A VA OIG report on preventing veteran suicides finds that the DoD is still not sharing attempted suicide information on service members transitioning out of the armed services with the VA from its DOD Suicide Event Report system, despite a 2014 federal mandate that it do so.
Two former Tenet executives are facing conspiracy and wire fraud charges in Georgia. The indictment says that from 2000 to 2013, the executives engaged in a scheme to pay over $12 million in bribes to clinics in Georgia and South Carolina so that providers there would refer pregnant patients to Tenet hospitals to deliver their babies. Tenet billed $400 million to the Georgia and South Carolina Medicaid programs as a result of these referrals.
Northwestern University (patient outcomes monitoring)
Parachute Health (durable medical equipment ordering)
PeraHealth (at-risk patient identification)
StayWell (patient education)
Tissue Analytics (wound documentation)
Epic actually rolled out the App Orchard site early this year, but this is the first public access to the apps it contains.
Epic’s 1.5-day App Orchard Conference will be held November 9-10 at its Verona, WI campus.
Reader Comments
From Kim Wisconsin: “Re: Epic UGM. Clients watched KLAS VP Taylor Davis and Judy Faulkner prance together in wizard costumes on stage. Needless spending on top of what it cost Epic to attain Best in KLAS?” Unverified. Epic’s UGM involves a lot of voluntary whimsy and I’m OK with that, but I’m always skeptical of KLAS’s objectivity and having one of its executive participate in a vendor’s user group meeting skit does little to allay my concerns. Imagine a Consumer Reports editor cavorting on stage at a Ford PR event, although that’s unfair since KLAS is light-years away from the objectivity and science behind Consumer Reports despite the inevitable industry comparisons. Still, customers of both Epic and KLAS make their own informed decisions, so they know what they’re buying and it’s nobody else’s business.
From George St. Short: “Re: executive attributes. What is your observation about strengths and weaknesses and how it affects companies?” That’s a broad topic, but I will summarize thusly. Most of us know our strengths. We don’t, however, know our weaknesses, and that’s where we stumble. Just ask the people you work with to list what you’re bad at. Try to improve, get someone else to handle that function, or both.
From The PACS Designer: “Re: digital pathology. The era of digital pathology is upon us and can be seen through this digital pathology sample. You will see the digital pathology records in your EHR when vendors begin to add them to their EHR systems in the years to come.”
From OnlyForGiggles: “Re: national EHR procurement in Singapore. It’s been four years in the running and Allscripts and Epic are the finalists. Cerner didn’t even bother showing up at this month’s HIMSS Asia. Accenture is running the procurement with Oracle as a partner and only Allscripts runs Oracle. The Ministry of Health CIO is a former Accenture partner and has now installed himself also as CEO of the IT arm of the Ministry of Health. He is partial to awarding contracts to his former employer, so both companies would do well to sidle up to Accenture. We see this kind of drama in the US and UK and Singapore, alas, is no exception.”
From The Mechanic: “Re: Athenahealth. One of its 35-bed inpatient sites is already leaving them and returning to CPSI.” Jackson Medical Center (AL) says collections dropped 75 percent after they implemented Athenahealth, so they’ve gone back to the Thrive EHR solution offered by CPSI subsidiary Evident in what they call a fairly easy transition.
From Super Bee: “Re: EClinicalWorks. Cold call emails cite an ‘AmericanEHR’ survey that finds EHR tops at many categories. It would be more impactful if they actually provided the study, but in addition, ECW isn’t on any of that site’s Top 10 lists.” That site doesn’t inspire a lot of confidence with outdated information and no recent news items. It was developed by the American College of Physicians to sell reports and to charge EHR vendors to create profiles on its site or to run ads. Its top five EHRs by user satisfaction are CattailsMD (which I thought was long gone or at least renamed, but maybe not), Praxis, Waiting Room Solutions, ABELMed, and Sevocity.
From Beefy Goodness: “Re: ONC’s inpatient EHR certification stats. Epic has overtaken Cerner for the #1 spot in data updated through July.” The chart is above, although it also list hospitals using Siemens Medical Solutions that might be reasonably added to Cerner’s total to keep it on top. Epic is the only vendor that has customers using 2015 certified technology. Also note that while the data source was updated in July 2017, the graphic depicts only participation through the 2016 program year.
From Spacemen Collection: “Re: Sunquest. President Matt Hawkins is leaving, to be replaced by Mike Epplen, who has been president of fellow Roper acquisitions Data Innovations and Atlas Medical.” Unverified, although the non-anonymous source is solid. UPDATE: Hawkins will become CEO of the combined Navicure-ZirMed when that merger is completed in early November.
From Frank Sumatra: “Re: MyWay. Physicians are telling me that Allscripts will shut off the hosted version within five weeks, but can’t get them their data for 12 weeks. Practices will also have to pay $5,000.” Unverified. I invited the Allscripts media contact to comment but haven’t heard back. MyWay was retired several years ago as I recall to avoid adding ICD-10 support, so practices have had five years to seek an alternative. MyWay is disproportionately represented among the many embarrassing points in the company’s history (search HIStalk for a fond look back).
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Vocera. The San Jose, CA-based company offers the leading platform for clinical communication and workflow, with 1,400 hospital and health system customers around the world using smartphone-based secure texting or making hands-free calls using the Vocera Badge. Vocera interoperates with 120 clinical systems to reduce alarm fatigue, reduces staff response time, and improves patient care, safety, and experience. Vocera ensures that critical information reaches the right person at the right time on the right device, or as Halifax Health VP/CIO Tom Stafford says, “There is no other communication solution I’m aware of that can send a notification as closely and instantly to a nurse than the Vocera system.” Hospitals use the system to increase ED and OR throughput, prioritize clinical alerts, optimize patient placement, improve collaboration, strengthen patient communication, and reduce care team burnout. Halifax Health just implemented a real-time sepsis surveillance program by integrating Wolters Kluwer Health’s POC Advisor with its Vocera technology to quickly alert clinicians of a potential sepsis case, while Dayton Children’s Hospital (OH) connects pediatric patients to nurses by connecting Hill-Rom’s nurse call system with :Star Trek”-like Vocera badges to alert them when the child presses buttons for “pain” or “potty.” Gartner’s Hype Cycle report names Vocera as an example of a technology vendor with offerings in several categories of the real-time health system. Thanks to Vocera for supporting HIStalk.
I found this new YouTube video that describes Halifax Health’s use of Vocera in its ED.
This week on HIStalk Practice: Volunteers in Medicine Clinic Executive Director Raymond Cox, MD discusses the role data access plays in caring for the underserved. PeakMed Direct Primary Care founder and CMO Mark Tomasulo, DO shares his thoughts on the ways attempts at health insurance reform are driving the DPC business model. Deadline extended: HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide over at HIStalk Practice.
Webinars
October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRX. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Physicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Associates automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.
October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine; Gary Palgon, VP of healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Leerink Transformation Partners forms its first healthcare IT growth equity fund with $313 million in assets under management, led by managing partners Todd Cozzens (Marquette Medical, Picis, Optum) and Jared Kesselheim, MD, MBA, both previously with Sequoia Capital and Bain Capital Ventures. The fund’s initial investments are Outcome Health, Scientist.com, Vera Whole Health, PatientPing, Health Catalyst, and Kyruus.
IBM, which has laid off a significant part of its US workforce, now employs more people in India than in the USA, supporting the theory that low-cost overseas labor moves up the food chain from hardware assemblers to knowledge workers.
Sales
Emory Healthcare (GA) chooses Kyruus’s provider data management and patient access solutions.
