Carrollton Family Clinic (MS) files a class-action lawsuit against EClinicalWorks in an effort to recoup lost Meaningful Use incentive money and related IT expenses.
Emory Healthcare (GA) experiences a data breach when a former employee dumps Emory patient data onto a Microsoft Office 365 OneDrive Account associated with his or her new job at the University of Arizona College of Medicine.
CMS develops a new online performance data submission tool for physicians participating in the Quality Payment Program. The 2017 submission period runs through March 31.
I’ve been working in healthcare most of my life and my entire career. I have spent probably 42 of 45 years working in an organization now known as Northwell, which is a healthcare system in metropolitan New York. I held a a variety of responsibilities. I was executive director of two of their flagship hospitals, North Shore University Hospital and Long Island Jewish Medical Center. I was more recently responsible for the strategy and the management of their ambulatory care network, which now comprises over 3,000 physicians and multiple joint ventures in dialysis, imaging, urgent care, ambulatory surgery, and so forth.
In January 2017, I became as chief executive officer of a commercial, for-profit joint venture known as Formativ Health.
How hard it was to turn Northwell’s management services into an investor-backed joint venture company?
There are clearly differences between a not-for-profit, community-based organization and its culture and that of a for-profit, commercial enterprise. The difficulty is in having both of these organizations understand the culture of the other and figure out how to adapt their cultures, missions, and objectives together.
It’s not the business so much as the personality and character of the organizations that have to be understood. If you have a community-based organization, no matter how large or complicated — a not-for-profit, mission-driven organization like most of healthcare — to understand how to function and operate in a for-profit, commercial world is a challenge. Similarly, these commercial, for-profit organizations don’t get it when they’re dealing with a community-based organization like most of healthcare.
In what areas are physician practices least prepared to meet current and future expectations?
I would start with consumerism, the advent of transparency, convenience, and the expectations that most of the population has of other industries. Whether it’s banking, retail, or airlines, when you interact with any of those industries as a consumer, you have certain expectations about service and convenience. Healthcare is way behind in having that transparency, convenience, access, and service as part of its DNA.
Hospitals, physician groups, and practices need to adapt quickly. As you can see recently with Amazon, Google, and CVS, a myriad of industries and organizations are moving into the healthcare space. If the current healthcare providers don’t understand and adapt quickly, they’re going to get overrun and pushed aside.
How will practices and hospitals that are accustomed to staying busy and profitable just by opening their doors market their services and improve the patient experience?
Just as you asked the question, that’s the challenge facing healthcare today. Some are going to be able to understand the challenge, recognize it,and adapt to meet it. Others will be swept aside.
The new patients of today and tomorrow will accept nothing less than transparency, ease of access, convenience, and good service. They will no longer accept sitting in a waiting room with a 300-page novel that they can read while they’re waiting for their physician. They won’t accept that any longer, nor should they. That’s the new expectation.
Technology is going to have a lot to do with it, just like it does in other industries. This is another challenge for healthcare — to quickly develop and adapt the technology that the consumers of today are going to expect and demand. Technology that allows them to interact with their provider without going through a phone tree and filling out dozens and dozens of forms in a waiting room multiple times. This is an antiquated system.
There are good, understandable explanations as to why healthcare has been slower than other industries to react. A lot of it is regulatory. A lot of it is privacy concerns. Nevertheless, for whatever reason, it is what it is. It’s going to have to change and change very quickly.
Hospitals have been acquiring physician practices and are now merging with each other to form what could be just a few dozen national health systems. That gives them scale to improve communication, engagement, and patient satisfaction, but with the risk of being seen as a faceless corporation that doesn’t value people as individuals. Will patients see the situation getting better or worse?
What is transpiring now in healthcare has been experienced by many other industries throughout this nation. It could be the airline industry, banking, or accounting. There used to be the Big 8, now I think there are three accounting firms left. There used to be airlines like TWA, Pan American, and Eastern. They’re all gone. They were all swept aside. Either for some of the reasons we’ve already mentioned – adaptation, meeting some of the challenges that they faced, and they weren’t able to have that flexibility to adapt — or they were swept aside through this consolidation.
Healthcare is going through that as we speak. There are no longer these little community-based hospitals that were the local equivalent of the YMCA and a Main Street mom and pop store. They’re now all being brought together into these massive health systems. At the end of the day, there will be some number. We can guess the number of jellybeans in the jar, but there will be very fewer healthcare organizations. Not only are they consolidating as hospitals to each other, their physicians are consolidating into large medical groups and then again into hospitals to create these health systems.
There’s also now the trend where insurance companies are acquiring providers and providers are creating insurance companies. I think the latest trend is going to be the commercial market, like the CVSs and the Amazons, getting into healthcare. You’re having the retail meets the healthcare providers and vice versa. I don’t know who’s going to be left standing at the end of the day, but the landscape is going to be dramatically different than it was yesterday.
