EPtalk by Dr. Jayne 4/26/18

It’s good to see data backing up things you know are true from an anecdotal perspective. Recent data from Black Book Research reveals that younger healthcare consumers prefer healthcare organizations that have greater technology capabilities. These respondents don’t want to engage hospitals and other healthcare providers in a traditional face-to-face way and often prefer digital interaction. This parallels the rise in social media usage as well as what I observe in the real world. On a recent trip with a youth group, I watched a crew of teens stand around texting each other rather than having an actual conversation. I’m not in the under-40 crowd that was mentioned in the survey, but I know that I prefer online bill pay and online scheduling to sitting on the phone trying to take care of things, or having to write a check or send my credit card information through the mail.

The piece goes on to note that hospitals still aren’t putting budget or priority behind patient engagement or interoperability as well as they could. Revenue cycle issues such as billing or payment continue to represent a low-point in the patient experience. After dealing with the bills related to a surgery last year, I would agree. Interoperability is still a barrier, whether you’re talking about hospitals or ambulatory practices. I had a recent cringe-worthy experience trying to track down some lab results from a practice that claims to have a patient portal but that in reality has failed to configure it so that patients can View/Download/Transmit or even see their CCDA. They don’t have online scheduling but do have online bill pay, but I haven’t been able to test drive it since they haven’t sent my claim to insurance yet, even though the visit was more than 30 days ago. That shows that they have opportunity for improvement in ways other than communication, and if I have to go back I’m going to be tempted to offer them my business card – especially since I know they attested for various incentives and lacking VDT capability is a big red flag.

The Net Neutrality repeal went into effect this week, even as members of the House Energy & Commerce Subcommittee on Communications and Technology debated so-called “paid prioritization” where Internet providers can charge higher fees to allow certain content to move faster. Paid prioritization was compared to TSA PreCheck, allowing better access for those who can afford it. Informatics advocacy organization AMIA submitted comments suggesting that Congress should thoroughly evaluate the issues and consider situations where prioritization might benefit the common good, such as telehealth service traffic. AMIA encouraged the subcommittee to think about broadband access as a social determinant of health, providing examples of mental health services in rural areas and noting that healthcare is increasingly delivered outside the walls of hospitals and healthcare facilities. So far, I haven’t noticed any appreciable slowness for any sites except LinkedIn, which is always a little squirrely anyway.

There has been a fair amount of anxiety in the physician lounge as practices await their first encounters with the long-awaited new Medicare card. As seniors become eligible for Medicare, they will be issued the new cards, although existing beneficiaries may not receive their cards for months depending on what state they are in. The CMS website lists a wave deployment for the new cards, with 13 states and territories scheduled to receive their cards in May, and with everyone else listed as “After June 2018.” It boggles the mind to think that despite knowing how many beneficiaries are out there and how many cards can be produced in a given length of time, that they can’t be more specific than that. Practices that see a large volume of Medicare patients would be wise to try to update information while scheduling appointments and during telephone encounters so that they don’t bottleneck at the front desk once the new cards are widely distributed in their state.

Watch out for patients with the old Medicare card who might have read this article that recommends they don’t carry their card and instead carry a photocopy with the numbers blacked out. It suggests that patients should tell medical providers their SSN/Medicare Number verbally for a visit. That will go over like a lead balloon at most medical offices, and I can only imagine the denials from number transposition or other errors.

The Leapfrog Group released its Spring 2018 Hospital Safety Grades, scoring approximately 2,500 facilities across the country from A to F. Five formerly failing facilities made it to grade A this time, with a total of 46 hospitals earning an A for the first time. My favorite academic medical centers scored a B and C, while small community hospitals that handle few complex cases scored As. Although I appreciate the need to try to report data in a meaningful way, as a patient I would choose the academic medical center regardless of score in the event I needed a complex procedure.

CMS is again trying to make us crazy, with the recent release of nearly 1,900 pages of fun hidden in the guise of its Inpatient Proposed Rule for Fiscal Year 2019. I do like the idea that CMS wants hospitals to publish their charge masters on the Internet, but the charge master is less relevant than knowing what the range of accepted payments is on those charges. CMS has requested public comment on the latter, so it might be forthcoming as well. Whenever I have to transfer self-pay patients from our very cost-effective urgent care to the nebulous costs of the hospital, I always have the conversation with them about saying up front that they are self-pay and asking if there is a discount for paying promptly in cash. Especially with younger patients, they don’t know they could end up with collections agencies hounding them, bad credit, or even a medical bankruptcy.

Although there’s an increase in the overall inpatient payment rate, higher numbers of uninsured patients will lead to more delivery of uncompensated care. I’m a big fan of the proposal to eliminate duplicate measures across Pay for Performance and Inpatient Quality Reporting programs, as well as the elimination of reporting for measures identified as “topped out.” Even with high scores, generating, parsing, and distributing reports is a pain for technology and operations support teams. There’s always at least one provider who thinks he should have had 100 percent rather than a meager 98 percent, and demands a chart review to prove his point. The comment period is open through June 25 with an expected final rule due sometime around August 1, although we know those release dates can be fluid.

Have you read the 1,882 pages yet, or are you just waiting for the movie? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/26/18

Doctor on Demand Announces $74 Million Series C Financing

Doctor on Demand raises $74 million in a Series C funding round led by Princeville Global and Goldman Sachs Investment Partners.

2018 Healthcare Prognosis

Venrock survey takers believe the Amazon/Berkshire Hathaway/JPMorgan deal won’t amount to much in the near-term, but do feel Amazon (and Apple) are poised to make big healthcare progress in 2018.

Trump After Dark: No Action Jackson edition

Senate Democrats publish allegations against VA Secretary nominee Ronny Jackson, MD that include giving out prescription drugs to staffers, drinking to excess while on the job, and managerial misconduct.

HIStalk Interviews Kevin Fleming, CEO, Loyale Healthcare

Kevin Fleming is CEO of Loyale Healthcare of Lafayette, CA.

Tell me about yourself and the company.

I’ve been in financial services in the healthcare industry for about 30 years. I had a long career at Ernst & Young. I ran a nationwide M&A practice and did well there. I then transitioned to Electronic Data Systems, where I was an executive. I ran a large strategic business unit with healthcare and financial services companies, some of the largest in the nation. It was heavy lifting — IT outsourcing, business process operations, claims processing. Roll up the sleeves, serious heavy lifting type of operational and IT activities.

Then I got a greater good calling. I took over as CFO — and then as the turnaround CEO — of the first full risk-bearing accountable care organization in the United States called Paradigm Outcomes, based in California but with a nationwide footprint. A lot of Paradigm’s business model was baked into what we now know as accountable care organization standards and programs.

I tried multiple times to retire but failed miserably at each of those. I found that my calling in life was to work. I took on another greater good calling, which was to help patients and providers deal with what perhaps is the most complex, perplexing, and most important issue — or at least it should be on their plate — and that is the phenomenon of consumerism in healthcare. That’s why I joined EPay Healthcare, and we’ve since rebranded to be Loyale.

As the tagline suggests, Loyale thinks patient responsibility shouldn’t be a burden. It’s an opportunity to create lasting loyalty and Net Promoters out of patients. In fact, the very survival of a lot of what we call the healthcare delivery network today depends on being able to do that.

How much patient dissatisfaction is caused by the financial aspects of their encounter?

I think if there were an accurate capturing mechanism for that, it would probably be well north of 80 percent. The patient’s first experience entering a healthcare setting is often administrative and that immediately becomes financial — looking for a co-pay. Their last experience is making that final payment or some other outcome, such as not paying a collection agency.

We see a lot of companies avoiding even capturing the satisfaction with the financial dimension of the relationship. We think that’s not only fundamentally wrong, but dangerous. To some degree, it’s low-hanging fruit, something that could change in a hurry with a little bit of effort. It could change dramatically for the better with a real patient financial engagement solution. That’s what we’re all about.

Consumers are fine with other industries in which companies require payment upfront and that market selectively to those who can afford their product or service. How can a physician practice have a different kind of relationship with people they know are able and likely to pay versus those who are not?

That hits one of the critical success factors to patient financial engagement. It’s a critical part of patient satisfaction overall.

The number one issue now — even exceeding anxiety over the clinical procedure to be performed — is financial anxiety. The inability to deal with the responsibility that everybody knows is coming, especially with the proliferation of high-deductible plans. The patient knows it’s coming. They don’t know the exact amount, but they know it’s going to be negative.

Using segmentation upfront to understand where a patient is with regards to both ability to pay and propensity to pay is a wise thing to do. It’s wiser yet to use it to dictate how you to interact with the patient financially.

That should never mean, in any way, compromising the quality of clinical care delivered. In fact, it’s consistent with the Hippocratic Oath — do no harm. The harm that the patient is afraid of is not just clinical, it’s financial. If you’re identifying those patients who are going to have a hard time paying and giving them options up front — showing a plan, showing a solution to eliminate that anxiety — you’re helping them, and of course, helping yourself.

Studies have shown that patients, younger ones in particular, are willing to pay if given a convenient way to do so. Does technology play a greater role in financial transparency and ultimately collections?

Yes, very much so. There are five or six golden opportunities for healthcare in having a patient financial engagement business strategy and follow-through capability. That’s one that’s near the top of the list — having a powerful digital channel, a portal, a go-to place.

You probably saw some of the same studies that I did that suggest in the next five years or so, Millennials will be making 70 percent of all healthcare decisions in the United States. I don’t know if that’s true or not, but we do know that the percentage is increasing constantly. Sixty to 80 percent of Millennials want to do all their business online, including clinical interactions, including making payments.

That does a lot of good things for everybody. You’re servicing them in the channel where they want to do business. You’re servicing them better at a higher standard that can cover all things clinical and financial in one setting. Working with us, they’re exposed to financing tools and vehicles, a variety of them that they probably wouldn’t see elsewhere. They’re able to work out their own plan, their own financial solution if you will, to deal with their responsibilities.

I don’t think that’s unique to Millennials. Obviously as a demographic, especially as they move more and more into prominence by numbers, they’re focused more on healthcare decisions. We’ve found high pickup rates for almost all demographics, including those at the upper end of the Baby Boomer age range. It’s not unique. People want to be able to do business in a convenient setting and a digital portal is very much one of those options.