South Africa’s Areta Health will implement Medsphere’s subscription-licensed, cloud-hosted healthcare IT solutions in its Specialist Day Hospital system.
People
UW Medicine (WA) hires Joy Grosser (University Hospitals) as CIO. She had been CIO of University Hospitals for just over a year.
Ed Gaudet (Iboss Cybersecurity) joins Censio as CEO.
CheckedUp hires Jim Decker (AMD Group) as VP.
Seattle Children’s (WA) promotes Eric Tham, MD, MS to VP and associate CIO over research IT, clinical applications, and analytics.
Announcements and Implementations
The American College of Radiology’s newly formed Data Science Institute hosts its first meeting in its Reston, VA headquarters, convening an international group of artificial intelligence experts, device vendors, and physicians to discuss the use of algorithms in clinical workflows. ACR DSI is building consensus around a vendor-neutral framework to apply AI to patient care that will include developing imaging use cases, setting interoperability standards, testing algorithms, and addressing regulatory issues.
Society for Imaging Informatics in Medicine holds its second conference on using machine intelligence in medical imaging (SIIM C-MIMI) at Johns Hopkins Medicine, with keynotes offered by presenters from Google Cloud and the FDA.
Allscripts will integrate medical reference and patient education information from Merck Manuals into its EHRs via an HL7-compliant Infobutton.
Nuance releases Dragon Medical Virtual Assistant, which applies voice biometrics and text-to-speech via a smart speaker conversational user interface to automate high-value EHR clinical workflows.
Lightbeam Health Solutions will integrate AI technology from DocSynk into its population health management platform to improve identification and targeting of patient groups.
Ability Network announces the Ability Insight Medicare revenue cycle analytics and benchmarking application for SNFs, home health agencies, and other LTPAC organizations.
Talent management solutions vendor HealthcareSource launches a healthcare job search site that is integrated with its Position Manager applicant tracking system. The company’s CEO is industry long-timer J.P. Fingado (API Healthcare, Cerner, Dynamic Healthcare Technologies). HealthcareSource says it has 3,000 healthcare customers of its Quality Talent Suite.
Healthcare Growth Partners posts the first in a six-part series on due diligence in health IT transactions, this installment covering accounting and tax considerations.
Government and Politics
The Department of Justice charges several executives of for-profit hospital operator Tenet Healthcare with Medicaid fraud, claiming that some of its Atlanta-based facilities paid $12 million in kickbacks to a medical clinic that serves pregnant women who are in the US illegally, steering them to Tenet hospitals for their deliveries that were then billed to Medicaid for $400 million.
A report on veteran suicide by the VA OIG finds that despite federal mandates going back to 2014, the Department of Defense still does not share attempted suicide information from its DOD Suicide Event Report system with the VA. The report also notes that 11 percent of the patients identified by the VA as being high risk for suicide did not have a suicide prevention safety plan in their EHR record and that the VA’s use of EHR suicide risk flags could be improved. A previous report found that veterans have a 21 percent higher suicide risk compared to civilians, with 20 of them killing themselves each day, 30 percent of those after recent VA visits.
Former HHS CIO Frank Baitman says he doesn’t understand why Healthcare.gov needs to go offline for 12 hours every Sunday (including the first day of open enrollment period) as announced by HHS. The system was down less than 1 percent in previous years vs. a scheduled 6.6 percent this year, triggering several letters from senators to CMS Administrator Seema Verma questioning whether the impetus is political rather than technical. The open enrollment period has already been reduced from 12 weeks to six and outreach programs for signups have been cut almost entirely.
HHS Secretary Tom Price apologizes for the $400,000 worth of chartered plane flights he has taken – some for questionable purposes and five in a single week — in the past few months in potential violations of federal travel laws, declaring that he won’t take any more charters and that “taxpayers won’t pay a dime for my seat on those planes.” He will repay the $52,000 portion represented by his own seat, but taxpayers remain on the hook for the additional $350,000 Price spent to bring HHS employees along for the ride. Meanwhile, a Politico investigation finds that fiscal hawk Price and his wife also took global trips on military aircraft that raises his total since May to more than $1 million, but HHS says Price reimbursed the government for his wife’s travel. Price, his wife, and eight HHS employees took a private jet from Berlin to Geneva at a cost of $16,000 for the flight offered by several commercial airlines for between $60 and $260. Price railed about Democrats flying charters when he was a Congressman, citing “fiscal irresponsibility run amok in Congress.”
Technology
Fujitsu develops a wearable, hands-free speech translation device that can identify the voices of two speakers and translate their speech into the other’s language. The company claims 95 percent accuracy in a typical hospital setting. It was developed to help hospitals in Japan converse with their patients who don’t speak Japanese.
CEO Judy Faulkner talks up Epic’s new Share Everywhere, which allows any provider (even those who don’t use an EHR) to view a patient’s records via C-CDA.
Faulkner advocates eliminated the term “electronic medical record” in favor of the “comprehensive medical record,” which of course why the term “electronic health record” was created to describe systems that manage information extending beyond the four walls (at least for that term’s first five minutes of life, after which overzealous and often crappy EHR vendors misappropriated the term to describe their unchanged systems to sound sexier).
Epic demonstrated the use of consumer technology such as Google Home and Amazon Echo that can allow patients to connect to MyChart to request prescription refills.
The company announced Payment Guardian for reimbursement.
Epic is working on using artificial intelligence to assist clinician users, with Epic being noted this week in Microsoft’s Ignite Vision keynote speech by CEO Satya Nadella as an AI-first healthcare leader.
CVS joins the opioid abuse fight in a puzzling manner, limiting new opiate patients who are covered by insurance to a seven-day prescription supply, limiting the number of doses its pharmacists will dispense based on product strength, and declining to dispense extended-release opiates until immediate-release products have been tried. It’s interesting that a drugstore chain – which has limited access to a patient’s medical history – feels it needs to override physician prescriptions, although certainly state medical boards, pharmacy boards, and other overseers haven’t made much of a dent in questionable opiate prescribing.
This might be a good early warning. Doctors performing a bronchoscopy on a long-term smoker find that his lung mass isn’t cancer, but instead is an easily removed plastic play set traffic cone he swallowed as a child, which caused no symptoms until 40 years later.
Sponsor Updates
Boston Software System publishes “Simplifying Legacy System Decommissioning.”
Parallon Technology Solutions publishes a white paper for CIOs and chief medical officers titled “Upgrading to Integrated Meditech 6.16.”
Robert Lord, co-founder and president of Protenus, is chosen as a New America Cybersecurity Policy Fellow, where he will focus on defining the program’s next-generation healthcare cybersecurity efforts.
Datica CEO Travis Good, MD will moderate a panel event at the Health 2.0 conference next week titled “What does the success of digital health look like?”
Lightbeam Health Solutions publishes a case study describing Princeton HealthCare System’s 15 percent reduction in inpatient admissions after implementing the company’s population health management platform.
The Chartis Group publishes a white paper titled “The Shift to Value: Understanding Market Dynamics to Inform Your Strategic Course.”
Meditech AVP Cathy Turner, MBA, RN will serve on a panel at Northeastern University’s Nurse Innovation and Entrepreneurship Summit this week.
EClinicalWorks will exhibit at Health 2.0 October 1-4 in Santa Clara, CA.
Iatric Systems will exhibit at the HCCA Regional Conference September 29 in Indianapolis.
Boston Voyager profiles Image Stream Medical CEO Eddie Mitchell.
InterSystems will exhibit at the CompuGroup Medical User Conference October 3-5 in Las Vegas.
Intelligent Medical Objects Senior Software Engineer Yunwei Wang becomes the first to successfully complete the Health Level Seven International inaugural HL7 Proficiency Exam.