What’s that going to mean for the patient? I’m going to be optimistic. I think what they will have is a much more open, transparent, and accessible healthcare system than they had yesterday, notwithstanding the Marcus Welby image of the kind, gentle healthcare provider — whether it was a hospital or a physician — of the past.
People need ease of access. They need high levels of service. Competition for access and service is a good thing. Healthcare needed a prod to become more convenient and more focused on the patient, satisfying their needs for both service and access. This will ultimately be a good thing. It will be disruptive to the providers, but I think it will ultimately be very positive for the patients.
What service and technology improvements do you recommend to practices?
That’s the focus and objective of Formativ. We’re looking to fill this gap — I consider it a gap — between connecting the patient with the physician. Right now, it’s a very frustrating experience for both physicians and patients. Walk into virtually any physician’s practice and it’s like walking into a three-ring circus. There are all kinds of activities. You’ve got phones ringing. You’ve got people standing and waiting to make a new appointment. You’ve got these poor people behind the desk trying to juggle and balance handing out paper and moving patients back into the exam area. The organizational skills these poor receptionists need to balance and manage are incredible.
We go in and say, there’s no need for all of this. Like in other industries and other experiences, you can take that noise out of the waiting room and out of that day, moving it to the day before. Get it done in a more relaxed and more manageable setting. You can pre-register. You can get all the patient demographic and insurance information before you walk into the waiting room. You can do it electronically. When the patient walks into that waiting room to see their physician, it becomes a clinical experience, not an administrative nightmare.
When they’re leaving and need care coordination, follow-up care, or prescription refills, you can all do this electronically or over the phone by someone who is dedicated to help that patient navigate the system rather than trying to cram it all in to the same time you are there to have a clinical experience. You can do this through technology and dedicated service.
We refer to that as our patient access service. Individuals who are sitting anywhere are interacting with the patient, have the ability to see into the electronic health record of that patient, can communicate with the clinical providers through the electronic health record, can answer patient questions, can get schedules and appointments made, can answer insurance questions, and can help coordinate that whole experience for that patient.
Do you have any final thoughts?
It’s an exciting opportunity for those that recognize the challenge and the need that the population is demanding from their healthcare providers. For those who are willing to step up and to meet that challenge, it can be a very exciting and rewarding opportunity.
I’ve been doing this for well over 40 years. It’s been a pleasure and an honor to try and meet the needs of the community of patients — who, more often than not, experience some hardship or problem with healthcare – and try to relieve them of some of the frustration and the anxiety. Through technology and personalized service, there’s this incredible window where those that are willing can step through. I believe the receptivity of patients is going to be extraordinary.
I’m just blessed to be able to have the opportunity to see the transformation and be part of it. It is coming, make no mistake about it. Don’t think it’s not. There is a wave of consumerism that will engulf healthcare. I hope and expect that most of the healthcare providers will be able to step up to meet the challenge.
Doctors at the VA hospital in Roseburg, OR point to shady administrative efforts to boost quality ratings, including discharging sick ED patients and steering the chronically ill to nearby hospice care to avoid in-hospital deaths.
SSM Health (MO) notifies 29,000 patients of a November data breach involving inappropriate employee access. The call-center employee honed his activities in on a small group of patients with controlled substance prescriptions from a particular PCP in St. Louis.
Some systems of Jones Memorial Hospital (NY) – including Meditech — remain down following an unspecified December 27 cyberattack.
The hospital is asking patients to bring in their insurance card, meds list, and whatever medical history they have.
Reader Comments
From Debtor: “Re: news article calling American Well a start-up. What’s the shelf life? That company was founded in 2012. Or is it just a more-hip way to say ‘small business’ with no implicit time constraint?” I agree. I posit that a “start-up” will possess these characteristics, the absence of any meaning it’s just a less-sexy “business”:
Founded within the past five years.
Has not been acquired.
Founders are still running the show.
Annual revenue is under $50 million and headcount under 100.
Implicit valuation is less than $500 million and funding is via bootstrapping, angel investors, and early funding rounds.
The business model is uncertain and stability is absent.
Growing quickly while remaining unprofitable.
From Sparsely Populated: “Re: hospital construction. All those publish or perish authors should consider trying to correlate big health system construction expense with patient satisfaction and improved outcomes.” That would be interesting, as is the fact that some are questioning why health systems are building Taj Mahospitals while proclaiming themselves fit for purpose as benevolent overseers of declining public health. It’s a Pandora’s box of trying to tie non-clinical hospital overhead to their effect on the only metric that matters – patient outcomes. Locals, however, don’t understand or don’t care that health system costs sap the national economy even if they boost the local one, so they’re proud to show off fancy buildings to visitors.
