protocols.

In a study done in a large eastern US health system, researchers sought to establish that continuous surveillance could alert clinicians about signs of OIRD more effectively than traditional monitoring devices connected to a nurse’s station without compromising patient safety. The results showed that a continuous surveillance analytic reduced the number of alerts sent to the clinical staff by 99 percent compared to traditional monitoring. No adverse clinical events were missed, and while several patents did receive naloxone to counter OIRD, all patients at risk were identified early enough by the analytic to be aroused and avoid the need for any rapid response team deployment. (6)

Clinical Workflow

When CIOs are considering a continuous clinical surveillance solution, they should look for a platform that fits seamlessly with their institution’s clinical workflow. This is especially important outside the ICU, where the staff-to-patient ratio is lower than in critical care. In these care settings, a solution that can be integrated with their mobile communication platform ensures that alerts will be received on a timely basis.

In addition, the continuous surveillance solution should have an open interoperability standards based architecture that integrates with the hospital’s EHR, clinical data repository, and other applications. Especially in these times, it must support strict security protocols as part of an overall cybersecurity strategy.

Clinicians are beginning to recognize that continuous clinical surveillance can help them deliver better, more consistent, more efficient, and safer patient care. In this respect, it reminds me of the timeframe after publication of the famous IOM report that highlighted the dangers of medication errors in the US healthcare system. Companies scrambled to provide a solution, and when automated medication administration was first introduced, the technology was unimaginably clunky. As many of us remember, COWs left the pastures and moved onto hospital floors.

I had the opportunity to watch clinicians who had significant doubts about bar coding and scanning try these new tools. It only took that first patient where the technology helped them avoid dispensing an incorrect medication to turn a skeptic into an evangelist. They quickly realized their patients were safer because of the new technology. Clinicians will discover that continuous clinical surveillance offers the same type of patient safety benefits.

Eventually, hospitals will use continuous surveillance with acutely ill patients in all care settings. The ability of analytics to interpret objective physiological data in real time and enable clinical intervention for deteriorating patient conditions that could otherwise be missed is just too powerful to ignore.

REFERENCES

1. Giuliano, Karen K. “Improving Patient Safety through the Use of Nursing Surveillance.” AAMI Horizons. Spring 2017, pp 34-43.

2. Overdyk FJ, Carter R, Maddox RR, Callura J, Herrin AE, Henriquez C. Continuous Oximetry / Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During Patient-Controlled Analgesia. Anesth Analg. 2007;105:412-8.

3. Weinger MB and Lee La. No patient shall be harmed by opioid-induced respiratory depression. APSF Newsletter. Fall. 2011. Available at: www.apsf.org/newsletters/html/2011/fall/01_opioid.htm.

4. “Improving Patient Safety through the Use of Nursing Surveillance.”

5. Centers for Disease Control and Prevention, “Data & Reports: Sepsis.” https://www.cdc.gov/sepsis/datareports/index.html

6. Supe D, Baron L, Decker T, Parker K, Venella J, Williams S, Beaton L, Zaleski J. Research: Continuous surveillance of sleep apnea patients in a medical-surgical unit. Biomedical Instrumentation & Technology. May/June 2017; 51(3): 236-251. Available at: http://aami-bit.org/doi/full/10.2345/0899-8205-51.3.236?code=aami-site.

Readers Write: Analytics Optimization: Doing What It Takes

Analytics Optimization: Doing What It Takes
By Lee Milligan, MD

Lee MIlligan, MD is VP/CIO of Asante of Medford, OR and a director of the governing boards of Asante, Oregon ACO, and Propel Health.

I recently surveyed a number of large and medium-sized integrated healthcare institutions in the Pacific Northwest with a focus on the analytics experience. I sought to answer one question: how do the operational and clinical end users perceive their experience of requesting and receiving information? I talked to CIOs, CMIOs, and directors of analytics.

Although the conversations touched on many concerns, three themes emerged that I now call the “Three Reporting D’s” – delay, distrust, and dissatisfaction. End users are just not getting what they need to do their jobs on time. Despite the adoption of sparkly analytics software products, the problems continue to fester.

We experienced a similar disconnect a few years back, and have, over the course of three years, re-architected our approach. Although we still have room for improvement, I’d like to share a bit about what we learned and how this reboot has led to a more satisfying end user experience.

We started the internal investigation by looking at the entire end-to-end experience from the customer’s perspective. Using a lean management technique known as value stream mapping, we drew out on a white board all of the steps that a typical end user would experience as they requested information from our analytics team. Surprisingly, this took quite a while and we ran out of white board space.

This was telling. Why does this process include so many steps? It reminded me of the 1990s Windows installations where the customer would continuously have to click “next” to move the process forward.

One of the keys of this lean technique is to identify the steps in the process that add value and eliminate the rest. We got stuck on the definition of value. What is valuable to the end user? When we honestly answered that question, a surprising number of steps were removed.

Next we asked, what’s missing? That question required us to walk in the shoes of our customer, like a doctor’s seeing the world through the patient’s lens. I also had the advantage of two additional frames of reference:

• I personally requested that a report be built for me from scratch using the prior method, and
• I asked the BI developers to CC me on all email communications between them and the customer.

Both experiences unearthed missing fragments, which ultimately informed our strategic BI architecture. Most of the changes we instituted were budget-neutral, process-related improvements. However, I would like to highlight two changes which cost a few bucks that delivered tremendous ROI.

Customer/BI Developer Partnership and Communication

We recognized fairly quickly that these relationships were in need of optimization. First, the customer rarely knows what they want. That’s not to say they can’t make a request. However, they frequently request what they don’t ultimately need or want.

Second, I discovered through those CC’d emails that they are requesting many additional discrete elements, far beyond the initial scope, usually as they learned more about what the information looks like. In other words, they didn’t fully understand what they were looking for and we were unprepared to fully discover with them what they ultimately need.

To plug that hole, we instituted a new position within our team, the clinical data analyst. Something akin to the business analyst in the corporate world, this role is responsible for working directly with the end user to accomplish two goals: (a) to fully understand the ask to detail this in the agreed-upon scope, and (b) to commit the requestor to actively participate in the data development process.

Also, our team of BI developers desired guidance on how they should communicate with our end users. We had naively taken that piece for granted. They requested clear direction on how to frame conversations, how to respond to specific requests that are outside of agreed-upon scope, and how to ask better questions of the initial ask.

Teaching/Training

We surveyed our customers and discovered something astonishing. Many are not using the reports and data that we have delivered. When pressed, it became clear that many did not fully understand the information produced and even fewer understood how to incorporate this data into their workflow to better inform operational decision-making.

We developed a new role as a principal trainer within ITS-Analytics. The goals of this role are twofold: (a) to work directly with end users to assure a full and practical understanding of the delivered information (i.e., how to read the report, what the symbols mean, how to navigate an analytics dashboard, etc.), and (b) to lead our self-service domain. The self-service aspect has significant potential to meet customer’s needs in a rapid, nimble fashion.

Putting it all together, our take-home lesson has been the criticality of performing regular internal assessments in order to verify that we are meeting our customer’s needs—from their point of view—objectively and subjectively.

CIO Unplugged 3/21/18

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

This is my final HIStalk “CIO Unplugged” post.

I began “blogging” 15 years ago as CIO with University Hospitals in Cleveland. It was an internal, interactive SharePoint hosted site. It became an effective tool to engage my team. I shared what was going on with the health system and IT and asked questions to solicit feedback. It worked well, so I adopted the same format at Texas Health.

A member of my team suggested that I share my blog broadly via a national forum. She entered me in a “contest,”submitting samples, Bam! “CIO Unplugged” was born. When the publication folded, Mr. HIStalk picked me up.