Kyruus will exhibit at the Boston Bar Association’s Life Sciences Conference October 3 in Cambridge, MA.
September 28, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 9/28/17
Hot on the heels of Anthem and Express Scripts as they work to curb the opioid epidemic, CVS Health announces restrictions on coverage for certain opioid doses and durations. The Caremark unit of CVS is one of the largest pharmacy benefit managers, covering nearly 90 million patients. Starting in February, patients requiring short-term opioid therapy will be limited to seven days of medication.
I was surprised to learn that some patients with short-term pain needs were receiving 20-30 day supplies of medication since I don’t see a lot of that prescribing behavior in my community. Patients requiring long-term treatment will be limited to a dose of 90 morphine milligram equivalents. Patients must also demonstrate that they’ve been treated with immediate-release medications before they will be allowed to fill prescriptions for extended-release medications. Physicians will be able to appeal the restrictions through a prior authorization process, and employers and insurers can opt out of the restrictions. They’re basing the restrictions on recommendations from the CDC, issued last year. CVS is also adding medication disposal units in 750 of its pharmacies.
The healthcare IT season is starting to heat up, with the Epic user group underway and the Cerner conference approaching. From a vendor standpoint, the buzz ebbs and flows until it reaches its apex at HIMSS, but I’m starting to see some activity among health systems and larger medical practices. Maybe it’s the potential relaxation of some of the regulatory burdens that people were anticipating, or perhaps there are other forces at play, but groups seem to be talking about making technology and systems investments when they had previously been keeping their purses closed.
I’ve been asked to give input on a couple of RFP documents, which could result in some large purchases that I didn’t see happening in the next couple of years. It could also be that organizations want to use the relative regulatory lull to get ready for any future crushes. I’ve worked with a couple of groups that have done rip-and-replace system transitions across reporting periods and shifting regulatory requirements, so I agree it’s smart to move things forward now if you think you’re ready to make a change.
I’m not mourning the demise of the 2014 NCQA Patient Centered Medical Home Standards, which are nearing their end. Practices who had already purchased the 2014 survey tool can use it through September 30, but after that, organizations have to transition to the 2017 standards. This has been a confusing time for many of my clients and I’m certainly looking forward to being able to support groups on a single set of standards. Patient-Centered Medical Home efforts continue to get quite a bit of attention, even for practices that aren’t trying to maximize their payments under MIPS.
I’ve been trying in vain to contact a colleague in Puerto Rico, not only so I can know that he’s OK, but also to ask if there is anything I can do to help other than sending money. The reports I’ve seen are personally heartbreaking and professionally unfathomable. A week after Hurricane Maria’s landfall, most of the island is still without power, including more than 50 of the island’s hospitals. A little more than half of the residents have access to drinkable water.
The hospitals that are still open are running on generators and attempts to connect them to the power grid have resulted in a few hours of success followed by a return to the generators. Patients are seeking emergency care in larger numbers than facilities are prepared to handle — partly due to water, power, and supply shortages — but also due to the fact that many facilities are also damaged and unable to operate at all. Those facilities that are able to run are not at full staffing levels and surgical case volumes are limited.
Some descriptions liken it to a war zone, with healthcare providers making due with whatever then can find. It sounds like pharmacy stocks are holding out, although there are glitches with electronic payment systems and technology infrastructure. Patients are being evacuated to Louisiana and South Carolina, with the Navy’s hospital ship USNS Comfort expected to arrive next week.
The Comfort is no stranger to natural disasters, having been on station in Haiti following the 2010 earthquake and in the Gulf of Mexico following Hurricane Katrina in 2005. It can staff up to 1,000 hospital beds and has 12 operating rooms. Still, patients with critical needs, such as open heart surgery, are being encouraged to travel to the continental US for surgery, although travel off the island remains an issue.
The Department of Health and Human Services has relaxed rules on physician licensure, allowing physicians to practice in the emergency area under an unrestricted license from another state rather than requiring them to be licensed where services are rendered. HIPAA penalties are also being waived with regard to distribution of privacy practices documents and sharing medical information with family members. It could be six months before power is fully restored and the needs will be great to combat public health crises related to the storms and flooding.
The One America Appeal, originally launched by the five living former US Presidents to support recovery from Hurricane Harvey, has been expanded to include areas devastated by Irma and Maria. Donations will go to a fund managed by the George H. W. Bush Presidential Library foundation, which will distribute them to existing disaster relief funds supporting affected areas. The Foundation will ensure that 100 percent of donations will go to hurricane recovery, and donors can specify which recovery effort they want to support, if desired. I’m hoping I hear from my friend soon and that he and his family are safe.
Despite receiving $2.1 billion in emergency funding, the Trump administration says the Veterans Choice healthcare program may run out of money as early as December.
A former IBM Watson employee remembers his time working on Watson, saying, “There’s a lot of money in marketing and there are a lot of ads on TV but I don’t actually see the products. Anytime anyone would want to see a product roadmap or wanted to see what the future is or when it was coming out, we never really got that timeline.”
A CBO estimate on costs associated with expanding Medicare telehealth coverage concludes that “enactment of this provision would reduce direct spending by $80 million over the 2018-2027 period.”
Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 2 of 4) By Bruce Brandes
Bruce Brandes is founder and CEO of Lucro of Nashville, TN.
As any industry observer knows, health systems continue to consolidate in an attempt to ensure their viability given unprecedented financial and operational pressures. Many organizations struggle to fully leverage their scale post-merger. Most often the difficulty is to align focus, priorities, internal knowledge. and industry experience across the expanded team as they integrate.
Misalignment is usually the main contributor to the length of the sales and purchasing process. Too often people fall in love with a PRODUCT without first clearly defining the PROBLEM they seek to solve. This challenge is exacerbated by complex purchasing decisions that require collaboration across multiple stakeholders to make the right choices.
My 16 year-old daughter, Lily, recently got her driver’s license and immediately spent lots of time and energy looking to buy a car (product). Much to her chagrin, the head of home operations (my wife) and the economic buyer (me) defined the problem as our daughter needing transportation, and buying a new car was only one of several options for us to address this issue. As we considered how to best solve her transportation problem weighed against other family priorities, we decided to simply get Lily an Uber account and an extra key to use our cars when available.
The same disconnect happens every day in healthcare. So much sales activity and investment are squandered on potential buyers who are only empowered to say no — not yes — to an actual buying decision. With the best of intentions, they may not be aware they are wasting time pursuing deals that will never come to fruition. Just like the sales guy at the car lot with my daughter.
By first defining the problem and enabling appropriate enterprise visibility, we can avoid projects that are misaligned with organizational priorities. Further, we may also discover that due to poor or fragmented communication, we are pursuing a project where:
An organizational decision on how to address this problem has already been made.
Others within the same organization are already pursuing a similar project in parallel.
The organization already owns existing products, best practices, or internal resources that should be compared as an alternative to buying something new
In working with many health systems to design a solution to this common inefficiency, we borrowed concepts from established solutions we all now use to make buying decisions in our personal lives (Amazon, Airbnb, Yelp, Angie’s List, Pinterest, TrueCar, Zillow, etc.) Healthcare organizations need a better, digital way to define and share the ideas or projects they are considering, to detail objectives, success measures, categories, budgets, timelines, etc. to promote transparency and alignment.
Additionally, while vendors use a CRM like Salesforce to track their sales activity with prospective and current clients, health systems do not have a similar system to capture and coordinate buying activity with the vendor community (and Salesforce is too complex to serve that purpose for buyers). Gaining visibility into past and current interactions and assessments of vendors and their products is essential to unify knowledge across diverse stakeholders.