From Deal Watcher: “Re: wondering about EHR decisions. Singapore docs want Epic and the CIOs want Allscripts in a decision that was supposed to be made by December 31. Nova Scotia has been out on RFP and it’s between Allscripts and Cerner, perhaps on hold since the entire Canadian Maritime was considering collaborating on a single integrated EHR. The VA is still delayed despite strong rhetoric from Secretary David Shulkin – if interoperability is their goal, why invest $10+ billion in a new EHR that won’t get them very far instead of waiting a few years for MU3 and mandated APIs that will allow interoperability initiatives like the Carin Alliance go mainstream?” Singapore will announce its decision in the next 2-4 weeks, I hear. I haven’t heard about anything new from Nova Scotia. I’ve also never heard of the CARIN Alliance, an apparently for-profit member organization convened by former government officials as a Leavitt Partners project to facilitate consumer-directed exchange.
From MD Professor: “Re: prescription drug monitoring programs. In my state, the focus on reducing opiate prescribing has seen skyrocketing rates of IV heroin use and overdoses even as available treatment programs have been reduced in number and insurance covers less of the high cost. Prescribing of even non-opiate controlled substances requires five minutes to deal with the state’s website. It only works with some browsers and enforces rigid password and reset rules that encourage poor security practices. The hospital says EHR interfacing is too expensive. I personally think the state makes the process cumbersome on purpose to dissuade clinicians from prescribing, so I don’t expect improvements to PDMP integration or usability any time soon.” You’ve identified four significant problems: (a) reducing the supply of legally manufactured opiates has raised their street cost and pushed users to less-reliable products that may kill them or steer them to crime to pay for their habit; (b) we are mired in the never-ending “war on drugs” that cannot be won by Darwinism, incarcerating users or dealers, fining drug distributors, or trying to limit access to drugs; (c) addicts trying to quit have few affordable treatment options; and (d) the use of PDMPs is creating unintended consequences even as it sucks up provider time. I don’t know the answer, but I’m pretty sure PDMPs specifically and technology in general aren’t it. A public health expert would tell you that few chronic conditions can be resolved by shaming or punishing those who have them, even if their own choices contributed.
From Jennifer Coons, RN: “Re: Seiling Municipal Hospital (OK). I know there have been lots of comments and rumors on HIStalk about my hospital and our decision to change vendors and I wanted to take time to address them and put them to a close. I appreciate your consideration in posting this letter to your readers.” Jennifer is administrator of the hospital. Click the graphic above to enlarge her letter explaining why the hospital recently reversed its decision to replace CPSI/Evident Thrive with Athenahealth and is now back on the former.
From Sick Doc: “Re: urgent care centers. I became ill with a high fever on New Year’s Day. All the urgent care centers were closed for the holiday.” I’ve often said that it’s no wonder that people show up in the ED for non-emergent issues. Private practices are nearly always closed outside of what used to be called bankers’ hours, urgent care centers set their own hours, and health system clinics stick to a university-like schedule, with only the ED offering the certainty that the lights will be on and the desk staffed. You would think a provider business case exists for being available for the other 14 or so hours each weekday plus weekends and holidays. I wonder if telemedicine providers similarly limit their availability?
From Banner Downgrade: “Re: Banner – University Medical Center, Tucson, AZ. A patient writes to the paper to complain about the EHR.” The letter writer says that following Banner’s “downgrade’ from Epic to Cerner:
His 30-minute appointment took more than 3.5 hours.
Banner’s Cerner system doesn’t receive his information his local doctors are sending.
Automated paging is no longer offered, so waiting patient names are called out by nurses.
He received a 13-page printout (sounds like a visit summary and/or patient education handout) that previously he could have accessed online.
He no longer receives telephone appointment reminders.
HIStalk Announcements and Requests
Most poll respondents celebrate a winter holiday and most of those observe Christmas. Either way, the days are getting longer; we’re back in the post-holiday, pre-HIMSS frenzy; and it’s just 76 days until spring in the Northern Hemisphere.
New poll to your right or here: was 2017 an overall better year for you than 2016? You can elaborate further in the poll’s comments (click its “comments” link after voting).
Some reader survey respondents suggesting eliminating some sections of HIStalk. I decided to let democracy rule – vote on which of the listed sections I should keep or drop in a survey I call “HIStalk Hot or Not.” I’ll be making a few more changes in response to feedback from survey respondents, one of whom received a late Christmas present in the form of an Amazon gift card (check your junk mail, folks, since all I had was an email address and the emailed gift card hasn’t been claimed yet).