It also reduces dramatically the provider’s cost to collect. As you can imagine, once the automation is in place, the cost of service is pennies on the dollar compared to rendering physical statements. Maybe a lot of those statements, because you extend out to multiple collection cycles because the patient isn’t paying. To pay for a call center, to pay for facility staff who many times would just as soon not to be involved with this at all.

They went to medical school, but now with the bleed-over effect, as we call it, instead of delivering medicine, they’re answering patients questions about, “Why is my estimate so high?” All that can be done extremely well in a digital portal. That needs to be a primary part of any provider’s financial engagement strategy, in our opinion.

Hospitals that don’t often have a strong reputation for being friendly or efficient with their billing and collection practices are increasingly acquiring, sometimes invisibly, practices and urgent care centers. Are you seeing patient engagement and loyalty changing as a result?

I had a front-row seat to consolidation in the financial services industry. We’re seeing a slightly different version of the same movie and the same end effect — a lot fewer entities. The banking industry consolidated almost by 50 percent in terms of the number of banks. A few large networks and regional networks were established. Specialty players came in, like PayPal, and picked up some very lucrative areas.

The same thing is happening in healthcare right now. Hospitals and healthcare networks are looking at that same near-extinction event as the financial crisis of 2008-9. They are over-leveraged and their operating cash flows are impaired for a lot of reasons. One at the top of the list is patient responsibility and the inability to collect. There are a lot of reasons that consolidation will pick up steam.

That’s one reason we were selected by the nation’s largest healthcare network, HCA, to be their platform and solution standards. The idea of episode of care. You can deal with a patient if they have a primary care physician or urgent care physician that they see ad hoc who then refers them to the hospital or outpatient setting, surgery centers, and so on. It doesn’t really matter. Our system will pick up all those physicians, all those caregivers, and amalgamate them into one financial episode of care.

The patient can see all of that at once. Instead of receiving five different bills and maybe one financing option or even maybe none, they’ll see a holistic solution for all the episodes of care coming from that healthcare network. In terms of consolidation, that’s an important thing to be able to do.

Part of this is you always want to service the patient better. But in terms of share of wallet, you want to be giving care in all those different modalities and stages and presenting an easy to understand financial bill instead of alternatives in aggregate for all of them. That’s a tremendous advantage.

Are providers recognizing that, as in other businesses, patients who are willing and able to pay cash up front would probably be more inclined to do so if they’re offered a discount?

The more forward-thinking ones are. We have a tool within our platform called Affordability Workbench. One of the doors, if you will, is our prompt pay discounts. Those would be highly apropos for self-insured patients who are not otherwise getting negotiated discount rates. The full charge master price without any discounts just isn’t going to work for them. There’s no way they can shoulder it.

I can’t say that’s universally applied, but we’ve specifically provided for it in the toolset for that very reason, to give the patient options that they don’t always see. Hopefully one of them works.

We also have a comprehensive array of payment plans that are extremely flexible. The patient is able to self-construct their own payment plan according to their cash flows within certain parameters that the facility controls. We have connections with all of the major third-party lenders, secured and unsecured facilities, and a pretty good idea of where they play well and where they won’t play well based on a provider’s requirement and patient financing needs.

Do you have any final thoughts?

The critical thing here is to get in the game and to play the game to win. If this plays out like the financial services industry consolidation, as many as half the healthcare providers in the country just won’t be there, probably within the next 10 years. You have behemoths like Walmart, Walgreens, Amazon, and CVS aligning with the mega payers. They are going to cherry pick some of the very best business in primary care, urgent care, and pharma. They are absolute experts and masters at consumerism given their retail origin.

It’s vital to play this game to win. Status quo is not winning. Just getting started is the biggest part of the battle. We have phased implementation with customers, so they can do it in pieces that they can absorb. Within 18 to 24 months, they’re all the way there.

The biggest message I would leave is to get in this game. This is the biggest issue on the table, the biggest elephant in the room. I know you’ve got a lot of other fires burning around you — value-based care, EHRs, filling capacity, and so on — but no patient, no mission. No money, no mission. Those are literally the table stakes here. Get in the game and get in the game to win.

Morning Headlines 4/25/18

CMS Proposes Changes to Empower Patients and Reduce Administrative Burden

A proposed HHS rule would retarget the Medicare and Medicaid EHR Incentive Programs to “a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.”

Ping An healthcare unit maps out plan for $1.1 billion Hong Kong IPO

China’s largest Internet healthcare platform, insurance subsidiary Ping An Healthcare and Technology, plans a $1.1 billion IPO on the Hong Kong exchange.

Transcription Service Leaked Medical Records

Kansas-based transcription firm Medantex takes down its customer web portal after security researcher Brian Krebs notifies the company that its audio recordings and site administrative functions were wide open to any Internet user.

After Trump Hints V.A. Nominee Might Drop Out, an Aggressive Show of Support

The Senate postpones the VA secretary nomination hearing of Admiral Ronny Jackson, citing allegations of improper conduct in his military career that require further investigation.

News 4/25/18

Top News

A proposed HHS rule would retarget the Medicare and Medicaid EHR Incentive Programs to “a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.”

CMS proposes renaming the incentive programs to “Promoting Interoperability Programs,” noting that the word “incentive” is obsolete now that most payments have ended.

The rule would require using CEHRT certified for the 2015 Edition beginning with the 2019 covered year. It would allow a 90-day reporting period for 2019 and 2020.

HHS proposes to replace the six Medicare EHR Incentive Program measures with four:

• E-prescribing
• Health information exchange
• Provider-to-provider exchange
• Public health and clinical data exchange

HHS also proposes two opioid-related e-prescribing measures for connecting to PDMPs and verifying treatment agreements that would be optional for the first year.

The proposed changes would also require hospitals to publish their charge master price list online every year, but asks whether more specific information might be useful to consumers, such as details on a hospital’s average discounted charges across all payers. HHS also asks if providers should be required to disclose a patient’s out-of-pocket cost for a service before performing that service, presumably to reduce surprise out-of-network charges.

The public’s comments about the 1,900-page document are due June 25.

Reader Comments

From Stealthily Healthy: “Re: HLTH conference. I’ve been asked a dozen times if I’m attending and I’m uncertain. What do you think?” Beats me. The speaker roster is huge, which I expect is because the VC-funded first-time conference used its cash to pay expenses and hype it up a bit. They’re also offering free provider registration hoping to give vendors their money’s worth in corralling prospects. I’m not sure anyone’s thrilled at going back to Las Vegas in early May after just leaving HIMSS there in March. The big question is whether it will do well enough financially to warrant a repeat next year. The conference claims it will create “a much-needed dialogue focused on disruptive innovation in healthcare” even though it’s run by two tech guys with zero healthcare experience and the track record of folks waving the “disruptive” flag without understanding what they’re disrupting isn’t great. We have way too many healthcare conferences, but fortunately for those offering them, way too many people willing to spend their employer’s time and expense money to attend them with questionable outcomes beyond glad-handing self-validation. Ironically, I would bet that high-accomplishment conference presenters didn’t actually waste their early-career time attending those same conferences.

From System CIO: “Re: HIStalk. It’s a really valuable read for me. I’m not one of those CIOs who is constantly networking with everything and everyone in our industry to keep up (primarily because there’s so much work to do and time necessarily spent focused inwardly) but HIStalk allows me to see/stay connected more broadly. Thank you for all of the time and effort you spend to make it what it is.” Thanks for making my day.

HIStalk Announcements and Requests

I’m getting good responses to this week’s question. I’m sure yours would be even better (hint).

Listening: reader-recommended The Prefab Messiahs, a barely-noticed early 1980s punk band that college students have rediscovered with their new album. It’s raw and I expected the typical garage band weak vocals, but they sound good when belting out wry, withering social commentary on songs like “The Man Who Killed Reality.”

I’ve seen video from recent conferences in which attendees were urged to hug each other, dance at their seats, or exchange high-fives, all of which seem not only to be crassly contrived, but straying way outside the comfort zone of many in the audience. I remember one hospital management event I attended where they hired a super-cheesy motivational speaker (some local guy who formerly played in an awful rock band with small talent and big hair) who demanded that we all “share” with our tablemates, which made me want to rip off his $2,000 suit and choke him with it. At the long-awaited end of his de-motivational speech, he brought up a slide of his wife and fake-cried about how much he loved her, leading all of us recent sharers to wonder what exactly we were supposed to do with that. Dear conference organizers and presenters – just do your presentation without expecting the paying audience to do anything except watch. Or just thrust your microphone Ozzy-style at the crowd and let them read the slides while you wiggle your hands approvingly as a conductor rather than performer.

Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

May 29 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

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

Acquisitions, Funding, Business, and Stock

China’s largest Internet healthcare platform, insurance subsidiary Ping An Healthcare and Technology, plans a $1.1 billion IPO on the Honk Kong exchange. The 900-employee, AI-assisted service provides 370,000 free consultations each day and offers free, two-hour prescription delivery in major cities. Its network includes 3,100 hospitals and 7,500 pharmacies. Reports from a year ago suggested that investors were losing interest because of profitability concerns despite huge demand that is driven by dissatisfaction with China’s overwhelmed healthcare system.

Twitter co-founder Biz Stone invests an unspecified amount in India-based Visit, which offers AI-supported video visits.

Sales

War Memorial Hospital (MI) expands its use of FormFast electronic forms and workflow solutions, integrated with Meditech 6.1.

Announcements and Implementations

Mobile technology vendor Dictum Health adds a video laryngoscope to its Virtual Exam Room platform. The company offers a suitcase-sized patient examination system, an in-clinic telehealth system, and a medical telehealth tablet connected to cloud services.

A small KLAS study on clinical process improvement finds that Stanson Health and LogicStream Health lead the way in analyzing clinician EHR use to optimize alerts and order sets, respectively, and identifying training opportunities for individual users. KLAS also finds that while many clinicians don’t trust the data presented to them or ignore recommended care guidelines and workflows, frontline doctors say that tools from Stanson and LogicStream are easily understood and useful.

Government and Politics

The Senate postpones the VA secretary nomination hearing of Admiral Ronny Jackson, citing allegations of improper conduct in his military career that require further investigation. President Trump nominated Jackson via Twitter without the usual vetting process that would have resolved any confirmation issues outside the public eye. The New York Times says the issues were raised by anonymous White House associates of Jackson and involve his oversight of a hostile work environment, overprescribing of drugs, and claims that Jackson drank on the job. President Trump distanced himself in his reaction to the delay, blaming partisan opposition but admitting, “There’s a lack of experience.” He concluded, “If I were him, I wouldn’t do it.”