It’s a labor of love involving 10 years’ worth of bi-monthly posts on a wide range of topics. I purposely avoided hardcore technology topics since you get plenty of that content already. Harder to find is transparent insight into what at least one CIO thinks about, primarily around life, teamwork, and leadership.

Through the years, I acknowledged many individuals who enabled my professional endeavors. Everyone from parents, siblings, family, friends, managers, teams, and pastors. I will use my final post and give thanks one more time to those who did the real work — my teams, the IT caregivers.

I have the privilege of representing my teams in good and bad, and it is overwhelmingly good. While I received accolades in my journey, it is all about the teams that make things happen. The teams are the individuals who make all the good possible. Saving lives, impacting quality of care, lowering costs, and enabling the fulfillment of organizational goals and missions and visions. Despite attempts to deflect light received onto them, they often remain in the shadows, hidden.

Leaders often forget that without teams, we are nothing. It is all about the teams who work in the trenches. Trenches (cubes, offices, home, etc.) are where real work gets done. Trenches are where sacrifices are made. Trenches are full of unsung heroes. Trenches are where lives are saved.

While we are at conferences, our team is in the trench. While we do interviews, our team is in the trench. While we attend meetings, our team is in the trench. While we write blogs, our team is in the trench. When we vacation, our team is in the trench.

I will end calling out three individuals who serve in the trench. My assistants, who I prefer to refer to as partners.

Carol (2003-2007). My very first partner. Brash and sassy, she had my back. She was strong and never took no for an answer as she opened doors previously closed to enable my success. A pastor’s wife, she prayed for me, and boy, did I need it! Attending her mother’s funeral, Carol surprised all of us with skill and passion playing drums for a 30-minute solo rivaling Neal Peart and John Bonham. Carol helped me become a CIO. Now retired, we connected when I returned to Cleveland and had a good time catching up.

Dedie (2007-2015). I knew the moment we interviewed that Dedie was the one to help me be successful in Texas. A Katrina refugee, Dedie and I hit it off immediately. While she appears much younger, we are both 1980s kids and would easily have been high school buddies. Dedie jumped on a few grenades for me and shielded me. Also a pastor’s wife, she prayed for me daily. I loved visiting her church. I bettered my speaking abilities watching her husband preach. When I divorced, Dedie and Thad walked through the valley with me until I remarried. Our friendship continues today.

Virtual (2015-2017). Having no partner while in NYC reminded me how much I missed having one.

Dara (2017-20XX). It has only been a few months, but I can already tell that we are hand and glove. Dara came from within my organization, so we have a huge head start. She is proactive and stays one step ahead of me. I was overwhelmed recently with presentations and she put together presentation starter sets that cut my creation time in half. Dara creates space in my schedule for reflection and ensures that I take care of myself. We have dined with spouses and have built a firm foundation for many years to come. I hope Dara is my last partner.

To those who served with me in the trenches, thank you. What inspiration, strength, and hope you gave me knowing you were there. You did amazing things. When it all comes down, it is really about you who are serving in the trenches. You are the ones who save lives. You are the ones who make a difference in the lives of caregivers and patients. Silently. Quietly. Hidden. In the trenches.

Thank you, Mr. HIStalk, for having me all these years.

“CIO Unplugged” may continue. Connect with me on LinkedIn to learn more.

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

Morning Headlines 3/21/18

VA Open Application Programming Interface Pledge Gains Momentum to Shape a New Direction for Health Care

UPMC Chief Innovation Officer Rasu Shrestha, MD, MBA will lead the VA’s API project that was announced at HIMSS18.

Intermountain Healthcare employees brace for more job cuts as Utah’s largest employer readies to ‘adapt or die’

Intermountain Healthcare employees prepare for another round of layoffs as the Utah-based health system continues cost-cutting efforts to remain competitive with disruptors to the healthcare field like Amazon and Google.

VA-Cerner numbers skyrocket

The VA’s Cerner project will cost $16 billion instead of the previously hinted $10 billion, according to comments made in a House Appropriations Committee by Rep. Debbie Wasserman-Schultz (D-FL).

News 3/21/18

Top News

Houston-based RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy and will sell the business due to the servicing costs of the extensive debt it took on to fund its acquisition strategy.

The company says it fired unnamed executives who intentionally misstated its revenue and earnings.

A lawsuit filed in late 2016 claimed that CEO Paul Parmar masterminded a series of fraudulent acquisitions to allow him to falsify revenue numbers while misappropriating cash.

A private investment firm owned by former Blackstone executive Chinh Chu bought the company for $309 million in early 2017.

Reader Comments

From Stern Countenance: “Re: Tronc. Mike Ferro is out as chairman following allegations of inappropriate sexual behavior. Justin Dearborn, one of his cronies from his Merge Healthcare days, will replace him. Ferro was already a jillionaire with the sale of Merge Healthcare to IBM plus he was rich before he joined Tronc. Ferro gets a $15 million consulting contract as a farewell gift. Now Justin gets to be a jillionaire, too. These guys are no dummies when it comes to money, including running Merge into the ground by slashing and burning to make numbers that looked good enough to get IBM to buy the company.” There’s another healthcare connection – Tronc (the former Tribune Publishing) is selling the Los Angeles Times to NantHealth’s Patrick Soon-Shiong for $500 million in cash. I interviewed Justin Dearborn in early 2014; IBM bought Merge Healthcare for $1 billion in mid-2015 to expand its Watson offerings.    

From Obsidian: “Re: HLTH conference. Between JPMorgan and HIMSS I’ve seen 100+ billboards and ads for this new conference that’s supposed to be the greatest thing since sliced bread. What do you and your readers know about it?” The conference, taglined as “The Future of Healthcare,” will be held in Las Vegas May 6-9. They expect 2,000 attendees and will offer a smallish exhibit hall. The guy in charge is money guy and conference organizer Jon Weiner, who has zero healthcare experience in advocating for “disruptive innovation.” He has raised $5 million in funding to launch the conference. Among HLTH’s handful of sponsors are Change Healthcare, Optum, and UPMC. The massive roster of 250+ presenters includes the CEOs of Allscripts, Geisinger, 23andMe, Optum Health, Change Healthcare, Sharecare, Intermountain Healthcare, and Athenahealth. HIMSS (and its newly acquired Health 2.0) seems to have most of the bases well covered and JPMorgan is where the money guys and CEOs hang out, so I’m not quite sure how HLTH will convince people to spend another $1,850 registration fee and four days away from work to go back to Las Vegas (assuming most of its attendees will have just returned from HIMSS18). However, I shouldn’t underestimate the willingness of healthcare people to spend their employers’ money on conferences with questionable ROI to anyone except the attendee, who gains validation for getting his or her employer to foot the bill. Readers: are you going, and if so, what’s the draw beyond the HIMSS and JPM conferences?

HIStalk Announcements and Requests

I get excited by two Northern Hemisphere calendar days – the winter solstice on December 21 (after which daylight lasts longer every day through the summer solstice on June 21) and the spring solstice equinox (thanks for the correction) Wednesday, which is when spring officially begins. Actually I should add a third celebrated date that I call the HIMSS solstice, the last day of the HIMSS conference in which the crazy-busy health IT period that starts January 2 ends, replaced by a relatively lazy summer that lasts until Labor Day.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Parachute Health, which offers a durable medical equipment ordering system, raises $5.5 million in a seed funding round.

Sales

• Orlando Health extends its Affinity RCM contract with Harris Healthcare for three years with an additional one-year option.
• Piedmont Healthcare (GA) expands its use of Glytec’s EGlycemic Management System to all of its acute care facilities.
• Partners HealthCare expands its use Kyruus ProviderMatch patient access solutions.
• University of Maryland School of Dentistry will implement DrFirst’s mobility suite to help dentist prescribers meet the state’s July 1, 2018 prescription drug monitoring program mandate.
• Lawrence General Hospital (MA) will implement Meditech’s Expanse EHR.