Anonymous Epic Developer’s DonorsChoose donation funded math games for Ms. M’s first-grade class in Goldsboro, NC and solar energy study materials for Mrs. Z’s elementary school class in Brooklyn, NY. Anonymous made a donation that paid for a STEAM center (resources and furniture) for Ms. M’s elementary school class in Albuquerque, NM and a laptop and case for Mrs. H’s high school class in Fayetteville, NC. The teachers took the time to email me on New Year’s Day to say thanks.
This may be the last DonorsChoose update based on responses to the “keep or drop” survey above. One reader survey respondent dismissed the DonorsChoose updates as undesirable “virtue signaling,” a term (made up by a magazine in 2015) that I had to look up and found to be incorrectly applied since it indicates saying but not actually doing something virtuous (like helping teachers in need). Not to mention that I’m celebrating reader financial support of students, not bragging on my own. I admit that while most of the 570 reader survey responses were constructive and/or supportive, others ranged from dismissive to downright hostile and that always stings for awhile.
Last Week’s Most Interesting News
A consultant says Vermont’s HIE is not meeting the needs of its stakeholders and advises it to improve its services and financial sustainability.
A physician says missed meds are due to complex psychological issues rather than just patient forgetfulness, raising the question of whether a Big Brother-like pill tracker can improve outcomes.
The Indian Health Service issues and RFI for help in planning an IT future that will likely not involve the VA’s VistA, on which its RPMS systems are based.
Webinars
January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.
Cancer informatics vendor Inspirata acquires Toronto-based Artificial Intelligence in Medicine, whose product uses AI/NLP to extract oncology information from clinical documents.
Sales
Union General Hospital (GA) chooses Cerner to replace McKesson Paragon and Athenahealth, planning a CommunityWorks deployment of Millennium, RCM, and HealtheIntent.
Decisions
Slidell Memorial Hospital (LA) will switch from McKesson to Epic in 2018.
Lavaca Medical Center (TX) will replace Healthland with Cerner in 2018.
Merrick Medical Center (NE) will replace Healthland with Epic.
Wayne Medical Center (TN) will switch from Meditech to Cerner in June 2018.
These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
Announcements and Implementations
Sweden-based telemedicine and care center operator Doktor.se opens a clinic in a Swedish county where primary care is free, meaning that under Swedish law, everyone in Sweden can now access free virtual visits.
Doctors at the VA hospital in Roseburg, OR say metrics-obsessed administrators ordered them to discharge sick ED patients to make sure the hospital’s VA quality ratings (and administrator bonuses) didn’t suffer even though more than half its beds are always vacant. The hospital is also alleged to have told doctors to avoid listing congestive heart failure as an admitting diagnosis (since the hospital would be penalized for poor preventive care) and to steer chronically veterans to hospices to avoid having them counted as an in-hospital death.
Other
How cold it is? It’s so cold that exhibitionists are flashing drawings of themselves. It’s so cold that lawyers are putting their hands in their own pockets. It’s so cold that systems at IU Health Ball Memorial Hospital (IN) have gone down due to a shattered fiberoptic line.
Here’s Vince’s 30-year look back at the health IT landscape of January 1988, when long-timers might have been distracted by the latest episode of “The Cosby Show,” the end of the war in Iraq, or the scramble to get Michael Jackson “Bad” concert tickets.
Sponsor Updates
Leidos Health publishes a white paper titled “Ready or Not, It’s MACRA Time.”
Meditech announces its support for several STEM-related school initiatives.
Audacious Inquiry’s Julie Boughn is recognized as a 2018 FedHealthIT100 awardee for contributions in modernizing enterprise health IT.
AssessURhealth announces several 2017 company milestones, including a 170-percent increase in customer growth.
Besler Consulting releases a new podcast, “American Healthcare: Worst value in the developed world?”
CoverMyMeds celebrates its 2017 North American Visionary Innovation Leadership Award from Frost & Sullivan.
KLAS recognizes CTG as Best in KLAS for Partial IT Outsourcing.
Israel-based HMO Meuhedet inks a deal with American Well valued at between $50 million and $60 million. The company, which is the country’s third-largest HMO, will be the first non-US business to work with American Well. Israeli-born brothers Ido and Roy Schoenberg – both physicians – founded the telemedicine company in 2006.
A medical device sales tax of 2.3 percent goes back into effect after a two-year hiatus, a development the Advanced Medical Technology Association believes will stifle innovation and lead to the loss and/or creation of jobs.
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:
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.
Epic for health system-connected private practices.
Meditech for small health systems and those in Canada.
CPSI for cash-strapped rural and safety net hospitals.
Allscripts for hospitals in Australia and Europe, with newly acquired Paragon remaining an unknown.
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.
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.
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.”
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.
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.
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 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.
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.
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.
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.
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.”
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.
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.
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.
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.
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)
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.
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.
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, 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.
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.”
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.”
I had an old physician colleague whose favorite hobby was bitching about EHRs, and one day told a story about…