Privacy and Security

Kansas-based transcription firm Medantex takes down its customer web portal after security researcher Brian Krebs notifies the company that its audio recordings and site administrative functions were wide open to any Internet user. Medantex says it had been attacked by WhiteRose ransomware and apparently misconfigured the servers it rebuilt, exposing them to the world. I tried to pull up the company’s public webpage and was blocked by Bitdefender’s malware detection system.

Other

A small study finds that anticoagulation lab test and drug ordering improves when physicians use the CDC’s PTT Advisor app.

The family of Prince sues Trinity Medical Center (IL) for failing to correctly identify the counterfeit drug he had taken before the singer’s private plane made an emergency landing in Moline on April 15, 2016. They’re also suing Walgreens for filling his narcotics prescriptions that were written under his bodyguard’s name. Prince lied about his drug intake and refused all testing in the hospital in hopes of concealing his years-long addiction from the public, but the family says the hospital should have run extensive tests to determine that the black market drug he thought was Vicodin actually contained fentanyl. He died six days later of a fentanyl overdose. That’s the disadvantage of being a celebrity addict surrounded by sycophantic coat-tailers– your star-stuck doctor will write any prescription; your handlers will get it filled under their name and score illegal drugs to supplement when necessary; and you have enough time, money, and enablers to make addiction seem like a normal response to pain, stress, or disappointment.

Sponsor Updates

• IMAT Solutions will exhibit at the National Association of ACOs spring conference in Baltimore April 25-27.
• LabFinder.com will use Ellkay’s integration services to connect with physician office EHRs.
• Obix Perinatal Data System vendor Clinical Computer Systems, Inc. earns SOC 2 and HITRUST certification.
• AdvancedMD will exhibit at ACOG April 27-29 in Austin, TX.
• Aprima will exhibit at AROC April 25-26 in Atlantic City, NJ.
• Arcadia will exhibit at the NAACOS Spring 2018 Conference April 25 in Baltimore.
• AssessURhealth publishes a new customer success story featuring LoCicero Medical Group.
• CarePort CEO Lissy Hu, MD will present at ACMA National April 26 in Houston.
• Netsmart receives the first ONC-Health IT 2015 Edition Certified solution for palliative care.
• Spok and Bernoullli Health partner to improve clinical alarm management.
• The local paper profiles CoverMyMeds after its top ranking as a best place to work in Columbus, OH.
• CTG will exhibit at the Texas Regional HIMSS Conference April 26-27 in Dallas.
• DrFirst VP Linda Fischer will participate in a panel discussion at the Critical Connections’ Opioid Crisis Symposium April 25-16 n Baltimore.
• Consulting Magazine names Divurgent Principal Ralph Whalen a 2018 rising star in healthcare.
• EClinicalWorks will exhibit at the 2018 Physician Practice Management & ASC Symposium April 25-26 in Nashville.
• Healthwise will exhibit at GetWellNetwork’s getconnected 2018 conference April 30-May 2 in National Harbor, MD.
• InstaMed will exhibit at the Georgia MGMA Annual Conference April 29-May 1 in Savannah, GA.
• AWS features Kyruus in its coverage of hot startups for April 2018.

Blog Posts

• Lessons Learned in 40 Years of Software Development (Medicomp Systems)
• EHR Optimization as a Bridge to Population Health Management (Pivot Point Consulting)
• 5 Questions Every Practice Owner Should Ask (AdvancedMD)
• FDA Releases New Guidance on Children’s X-ray Exams (Agfa Healthcare)
• Using Real-Time Data to Impede the ‘Quiet Killer’ (Bernoulli Health)
• The Differences Between LPN vs. RN: Choosing a Nursing Career (CareSync)
• How Hospitals Can Improve On-Site and Post-Service Self Pay Capabilities (Change Healthcare)
• Are you using data to understand your pharmaceutical costs? (Nordic)
• Leveraging Data to Improve Your 3-Day Rule Waiver Program (CarePort Health)
• A Positive Response to Negative Reviews About Your Urgent Care (DocuTap)
• Striving for Health in Rural America (EClinicalWorks)
• Project Spotlight: Calderdale & Huddersfield NHS Foundation Trust (UK), Part 2 – Jackie Murphy & Dr. Allistair Morris (The HCI Group)
• The Secret That One Third of Hospitals Already Know (HCTec)
• Online Appointment Scheduling Helps Staff and Patients (Healthgrades)
• Does Your Workflow Do This? 4 Requirements for an Enterprise Approach to Communications (Spok)
• Teaching the Importance of Protecting Patient Privacy – Inside and Outside the Hospital (Iatric Systems)
• Four Important Steps to Clinical Optimization (Leidos Health)
• Tips for Managing Coding Quality (Impact Advisors)
• ‘Trust’ and Shared Access in EMRs: an Interview with Dr. Tzfanya Korach (Imprivata)
• Respond at Your Own Risk: Avoid these common reputation management mistakes (Influence Health)
• Separating the Hype from Reality in Healthcare AI (InterSystems)

Contacts

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

Morning Headlines 4/24/18

Former VA CIO optimistic that IT initiatives will move forward

Former acting VA CIO Scott Blackburn downplays speculation that his departure, as well as that of former VA Secretary David Shulkin, MD will hinder the agency’s progress on purchasing and implementing a new Cerner EHR – a contract he expects will be signed within the next couple of months.

Hacker Group Is Targeting Healthcare For Corporate Espionage, Symantec Warns

Symantec reports that a new hacker group called Orangeworm is conducting industrial espionage through custom malware attacks on medical imaging software.

Defense Electronic Health Records Program Seeks Help Organizing Influx of Data

The Defense Health Agency looks for vendors capable of consolidating and migrating data from its enterprise storage systems as it moves to the new MHS Genesis EHR.

Feedback on New Direction Request for Information (RFI) Released, CMS Innovation Center’s Market-Driven Reforms to Focus on Patient-Centered Care

CMS looks for additional feedback on direct provider contracting, which would enable Medicare patients and providers to bypass an administrative middleman in an effort to lower costs and improve care.

Readers Write: How AI and Blockchain Can Combine to Benefit Population Health

How AI and Blockchain Can Combine to Benefit Population Health
By David Campbell

David Campbell is senior developer for Macadamian of Gatineau, Quebec.

The adoption of artificial intelligence (AI) continues to gain momentum as we see how it can augment a healthcare system’s effectiveness. Similarly, blockchain’s potential is very appealing to the healthcare industry for helping to solve the interoperability challenge.

While they have each individually demonstrated their potential to impact the industry, combined together they could greatly benefit population health and transform healthcare.

It seems inevitable that AI will revolutionize healthcare. The potential of AI is massive and our responsibility is to harness its power to maximize its benefits. For instance, how useful would it be for a doctor to compile a list of conditions to which their patient is susceptible to based upon their medical records and cross-referenced with general medical trends? AI can make this happen.

However, before AI can play a full role in healthcare, data collection, transportation, and storage present some complex privacy, integrity, and availability challenges that must be addressed.

Finding data sources is another major hurdle, but with the advent of consumer Internet of Things (IoT) devices, raw data is increasingly available. AI algorithms can use anonymized data from these devices to show general population health trends, but the challenge is mining the huge amount of raw data for useful information with a finite amount of computing power.

Enter blockchain.

Healthcare blockchain represents another source of medical data. The prevalence of these blockchains in the medical domain is increasing because they store transactions in a network of distributed servers, which offers a high degree of availability. This adds protection against network outages and hardware failure. Also, the format of the transactions makes it almost impossible to tamper with the data. Data integrity and accountability are paramount to any healthcare solution.

While the quantity of data does not approach the amount of raw data that can be collected by medical devices, the data received by a medical blockchain is richer.

Using a blockchain solution in an electronic health record (EHR) system allows for the creation of transactions between entities such as patients and medical conditions. In this case, we can think of the diagnosis of a condition as a transaction between a patient and a known condition.

Not only can we store this information as a distributed immutable transaction in a patient record, we can also record the relationship. By updating a patient record using transactions between entities, a graph database can be constructed.

A graph database is a way of storing unstructured data and the relationships amongst the data. For example, if a physician prescribes a drug to a patient, the patient, the doctor, and the drug would be stored along with the relationships amongst the pieces of data. The relationship between the doctor and the patient would be regular doctor / patient or it could be specialist / patient. The relationship between the drug and the doctor would be prescriber.

The graph database can show latent variables, which is information hidden within the data. This can be taken a step further.

One example of a machine learning algorithm that uses graph database to extract and use latent variables is a Bayesian network. A Bayesian network is a graph database built on relationships of cause and effect.

The strength of a Bayesian network is its ability to determine probabilities. When applied to general population health data, it can help make powerful predictions and correlations between seemingly unrelated pieces of information.

For example, smoking has an elevated probability of causing lung cancer. AI can mine data surrounding this relationship from a general graph database using various algorithms. The resulting Bayesian network can be used as a model to predict diagnosis based on the medical history of a patient.

Think about the possibilities where healthcare organizations can leverage the power of these two technologies so that they can find the largest number of common connections such as: if a population is suffering from Condition X and the largest shared connection is prescription to Drug Y, it would be reasonable to investigate whether Drug Y has a side effect that causes or contributes to Condition X.

This only begins to scratch the surface. While there are many obstacles, the potential for AI and blockchain to combine forces is immense and could prove to transform healthcare as we know it.

Curbside Consult with Dr. Jayne 4/23/18

I met up with a colleague this weekend who is knee-deep in an enterprise-wide EHR installation. They’re rolling it across several hospitals and are dealing with the challenges of trying to unite community-based physicians, hospital-employed physicians, and a couple of residency programs on the same platform.

My friend is one of the hospital-employed physicians. He splits his time between clinical and administrative duties. Originally hired to streamline implementation of the hospitals’ soon-to-be-legacy EHR nearly a decade ago, he has a great deal of experience in change leadership and trying to unite people around a common goal. He was looking forward to the new project, thinking it they could use some of the same strategies and techniques that had been used with success in the past.