People

Change Healthcare hires Fredrik Eliasson (CSX) as EVP/CFO.

UPMC Chief Innovation Officer Rasu Shrestha, MD, MBA will lead the VA’s API project that was announced at HIMSS18. The VA’s Lighthouse project involves standards-based data exchange via an open API framework. Organizations that have signed its Open API Pledge are UPMC, BIDMC, Partners HealthCare, Mayo Clinic, Cleveland Clinic, Fairview, Geisinger, Intermountain Healthcare, Jefferson, Rush, and VCU Health.

Steve Weichhand (Avaap) joins Divurgent as VP of professional services.

Charles Tuchinda, MD, MBA is promoted to the newly created role of EVP and deputy group head of Hearst Health and VP of Hearst. He will also continue in his role as president of Hearst-owned First Databank.

Announcements and Implementations

Diameter Health gives its clinical data management users the ability to track user-defined patient populations over time, with a sample use case being a health plan that wants to update its patient list with fresh HIE information on a specific schedule.

Healthcare sharing ministry Medi-Share will use payment processing systems from Liquid Payments. This is interesting mostly because of the business model of Medi-Share, which is run as a ministry but is effectively an insurer since its 375,000 members agree to share their healthcare bills that are discounted via Medi-Share PPO provider agreements. Faith-based plans, which don’t guarantee that they will cover medical bills and sometimes exclude preexisting conditions, require a pastor’s recommendation and the member’s pledge to avoid using drugs, smoking, and behaving immorally. The plans are not regulated.

Clinical Architecture releases Symedical on FHIR, a RESTful API based on the FHIR Terminology Service standard.

Government and Politics

The VA’s Cerner project will cost $16 billion instead of the previously hinted $10 billion, according to comments made in a House Appropriations Committee by Rep. Debbie Wasserman-Schultz (D-FL). Cerner will get $10 billion (which is probably where the earlier figure originated), the VA will spend $4.6 billion on infrastructure improvements, and another $1.2 billion will be budgeted for third-party project management (Booz Allen Hamilton has already been awarded $750 million of that). Another tidbit dropped in a House Committee on Veterans’ Affairs hearing: VA Secretary David Shulkin had planned to announce during his HIMSS keynote that the VA’s contract with Cerner had been finalized, although continuing delays took that topic off the table.

Former VP Joe Biden expands on the Seema Verma-Jared Kushner announcements at HIMSS18 in a Fortune opinion piece, recommending that:

• HHS should cite providers for data blocking if they don’t provide patients with an electronic copy of their EHR information within 24 hours of their request.
• The Center for Medicare and Medicaid Innovation should create a uniform patient data portal for storing and sharing patient information.
• HHS should expand its Sync for Science program in which patients can contribute their medical records to research.
• The National Cancer Institute should create a cancer data trust to hold EHR, diagnostic, genomic, and outcomes data.

The New York Times reviews the NIH’s $1.4 billion project to collect genomic, medical records, blood, and wearables information from one million Americans. The “All of Us” research program – still in beta testing — hopes to uncover new diagnostic and treatment insights, but hasn’t made much progress in its first three years even though its 2017 budget alone was $230 million. Geisinger gave back its $50 million participation grant because endless meetings and conference calls weren’t going anywhere, while Kaiser Permanente felt NIH just wanted its data without its insights so it passed, too. Both organizations are creating similar systems and so is the VA, which is making good progress for a budget of just $250 million over seven years. Researchers also say it’s hard because patient information is scattered across multiple provider EHRs and the US doesn’t have enough DNA sequencing machines to handle the load. 

Other

The US News “top medical schools” for research are Harvard, Johns Hopkins, and NYU, while the top three for primary care are UNC-Chapel Hill, UCSF, and University of Washington.

Epidemiologists are being robbed of their ability to track infectious disease activity by the shutdown of US local newspapers, which provide higher-quality information than social media. 

Sponsor Updates

• Optimum Healthcare IT publishes an infographic titled “The Complex ERP Lifecycle.”
• Aprima will exhibit at the Association of Independent Medical Software Value Added Resellers Annual Conference March 23-24 in San Antonio.
• CoverMyMeds will host TechPint March 22 in Cleveland.
• Nordic publishes a podcast titled “How will transitioning to Nordic’s maintenance and support affect my internal teams? Q&A with Loma Linda University Health.”
• HCTec publishes a new case study, “Outpatient CDI Model Increases Revenue Opportunities and Positions Health System for Future Success.”
• Healthwise will exhibit at the 2018 Midwest ACE User Group Conference March 21-23 in Chicago.
• Image Stream Medical will exhibit at the AORN Global Surgical Conference & Expo March 24-28 in New Orleans.
• Kyruus will exhibit at the Cleveland Health IT Summit

Blog Posts

• Bermuda Hospital Board Deploys Access’s eForms Solution to Enhance Registration and Integrate Patient Documentation with Cerner (Access)
• Common Risks Areas of ERP Implementation (Optimum Healthcare IT)
• Overview of the Current Administration’s Approach to HIT (Datica)
• Consultant’s Corner – Kathi Goovert (Huntzinger Management Group)
• HIMSS 2018: A Universal Agreement to Put Patients First (CarePort Health)
• The 3 Best Alternative, Non-Nursing Jobs for Nurses (CareSync)
• The responsibility of a leader (Meditech)
• Freezer Failure – How to Protect Critical Biomedical Materials (CenTrak)
• Framework for Success: Provider Workflow Optimization Hits New Heights (Crossings Healthcare Solutions)
• Have You Connected Your Patients to their Benefit & Estimate Information on your Organization’s Portal? (Culbert Healthcare Solutions)
• HIMSS 2018 Recap: By the Numbers (Direct Consulting Associates)
• 3 Takeaways from HIMSS18 (Dimensional Insight)
• Value-based Care Trends – What’s on the Horizon in 2018 & Beyond (Divurgent)
• Leaving Las Vegas: FormFast’s Recap of HIMSS18 (FormFast)
• 6 Questions to Ask When Preparing for a Legacy System Requirement (Hayes Management Consulting)
• What Patient Safety Means to Consumers and Hospitals (Healthgrades)
• Improving Patient Experience Through Innovation at HIMSS18 (Healthwise)
• What Works – IT Roadmap Providers Path to Operational Excellence (Huntzinger Management Group)
• Is your organization as healthy as you think? (Hyland)
• A Personal Story of Patient Safety from Impact Advisors’ President (Impact Advisors)
• Putting a Face on Effective Facebook Marketing Methods (Influence Health)
• Payment Device Questions – What Healthcare Organizations Need to Know (InstaMed)
• Health Systems Can Own the Customer Relationship (Docent Health)
• Nine Questions Urgent Cares Should Ask Before Hiring a Collection Agency (DocuTap)

Contacts

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

Morning Headlines 3/20/18

Constellation Healthcare Technologies Files Voluntary Chapter 11 Petitions to Facilitate an Orderly and Efficient Sale Process

Following earnings discrepancies, an executive exodus and investigation for fraud, Constellation Healthcare Technologies files Chapter 11 for several of its subsidiaries.

Joe Biden: To Save and Improve Lives Using Data, Details Matter

Former Vice President and founder of the Biden Cancer Initiative Joe Biden responds to the Trump administration’s MyHealthEData initiative with next steps that include mandating the provision of a patient’s digital health data within 24 hours of treatment.