As we focus as an industry on important topics like care coordination, healthcare organizations must also apply coordination to implement modern tools and processes that achieve the efficiency and alignment needed to make better decisions faster regarding vendor partners.
The Treatment for BCD (Big Company Disease): How to Streamline EHR Decision-Making By David Butler, MD
David Butler, MD is associate CMIO of the Epic/GO project of NYC Health + Hospitals of New York, NY.
I’ll never forget it. I was presenting to a large group of physicians about how we need to implement, adopt, and standardize the EHR to meet quality metrics and decrease total cost of ownership. Before I could finish stating the “S-word” (standardization), a more senior physician looked over his glasses and declared, “Son, I’ve been in healthcare for over 30 years and I can tell you for a fact that this is simply not going to work.”
I had to agree with a portion of his statement. I also had a degree of skepticism about whether this would work or not. However, the former part of his statement caused me to pause and ask, “With all due respect, Doctor, have you been in THIS healthcare for 30 years?”
While I’m not sure he appreciated my Gen X retort, what I said was true. No one has been in today’s healthcare environment for 30 years. A senior executive mentor from McKinsey once told me, “If someone tells you that they understand healthcare today, they’re either lying or just have not been paying close enough attention.”
How We Got into This Mess
The US has wrapped technological advancements in healthcare around an antiquated legal and compliance system that was designed for the long-gone days of paper-based record keeping. We have essentially paved the cow path. Years after these technical infrastructures in healthcare have been hardwired and codified, we are now asking the question, “How can we unwind this and do it the right way?”
Unfortunately, much of the capital dollars and funding that attained the EHR are no longer available to optimize the EHR (understatement of the year). Very few practicing physicians have the time or legal prowess to navigate a fleet of internal compliance, risk, legal, and information technology “experts” who have all agreed that “x should not be turned on.”
All is not lost, though. We have figured out ways to map and execute the transition to digital healthcare, but we must do it together. EHR optimization starts with governance. In this article, I will share three guiding questions that physicians and physician executives can use to assure that their voices are heard and prioritized when EHR decisions are being made. Just as we do not triage a patient with a cough prior to one with chest pain, we must use this same approach when we collectively request changes to the EHR software.
BCD: Big Company Disease
Rule of thumb: The bigger the healthcare system, the slower it is to change.
At one large multi-hospital facility that shared a single instance of the EHR, a physician stated that it took three months for their EHR team to fix a misspelling on the after-visit clinical summary that we give to the patient. The road to EHR optimization is not a straight one, and you need a team to decide what you’re going to do every time you encounter a fork or a bend. Who makes decisions about EHRs in health systems? If you’re like most, this is a staggeringly complex and confusing process (and calling it a process at all might be generous). You’re likely suffering from BCD, or big company disease.
BCD is an epidemic. Hospitals and health systems must implement technology that helps them meet the goals of 2017 healthcare, Value-based purchasing, consumerism, MIPS/MACRA, ACOs … the list goes on. These goals require change in clinical and technology operations and this change must occur rapidly — or at least much more rapidly than the current pace at most organizations — to meet them.
BCD is fraught with complex requirements, departmental silos, poor stakeholder representation, and highly-educated and well-intentioned leaders whose decision-making authority has been stretched much further than their own comfort zones (and pay grades). As we’re working on the cure for BCD, these treatment options will alleviate many of its symptoms.
Three Questions to Establish Governance for EHR Optimization
1. Who makes the decisions about the EHR?
The first step of governance for EHR optimization is determining who the decision-makers are. If you employ a democratic philosophy of governance, then you must first decide what is your constitution (some call it a mission statement). This constitution drives every decision that you make, including who needs to be at the table from the key stakeholder groups: operations, clinical, and IT. These three functional branches of government compose the three-legged stool governance model. If you’re a large system, you’re also going to need three levels of stakeholders: site/local leadership, regional leadership, and corporate/system leadership. No matter how you answer this question, your governance model must be clearly defined and communicated throughout the organization.
2. What are your priorities?
Everything can’t be a priority. All optimization efforts, requests, and enhancements are certainly NOT created equal. After asking the two most critical questions—“can we?” and “should we?”—I often use and recommend adapting an impact effort matrix to determine the clinical impact and resource requirements for EHR project request prioritization:
Quadrant 1: The “Just do it” quadrant. High clinical impact, minimal resources.
Quadrant 2: The “Get the geeks, the execs, and the checkbook” quadrant. High clinical impact, high resources.
Quadrant 4: The “Diva” quadrant. Low clinical impact, high resources.
Before you do anything, make sure you know what quadrant you’re working in! Many organizations have found success building upon this simple framework with Lean or other process improvement methodologies.
3. How are we going to make this happen?
You have your governance model established with balanced representation or your three-legged stool. Now, how do you get these people together to actually use the framework to make critical EHR optimization decisions? This is one that plagues virtually every organization I work with. “I didn’t know WE decided that” or “when are the meetings even held?” are common stakeholder grievances.
When the governance group can’t all come together, you end up making decisions based on time constraints instead of thoughtful ones with the right people around the table. Keys to recovering from BCD include:
Clear roles and responsibilities. What is each committee responsible for accomplishing at the end of the day? (Oh, this is called a charter.) These obligations should be fully defined and every committee member should know this for their committee, as well as the others in their organization.
Effective meeting management and tools. Before each governance meeting, tackle these items. Determine which decisions, if any, can be made without meeting. Pre-plan the meeting – set the agenda for this meeting by highlighting what was discussed at the last meeting and the action items/decisions to be made at the meeting. Meeting polls — If your governance committee is large, this is a great way to determine consensus quickly. Virtual meeting tools exist that make interaction and measurement much easier.
Transparent decision-making and prioritization. You have to share information and you have to share it often. Send out a post-meeting debrief to the committee and the other committees within your organization. Make sure everyone knows how the decision was made and how they can escalate an issue. IT should not be the first place to go to get an EHR solution fixed—physician leadership should determine this. Remember: EHR optimization is a clinical project, not a technical project.
Large-scale EHR optimization starts with an effective, mission-aligned, and accountable governance process. Nagging symptoms of BCD may linger longer than you care for, but with the treatment plan I’ve prescribed above, you’ll be in a much better state to move your organization forward.
The Problem List is the Problem By Sam Bierstock, MD
Sam Bierstock, MD is president and founder of Champions in Healthcare, LLC. He developed and trademarked the concept of Thoughtflow.
For years we have heard that the goal is for complete interoperability of electronic health record systems (EHRs). While this must certainly be achieved in the ultimate attainment of confluent data availability, it is important to be sure that exchanged data from differing systems is consistent. In this regard, we have a huge problem – problem lists.
As an interesting exercise, ask any physician the difference between a diagnosis and a problem. It will readily be seen that very few know the difference, and those that offer an explanation of the difference will provide a wide variety of definitions. As a result, problem lists are loaded with a combination of current and inactive complaints, symptoms, and diagnoses, and generally are a mess. They are inconsistent, unmaintained, confusing. and vary between systems for the same patient. A patient who has been admitted to different hospitals using different EHRs will have a different problem list at each hospital, not to mention any problem lists that may exist in EHRs of physicians that they have seen as outpatients.
While I am unaware of any actual studies to assess the cost of inconsistent problem lists to the healthcare system, these costs must be enormous. Medical record departments and coders spend hours sorting out diagnoses since problem lists frequently populate discharge summaries from which billing data is extracted. Active and inactive problems must be identified and separated out. For instance, “Status Post Myocardial Infarction 1999” may be on the list but is not billable. Symptoms frequently appear and may confuse or diminish reimbursement or be entirely non-reimbursable. Productive cough for three days for instance is a symptom, not a diagnosis, and yet is typical of the types of problems currently listed.