The first thing that set him back was the way that the project was legally structured. Since it is a joint venture between the hospital and the residencies (which have ties to both the hospital and a medical school in the region), the software purchase was handled by a new entity with representation and funding from the constituent entities. Although technically they’re supposed to be partners, it sounds like there is constant tension between the parties as each struggles to be in control of various decisions. The hospital is definitely larger with its employed medical group and large number of community physicians who are on staff, but the residencies try to bring the weight of the medical school to bear and play the prestige card when they feel they’re not being allowed to be in charge.

From my time at Big Medical Center, I know that often the employed physicians are easiest to deal with. Although they will hem and haw and posture about various decisions, they ultimately understand where their paychecks come from and will eventually get on board with the project. There will be tensions among the specialties and between the hospital-based physicians and the ambulatory-based medical staff, but usually there is enough common identity to get everyone to pull together.

Then there are the community physicians, those who have admitting privileges at the hospital but who might also see patients at various other facilities. They tend to be a little more challenging to work with since they frequently will threaten to pick up their patients and go elsewhere if decisions aren’t to their liking. Depending on the specialties involved (think orthopedic surgery and interventional cardiology), the financial impact to the hospital can be significant, so project teams are often instructed to “play nice” with them.

The reality of the threat to “go elsewhere” is that it tends to be a hollow one. If you’re in a city with multiple hospitals or health systems, everyone has an EHR and everyone has similar challenges and mandates, so it’s unlikely that they can move their cases across the street and have 100 percent of their demands met. They’re going to run into employed physicians and hospital administrators over there, too.

Although some community physicians still attend at multiple hospitals, the stresses of that type of practice are great. We’re seeing more and more community-based physicians who have put their proverbial eggs in one basket with a single hospital and the pain of change is worse than the pain of same when it comes to moving to another facility. They already know how their current hospital schedules, what schedule they can be guaranteed in the operating room, if the hospital carries their preferred joint implants and medical devices, etc. Still, the EHR project teams have to deal with these threats and pressure from administrators to ensure physician happiness, so it’s something that has to be considered.

Residency programs are another situation entirely. In some of the smaller programs that aren’t based at an academic medical center, there may be a mix of attending physician types. Some might be from a local medical school, but rotate through the residency program a couple of weeks or one month a year to provide that academic pedigree. That can mean accommodating a dozen or more physicians and their opinions, although they don’t have a lot of dedication to the program since it’s not their primary focus. There may be full-time hospital-employed or community-based physicians that form the core of the faculty, and then part-time physicians who provide additional coverage or who keep working in the program as they move towards retirement or who just want to keep their toe in the residency world.

Then there are the resident physicians. Some may be dedicated to the program and will be part of the care team for three or more years. Others may just rotate through a month or two across a three-year span, such as family medicine residents who rotate through OB/GYN programs. These various structures lead to the need for a lot of users who are in the system but not on the system with great regularity, as well as a breadth of opinions about how the system should work that you won’t see anywhere else.

As we caught up over coffee, my friend lamented the fact that the organization seems to have underestimated how diverse the opinions would be when they began working with these different constituencies. He thought they would be able to apply some of the governance principles that they had used successfully on the hospital side in the past as they united with the other two hospitals, but the reality was very different. He’s been pulled into nearly a year of infighting, posturing, threatening to leave the legal entity, and backstabbing behavior. The lack of governance is a real challenge and he doesn’t have a lot of hope that it will be resolved anytime soon.

They’re also faced with cost overruns as they discover that certain parts of the project were under-scoped or not scoped at all. For example, the pathology lab interfaces were forgotten – the scoping team assumed they were part of the main hospital laboratory system. There were plenty of similar misses across the facilities, each of which adds a little bit more to the price tag. In the realm of under-scoping, they forgot to account for the needs of community physicians and part-time physicians in the training budget, failing to appreciate that these providers would want to train after hours or through different modalities than the hospital classroom. They’ve been working with consultants, but recently decided to add several other consulting groups to handle various subprojects, which will likely add more challenges to the situation.

It was good to commiserate and I think my friend felt validated in the fact that I see similar situations across the country. It doesn’t seem like there are a lot of good answers unless you have strong leadership that is willing to find the right mix of persuasion, financial incentives, and maybe even a “take no prisoners” approach to get the job done.

As our catch-up time wound down, my friend asked whether I knew of any good opportunities in the area or whether I had any recommendations on working with physician search firms. It seems he may be reaching the end of his tolerance for the process and I certainly sympathize with him. We scheduled another coffee date for the end of summer. I’ll just have to see how he is hanging in there.

How has your EHR project team handled governance? Did you survive a situation like this one? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/23/18

Beaumont, Henry Ford rethink the ICU

Beaumont Hospital Royal Oak (MI) redesigns its ICU to display data from Epic and monitors in a big-screen graphical format that increases real-time data visibility with fewer clicks.

Switching programs, MultiCare Spokane hopes to streamline medical records for patients

MultiCare Spokane (WA) will switch to Epic on June 1, putting the region’s largest health systems on the same EHR system.

An E.R. That Treats You Like a V.I.P.

Concierge ED business models take hold, catering to affluent families willing to pay thousands of dollars annually to gain access to VIP emergency rooms that — unlike hospitals that prioritize patients by acuity — get them in and out quickly by seeing only a handful of patients each day.

Epic Systems and MEDITECH Rise Atop Black Book 2018 Survey of Inpatient EHR Client Satisfaction Joining Cerner and CPSI

A survey of 3,000 hospital EHR users finds that two-thirds of hospitals don’t use patient information from outside their own EHRs because it’s not available within their workflows.

Monday Morning Update 4/23/18

Top News

The New York Times covers concierge EDs such as those run by Priority Private Care, where affluent families pay thousands of dollars per year to gain access to VIP emergency rooms that — unlike hospitals that prioritize patients by acuity — get them in and out quickly by seeing only a handful of patients each day.

The art-filled facilities don’t handle trauma, but instead address a market in which three-fourths of ED visits don’t involve emergency care.

The membership fees don’t include the cost of services themselves, which are billed to insurers at pricey ED rates. House calls, executive wellness services, and travel medicine are offered at extra cost.

The facilities have clinical staff without much to do, so they don’t discourage low-acuity member visits. The article profiles a man who dropped by to have staff look at a troublesome pimple.

The company has a cozy relationship with hospitals, offering “VIP services … including access to private rooms and direct admissions.” It has also extended coverage into the Hamptons, offering summer house calls and partnership with a helicopter service for medical transport.

HIStalk Announcements and Requests

Most poll respondents don’t go to Twitter to obtain health IT knowledge, news, or opinions. Some commenters expressed shock that others don’t share their active Twitter involvement as a source of information and connection to various communities; one respondent “called BS” that so many respondents voted “not very” (I’m not sure what kind of conspiracy he’s picturing, but IP analysis at least suggests there isn’t an organizational one); one claims that people who don’t use Twitter lack critical thinking skills, and another respondent said those voting negatively must not know how to use Twitter to participate in the “thriving community of thought leaders, influencers, and curious minds.” Taking the other point of view was a respondent who said he has never understood why people waste time on Twitter; another who says he tweets but is pretty sure he’s the only one reading; and another respondent who says decision-making executives don’t use Twitter and don’t care about any of the reasons listed by the Twitter fans. The vote was actually about six percentage points more in the “not very” category until a few folks tried to drum up support via Twitter in urging non-HIStalk readers to vote, but the resulting swing wasn’t significant.

New poll to your right or here: which organization do you feel more positively about following Cerner’s protest of University of Illinois Hospital selecting Epic?

I always learn a lot from responses to my “What I Wish I’d Known Before” questions and I usually end up being moved in some way (sometimes in an uplifting manner, sometimes not) from what readers share there. That’s true of last week’s question, “What I Wish I’d Known Before … Taking College Courses While Still Working Full Time.”

This week’s question is more pragmatic and targeted to health system IT management. I might have to add my own response since I’ve done this enough times to have some war stories. 

Listening: a surprise, marvelous new release from The Longshot, a new band formed by Green Day front man Billie Joe Armstrong, with a sound that ranges from dead-on “Please Mr. Postman” Beatles to thrashing punk to lighter-swaying balladry. I’m also liking (without being able to articulate why since I really don’t enjoy Sting much) the unlikely Sting-Shaggy reggae collaboration on “44/876,” which Rolling Stone aptly describes as “Roxanne hitting a Sandals resort” (trivia: the Jamaica-born Shaggy served in the US Marines as an artilleryman in Operation Desert Storm and developed his singing style from calling marching cadence). It channels the joy and color of a Caribbean island with UB40 playing on a cheap radio, which makes me long for coconut shrimp and a Carib beer while sitting on a decrepit plastic chair ankle-deep in pee-warm beach water. I’m also enjoying new, frenetic basement pop from Ohio-based pop Remember Sports (which just changed its name from just Sports), along with some great Norway art rock from Gazpacho, which has a new album due any day now.  

Webinars

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

Acquisitions, Funding, Business, and Stock

A PwC/CB Insights report finds that VC seed round investments have dropped considerably even as overall funding increases, AI had its first big investment quarter, and healthcare was the #2 sector (behind Internet) in both number of deals and deal value.

Decisions

• Sheridan Memorial Hospital (WY) will go live with a Change Healthcare cardiovascular information system in 2019.
• Hutchinson Regional Medical Center (KS) will switch from Philips Healthcare to Merge Healthcare cardio in September 2018.

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

People

Vocera’s board elects President and CEO Brent Lang as chairman, replacing Bob Zollars. I interviewed Brent a few weeks ago.

Announcements and Implementations

A Black Book survey of 3,000 hospital EHR users finds that two-thirds of hospitals don’t use patient information from outside their own EHRs because it’s not available within their workflows. Top-ranked vendors in client experience are CPSI Evident (small and rural hospitals), Meditech (101-250 beds), Cerner (teaching hospitals), and Epic (over 250 beds). 

Other

The Detroit business paper covers the ICU redesign of Beaumont Hospital Royal Oak (MI), which displays data from Epic and monitors in a big-screen graphical format. The ICU director says, “The regular Epic system, you needed to click 13 times to get to the chest X-ray we needed to see. Now we click once to get where we need. Deeper dives into data comes up as a long, scrolling, table five feet long that has everything lined up vertically by time. You see everything happening now and at anytime in the past.”

A Wall Street Journal article says the UK’s NHS is struggling with long waits and shortages of beds and doctors, but as Eric Topol notes, they’re still far ahead of the US.