Trump administration to seek stiffer penalties against drug dealers, reduce opioid prescribing

Trump administration officials share plans to fight the opioid epidemic, including the creation of national PDMP that would flag suspicious prescriptions.

Curbside Consult with Dr. Jayne 3/19/18

Many of the physicians and other health professionals I work with during consulting engagements are suffering from burnout. As I work with troubled organizations, I am finding an increasing number of non-caregivers experiencing symptoms of burnout as well. I’ve recently partnered with an executive coach to work on strategies that we can use to better assist these organizations. It used to be that teams became stressed during times of change or times of institutional uncertainty, but we’re seeing teams that are now under stress all the time. Budgets have been cut, positions have been eliminated, and remaining workers are expected to absorb the work of others regardless of their capacity for additional tasks.

Healthcare informatics work is becoming more high stakes as systems are more deeply intertwined in care delivery. It’s not just about keeping systems in a state of high availability anymore. Now, healthcare IT teams are expected to monitor clinical quality calculations, enable reporting that has significant financial ramifications, and monitor updates and patches to ensure there are no changes to critical business processes or reporting processes. At one hospital where I have worked, there is no budget for clinical informatics, so the IT team is handling everything from system maintenance to ensuring physician adoption, with little support from medical leadership. The analysts are stressed all the time, caught between a mandate to ensure clinicians use the system properly and not having any authority to actually get the physicians to come to training. The turnover rate in the IT department is high, and leaders don’t seem to understand why people don’t want to stay.

The executive coach I’ve partnered with works with organizations to try to build resilience. The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, or stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” The people we’re working with are adaptable – they’ve watched the evolution of healthcare IT systems and some of them have worked on everything from basic billing systems to complex enterprise applications. They’ve watched the growth of technology at the bedside, and have seen the need for more transparency in the IT organization as the number of departments using technology has grown. They’ve coped their way through the rise of E&M coding, Meaningful Use, MACRA, MIPS, and ACOs.

Even with those changes under their belts, we see people struggling with the day-to-day stressors that impact their work. People are double booked for meetings and more than once I’ve been confronted by a conference call participant who appears to be inattentive who responds by saying he’s on multiple calls. (I still don’t understand how that works, but people do it, so it’s definitely a thing.) Workers are reluctant to take much-needed time off because they don’t have adequate coverage or feel that they’ll be buried when they come back. Others don’t want to burden their coworkers with the extra work that might shift their way if someone takes off. I see IT analysts that are continually frustrated by buggy software and delayed release schedules, who feel it acutely when they can’t deliver solutions to their customers. They’re caught between the vendor and the end user and may feel powerless to remedy the situation.

We’re working with groups in this situation by helping individuals analyze their individual work styles and better understand their own strengths. We help them identify situations they find challenging and develop strategies to work through them. Unfortunately, learning new strategies and figuring out how to incorporate them in the workplace takes time, and already-stressed teams struggle with finding the time to do this type of contemplation and reflective work. It’s often the management level that is feeling the most stress, because they have little control over budgets and priorities but are expected to deliver results regardless. When working with managers, one of the first steps we take is to help them complete a 360-degree evaluation, where they understand how they are seen by supervisors, peers, and direct reports. In one organization, we struggled with even getting the team to find time to respond to the surveys required to complete the evaluations.

There’s a concept that’s referred to in clinical circles called Moral Distress. It’s defined as the state of knowing there is a “right” thing to do but there are institutional constraints present that make it impossible to pursue the correct course of action. We typically talk about this when discussing nursing shortages and clinical staffing issues, when clinicians have to make difficult choices on how they deploy scarce resources. It’s thought that being unable to care for patients properly creates a particular kind of stress that increases the risk of caregivers quitting. A study of nurses performed in 2014 found that 20 percent of nurses surveyed intended to leave their current position due to moral distress.

Although it’s not quite as severe as moral distress at the point of care, we’re starting to see similar levels of stress in the teams that support front-line caregivers. Those support teams feel it acutely when clinical staffers can’t complete tasks or don’t have the technology they need to care for patients. I watched one IT analyst tear up as he tried to help a nurse figure out a documentation issue, when he understood that problems in the EHR were directly responsible for errors in care that negatively impacted a patient. He had reported the issue to his manager previously and they had been working with the vendor to try resolve it, yet he was told to move on to other priorities. He feels personally responsible even though there wasn’t anything he could have done, other than not follow the instructions that his leadership had given him. This isn’t the first time he’s been in a situation where patients were impacted by system issues, and he’s actively pursuing a job outside of healthcare.

As leaders, we need to figure out how to make sure our teams have the resources they need to do their jobs properly and ensure that the ultimate customer, the patient, is taken care of. We’re often between the proverbial rock and a hard place figuring out budgets and staffing while we prioritize projects. Maybe we need to be more forceful at saying no to implementing an on-demand meal ordering platform when our laboratory and radiology orders platforms aren’t at peak performance. Maybe we need fewer 70-inch TVs in patient rooms and more functional desktops and mobile workstations so documentation can occur quickly at the point of care. Maybe we need to stop adding bells and whistles to our systems when we haven’t fully implemented the basics. These are issues that the C-suite deal with regularly as our hospitals try to keep up with the Joneses across town.

I’d be interested to hear from any healthcare IT leaders who are taking a back-to-basics approach and trying to refocus energies on reducing stress while helping workers be more resilient. Have you found the recipe for the secret sauce? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/19/18

Technical glitch and market turmoil overshadow Healthineers IPO

Siemens AG raises $5.2 billion in its Healthineers IPO despite technical glitches that delayed the start of business.

Giving patients control of their health information will help give patients control of their health

CMS Administrator Seema Verma and presidential advisor Jared Kushner reiterate the Trump administration’s commitment to the MyHealthEData initiative.

Amazon is hiring a former FDA official to work on its secretive health tech business

Amazon hires the FDA’s first chief health informatics officer, Taha Kass-Hout (Trinity Health), to head up healthcare project business development on its Grand Challenge team.

Monday Morning Update 3/19/18

Top News

Despite technical problems that delayed business on the German stock exchange by an hour, Siemens AG raises $5.2 billion in its Healthineers IPO. Funds will be used to invest in molecular diagnostics and to acquire US-based health IT startups.

Reader Comments

From Lizzie Borden: “Re: Theranos board and advisors. It looks like at least one member of the infamous company’s scientific advisory board is getting proactive about making sure industry insiders know she’s distanced herself from the company.” The Washington University School of Medicine has indeed assured the media that professor Ann Gronowski left the Theranos board at the end of last year, even though the company’s website still lists her as a member. Sources report that two other advisers still remain on the SAB, which was formed in 2016 to lend credibility to the company’s under-fire efforts.

HIStalk Announcements and Requests

Thanks to those who responded to “What I Wish I’d Known Before … Taking My First Hospital IT Executive Job.” I can’t say I’m surprised at how frequently hospital politics came up.

The next installment of the series is your chance to help future patients and caregivers learn from your past experiences in the hospital or ED.

Meditech was the favorite in a highly unscientific poll that mostly garnered votes from IP addresses associated with the vendors listed.

New poll to your right or here: How far along are EHRs in delivering a "comprehensive health record" that paints a full patient picture?

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Mazars USA opens a new office in Los Angeles.

Decisions

• Tri Valley Health Center (NE) will go live with Meditech on May 1.
• Morristown Medical Center (NJ) will go live with Epic in June.
• Northside Regional Medical Center (OH) will switch from Cerner to Meditech in June.

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

CNBC reports that Amazon has hired Taha Kass-Hout (Trinity Health) to head up healthcare project business development on its Grand Challenge team. Also known as the 1492 Lab, Amazon’s team stealthily launched last year to focus on projects related to medical records management and access, though not much has been heard from them since. Much is being made of the fact that Kass-Hout was the FDA’s first chief health informatics officer.