In 1970, I was a medical student at the University of Vermont when a dynamic, energetic, brilliant, and visionary physician who had recently joined the university staff brought his radical ideas about computerizing patient histories and findings to the attention of the industry. His name was Larry Weed, MD, and his system, “The Problem-Oriented Medical Record”, was rapidly changing clinical documentation across the country. A level of logic and thinking that had been missing in the assessment, planning, and treatment of patients’ conditions was being recognized for its enormous value. Problems included medical diagnoses as well as social issues and all matters that need to be considered to treat patients in their entirety.
But Dr. Weed’s system got sidetracked in the ensuing years by the introduction of independent electronic record systems designed by corporate vendors. In general, these system designers had a very poor understanding of the Problem-Oriented Medical Record, and as a result, all tended to handle diagnoses and problem lists differently (if they had them at all). As a result, decades later, few physicians can differentiate between “problems” and “diagnoses” and problem lists have degenerated into a morass of confusion.
For more than a decade, I had been advocating an approach to EHR design that differed from the standard approach of existing systems which were based upon reproduction of text-book clinician “workflows.” Although they frequently followed the textbook workflows, these designs were inefficient and had nothing to do with the way physicians think and work and have historically been abysmally received. Most physicians use EHRs today primarily because of legislative mandates and Meaningful Use requirements, but there is almost universal agreement that they are cumbersome and reduce efficiencies.
Since 2003, I have advocated a different approach which I call (and have trademarked) Thoughtflow and which I first described in the literature in 2004 – supporting the way physicians access, assess, prioritize, and act upon data. In other words, how they think and act.
One of the areas that can be addressed using this approach is the Problem List. As a first step, I had to decide what made it to the list in the first place, what constitutes a “problem.” I picked up the phone and I called Larry Weed. Now well into his 90s, Dr. Weed was as brilliant as ever, and I quickly learned the answer to my question about the difference between a problem and a diagnosis.
A problem, Dr. Weed explained, is the highest level of the current diagnosis. Understanding this basic principal provides a path to cleaning up problem lists, keeping them consistent and updated and maintaining active and inactive problems. EHR system designers do not understand this any better than most physicians do, and as a result, each has a different approach to the construction of problem lists in their systems.
Consider the following scenario:
A patient is seen in the emergency room with a five-day history of abdominal pain and constipation of unknown origin, and subsequently admitted for evaluation. The diagnosis is constipation and abdominal pain, which may appear as a combined problem or two separate problems on the admitting history and physical.
Problem #1: Abdominal pain x 5 days Problem #2: Constipation
The admitting doctor orders a GI consultation and some baseline studies including a flat plate x-ray of the abdomen. On the first day of admission, the x-ray shows an abdominal mass. The Problem List may now look like this:
Problem #1: Abdominal pain x 5 days Problem #2: Constipation Problem #3: Abdominal mass
On day 2, the patient has an exploratory laparotomy and is found to have carcinoma of the colon.
Problem #1: Abdominal pain x 5 days Problem #2: Constipation Problem #3: Abdominal mass Problem #4: Carcinoma of the colon
At this point, and at the sole discretion of the attending physician, Problems 1, 2 and 3 may be removed entirely from the Problem List, may be moved to inactive problems, or may stay on the list. They may stay there for some time or be moved by a future physician providing care for a different problem. There are no fixed rules.
However, if Dr. Weed’s dictum is applied, consistency is attained.
On day 1, when the x-ray shows an abdominal mass, “Abdominal mass” becomes the highest level of the current diagnosis, and therefore replaces both “Constipation” and “Abdominal pain X 5 days,” becoming Problem # 1. In my system design, clicking on the updated Problem #1 “Abdominal mass” resulted in a drop-down menu showing, in chronological order, the previous problems leading to the most current and the dates. So clicking on “Problem # 1 Abdominal mass” produced a drop-down that looked like this:
On day 2, after a diagnosis of Carcinoma of the colon, Problem #1 is further updated:
Clicking on each drop-down menu reveals configurable granular data dependent on user preferences.
Consistent with the concept of Thoughtflow as opposed to workflow, the design minimized any requirement for the user to update the problem list. Using vocabulary standards, clinical decision support software, language processing, and automated ICD-10 coding, the Problem Lists can be automatically updated. They can also automatically exported to an evolving discharge summary from which the automated coding provided billing and reimbursement data. The potential savings in time spend scouring charts by coders can be appreciated, as well as the accuracy of coding and assurance of reimbursement.
In addition, updated and current Problem Lists can also populate any medical summary screens which may have displayed overall summary data such as medications, allergies, past surgeries, etc. This assures an accurate, consistent summary of past maximally updated problems, or in other words, the highest level of current diagnoses. Symptom and other extraneous data will then not appear to congest the list and add to assessment and billing confusion.
Rapid maintenance of the list can be attained by simply dragging a problem that was inactive or resolved to the corresponding list. A problem “Myocardial Infarction 1990” could be moved at a physician or coder’s discretion to an Inactive or Resolved Problem list, while “Atherosclerotic Coronary Vascular Disease” remains as an active problem. Problems could be prioritized in order by simply dragging them to the desired position, and numbers changed automatically as the new position was attained or as problems were added or removed.
The inconsistency of Problem Lists is an inadequately discussed, but universally recognized issue with enormous costs to the healthcare system, both financial and with respect to quality of care. The issue also generates an enormous challenge to EHR design and to the assurance of interoperable, consistent patient information across the spectrum of healthcare systems, physician offices, disparate hospitals, and payers.
September 27, 2017InterviewsComments Off on HIStalk Interviews Scott Booker, CEO, Healthgrades
Scott Booker is CEO of Healthgrades of Denver, CO.
Tell me about yourself and the company.
I have a common thread in my background, a combination of product technology driving marketing solutions. I spent a lot of time in the hospitality space early on in my career with hotels and casinos developing CRM solutions. Most recently, I spent almost 10 years with Expedia, running the Hotels.com brand as president of about a $6.5 billion dollar revenue business worldwide. I’ve got a good mix of CRM and B-to-C Internet from my background.
The main focus of Healthgrades is to provide access to more appointments for health systems and physicians. Our strategy is basically a pithy strategy around choose, connect, and manage.
“Choose” is about providing the very best place on the Internet for consumers to do their research and choose a doctor. The logical next step, “Connect,” is making an appointment. Primarily that’s done by phone today, but we’re big believers in the efficiency and simplicity of online appointment scheduling. We have our own capabilities in that regard. “Manage” is the CRM components that wrap around that interaction with the consumer to acquire, engage, and retain them.
People complain almost universally that the provider directories of their insurers are outdated. What are the challenges in keeping that information current?
You’ve hit on a big one. The stat I’ve heard is that about 25 percent of physician information churns every month because of doctors moving, switching practices, ceasing to practice, or changing the insurances they accept. That’s a real challenge.
We put a lot of effort into validating that our information is accurate. It can come in many forms. One is working directly with the hospitals and what we do from the sponsoring of those listings on our site. We do primary source verification, which means calling out, faxing out, and emailing out. All kinds of work there to make sure that we have the accurate information. It’s a big part of what we do to make sure that the consumer gets what they need from that standpoint. It is a real problem, but we work hard to try to stay on top of it.
The CRM component and the ability to merge its information with publicly available data gives you a lot of data to work with. What insights can you derive?