UCSF’s Bob Wachter, MD worries in a New York Times op-ed piece that immunotherapy-based cancer treatments have made it harder to help families consider palliative care, with the staggeringly expensive and side effect-causing treatment offering near-miraculous cures but only for around 15 percent of patients. Wachter advocates that “comfort or cure” decisions not be considered as mutually exclusive by insurers, training doctors on how to explain benefit vs. harm, and including in studies the question of how to identify that minority of patients that could benefit.

An NPR reporter trying to get her mother placed in a rehab center has to pay $12,000 due to Medicare’s “dueling rules and laws” that require a three-night inpatient hospital stay to be covered for rehab placement, while hospitals are threatened with audits for admitting rather than keeping patients on multi-day observation. In her mother’s case, the “admission or observation” decision was made by McKesson InterQual. The reporter concludes, “I sped to the hospital in a rage. I demanded to know why they were releasing her when she still couldn’t walk. Further, I wanted to know, why were they calling her an ‘outpatient’ when she was sleeping in their bed, under their blankets, wearing their hospital gown, and being cared for by their staff.”

This is brilliant: Children’s Healthcare of Atlanta at Scottish Rite soothes NICU babies by recording their mothers singing and reading stories to them, with the CDs then played back to them when the mom can’t be there.

Sponsor Updates

• WiserTogether releases a new version of its Return to Health platform that guides consumers to the most effective treatments for their specific conditions and attributes.
• The SSI Group will present at the HFMA Texas State Conference April 22 in Austin, TX.
• Surescripts will exhibit at the AMCP Managed Care & Specialty Pharmacy Annual Meeting April 23-26 in Boston.
• Philips Wellcentive will exhibit at the NAACOS event April 25-27 in Boston.
• ZappRx will exhibit at the ASEMBIA Specialty Pharmacy Summit April 29-May 2 in Las Vegas.
• ZeOmega releases the annual updates to the integrated patient assessments of its Jiva PHM solution.

Blog Posts

• Data-Enabled Strategy for the Social Determinants of Health (Redox)
• Technology That’s Driving Accessibility for the Visually Impaired (Salesforce)
• Healthcare Payer and Provider Contract Management (The SSI Group)
• 5 core competencies of molecular lab management (Sunquest)
• Texting that’s simple and secure. (Voalte)
• Hospital Communications: Reading Hospital Sets Gold Standard for Conducting Joint Commission Surveys (Vocera)
• Don’t Flex Your PTs: 4 Ways to Make Use of Patient Cancellations (WebPT)

Contacts

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

What I Wish I’d Known Before … Taking College Courses While Still Working Full Time

That taking classes when you’re over 40 is pointless. Few, if any, employers believe that those over 40 have anything left to offer, regardless of one’s interest in continuing their education and staying current.

Nothing. I was glad I earned my MBA while working when I was 24-25 years old. At the time I knew it would be a short-term sacrifice for long-term gain and it was. I started the program part time in the evenings while I worked full time and concluded full time while working part time for eight months. To those of you in your mid-20s thinking about earning an advanced degree, get practical work experience for a few years first. It will make the degree more valuable as you will apply professional experience to course work and learnings from the program immediately in your work setting.

I wish I had known just how little sleep I would get! I went back to school after a divorce. I was a single parent working full time, carrying a full load of at least 12 credit hours, and it was a huge test of my stamina. However, it was the most rewarding experience. I wish there were online programs when I did it, I had to physically go to school.

I encourage all of my employees to follow their dreams and go to school as well. One finished her MBA, another just graduated with a BA, another is in school now. They all found programs that are online and that seems to be more manageable.

It’s worth doing. Time management, prioritizing and letting the unnecessary stuff go are the keys to sanity. And remember, there is a light at the end of the tunnel. Just get through one class at a time and eventually you’ll be done.

Engage with your full-time college student peers sooner — they can help you through. I worked full-time nights as a nurse, taking graduate-level business classes in the morning. I was so tired I didn’t sense how curious the ‘regular’ students were and how much they wanted to get to know me. Once I made the effort, they became a great support system.

I tried to do it 20 years ago with young kids, a more than full-time job, and travelling. Not surprisingly, I could not sustain the effort and was unprepared for the amount of non-class time I would have to commit, so that effort ended. Fast-forward to 2016, and tried again, this time with a completely online program. The coursework was still extremely challenging (more so than I remember from my brick-and-mortar experience), but the flexibility made all the difference in the world. Bottom line: be ready to commit the time and be realistic about your current life situation before jumping back in.

The course that seemed so valuable to gain new expertise ends up being little more than a high-level theoretical overview of the area. After a day of professional work with software, a computer science course seems like a step backwards, learning old techniques and theory. I find myself questioning the expertise of the professor compared to my professional colleagues. After a week of full-time work, I rarely have much energy to spend on deep learning, so I find myself doing the bare minimum to get by. I’m surprised at the low-quality work that is acceptable to get a decent grade.

I wish I’d had the foresight to schedule time for social activities when I first went back for my master’s. If I don’t look for opportunities to meet up with friends early, I either end up becoming a hermit or accepting last-minute invitations too close to class deadlines.

I wish I’d known how helpful programs like Khan Academy and even YouTube channels can be for brushing up on the basics. My advice for anyone going back for another degree after a long time out of academics would be to put pride aside and find a way to test how much you may have forgotten.

That I would immediately want to quit my job and go to school full time, forever.

It’s 100 percent worth it when you’re done. MBA.

You will be forced into TOUGH choices. After a while, it becomes hard to juggle school, work, and family. Additionally, I had travel related to school and for work. I ended up quitting work midway through the degree because my employer didn’t care about my MBA and I felt that I had reached my ceiling there. That helped me regain sanity.

I wish I’d known how much effort it would be. I knew college courses were hard, but I signed up, waxing nostalgic over going to college full time. Working then going to class after was totally different. It was basically paying a ton of money to do extra work. It feels especially hollow when you realize there are a dozen courses online where you could learn the same things for free.

That as time-consuming as it was, it wasn’t as bad as I thought it would be. I had put off getting my master’s degree for years because I thought I wouldn’t be able to handle all the extra hours. Once I got into my new routines, it was challenging but doable.

That success in school meant getting up early before work to read, staying up late to complete assignments, eating lunch at my desk at work while reading, and basically using every free moment to pull out my tablet and/or phone and chip away at assignments. Oh, and doing schoolwork on every vacation for four years, including on cruise ships.

Even though it was hard, it was worth it.

Academia is very different then real world and professors have a book perspective on leading business. Look for a school that has professors who have worked in your field and can provide real-world perspective.

There were three things I wanted to do well: work, family, and school. I found that one of these always suffered, and since family had the least-noticeable short-term consequences, that’s usually what I sacrificed. In the long term, however, the family impact was significant and I ultimately stopped taking classes. For anyone who is married or has a family, I would ask them to seriously consider whether a lack of degree is truly what is holding them back in their career. For me, it was not, and school was not worth sacrificing family time. If you’re single, go for it!

I wish I had known that my academic medical center’s (!!) implementation of software and a third-party vendor was done to suppress the usage of their highly-touted education benefits. I stopped taking classes after it became too much of an exhausting chore to utilize the “XX credits per year free!” benefit. (The “Benefits” [sic] department kept insisting I needed to pay for classes and fees that should have been covered by the education benefit.)

That it is well worth it – should have started sooner! Don’t be afraid to take more than one course at a time so you can finish your degree.

That I would be giving up my personal time completely for three years to complete my graduate degree. Online and flexible sounded wonderful when I started, but on top of a 50-hour work week, it didn’t take long for me to be on the computer every waking hour just to keep up.

The struggle was worth the effort. It took me five years to complete what would have been a full year on campus, but having that BS degree allowed me to move on. Without it, I would have not been eligible for most of the positions around the country that I have enjoyed and friends I made along the way. Now getting ready to retire from this life in HIS-land after 41 years.

That it was going to take five years for a master’s. I would still do it; it was the best thing I did for my career.

That work levels are exponential with more classes when you have a full time job. One class seems like a class load of work, two seems like four, and three seems like eight. I suspect with so much time taken up with your real job, being a full-time student makes the impact on limited free time more forcefully felt.

If there was an option to move the registration of the course to incomplete, audit, or pass/fail when work falls apart. Time allowed for completion of incomplete.

I had a very positive experience in completing a master’s degree while working full time. But it could have been a very different experience and outcome if it weren’t for the following factors:

• The program was an asynchronous distance learning program, so I could do the work at night regardless of when I finally got home.
• There was a lot of flexibility in the time for completion of the degree, so I could limit myself to one course at a time.
• The faculty were excellent. I was impressed by the other students in the program. The topics, even in the required courses, were interesting, all of which kept my motivation high.
• I had some flexibility in juggling my work responsibilities as I wasn’t doing full time patient care and my work deadlines tended to have some advance notice.
• I had very minimal travel requirements for my job and for the degree.
• My spouse was supportive in every possible respect

Taking two+ courses while working full time is incredibly difficult, especially if you come home from a day at work mentally exhausted. My tip: wake up early and get schoolwork done before you go to work. It’s tough, but it can be done! I would not recommend taking more than two courses at a time.

I did this in my late twenties while earning my MBA and enjoyed it thoroughly. Having context for the classwork in my daily life kept my engagement level high and helped to develop my time management skills. I would not necessarily recommend approaching undergraduate work this way, as there are important social aspects to a college education.

Weekender 4/20/18

Weekly News Recap

• The Illinois state procurement board recommends voiding University of Illinois Hospitals’ $62 million Epic contract, saying that Cerner’s bid was lower and referring the issue to the state’s Executive Ethics Commission after noting that Impact Advisors was involved in the selection and could have been awarded implementation services work as a result.
• Livongo Health acquires Retrofit.
• VA Interim CIO Scott Blackburn, who was heavily involved in its plan to implement Cerner, resigns and is replaced by the White House with by the Trump campaign’s former data director.
• A study finds that app-issued medication reminders don’t help people with high blood pressure bring it down.
• Hospital chain Community Health Systems lays off at least 70 Nashville-based corporate IT employees.