Announcements and Implementations

In Bermuda, the Hospitals Board integrates eForms from Access with its Cerner EHR at King Edward VII Memorial Hospital and the Mid-Atlantic Wellness Institute.

Medication management vendor DrFirst deploys FDB’s new Opioid Risk Management Module as part of its support of Nebraska’s PDMP. In January, Nebraska became the first state to require tracking of all prescription drugs.

Other

This sounds a bit Big Brotherish to me: Herman Miller introduces a smart office chair that, when paired with its smart desk and app, gives employers insight into how long workers spend at their desks, times of highest productivity, and whether they’ve gone to the restroom or left for the day.

Sponsor Updates

• Parallon announces a reseller agreement with Cerner.
• CommonWell Health TV interviews Redox Chief Customer Officer Devin Soleberg.
• ROI Healthcare Solutions launches the ROI Resource Group.
• Santa Rosa Consulting adds an analytics migration program to its business intelligence and analytics services.
• Philips Wellcentive will exhibit at the Population Health Colloquium March 19-21 in Philadelphia.
• Wolters Kluwer publishes its annual report.
• QuadraMed will celebrate Health Information Professionals Week, March 18-24, by providing HIP swag to any healthcare organization registering for a Lunch-N-Learn by March 30.
• Maryland Lt. Gov. Boyd Rutherford visits DrFirst’s headquarters to learn how the Rockville, MD-based company is fighting the opioid epidemic with Maryland-based partners MedChi, CRISP, and UMSOD.

Blog Posts

• How Healthcare’s Digital Transformation Can Drive Better Patient Engagement (Salesforce)
• Ambulatory Surgery Center Industry Updates and New Analytics Tool (The SSI Group)
• What Keeps a Hospital CIO Up at Night? (Summit Healthcare)
• Next-generation sequencing at scale: Guided variant assessment (Sunquest Information Systems)
• Surescripts Commends Congressional Leadership as EPCS Act Gains Traction in Senate, Following House Bill (Surescripts)
• Healthcare Marketing with HIPAA (SymphonyRM)
• Presumptive Eligibility for Charity Care: The Risk of Presuming Your Hospital is Compliant (TransUnion)
• A Training Revolution: Visage 7 Powers UF Health’s SIMulation (Visage Imaging)
• Close clinical communication gaps and avoid risks. (Voalte)
• Strengthening Patient Safety and Engagement Through System Standards (Vocera)
• A 10-Point Plan for Smart and Secure Electronic Communications with Patients (WebPT)
• Less clicks and more data at the point of care? It’s true. (Philips Wellcentive)
• 4 Pitfalls of Searching the Internet for Health Answers (WiserTogether)

Contacts

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

Weekender 3/16/18

Weekly News Recap

• Theranos CEO Elizabeth Holmes settles SEC fraud allegations by agreeing to pay a penalty, give up her company shares, and not serve as an officer or director of a publicly traded company for 10 years.
• A blog post from UCSF’s Center for Digital Health Innovation says EHRS can never be a “comprehensive health record” since important patient health information is created elsewhere.
• Epic CEO Judy Faulkner says the company won’t challenge the VA’s no-bid Cerner selection, but estimates the government could have saved at least $3 billion by choosing Epic.
• Inovalon announces that it will acquire Ability Network for $1.2 billion.
• Epic confirms that it will integrate Nuance’s AI-powered virtual assistants into its software.
• Cerner says the VA’s planned go-live will begin in Q4 2019 with pilot sites and will then involve 48 waves that will be completed in 2027.

Best Reader Comments

With respect to Holmes, she DOES still face jail time. The settlement with the SEC covers only civil – not criminal – charges. The SEC has no criminal enforcement capability. The DoJ can pursue criminal charges if they deem it worthwhile. (Debtor)

My opinion / observation is that CommonWell is vaporware and it’s largely due to Cerner’s leadership or lack thereof. Athena went elsewhere to do real exchange. McKesson and Allscripts stopped talking about it. Cerner used it to land the ultimate whale in the DoD and has delivered LESS THAN the Joint Legacy Viewer for interoperability. With the DoD and VA combined, my family of five is in for about $250 to Cerner. For that price, I think I’m entitled to my equivalent of a Yelp review. (Vaporware?)

It’s very much en vogue to simply say API over and over again, but the fact remains – at some magical moment in time, you need as much data as relevant to the situation in order to make the best decision possible. APIs don’t actually accomplish that in general, and in the contrived example where one might try, you’d have the slowest computer system known to man. (UCSF only semi correct)

Agree with the interoperability problems in non-medical systems. It is only because we users demand a high level of accuracy that we complain so bitterly about the difficulties and errors. There are less complex data systems out there that perform much worse than the top tier of EHRs, but lives are not on the line, so we let it ride and only complain under our breath. (Graduated When?)

Thanks for highlighting Dan Linskey’s session. I was huddled out in the Boston suburbs with my kids on those awful days, but last Thursday evening, I felt as if I was standing next to Linskey – heart racing – listening to “Channel 1” in the middle of Boylston street. I cannot recall a more emotionally immersive experience. I will wonder all year how it is that I stumbled upon that talk at 5:30 – bleary-eyed as I left the exhibit floor. (Neil)

KLAS for validation. CIOs I work with generally find KLAS credible because the comments they read reflect the experiences they’ve had. They also conduct their interviews in person, which helps. Maybe not statistically bullet proof, but still credible, IMO. (Ex Epic)

Thank you for including this comment: “I’ve been the recipient of a couple of sexist comments this week – things that people would never, ever say to a male CMIO – so we definitely have a long way to go.” So many of my male colleagues just frankly don’t believe or seem skeptical that this behavior is as widespread as it is, suggesting that it’s only the creeps who make comments like that and that the comments are rare. Nope. (Kallie)

Love or hate KLAS, they have made both the provider buyer community and the vendor seller community pay them for telling them what to do. First, you have to understand the founders of KLAS are all prior leaders of HIS vendors and topnotch salesmen from days gone by. They were very successful in that world and they simply used those skills and tools they honed selling hospitals IT systems to sell them on needing someone to measure the vendor community and the vendor seller community on needing someone to tell them what they clients wanted and what their competitors where doing. It’s the perfect storm of a sales job and all of you bought it. They knew no vendor could pass up the notion of competing against its competitor, as healthcare is such a lead/follow vertical that once any provider stated they used KLAS, then others just followed because no one wants left out. (Real KLAS)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. C in New Jersey, who asked for take-home science kits for her elementary school class (note that the photos were taken in the homes of students). She reports, “As soon as I received the materials and displayed them in the room, the students went wild! They could not wait to pick a kit and take it home to do some extracurricular learning! What is so great about the kits is that the students will be able to use them year after year. I already have students in the upcoming grade looking forward to science because of the wonderful materials we now have in our room. Thank you so much for keeping our students engaged in learning in and out of the classroom! Your donation will reach many young minds this year and in years to come!”

Also checking in was Mr. M from Wisconsin, whose describes his school’s area as “hardest hit by poverty, lack of jobs, mental illness, childhood trauma, and civil unrest.” We provided STEM games, which he acknowledged with, “Our students are lacking critical math skills, but they find our math book to be too confusing. We are incorporating games like Farkle into our curriculum. It is really effective because the games are fun. There is a huge push away from procedural knowledge to conceptual knowledge. What this means is they want kids to understand why the math works, but they are moving away from actually being able to do the math. I find this to be foolish. So we are working on ways to memorize numbers and how to manipulate them.”