That’s one of our core competencies that goes back many, many years. We started off as a quality ratings business for hospitals, where we would take in claims information from every source we could get our hands on and use that information to assess quality for specialties of a hospital. It’s a small piece of what we do today. More of the strategy is what I talked about earlier.
But the information, the data that underlies that, is still very, very valuable. It helps us inform the kind of information that we put on profiles and so forth. It gives us insight as to what’s going on in the region around that hospital that can inform and help management make decisions, and in particular, acquire patients.
An example would be a particular hospital that is saying, “We want to focus on this segment of orthopedics. We think that’s a big play for us. We’re good at it. People have known us for that. How do we go and make sure that everybody in our region knows that?” We can look at the claims information around that region of the hospital. We can overlay that with retail data and demographic data. We build fairly sophisticated data science predictive modeling to go out and reach and target those consumers, whether it be by digital campaigns, email campaigns, print campaigns, and so forth. There’s a lot of insight that goes into that information that we can provide about those patients or customers that are in a particular region.
There’s a lot of insight there that we pride ourselves on. We think that’s a core competency and a differentiator for us. We’ve had data science in our organization as a core competency for many, many years. For the clients we work with, that’s probably one of the things that they most like about the insights they can get from us.
Can consumers use Hotels.com-type search filters for provider location, availability, and cost?
I’ll hit on the cost one for a second. We believe that cost is an area that we need more transparency on. It’s on our radar. It’s a challenging one to go after, but it is something that we’re continuing to look at.
With regards to setting appointments, you’re absolutely right. We provide a bunch of filtering capabilities to help consumers narrow down to a selection they want from an online appointment scheduling capability. You can look at today, the next day, next three days, and so on and so forth. You can look by insurance or by the gender of the physician. There’s many filtering capabilities.
What providers like in working with us is that is in many cases, the rock star physicians, if you will, don’t have a lot of slots available over the next couple of weeks. We know from our research that the next two weeks is really important as consumers are on our site looking to make an appointment. If the physician they look at is not available, we provide a feature where you can look at other doctors in the practice that can also provide that same kind of service and that do have availability within the two weeks. Cross-promote is what we call it, so that consumers don’t have to wait if they don’t want to.
There’s a lot of the same functions and features that you might find in online travel that we’re bringing to the table in making an appointment.
What homework should a consumer do in choosing a hospital for elective care given that the several available hospital ratings systems don’t necessarily agree?
There’s a lot to unpack in that one. We believe that it is difficult to pin quality on a particular doctor, because the quality of care that you get is really related to the team of the hospital you’re associated with or going to go see. That’s where the ratings actually come into play.
We’ve been doing this for almost 20 years on the quality ratings side of things. There’s a lot of sophisticated data science that goes into this. We have a medical advisory board that’s involved with our team, to try to make sure that we are doing everything we can to present the right kind of information from that standpoint.
All of the many quality ratings have a similar intent. The core of it is, what kind of data are they using? What are they risk-adjusting for? Are they using reputation versus not? Some of the publications will use the reputation of an organization, but that’s really just branding. We don’t do that. We don’t feel like that is a representation of the actual quality you’re getting at a hospital.
When you choose a physician, or you’ve got a surgery or something that needs to happen from that standpoint, it’s really about the care team that you’re going be involved with. As a consumer, that’s what I would be interested in. If I choose a doctor, what hospital are they associated with? Then, from that perspective, what kind of ratings do they get overall?
What are the benefits and the challenges of allowing people to rate their doctors online?
I would make an analogy to other industries where there’s typically a trusted third-party site, maybe more than one, where consumers can go to get more unbiased opinion about a particular product or service that they’re offering. You could talk about Zillow and real estate; or Tripadvisor and Hotels.com and travel; or Cars.com and autos. That’s a function that consumers have been taught in other industries. They expect it in all industries from that perspective. When you think about it from a healthcare perspective, it’s very similar. A lot of consumers come to our site just to look and validate based on the patient engagement survey score and comments.
When consumers come to a site to do a review – and I’ve seen this in the travel space — as a company, you’ve got to do what you can to make sure fraud’s not happening. If there’s stuff that shouldn’t be happening, you take care of that through various validation processes that you put in place. We certainly have that, and probably more so in this case because it’s healthcare. But I think that trusted third-party review process is important for consumers to get some validation that is from a third party.
What we see is that for the most part, people review at a relatively high level. When there is a poor review, we have the capability for the doctor’s office or the physician to respond to a review. The same thing happened in hotels. When we provided that capability for hotels to respond to a review, it put a human from behind the curtain and brought them out in front. The consumers really like that.
When that happens in the hotel space, you get higher conversion. When those hotels embrace the reviews and realize that this is like primary research — where I’m getting direct feedback that I can respond to, improve on, and make things better — their conversion continues to rocket. That’s the same thing you see in the healthcare side of things. When docs and offices are responding, that helps consumers have a better understanding.
We’re using pretty much the Press Ganey survey when we do reviews on the site. A lot of it has to do with the experience at the office. If somebody says they waited an hour before they got in to see the doctor, the doctor can say, “Yes, that was an issue that day. We were overbooked. Something happened and we’ll make sure it doesn’t happen again.” That is something that consumers can understand.
Putting a human behind that review process is really important. Certainly consumers value that feedback on reviews to make a decision about a doctor.
Do you have any final thoughts?
Healthcare is obviously a bit behind other industries in terms of adopting consumerism. But all the executives that I talk to now — and I speak at board meetings and various conferences and interact with CEOs — view consumerism and wanting to be where the consumer is online as a top priority. Now it’s a matter of marshaling their resources and putting the full effort behind it. The systems that do that — that go all-in on online appointment scheduling, embrace reviews, and respond to those reviews to make their experiences better for the consumer — are going to be well ahead of their competitors.
We’ve always been in the CRM business, but we have a new solution coming to the market that is around CRM. We call it the Healthgrades Consumer Intelligence Platform. Other industries have already adopted a similar component. They utilize CRM to aggregate the information about consumers, acquire consumers, then engage and retain them. That whole equation of acquisition, engagement, and retention is something that hospitals haven’t quite figured out yet, but it’s very, very important. Those that do are going to have a leg up.
My belief is that although healthcare has moved slowly, it is moving faster than it ever has, partly because of consumerism. As consumers have to make their own decisions and pay more of their own costs for healthcare, there’s a real opportunity to improve the service and the experience of consumers going forward.
Comments Off on HIStalk Interviews Scott Booker, CEO, Healthgrades
The FDA announces the vendors it has selected to participate in its new digital health software precertification pilot program: Apple, Fitbit, Johnson & Johnson, Pear Therapeutics, Phosphorus, Roche, Samsung, Tidepool, and Verily.
September 26, 2017NewsComments Off on News 9/27/17
Top News
After culling through the applications of over 100 interested companies, the FDA selects Apple, Fitbit, Johnson & Johnson, Pear Therapeutics, Phosphorus, Roche, Samsung, Tidepool, and Verily to participate in its Pre-Cert pilot program. Announced in late July, the pilot will help the FDA better understand how the fast-tracking of pre-certified companies could impact the market. The nine companies have agreed to give the FDA access to measures related to their software development, testing, and maintenance; and to participate in FDA site visits.
Reader Comments
From Agnes Scott: “Re: Agensian HealthCare (WI) files suit against Cerner for $16 million in lost revenue as a result of a messy changeover from McKesson in 2015. The health system claims it’s still losing $200,000 a month because of coding and billing errors. Cerner claims it fixed the problems in 2016.”