Best Reader Comments

Regarding VA software: The most interesting part of this is the conflict of interest with Leidos leading the Epic MASS project. SMS was part of the Lockheed acquisition with Leidos. SMS/Leidos was required to rebid on the MASS project in 2017 with an updated ROM. Leidos leads the DoD Cerner implementation, and now the Epic MASS scheduling implementation. Given the history surrounding the Coast Guard failed Epic install in 2016, this seems like a conflict of interest for sure. (Douglas Herr)

Providers prefer MHS Genesis to AHLTA, the absolute worst EMR ever. And yet, AHLTA is still more interoperable, because AHLTA is connected to the read-only Joint Legacy Viewer (JLV) and Genesis is not. Live for a year and connected to nothing and no one. It’s either “can’t” or “won’t” and neither is an acceptable answer. (Vaporware?)

Is it a good or bad thing that Dr. Jeffrey Johnson stopped practicing (at this hospital at least) because he wouldn’t learn how to use an EHR? I don’t know if it’s good or bad. But I wouldn’t want my money riding on the chance that a 75 year-old obstetrician is keeping up with the latest practice standards and could really do the job that an OB-GYN needs to do. I would not be surprised if some of his colleagues are relieved. Something had to “force” him into retirement, maybe it’s good that it was this. (Filutanion)

Mumps evolved to Standard M before InterSystems consolidated its dominance on the M market, and Caché to this day not only fully implements Standard M, but all the modern object-oriented extensions are built seamlessly on top of Standard M. Another current Standard M implementation is GT.M Many people don’t realize that M(umps), being the original NoSQL platform, is very well suited for the type of data processing that’s needed in healthcare. (Eddie T. Head)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. M in Philadelphia, who asked for headphones for the classroom learning center. She reports, “The headphones have been great for students to use during their time on the computers. There is no longer a noise distraction to the other students who are working on something other than the computer. The students who are on the computers can hear the sound more clearly now that they have headphones. I’m so glad that the students are now able to go to their centers and produce quality work with a noise distraction! We are so grateful!”

We also supported Mrs. I’s South Carolina classroom project to promote gender and ethnic diversity in STEM fields, proving it with a camera and supplies. Individual students passed along their thoughts:

• The STEM career project really helped me get more insight on what I want to be. It gave me an exposure on what to expect and what classes I need to focus on in high school and in college. I appreciate the fact that we had a guest speaker and she was great! (Samantha)
• Thank you for your generous donation to us. Thank you for making it possible for us to get exposed to the different carriers on the STEM fields. The STEM career project has made me more aware of the field in OB-GYN and has made me feel like I am ready for my future. The guest speaker made me realize that money is not everything. I learned that the love for the profession is more important and should be what drives you to do your best every day. (Joseph)
• The project has really opened my eyes and it is making me want to strive for greatness. I am not happy with the number of years I have to be in school to become a medical doctor. But I would still try, because the guest speaker was a minority and I believe that if she could do it, then I can do it too. She taught me to keep going and never give up no matter what.

I’m all-Android except for my aging IPad Mini, so I rarely have reason to visit the Apple Store. I dropped in today to check out the new 9.7” IPad since I think it’s probably the best tablet available in that price range ($329, although it’s galling that Apple still charges a lot for extra memory instead of supporting SD cards like Android tablets do). The store seems to have gone downhill – it was slightly crowded (less than I recall from my last visit) and I was happy not to be waiting for the Genius Bar, but employees ignored me even though they were just standing around. I asked an Apple guy who was steadfastly avoiding eye contact about the tablet and he just pointed at a table and said, “First two corners.” Nothing in the whole store was labeled or priced, so you had no idea what you were looking at, and had those products been truthfully labeled, the sign would have said “overpriced and uninspiring.” I may still end up with their tablet since they’ve priced it low since it’s little improved from the old one, but the experience so far was memorable only in negative ways. It feels like that dent in the universe is repairing itself.

InteliSys Health CEO Tom Borzilleri told me in a recent interview that CVS and Walgreens charge a lot more for prescriptions than independent or grocery store pharmacies despite consumer perception that they’re the price leaders. A new Consumer Reports article proves Tom to be correct. The magazine price-checked a one-month supply of five commonly prescribed generic drugs and found a range of $66 (from HealthWarehouse.com) to $928 (CVS). Independent pharmacies were among the cheapest, but the range was huge ($69 to $1,351). I hadn’t heard of HealthWarehouse.com, but it looks great for cash-paying patients – it sells a 90-day supply of generic Lipitor for $19.80, for example. They also sell over-the-counter drugs, diabetic supplies, and veterinary prescriptions (their prices for flea and tick meds are really low).

Bloomberg profiles data mining company Palantir Technologies, started by Peter Thiel and other former PayPal executives. The article describes JP Morgan’s use of the product to monitor its bank employees, summarizing it as “an intelligence platform designed for the global War on Terror was weaponized against ordinary Americans at home” as it analyzed bank employee emails, browser histories, GPS locations reported from company-issued phones, recorded phone call transcripts, and printer and download activity. It is being used by police departments in several US cities and those agencies can now identify more than half of US adults. JP Morgan invested in the company as well, but the company cut back on its use after it was exposed. Palantir has scandals of its own: it admitted to stealing some of its technology (claiming it had a right to do so because it was for the greater good) and it pitched programs to sabotage liberal groups, spy on and infiltrate progressive activist groups, run bot-powered social media campaigns, and plant false information to discredit liberal groups.The company, once exposed, used the Cambridge Analtytica excuse – they say it was the unauthorized work of a single rogue employee. Palantir offers healthcare solutions such as clinical trials analysis, fraud detection, and value-based care analysis for insurers.

I missed this first time around. An office design ideas site profiles the new Chicago digs of Strata Decision Technology. This is one more reason I know I’d make a terrible CEO – I would be too cheap to spend more than the bare minimum on everything, so my company’s offices would like like one of those unfinished farm garages made of sheet metal.

“Big Pasta” fights back against the low-carb movement, with companies such as Barilla funding the research behind mass market headlines such as “Eating Pasta Linked to Weight Loss in New Study.” This is a reminder for those who don’t understand that not all research is created equal: (a) someone has to fund a study to begin with, and the funder often has a financial interest in the findings; (b) studies that don’t deliver the hoped-for findings are often buried while the favorable ones are promoted; and (c) headlines are chosen for clickbait value rather than for scientific validity, with the publisher basically colluding with the study funder to make the findings seem a lot more significant and trustworthy than the underlying research supports. Highly-touted studies should always be approached with skepticism – who paid, who did the work, what methodology did they use, and how generalizable are the results?

Hiral Tipirneni, candidate for the Arizona House and a former ER physician who hasn’t practiced following a 2007 malpractice judgment, takes heat from her opponents for running a campaign ad showing herself in scrubs but wearing an Apple Watch that indicates the photo was made long after her physician days were over. 

Princeton University will hold an on-campus memorial service for highly influential professor and health economist Uwe Reinhardt on Saturday, April 21. He died November 15, 2017 at 80 after a 50-year Princeton career.

Yale health economist Zack Cooper, PhD isn’t impressed with the just-announced consumer health platform project between Independence Health and Comcast.

In Case You Missed It

• News 4/20/18
• EPtalk by Dr. Jayne 4/19/18
• HIStalk Interviews Nathan Read, Senior Director of IT, The George Washington University Hospital
• News 4/18/18
• Curbside Consult with Dr. Jayne 4/16/18
• HIStalk Interviews Matt Sappern, CEO, PeriGen
• Monday Morning Update 4/16/18
• What I Wish I’d Known Before … Selecting a Consulting Firm for EHR Implementation or Optimization

Get Involved

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

Morning Headlines 4/20/18

Tulare hospital’s creditors lining up in court

Healthcare Conglomerate Associates – former management company of Tulare Regional Medical Center (CA) – attributes its past struggles with payroll to glitches in the Cerner system it implemented in 2016. Parent organization Tulare Local Healthcare District filed for bankruptcy last fall.

New CHCF Investment Streamlines Care Coordination in the Safety Net

California Health Care Foundation’s innovation fund invests an unspecified amount in Collective Medical.

Comcast and Independence Health to partner on new health care platform

Comcast and Philadelphia BCBS insurer Independence Health will launch a health technology platform for consumers that will focus on patient communication and education, and telemedicine.

News 4/20/18

Top News

The State of Illinois Procurement Board finds evidence of a conflict of interest in the $62 million contract awarded to Epic by University of Illinois Hospitals and Health Sciences System, prompting the board to refer the matter to the state’s ethics commission for a public hearing. The review follows a protest by Cerner that it lost the bid despite offering a lower total price. 

Cerner was one of the health system’s incumbent vendors, along with Epic and several other companies.

Board members seemed to agree with Cerner’s attorney that it may have been improper for the health system to hire Impact Advisors to assist with the selection since they also provide Epic implementation services.

Cerner also claims that Epic’s bid did not include the price of those implementation services, which it says could reach $100 million, and that it was not allowed to demonstrate its software.

Reader Comments

From The Hypocritical Oath: “Re: Cerner’s protest at U of Illinois. It’s especially embarrassing given: (a) the hypocrisy of its $16B no-bid VA contract, and (b) the fact that they’re the incumbent vendor and the client hates them so much that they’d rather start over with a new EHR instead of continuing the relationship. I don’t think a demo is going to change much.” Losing vendor protests don’t usually turn out well, especially with regard to public perception (do I as the next potential customer want to consider someone who might sue me if I don’t choose them?). It certainly didn’t help Allscripts when it tried the same thing years ago, when it finally smartened up and dropped its absurd lawsuit against NYHHC and Epic only after firing its own executive team. Imagine the frosty relationship if Cerner prevails and the hospital is stuck implementing a system that it doesn’t want.

From Jolly Rancher: “Re: UNC Health. Several sites have mistakenly said they were the first health system to earn Stage 7 in the HIMSS Analytics categories of inpatient, ambulatory, and analytics this week. They were not.” The HIMSS-owned rag made a mistake in re-wording UNC’s press release in an attempt to look like an actual news report, apparently failing to notice that UNC’s press release said it was the only health system to earn all three Stage 7 designations that has ALSO been named as “Most Wired Advanced” in an unrelated award (the release clearly trying to one-up Duke by even bringing that up). Duke did its three sevens (I’m tired of typing it, so I’m dubbing the trifecta as AM21) on February 22. Other sites embarrassed themselves by either making the same mistake or by using the HIMSS rag’s site as their source instead of reading the actual press release.