HIStalk traffic always spikes during the HIMSS conference, this year peaking at nearly 12,000 page views and 8,400 unique visits on Wednesday, March 7. That’s not quite a record – July 30, 2015 (DoD announcement day) saw 17,000 views on 12,000 visits, sporadically making my overloaded server (since upgraded) unavailable for some of that afternoon.

I didn’t get many responses to my question about the best and worst parts of the HIMSS conference, so I’ll just list them here:

• Best: the companies that exhibit are reaching out in more meaningful ways, with panel discussions, lunch and learning events. The worst: getting hit in the head or back by the ubiquitous overloaded backpacks. The carriers don’t seem to be aware that they have heavy luggage on their back.
• It’s always fun seeing old friends, but my favorite part of this year was having a virtual HealthTap doc stroll up to me while I was Facetiming my kids. We had a nice conversation with the doctor, who was very friendly, and although my kids are still confused about it, we’ve had some fun conversations around the type of work I’m in. Way to stick out, HealthTap!
• Best: networking opportunities and having a large number of products and vendors all in one place. Worst: not seeing any major new items or topics. I finished the conference thinking either I have reached some type of plateau in my knowledge and exposure to the industry and/or that the industry in general has plateaued. Considering focusing my time outside of HIMSS in the coming years.
• Was very disappointed in the Women in HIT networking event. I was really looking forward to it and encouraged many women to pay the $45 each to go. But I can’t figure out what the money paid for. Very crowded, cold, and barely food — had to pay for dinner afterward. I truly hope there was money left over for a nice donation somewhere. A speaker or sit-down event where you can hear people talk to each other would have been nice.
• The smoke was the worst. I enjoyed meeting folks and learning about their different technologies. As a fellow vendor, I think the other vendors were more engaging and just happy to chat. Seems attendees are truly afraid to make eye contact and get roped into conversation. I approached it truly wanting to learn about others’ ideas, needs, and experiences. Wish I had learned more from attendees.
• Worst part: Las Vegas. Disgusting place. Why have a healthcare conference in one of the unhealthiest cities in the US?
• While my sentiment likely won’t be popular, I was pleased to see the rise of non-native healthcare companies at the conference. High time for outside influence in what might otherwise be a generally stagnant field. The worst was hearing the perspective of first-time attendees who were disappointed to discover the lack of a patient presence. If anyone out there is ready to host a conference dedicated to patient panels, I’m all in!

I had to re-read this article carefully because it sounds like satire from “The Onion.” Elon Musk considered buying “The Onion” several years ago and has since hired its top two former executives and four other staffers to work on a secret comedy project. Musk’s reply to inquiries was, “It’s pretty obvious that comedy is the next frontier after electric vehicles, space exploration, and brain-computer interfaces. Don’t know how anyone’s not seeing this.”

Another “Onion”-worthy story involves startup Nectome, whose tagline is, “What if we told you we could back up your mind?” The company proposes to inject preservatives into the brains of dying people while they’re on life support, in essence killing them in the hopes that the stored memories in their brains can somehow be recreated later despite lack of proof that dead tissue actually stores memories. A neuroscientist critic says, “Burdening future generations with our brain banks is just comically arrogant. Aren’t we leaving them with enough problems?”

University of Michigan stirs up controversy by offering its donors concierge medicine services in a program it calls Victors Care that costs $2,700 per year. It promises that customers get “enhanced access and time with their primary care physician.” Its website lists just one participating doctor. Concierge medicine has become increasingly common, but is always offered by private practice doctors rather than public university hospitals.

A NEJM article ponders the ethical challenges of using machine learning in healthcare, saying:

• Machine learning may unintentionally offer recommendations biased against race or genetics because of the data it was trained with
• Private companies might develop algorithms that will recommend activities that are designed to artificially inflate quality scores or increase the use of profitable products without actually improving outcomes
• Diagnostic methods and treatment best practices may not be well enough defined to support a machine-generated conclusion
• Physicians need to understand how the algorithms work rather than treating them as a black box since ethical challenges may result otherwise
• Physicians are ethically bound to withhold information from the EHR to protect patient confidentiality, but that practice would skew the performance of machine learning that expects to find a complete data set

The physician reader who sent me the article notes that while the authors worry about the perceived authority of AI-powered systems, that’s what medical records technology pioneer Larry Weed, MD proposed 50 years ago – a system in which lower-level providers interview the patient and enter their findings into the EHR, after which the doctor is offered a computer-generated list of possible diagnoses before seeing the patient. Weed wasn’t thinking about AI, though – his idea was “problem-knowledge couplers” in which technology would analyze the available patient data to provide an objective assessment, avoiding the problem in which doctors who are faced with too much data make decisions using instinct instead of relevant facts. The illustration above came from Dr. Weed’s 1983 presentation at the SCAMC conference – he was running self-developed software on a Northstar Advantage computer with 64K of memory.

Researchers develop an open source template for a 3D-printed stethoscope, clinically validating that the $3 result works just as well as expensive models while being affordable to clinicians in developing countries. They got the idea after playing with a toy stethoscope and realizing that it actually worked pretty well.

In Case You Missed It

• News 3/16/18
• EPtalk by Dr. Jayne 3/15/18
• News 3/14/18
• Curbside Consult with Dr. Jayne 3/12/18
• The Smokin’ Doc Celebrates a Successful HIMSS
• Monday Morning Update 3/12/18
• What I Wish I’d Known Before … Taking My First Hospital IT Executive Job

Get Involved

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

What I Wish I’d Known Before … Taking my First Hospital IT Executive Job

That shifting organizational culture takes time and patience. When you actually succeed and the culture starts to change, your employees who were barriers to change will start to leave the organization.

That budgets are boring and the software in the space doesn’t help. Where’s the digital disruption in the budget planning space?

How political and backstabbing a faith-based healthcare system can be. And how adeptly a CFO can play the game.

Hospitals still may not value the role of IS leadership. Control of budgets can be limited to the point of requiring approval for PC purchases and everyone in the department is viewed as a help desk function. Strategic vision and focus on critical topics such as information security are lacking. In those cases, your role as an IS executive is to prove your department’s worth and role in the organization and drive cultural change. This effort takes many years with seemingly slow progress.

That even as a physician executive, my clinical credentials would be a point of debate among all the physicians with whom I had to interact. They challenged my authority constantly because I didn’t see as many patients as them, didn’t see as sick of patients as them, didn’t see patients in their specialty, etc. They had a host of excuses for why they shouldn’t listen to me and unfortunately our senior leadership wasn’t willing to tell them they were full of bull and needed to just get in line. I had the last laugh though when I led the (successful) initiative with the operations side of the organization to change their contracts to require compliance with EHR use and tied it to their bonuses. Surprisingly, they all got in line after seeing a drop in their bonuses once the new contract was in place.

Not much because I did a consulting project for them before they offered me the position. So I had a pretty good idea what I was up against and how long I would want to work in that type organization. I also made it clear that if they did not agree with the recommendations in my report, they shouldn’t hire me. I’d recommend that approach (if available) to others to minimize unknowns.

That the same projects I rolled out quickly and successfully (1-2 weeks) in the mid-sized physician office where I was the boss would take months to years to complete in a hospital-owned ambulatory setting. Change management is easier when everyone is on the same page, but much harder when duties are dispersed over multiple locations and individuals with varying skill levels. Partnering with a strong operations administrator with experience helps ensure success.

Healthcare IT is messy. Gaining physician cooperation in institutions where they are not employed (which is the majority) ranges from tough to nearly impossible. Healthcare economics are messy.

As a CIO, how much of my job would be pure politics, trying to placate high-production specialties practices and physicians whose productivity (and income) was negatively impacted by EMR implementations. That and the realization to whatever lip-service we received from the rest of the C-suite regarding “innovation” and “investing in technology to improve patient care,” IT was always viewed as a cost center, and when the inevitable cuts came, IT is at the front of the line. Having said all that, given all of the challenges, discovering how rewarding it could be when you accomplished despite the obstacles.