Webinars
September 28 (Thursday) 2:00 ET. “Leverage the Psychology of Waiting to Boost Patient Satisfaction.” Sponsored by: DocuTap. Presenter: Mike Burke, founder and CEO, Clockwise.MD. Did you know that the experience of waiting is determined less by the overall length of the wait and more by the patient’s perception of the wait? In the world of on-demand healthcare where waiting is generally expected, giving patients more ways to control their wait time can be an effective way to attract new customers—and keep them. In this webinar, attendees will learn how to increase patient satisfaction by giving patients control over their own waiting process. (Hint: it’s not as scary as it sounds!)
October 19 (Thursday) 12:00 ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD CMO, Salesforce; and Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect; director, National Center for Primary Care; and associate professor, Morehouse School of Medicine; and Gary Palgon, VP, healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Announcements and Implementations
Singing River Health System (MS) deploys Nuance’s full line of computer-assisted physician documentation products.
Ability Network develops a new analytics and benchmarking tool for home health agencies, SNFs, and LTPAC facilities.
Halifax Health (FL) implements real-time clinical surveillance capabilities and analytics from Wolters Kluwer Health, along with mobile communications technology from Vocera, to more effectively diagnose and treat sepsis.
University of Iowa Health Care adds Carestream’s Vue Motion enterprise viewer, lesion management, and mammography software to its Carestream clinical collaboration platform.
IVantage Health Analytics launches a market intelligence tool to assist hospitals and health systems with strategic planning.
Allegheny Health Network deploys Appriss Health’s PMP Gateway to gives its prescribers access to the state’s PDMP from within Epic.
People
Mount Sinai Health System genomics spin off Sema4 names Jamie Coffin (Source Medical Solutions) president and COO.
Direct Consulting Associates hires Ranae Rousse (Encore) as VP of sales.
Acquisitions, Funding, Business, and Stock
Availity announces an unspecified amount of funding from Francisco Partners and existing investors. The Jacksonville, FL-based company also secured a $200 million revolving credit facility two months ago.
Digital patient education company Outcome Health will hire 2,000 employees by 2022 to help staff its new headquarters in Chicago.
Tempus raises $70 million in a Series C round led by Revolution Growth and New Enterprise Associates. The precision cancer care technology company has raised $130 million since it was launched in 2015 by Groupon cofounders Eric Lefkofsky and Brad Keywell.
PatientSafe Solutions raises $25 million in an investment round led by HighBar Partners, bringing its total raised to just over $141 million.
Government and Politics
TechCrunch reports that the CDC has organized a blockchain development team to assess the effectiveness of distributed ledger technology in the areas of population health and disaster relief.
Sales
Capital Health in the United Arab Emirates will roll out the TrakCare HIS from InterSystems at its Specialized Rehabilitation Hospital and Health Shield Medical Center.
Affirmant Health Network (MI) signs on with Epic for its Constellation software for clinically integrated networks. Affirmant will roll out the “seven-figure” platform across its six health systems, including 26 hospitals.
Vidant Health (NC) contracts with Premier for multi-year consulting, analytics, performance improvement, and supply chain services.
Richland Medical Center (WI) will replace its 20 year-old legacy systems with EHR, PM, and RCM software and services from Aprima Medical Software.
Luxembourg’s federation of hospitals signs on with Agfa Healthcare for enterprise imaging across its 15 hospitals.
Technology
The nonprofit Carolinas Center incorporates Vynca’s advance care planning technology into its My Health Peace of Mind digital planning tool for its network of hospice and palliative care facilities.
Change Healthcare works with The Hyperledger Project to develop a blockchain solution for claims processing and payment transactions.
Healthcare CRM company Evariant develops a call center solution that incorporates appointment scheduling, referrals, marketing automation, event registration, and reminders.
In an effort to better identify at-risk patient populations like prediabetic and undiagnosed diabetic patients, Lightbeam Health Solutions adds AI technology developed by DocSynk to its population health management offering.
Innovation and Research
The charitable arm of the National Council for Prescription Drug Programs gives $40,000 to Johns Hopkin Medicine (MD) as part of a medication safety research project that will assess the effectiveness of adding CancelRx software to the hospital’s existing e-prescribing technology.
Other
Point-of-Care Partners introduces ePrescribing State Law On-Demand to help e-prescribing and EHR vendors stay up to date with regulations in all 50 states.
Epic’s annual user group meeting (and related traffic) kicks off, with Wizarding-themed sessions in high gear today. Closet to 17,000 people are expected to attend, with almost an even split between Epic employees and customers. If tweets are any indication, the company’s App Orchard website is now live.
Sponsor Updates
AdvancedMD will exhibit at the Ascend rehab therapy business summit September 29-30 in Washington, DC.
ClinicalArchitecture will exhibit at the Pop Health Forum October 2-3 in Chicago.
VentureOhio recognizes CoverMyMeds CEO Matt Scantland as Entrepreneur of the Year.
The Nashville Business Journal recognizes Cumberland Consulting Group as the 10th fastest-growing company in Middle Tennessee.
LogicStream Health will host a happy hour during Epic UGM September 27 from 6-8pm CT.
Imprivata partners with health data integrity and management firm Just Associates to enhance its PatientSecure patient identification solution.
The Graham-Cassidy ACA repeal bill appears to be dead as three GOP Senators come out as firm ‘no’ votes. Senators Susan Collins (R- ME), John McCain (R-AZ), and Rand Paul (R-KY) have all come out against the bill.
Former HHS Secretary Mike Leavitt and former National Coordinator Karen DeSalvo, MD co-author an article in Modern Healthcare urging leaders and legislators working to overhaul the US healthcare delivery system not to overlook the social determinants that are associated with poor population health.
In England, Microsoft is following in Google’s footsteps as it launches an AI business unit focused on developing tools to alert providers of undetected patient problems.
Pfizer launches a six-person startup tasked with pursuing drug research that Pfizer is too busy to complete. The startup, called SpringWorks Therapeutics, has raised $103 million in early investments and will focus on pushing four Pfizer invented therapies through the remainder of their development cycles and into the market.
One of the more useful clerkships I completed during Medical School was one in Occupational Health. It provided me the opportunity to visit a variety of different workplaces and to learn about the health-related challenges faced by different types of workers. I worked with employees at a zinc refinery, a radiation-contaminated EPA Superfund site, at our affiliated health system’s laundry facility, a soap manufacturing plant, and several other locations. One of the workplace types we didn’t visit was the typical office setting. Although we learned about the repetitive motion injuries common in decorative butter-ball rollers, we didn’t learn much about health conditions caused or aggravated by computer use.
Since then, we’ve heard more about carpal tunnel syndrome and repetitive motion injuries. In addition to hand-related conditions, those of us who spend the majority of our days in front of a computer can encounter complications of decreased mobility along with symptoms such as numbness and tingling of arms and legs. Headaches, neck pain, and back pain are also common. Although many of those symptoms can be combated by ergonomic interventions, many companies lack the knowledge or resources to pursue special positioning devices, supplemental hardware, or new work areas. I have several colleagues with standing desks and those can make a difference with the mobility issues, but sometimes introduce additional problems when individuals embark on an activity plan that is different than what they have done previously.
The American Optometric Association also notes issues with what they call “computer vision syndrome,” which is a cluster of visual problems resulting from prolonged use of computers, tablets, cell phones, or e-reader devices. Symptoms can include blurry or double vision, eye burning, itching, and red eyes. It extends a little farther than the “eye strain” of old, and is also more prevalent due to the large number of workers exposed to computer work throughout the day. Some estimates cite a figure of up to 70 million workers who are at risk. The journal Medical Practice and Reviews recently published a paper on the condition, explaining some of the physiology behind the symptoms. Prior to reading it, I hadn’t really thought about the fact that computer work is known to reduce the frequency of blinking, leading to dry eyes and irritation. Although the paper specifically looked at the condition in Africa, it cites computer vision syndrome (CVS) as “an emerging global epidemic, which if not clearly understood and appropriate interventions designed, may have negative impact on productivity and economic development.”