From VA Software: “Re: the Columbus, OH Ambulatory Care Center. Went live last weekend on MASS (Medical Appointment Scheduling System). Its backbone is Epic (just the scheduling application) that then writes data back to VistA.” The MASS project was announced in 2015, with Systems Made Simple (Lockheed Martin) and Epic being awarded a $623 million bid in what I think was a competitive RFP. The project was placed on hold in 2016 while the VA tried to decide whether to develop its own system, but Congressional pressure (or so I’m assuming) led for it to be restarted even as the VA decided to give Cerner a no-bid contract. Maybe the VA wants MASS to succeed to prove the value of commercial software, or maybe it hopes it fails so that Cerner looks like the only viable commercial software choice – I really don’t know, but would enjoy hearing from someone who does.

HIStalk Announcements and Requests

I need more responses to my question this week – care to chime in?

I’m already tired of this phrase that everybody is copying after hearing it: “punching above their weight,” which Google turns up as being used by news sites 3,000 times all of a sudden. I’m hoping against hope that it will die out as people stop trying to be imitatively clever. Soon it will fade and you’ll hear it only from folks who still post-faddishly write “to die for” and “I threw up in my mouth a little bit.”

Webinars

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

Acquisitions, Funding, Business, and Stock

Provider data management and scheduling software vendor Kyruus raises $10 million in a corporate funding round, increasing its total to $72 million.

Health IT appears to have created cash flow problems within the financially strapped Tulare Local Healthcare District (CA), which filed for bankruptcy last fall. Former management company Healthcare Conglomerate Associates, which is hoping to recoup over $16 million from the district, attributed its struggles with payroll at Tulare Regional Medical Center to glitches in the Cerner system it implemented in 2016. An independent EHR implementation consultant is also looking to be paid, which lawmakers say may not happen any time soon.

Medeanalytics relocates its headquarters to its expanded office in Richardson, TX.

Sharecare SVP of Corporate Communications Jen Martin Hall responded to my inquiry about its joint venture with HCA, confirming the rumor reported by reader Private Privatized earlier this week:

HCA and Sharecare are putting operations of Share Lab, their joint venture to develop a next-generation online scheduling product, on hold. While the Share Lab team built a great product which was successfully deployed into an HCA facility and was demonstrating promising initial results, we couldn’t agree on a go-to-market strategy.

California Health Care Foundation’s innovation fund invests an unspecified amount in Collective Medical, which closes patient care communication gaps by using analytics to create a shared set of patient information, such as turning HIE data into clinically useful information. The company’s November 2017 Series A funding round raised $47.5 million.

Sales

• Rio Grande Valley HIE (TX) selects data normalization and quality reporting services from Diameter Health.
• Tufts Medical Center (MA) joins the the global health research network of TriNetX.
• West Virginia University Health System will utilize analytics and consulting services from Premier.
• TriHealth (OH) signs a $10 million contract with IBM for Watson Health enterprise imaging solutions and cloud-based clinical review services.
• The Menninger Clinic (TX) chooses Cerner Millennium and RCM.

People

GetWellNetwork names Nikia Bergan (Advisory Board) as chief revenue officer.

Ciox Health hires Arvind Ramakrishnan (IRI) as chief operations officer for clinical data acquisition and insights.

Announcements and Implementations

Comcast and Philadelphia BCBS insurer Independence Health will launch a health technology platform for consumers that will focus on “the effectiveness and efficiency of patient communications and education” that includes patient education and telemedicine. The insurer got the idea from the Amazon, Berkshire Hathaway, and JP Morgan project, explaining, “We’re going to use all of the data that we have from both companies and actually be able to create specific journeys for you.”

Frankfort Regional Medical Center (KY) goes live on Meditech Expanse with help from Parallon Technology Solutions.

The Fred & Pamela Buffett Cancer Center at the University of Nebraska Medical Center implements an HL7-based discrete genomic results reporting system from GenomOncology to access results more easily via EHR.

Olympus will allow endoscopy images to be shared across health systems via its Knowledge Exchange System connected to InterSystems HealthShare.

Government and Politics

The White House assigns Camilo Sandoval to acting CIO of the VA following Scott Blackburn’s resignation earlier this week, giving him a potentially important role in its Cerner project. Sandoval, a former Trump campaign data director later named as senior adviser to the undersecretary for health, was one of several political appointees who former Secretary David Shulkin accused of conspiring to get him fired. The White House says a permanent candidate for the job is being vetted.

The FDA includes cybersecurity as part of its new Medical Device Safety Action Plan, emphasizing the need to shore up device vulnerabilities that could compromise patient safety. The plan will also help direct the ongoing establishment of the FDA’s National Evaluation System for health Technology (NEST) program.

Other

The local paper covers Mayo Clinic’s (MN) employee training ahead of its May 5 Epic go-live. Over 26,000 staff have been shuttled to a training center daily over the last three years. The clinic has hired 260 trainers to handle the crowds. The center will stay open for ongoing training through 2019.

A new KLAS report on inpatient systems in under-200 bed hospitals contains interesting facts:

• The most-installed vendor systems in order are from Cerner, Epic, Meditech, CPSI, Allscripts, Medhost, and Athenahealth, with those first three getting most of their count from hospitals that are part of a multi-hospital health system.
• KLAS notes that Meditech’s cloud-based Expanse system has  allowed the historically “mediocre developer” to elbow its way into the #3 spot in perceived innovation, behind Athenahealth and Epic and ahead of Cerner (but it’s a close race among all four). Allscripts Paragon, Medhost, and CPSI Evident trail the others by far.
• Allscripts is trying to salvage Paragon despite McKesson’s fumbling that caused some customer loss, although Allscripts is belatedly developing an integrated ambulatory EHR (Avenel) that help may keep customers in the fold.
• On the RCM side, Epic and Meditech customers like their respective product capabilities; those of Cerner like its RCM services while continuing to be disappointed with its revenue cycle software; Athenahealth’s users appreciate its percentage-of-collections cost model; and Paragon, Evident, and Medhost customers say their vendors do little to help them reduce costs or provide new revenue models. 
• Some Meditech legacy users have defected instead of upgrading due to ineffective support and a prohibitive cost structure.
• Some customers have cancelled their Athenahealth contracts and gone back to previous vendors CPSI and Medhost doe to perceived gaps in functionality.
• Most new deals outside of critical access hospitals are going to Epic and Cerner. with Epic’s weak spot being its provider-hosted model and Cerner’s being its longstanding problems with its revenue cycle software.

A Chicago Tribune investigative report finds that Bala Hota, MD – former Cook County Health and Hospitals System CIO / CMIO – fraudulently obtained reimbursement for $248,000 in expenses that he claimed were work related but that in fact involved purchases of toys, ITunes products, and a piano, leading to his resignation in 2014 as auditors uncovered the issues. He repaid the money last year and is now VP, chief analytics officer, and associate CIO of Rush University Medical Center.

Employees of Theranos – back when they had some – drank the Elizabeth Holmes Kool-Aid in believing that Wall Street Journal reporter John Carreyrou was mistreating the company in exposing its fraud to the world, so they created a Space Invaders-type game called “Haters Gonna Hate” that used Carreyou’s head as the invaders to be shot at. Not only was this possibly the only company technology that ever actually worked, insiders went all Jim Jones in chanting “F— you, Carreyou” at an all-hands meeting. They have a dazzling array of reasons to be feeling really stupid right about now.

Sponsor Updates

• EClinicalWorks publishes a new customer success story featuring Righttime Medical Care.
• LifeImage publishes a new white paper, “Healthcare network as a catalyst for a convergent industry influencing clinical outcomes.”
• Lightbeam Health Solutions will exhibit at NAACOS April 25-27 in Baltimore.
• Mobile Heartbeat achieves Zebra Technologies Validation for its MH-CURE clinical communications and collaboration platform.
• Netsmart will exhibit at at NATCON April 23 in Washington, DC.
• Nordic releases a new podcast, “What is it like to be an affiliate project manager?”
• PokitDok demonstrates its commitment to security through SOC 2 Type II Certification.
• Forbes includes Impact Advisors in its list of best management consulting firms for 2018.
• Surescripts becomes a benefactor sponsor of the National Council for Prescription Drug Programs.

Blog Posts

• Interoperability 2.0 – Creating a Holistic Model of Care Part 2 (Medicity)
• Documentation at Phoenix Children’s saves time, money (Medicomp Systems)
• An Insider’s Look at Unique Device Identifiers (FDB)
• From the Road – A Consultant’s Perspective, Volume 1 (Optimum Healthcare IT)
• How to Eliminate Alert Fatigue (Meditech)
• Three Key Steps to Prepare IT for Machine Learning (Liaison Technologies)
• Help Your Employees Roll with the Changes (Access)
• Rethinking the Traditional Approach to Revenue Cycle Management (MedData)
• Trend-Weaving Medecision Liberation 2018 – Part 1: Liberating Healthcare Through Data Liquidity and Consumer Engagement (Medecision)
• Experts in Home Health Give Their Thoughts and Advice for 2018 – Part VI (Netsmart)
• Parallon Technology Solutions successfully leads Cass Regional Medical Center to Meditech Ambulatory 6.15 go-live (Parallon Technology Solutions)
• Should your health system offer automated payment plans? (Patientco)
• Three Areas Providers Should Focus on to Maximize Savings and Deliver Quality Care (Pivot Point Consulting)

Contacts

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

EPtalk by Dr. Jayne 4/19/18

So many things are going on in the healthcare IT world that it’s impossible to keep up. I came across an article about the telehealth program at New York Presbyterian, which has been implemented in the emergency department to reduce wait times. The Express Care program is credited with a significant impact, moving the needle on low-acuity patients from a more than two-hour wait to one that sits closer to 30 minutes. The patient care flow is integrated into the existing emergency department care path. At the time of the initial nursing examination, patients who meet criteria are asked if they want to participate in a virtual visit in a private room rather than waiting for an in-person visit. Patients are seen by the system’s existing emergency physicians, which is said to reduce potential patient concerns about quality of care.

New York Presbyterian is known for some of its other virtual programs, including a second opinion program that is delivered through an online patient portal. They also have an inter-hospital consult program for system physicians to collaborate along with a digital urgent care service. Virtual visits can be done in lieu of some office visits, and they also staff a mobile stroke unit.