Most hospital CIOs are politicians, and as such, are reluctant to measure the value of their projects, like ROI.

Existing politics and relationships can be your death knell. When you arrive to your first C-suite job, be mindful about these two items. If you are not, it can put you in a very bad position. My advice is to use the two ears-one mouth ratio to listen and observe to figure out what is what. There are many reasons the team you just joined is there. They have most likely figured out how to keep their high-paying, high-perk jobs and they are not about to let the new person on the team mess that up.

Real power does not always lie with the obvious titles. Try to become aware of who is really running the show and who the CEO really relies on. Also, some CEOs promote politics more than perhaps they should. It then becomes high-stakes gaming where you, as the newbie, will lose if not careful. It is a harsh reality of many C suites, but it exists. I have worked in six organizations with various levels of C-suite politics. Four of them were fraught with really messed up, toxic behavior. Two were not.

Even with that said, I would not trade any of those experiences as it has helped prepare me for the job I have today. In my current role, while I have our office and company politics fairly figured out and know when to speak up and when to duck, it is a constant part of the job to help ensure I am not a casualty from an ill-timed or ill-placed remark or taking a stand when I could have just let it go. It is truly an art at this level and takes a lot of practice, observation, willingness to not die on every hill, and of course a bit of luck.

Morning Headlines 3/16/18

Mediware Announces New Headquarters In Overland Park

Mediware Information Systems will build a 66,000 square-foot global headquarters in Overland Park, KS that it expects to open in mid-2019.

UnitedHealth Group Announces Leadership Actions

Sir Andrew Witty (GlaxoSmithKline) will join Optum as CEO, replacing Larry Renfro, who will become a managing partner of Optum Ventures and its new $100 million fund.

Mount Sinai Announces Appointment of Joel Dudley, PhD, as Executive Vice President for Precision Health

Mount Sinai Health System (NY) taps Icahn School of Medicine Associate Professor Joel Dudley to lead its new Precision Health Enterprise, which will focus on external partnerships with technology companies as part of its strategy to develop personalized therapies for patients.

News 3/16/18

Top News

Theranos founder Elizabeth Holmes will pay the SEC $500,000 to settle charges that she and the company fraudulently raised over $700 million. Holmes will also give up majority voting control over the company, and some of her equity in it. She will also be banned from directing a public company for the next 10 years. Former Theranos President Sunny Balwani, who resigned from the company in 2016, also faces charges, which the SEC plans to litigate at a later date. None of the company’s star-studded board have been implicated.

Aside from the numerous alleged lies told to investors during presentations, media interviews, and product demos, Holmes and Balwani erroneously claimed that the company’s products were used by the DoD on the battlefield in Afghanistan and on medevac helicopters, and that the company would generate more than $100 million in revenue in 2014 – far above the $100,000 it actually pulled in. A separate criminal investigation is still underway.

My two cents: Investors should have done their due diligence instead of getting giddy from founder buzz. The Theranos hype machine, which the media dutifully fed on, made the company sound Silicon Valley hip instead of like a tiny-volume, would-be competitor to the fully-scaled big, national labs.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Mediware Information Systems will build a new 66,000 square-foot global headquarters in Overland Park, KS that it expects to open in mid-2019. The company acquired Medicare billing company MedTranDirect in January.

NantHealth reports a 2017 net loss of $175 million, with revenue up 8 percent year over year to $87 million. Q4’s $22 million revenue fell a bit short of analyst expectations. No mention was made of its August layoffs or sale of its provider and patient engagement assets to Allscripts, aside from labeling them as discontinued operations.

People

Sir Andrew Witty (GlaxoSmithKline) will join Optum as CEO, replacing Larry Renfro, who will become a managing partner of Optum Ventures and its new $100 million fund for technology, data analytics, and healthcare companies. Witty was knighted in 2012 for his services to the British economy.

Divurgent brings on Jeff Sassenscheid to handle the expansion of its ERP, HRIS, and HCM service lines.

I missed this in the pre-HIMSS media frenzy: El Camino Hospital (CA) promotes Deborah Muro to CIO.

Announcements and Implementations

Northwell Health (NY) will implement GMed’s enterprise endoscopy solution at 20 hospitals and ASCs. GMed was acquired by Modernizing Medicine in 2015.

Millennium Physician Group (FL) selects population health management technology from Lightbeam Health Solutions.

In Illinois, Community Partnership of the Ozarks prepares to launch a Mediware-based software project that will help to eventually connect 16 healthcare and social services organizations across the region.

WebPT and Modernizing Medicine develop an interface between their respective EHRs to enable better data sharing between physical therapists and orthopedists.

Salesforce adds care gaps and assessments functionality to its Health Cloud CRM.

Medicomp Systems adds care management capabilities for opioid addiction treatment to its line of Quippe clinical solutions.

Other

A VA study of 100 heart failure patients finds continuously streaming data from stick-on chest sensors to an analytics-based smartphone app is just as effective at preventing readmissions as a more expensive implantable device.

Patients at Danbury Hospital (CT) express frustration with scheduling and procedure delays resulting from a system-wide Cerner implementation earlier this month at Western Connecticut Health Network. Announced in 2015, the roll out included Cerner’s Millenium EHR, HealtheIntent population health management software, and a Soarian upgrade.

@Farzad_MD tweets out the results of an “aromatherapy” study that found alcohol prep pads were more effective at quelling nausea in ED patients than customary anti-nausea medication.

Weird News Andy wonders about the ICD-10 code for “airhead” after surgeons discover a giant air pocket where part of an 84 year-old patient’s brain should have been. The man sought care after suffering a mild stroke, but had otherwise lived a normal life.

Sponsor Updates

• PerfectServe creates an Apple Watch app to give end users easier access to its messaging technology.
• Learn on Demand Systems hires Laura Faughtenberry (Dude Solutions) as director of marketing.
• The Athena Breast Health Network (CA) selects LifeImage-powered Mammosphere to provide network management of medical images and associated clinical information to conduct the WISDOM breast cancer screening study.
• Meditech publishes a new e-book, “The Essential Guide to EHR Value & Sustainability.”
• LiveProcess will exhibit at the ANA Quality and Innovation Conference March 21-23 in Orlando.
• Loyale Healthcare rolls out its Patient Financial Manager solution to select Parallon clients including 170 HCA hospitals and EPs.
• The LiveHelpNow Challenge includes Vyne in its list of top companies providing exception customer service.
• Meditech will exhibit at the 2018 Home Care Optimization Symposium March 20-22 in Atlanta.
• National Decision Support Co. will exhibit at the National Comprehensive Cancer Network Annual Conference March 22-24 in Orlando.
• Netsmart will exhibit at the National Association of Psychiatric Health Systems March 19 in Washington, DC.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, achieves HITRUST CSF Certification.
• EClinicalWorks publishes a new case study highlighting Rainbow Pediatric Center’s use of telemedicine to improve ADHD patient compliance.
• Black Book Research ranks Optimum Healthcare IT number one for enterprise EHR implementation and IT advisory and customer satisfaction.

Blog Posts

• #HIMSS18 at All Levels: International, National and Local (Liaison Technologies)
• LifeImage LITE: Building Your Own Health Provider Network While Easing Your Access to Data (LifeImage)
• Machine Learning vs. Deep Learning (Lightbeam Health Solutions)
• Healthcare Team Communication Tools to Reduce Nurse Burnout (LiveProcess)
• Achieving the Healthcare Triple Play: Improving clinician engagement, patient care and utilization – Part 2 (LogicStream Health)
• 3 Benefits of Participation in BPCI-Advanced (Medecision)
• Why FHIR, APIs, and Apps are the Future of Interoperability (Meditech)
• Quippe’s Clinical Data Relevancy Engine: the diagnostician’s easy button (Medicomp Systems)
• Searching for That Treasured Pot of Gold (Navicure/Waystar)
• What Does Behavioral Health Have to Do with Home Health? (Netsmart)
• So you’re a vendor now: How to set expectations with your EHR affiliates (Nordic)
• Data-driven technology will transform the health industry (Experian Health)
• Four Questions Series: Joshua Jacobs, VP at Windsor Health Communities (PatientPing)
• Using a “Cookie” Mentality to Increase Patient Satisfaction and Collect More Payments (Patientco)
• Sugar. Butter. Flour. (PatientKeeper)
• How Smart Contracts Will Make Care Accessible to Telehealth Patients (PokitDok)
• Part 2: The “C” in ITSM (CTG)
• The National Sepsis Crisis – And How Health IT Can Help (Spok)
• The responsibility of a leader (Meditech)
• Prepare and Prevent Common Due Diligence Issues in Health IT Transactions: Operations Considerations (Part 4 of 6) (HGP)

Contacts

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

EPtalk by Dr. Jayne 3/15/18

Theranos CEO Elizabeth Holmes is charged with fraud and has agreed to a settlement without admitting guilt in the matter. People were eager to believe in the promise of new technology without proof. Various family connections and their endorsements added to the investment frenzy.

I see dozens of startup proposals every year and have a high degree of suspicion for vaporware or vaportech. I’m happy to sign non-disclosure agreements with organizations that legitimately want my opinion, but they have to be willing to show me what they’re doing before I’m going to get on board. I think some folks have lost their ability to perform due diligence given the constant hype around innovation and being the Next Big Thing. I feel sad for the lower-level investors who were caught up with Theranos and its deception.

This article from The Guardian was a hot topic in the physician lounge today. Physicians took immediate exception to the comparison of US physician salaries to those from other nations, noting that in other countries, physicians do not have to incur significant debt to complete medical training as they typically do in the US. No one disagreed with concerns around the cost of prescription drugs or administrative costs.

One member of the hospital administration noted that some of the starting administrators at Big Health System make more than starting physicians, which is a sad state of affairs since starting administrators often have minimal experience beyond their MBA coursework. Similarly, there was no disagreement with the US having worse population-based outcomes.

Every time I have to argue with a patient about unneeded tests, there is typically a comment from the patient along the lines of, “We have the best technology in the world and I deserve this test,” or, “I’m paying a lot for my insurance and it’s covered so I want it.” Patients often don’t see past their individual situations and don’t want to have decisions made based on populations and statistics rather than their own personal feeling about what should happen.

Culturally, we have issues with desiring invasive care, often to our detriment (take a look at some of the childbirth data) and not understanding the need to pursue lifestyle changes rather than medicating everything. We don’t want to wait things out. We want medication now whether we need it or not.

Also culturally, we make it difficult for people to access care. Many of my patients come to urgent care after 6 p.m. because they can’t take off work or have no sick days to seek medical care. Very few primary care offices in my area have evening hours, so the more expensive urgent care begins to fill the primary care void.

Having the worst maternal mortality rates among other “developed” nations is embarrassing and should be avoidable, but we’re not tackling it very well. Infant mortality is also nothing to be proud of. I’m shocked by how many Americans keep up with the Kardashians and a host of other celebrity or social media personalities, but can’t name things they can do to keep themselves healthy. Prevention isn’t sexy, nor is doing the hard work needed to lose weight or stay in shape. Insurance plans often don’t cover preventive treatments or put hoops in place for patients to jump through when they want to pursue non-invasive or non-surgical treatments for some conditions that might improve quality of life.

I had a patient recently who switched insurance plans and her new coverage won’t allow for replacement of her custom shoe inserts, which had broken down over time. The patient had previously been active and now has constant foot pain, which has limited her activities and probably has contributed to her weight gain. She was in to see me about a cortisone injection, and even just looking at the cost of my visit plus the cost of the injection and potentially a follow-up visit, it would have been cheaper to just pay for new orthotics than to treat the foot pain. The patient had lost her job and is working as a restaurant server, which isn’t helping her pain either. She’s diligently trying to save for a new set, but that’s hard to do when you’re living paycheck to paycheck.

HIMSS may be in the rear-view mirror, but the onslaught of emails and cold calls is just beginning. I’ve finally learned to link my HIMSS registration to a dummy email account so that the contacts can be sorted out. I used a burner phone number as well. A couple of the post-HIMSS emails have been personalized greetings from a specific resource thanking me for the interaction at the booth and making note of our conversation. Others follow a formula that doesn’t help me at all: Thank you for your visit to X Vendor, we are hoping to help your organization, we will be reaching out to you directly. A link to the company website or an attached product portfolio PDF might be helpful memory jogs and might be less easily deleted than the form email.

The best outreach I have received so far was from Formstack, with the subject line “Have you worn your green Formstack socks yet?” and asking for a follow-up. It definitely caught my attention, and yes, the socks were perfect for coming back from HIMSS. I’m sending my VMWare socks to my favorite engineer, so I can’t comment on their comfort. I wasn’t lucky enough to score Google Cloud socks. Socks were certainly on the menu this year. I did finally score some #pinksocks this year and they got some looks wearing them around town.

I’m still recovering post-HIMSS, most likely because I landed, unpacked, repacked, and immediately went cold-weather camping, which probably wasn’t in my best interest. From there, it was on to client work and clinical shifts. The 12-hour days are becoming more and more difficult. Maybe the longer daylight hours in the evening will lift my spirits. I don’t mind it being dark in the morning since I can sleep without the birds trying to drag me out of bed.

I’m putting together the list of meetings I want to attend the rest of this year and also planning for 2019, when I get to take my board recertification exam. What’s on your list of can’t-miss meetings? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/15/18

Theranos founder Elizabeth Holmes is not allowed to lead a public company for a decade

Theranos founder Elizabeth Holmes will pay the SEC $500,000 to settle charges that she fraudulently raised over $700 million. She will also be banned from directing a public company for the next decade.

Software snarl riles patients of Danbury network doctors and hospitals

Danbury Hospital (CT) patients express frustration with scheduling and procedure delays resulting from a system-wide Cerner implementation earlier this month at Western Connecticut Health Network.

Springfield agencies will soon get software to better connect and serve

Community Partnership of the Ozarks in Springfield, IL prepares to launch a Mediware software project that will eventually connect 16 healthcare and social services organizations across the region.

Morning Headlines 3/14/18

Electronic Health Record? Comprehensive Health Record? Connected Health Record!

A blog post from UCSF’s Center for Digital Health Innovation takes exception to Epic’s claim that it offers a “comprehensive health record,” pointing out that no EHR can be comprehensive since important information is also generated by numerous entities and sourced from non-clinical settings.

Cognizant Gobbles Up Another US Healthcare IT Services Provider

Cognizant will acquire Louisville, KY-based RCM services vendor Bolder Healthcare Solutions.

Presidential Order Regarding the Proposed Takeover of Qualcomm Incorporated by Broadcom Limited

The White House puts a stop to Broadcom’s hostile takeover of Qualcomm, meaning that medical device information systems and integration vendor Capsule Tech will remain a Qualcomm subsidiary.

Epic won’t challenge Cerner Contract

Epic’s Judy Faulkner says the company won’t challenge the VA’s single-source Cerner contract choice, but she estimates that Epic would have charged at least $3 billion less than Cerner and would have offered more interoperability with providers outside of the VA system.