I did some additional research into telehealth, looking particularly at the demographics of patients who gravitate towards the services. One might be tempted to assume that it would be millennials and Generation Y. I found some data from an Advisory Board survey of close to 5,000 patients that indicated that although more than 75 percent of patients said they’re open to a virtual visit, only 20 percent have actually experienced one. Of those who have used the services, nearly 60 percent are under age 50.

This might be due to payment policies more than affinity for technology, due to the Medicare restrictions on telemedicine services. It could also be due to employers providing telehealth services as a way to offset declines in employer-paid coverage and rising deductibles. A good number of parents would consider using a virtual visit for a sick child, and I suspect this is not only a function of accessibility and wait times but also one of convenience as workers struggle with leaving work for medical visits.

There are some variations in how medical providers want to approach telehealth. I was approached at HIMSS by vendors in two different models – one which was third party and another which hoped to leverage a client’s existing physicians to deliver services. As a provider, there’s a certain allure to having your patients cared for by members of your group, but that arrangement still requires providers to take call and provide services after hours. That arrangement is less appealing to physicians who see medicine more as a business than as a calling. Telemedicine visits tend to skew around a couple of key areas – acute care needs, and routine requests such as medication refills.

Lots of conversation in the physician lounge this week about Amazon exiting the pharmaceutical business before it even really got started. The company has spent the last year soliciting approval from state pharmacy boards so that they could become a wholesale pharmacy distributor. They completed the process in just 12 states and apparently discovered that it’s harder to recruit large hospitals away from their existing suppliers and contracts then they thought. In my experience, hospitals tend to be locked in with either McKesson or Cardinal Health or tend to be part of larger group purchasing programs that don’t make it easy to change suppliers. According to some reports, Amazon also failed to fully appreciate the complexity of fulfilling medical supply orders when some of the items must be refrigerated or frozen. That’s a wrinkle that certainly doesn’t fit smoothly into their well-oiled logistics and warehousing process.

Some of my procedural colleagues in smaller organizations had been hoping Amazon would be able to make a go of it, to enable speedy deliveries of smaller-scale orders so that they don’t have to deal with the larger vendors. The ability to ask Alexa to ship you a couple of cases of normal saline or some assorted suture materials certainly might be a draw when you’re already using her to order your coffee and restock your household supplies. Amazon may still head in this direction, delivering medical office supplies such as gloves and other consumables to smaller organizations such as independent ambulatory surgery centers and physician practices. For that book of business, they’re already approved for licensure in 47 states plus the District of Columbia. There is still a fair amount of speculation that Amazon might be entering the retail pharmacy or direct to consumer spaces. It would be interesting to see how they tackle some of the rebate issues that exist in the retail space and add confusion to the price of medications.

A reader reached out regarding my recent comments about groups that compensate providers based on RVUs as opposed to making the transition to value-based compensation. She recently did some compensation analysis research and noted that the majority of physicians are compensated largely based on productivity, with potentially 10 percent or 20 percent being paid relative to quality metrics, patient satisfaction, or access. She found an interesting trend with groups that are moving towards paying physicians a guaranteed salary in order to account for time spent on non face-to-face activities such as chronic care management. Guaranteed salaries are also cited as a way to help smooth out access issues in group practices, where one provider might create bottlenecks because he or she won’t allow patients to see a colleague due to fear of lost income. Guaranteed salaries may also hold potential for reducing burnout and increasing collaboration. These goals are typically aided by structures which might pay bonuses based on group growth rather than individual productivity. New models of compensation which include guarantees typically include a performance threshold to ensure physicians maintain a minimum level of activity.

These new compensation models may lead to increased reporting needs for organizational leaders, which translates to requests for IT teams to generate data for compensation analysis. Several of the practice management systems I work with struggle with functions like capitation and prospective payment management, so they may also be ill-equipped to handle this level of productivity reporting. If you’re on the technical or support side it might be tempting to ignore trends in provider compensation, but it might be worth following if those trends are going to start sending more work your way.

Is your organization structuring compensation to encourage collaboration? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/19/18

Warnings of $100M Overpayment Prompt Recommendation to Void Contract

The State of Illinois Procurement Board finds evidence of a conflict of interest in the $62 million University of Illinois Hospitals EHR implementation contract awarded to Epic, prompting the board to refer the matter to the state’s ethics commission for a public hearing.

Statement from FDA Commissioner Scott Gottlieb, M.D., on new efforts to enhance and modernize the FDA’s approach to medical device safety and innovation

The FDA includes cybersecurity as part of its new Medical Device Safety Action Plan, emphasizing the need to shore up device vulnerabilities that could compromise patient safety.

Kyruus Raises $10 Million to Fuel Continued Growth

Provider data management and scheduling software vendor Kyruus raises $10 million, bringing its total funding to $72 million.

HIStalk Interviews Nathan Read, Senior Director of IT, The George Washington University Hospital

Nathan Read is senior director of IT at The George Washington University Hospital in Washington, DC.

Tell me about yourself and the hospital.

I’ve been in healthcare IT my whole career, which is going on 20 years now. The first 15 to 20 years was working on the software vendor side. I was a software developer for a laboratory information company and an EMR company in Texas. I ultimately became the COO of that company that led to an acquisition by a publicly-traded healthcare company, NextGen, where I stayed on there as vice-president of R&D for a few years before I moved over to hospital IT operations. It’s an interesting background in the sense that I’ve been on both sides of the business for my career.

I’m the CIO / senior director at an academic hospital in the heart of Washington DC. We’re engaged and involved in a variety of technology-related projects that are specific to all hospitals and healthcare. Being located in DC, we have some uniqueness into the types of things that we pay attention to.

What are your major technology platforms?

We’re a big Cerner shop. We have IBM/Merge, which has a pretty significant presence in terms of imaging at the hospital.

As a former vendor executive, what was the biggest surprise or the biggest change when you took the job at the hospital?

How lean hospitals run. When you’re selling healthcare products, a lot of the products on the market are very expensive. There’s always pushback for discounts and pricing. But to see how lean hospitals in general, not just in IT, have to operate with the limited budget and a lot of the pressures that the hospitals feel from the insurance companies and payers. They’re always getting crunched from a price point.

It’s kind of interesting seeing this day coming where the technology solutions are expensive and their prices are only going up, and yet the reimbursement for the patients that we’re caring for tend to be going down. The hospital market in general is lean. There’s not a lot of margin in it. Those two worlds are going to collide at some point, probably in the near future. Technology purchases are going to be limited because of that.

Knowing the financial constraints, what does it take to get you to investigate a product?

A good champion in the hospital. The person bringing it has to be strong and supportive. If there’s not a clear ROI that we can come up with relatively quickly, it’s not worth doing any other parts of the investigation. Is it improving patient safety? Those are probably the top three things.

What makes an ROI attractive?

Obviously there’s the financial side. Is there a financial benefit to the organization through the purchase? Also compliance and patient experience. It’s important to our organization to have a positive reputation and have our customers who are our patients have a high level of satisfaction. But that factors into reimbursement as well, so it comes a little bit back to the financial side. Really our mission is patient care and the focus is on that.

There’s some cool technology stuff that we do, especially being an academic hospital, that’s new to the marketplace. We do those things, but they are usually offered at a highly discounted price or are free because they’re interested to get their product proven in the marketplace and in an academic setting. We’re doing some virtual reality stuff that’s relatively new to the marketplace.

What technologies are attractive in terms of patient experience and patient engagement?

Anything that gives you real-time data on the patient experience so that you can react to it. I don’t know if this is unique to being in the DC marketplace, but if our patient is not having a positive experience, they’re quick to report that. Within 24 to 36 hours, you’ll see patients escalate within our own organization if they’re not having a good experience.

The ability for us see, in real time, if there’s a patient not having the experience we want them to have that we can then respond to is powerful for us. It doesn’t do us any good to find out a week later or a month later that a person had an experience that wasn’t what the hospital wanted. We need to know within 24 hours of that happening so that we can do some service recovery and respond to those patients. Luckily we don’t have a lot of that, but there are human interactions that at times create perceptions that we want to address quickly.

How do you get that real-time patient satisfaction feedback?

Right now it’s not through technology. It’s manual. We do rounding every day. Outside of the nurses who are required to round on their patients hourly, management rounds on patients every day. Even myself as the IT leader will go up and round on five or six patients every day. I talk to them about their experience, whether it’s the cleanliness of the environment, physician communication, nursing communication, or pain control. We have a template that we go through. If every leader is doing five or six patients, that pretty much covers every patient at the hospital every day. If there’s any patient experience issues, there’s a protocol we follow to address those right away. That’s been very successful.

There are some technology solutions that we have started to look at where, through the TV system, patients can provide real-time surveys or concerns that are reported back quickly. We haven’t implemented anything like that, although I know some hospitals have. It’s something that we’re looking at.

What hospital strategic decisions or changes are requiring IT participation?

Patient experience. Improving our overall scores, the CMS score that came out. There’s a lot of focus on our part about how we move those scores up. Our reputation in the community, improving that reputation and continuing to work towards being seen as the top academic hospital in this region. Those things typically drive leadership conversations and then what IT systems can be put in place to support that.

We have implemented patient portals and other technology solutions that were a Meaningful Use requirement. How can we enhance that experience to differentiate us from other healthcare facilities in the area?

What’s most different from the typical hospital in being a major teaching hospital in Washington, DC?

The complexity of the patients that come in. The DC metroplex draws a lot of different types of people. We have to be sensitive to variety of the patients that come into the hospital, which I’m sure is true of other big urban areas like New York. The case mix is diverse and the healthcare needs in the District are high, even though there are several hospitals in a pretty small radius. Most of them tend to be at capacity, so there’s always more need for more services in the District that aren’t necessarily provided.

Do you feel the impact of federal government decisions more acutely being in DC?

We have an opportunity to have some influence. For example, drug shortages are having significant impact on caring for certain patient populations. We have some government officials coming in this week to spend time with our physician leadership and walk around and talk to some of the nurses so they can better understand how these shortages are impacting care. I think that is a unique aspect of being here in the District.

Cyber security is obviously a huge topic in healthcare and has been for the last few years. We have some involvement with some of the agencies that come in and do some sessions with us to better understand our environment and to get feedback on potential regulatory changes and responses to cyber security. We’re physically located here and it’s easy for them to do that.