Risk factors for CVS include working with a monitor that is too close (20 to 28 inches is ideal) or monitor height that is too high. Placing the monitor in a lower line of vision causes the eyelids to be open a smaller distance, which reduces the frequency of dry eye symptoms because less of the surface of the eye is exposed to the air. Having a slightly lower monitor is also supposed to promote neck relaxation. Anti-glare filters are also recommended when glare is an issue. Since computer use is a major risk factor on its own, the authors note that due to the increased use of computers among students and children, symptoms are also present in that population.
Many of us in healthcare are highly focused on conditions that inject the most cost (and most comorbidity) into the healthcare system, such as diabetes, heart disease, obesity, and chronic pulmonary diseases. I was surprised to read that the estimated expenditure on eye diseases in the US is $16 billion each year, more than twice spent on breast cancer when you look at another disease to place it in proportion. In addition to the ergonomic recommendations, experts also recommend simple preventive steps, such as taking a break every 20 minutes to stare at an object at least 20 feet away. This recommendation poses a challenge for those of us doing close-up work in an exam room, which is rarely larger than 10×10 feet in many offices. It’s not clear whether switching back and forth between the screen and the patient adds to or helps eye symptoms. Workers with dry eye symptoms can also use moisturizing eye drops.
Eye symptoms and musculoskeletal issues aren’t the only things we have to worry about in the modern workplace, especially those of us that bring work home with us or work on highly flexible schedules. It’s been suggested over the last several years that exposure to artificial light at night may be linked to depression. One study in the journal Molecular Psychiatryshowed that hamsters exposed to dim light at night over a four-week period had changes in brain chemistry that were linked to depression. The good news is that the effects could be reversed by returning the hamsters to a normal light-dark cycle for a couple of weeks. The fact that the study was done with hamsters made me think about the fact that many of us feel like we’re on a hamster wheel on a daily basis, so perhaps the results are more relevant than we might think.
CDC, through its National Institute for Occupational Safety and Health, lists additional challenges in the office environment – temperature, humidity, light, noise, task design, and psychological factors such as personal interactions, work pace, and job control. In the world of healthcare IT, I definitely hear about the latter three. CDC also mentions that “job stress that results when the requirements of the job do not match the capabilities or resources of the worker may also result in illness.” In the world of ever leaner workplaces and job consolidation, there is no shortage of that type of stress.
I’d be interested to hear from readers in various sectors about how their employers are or are not addressing occupational health issues. Does your employer encourage you to check your bags so you don’t have to hoist them in the overhead bin? Are you allowed to relax while traveling or are you expected to work with your laptop balanced on your knees because it won’t fit between the tray table and the seat in front of you? Do home-based employees get a budget for ergonomic workstations or at least comfy chairs? Is it better in academia versus industry? Email me.
HHS Secretary Tom Price, MD confirms that he will no longer charter taxpayer-funded private jets to travel for business, explaining “We’ve heard the criticism. We’ve heard the concerns. We take that very seriously and have taken it to heart.” A recent Politico investigation found that Price has spent $400,000 chartering private jets since May.
The Trump administration will shut down Healthcare.gov for 12 hours every Sunday and overnight on the first day of open enrollment during the upcoming enrollment period, claiming the outages are for routine maintenance. The decision has drawn criticism from consumer advocates that say the administration is intentionally undermining the exchanges.
Kaiser Permanente CEO Bernard Tyson, MD writes a TIME article discussing the path the US took to arrive at employer-based health insurance coverage as the standard, the role CMS and ACA play in expanding coverage beyond the working class, and the way that technology will be used to deliver care in the future. In his summary, he explains “Delivering better health for all means transforming an industry so when someone needs health care, it is delivered in a 21st century way that combines technology with the personal touch.”
HHS Secretary Tom Price, MD decides to cease traveling in chartered planes until after the agency’s inspector general conducts a full review and audit of his travel expenses and the procedures surrounding them. While a timeline has not been released for the review, Price has assured taxpayers that, “We welcome this review. We want to make certain that we have the full confidence of not just this administration, but the American people.”
Reader Comments
From Mike: “Re: Cold call solicitations from ECW. Do you think they’re pressing as a result of the DoJ ruling, or do you see something like this as a best practice? ECW cites an “AmericanEHR” survey that finds the company to be best at many things like training, eRx, usability, satisfaction, population management, etc. This would be more impactful if the actual study was available via the e-mail. A quick skim of AmericanEHR’s website shows that ECW isn’t in any of their Top 10 lists.” I can’t speak to the cold calling, though I suppose it wouldn’t have surprised me in the heady days of HITECH. I’ll invite readers to weigh in with their experiences.
From MJ: “Re: Jackson Medical Center (AL) implements Evident’s Thrive EHR. Not good for Athena from an inpatient perspective. One of their 35-bed sites is already leaving them and returning to CPSI. Surprised the hospital was willing to disclose the cash flow details they saw between the two systems.” I couldn’t find any record of an Athena implementation at JMC. The announcement from CPSI’s Evident subsidiary does mention that the center is returning to Evident due to a 75-percent drop in collections with their previous vendor.
HIStalk Announcements and Requests
Just as I suspected: The vast majority of last week’s poll-takers will not spend an absurd amount of money on the anniversary edition of the iPhone. Ganay laments that there was no third, “hell no” option, while Pushing the Limits believes that if “one wants to purchase a Cadillac and has the resources then one can afford to make that choice; most of us can’t or choose to be a little more fiscally responsible. This pricing will be a real stretch for some who will unfortunately feel they MUST go for it. It is getting out of control, however, if we, as the consumers, continue to fork over these type of dollars. Next year’s version will be even higher. Whatever the market will bear!!” Technology Fan plays devil’s advocate: “Why not buy an X (a good reader poll would be to see if your readers pronounce it iPhone ‘X’ or ‘Ten’)? I purchased a Dell desktop in 1995 for $4,000, which is $6,500 in today’s dollars, so spending $1,000 for a top-of-the line miniaturized computing device that is light years ahead of Windows 95 doesn’t seem so unreasonable.”
New poll to your right or here: Have you been affected by the Equifax breach? Before you respond, I’ll preface this by saying this question is really about how you’ve been affected, and what steps you’ve attempted to take to protect your credit – either through Equifax’s offerings or some other vendor, so please share your experience in the comments section.
This Week in Health IT History
One year ago:
The GAO slams HHS in a report on cybersecurity preparedness in health IT.
InstaMed secures a $50 million investment from Carrick Capital Partners.
Former Tuomey Healthcare (SC) CEO Ralph Cox personally pays $1 million to settle allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.
HITRUST begins exchanging bi-directional cyber threat alerts with the Department of Homeland Security.
Hillary Clinton outlines her plans for improving healthcare, which includes improving the ACA, working to “integrate our fragmented healthcare delivery systems,” and helping to increase research and innovation.
Five years ago:
McKesson acquires population and risk management solutions vendor MedVentive for an undisclosed sum.
HHS Secretary Kathleen Sebelius and US Attorney General Eric Holder warn AHA and other hospital organizations that the government will take appropriate steps to pursue providers who misuse EHRs to defraud Medicare.
Nuance Communications acquires QuadraMed’s Quantim product line for health information management.
Nordic Consulting raises growth capital from SV Life Sciences, Health Enterprise Partners, and HLM Venture Partners.
Navigating Cancer raises $2.3 million to hire developers and integrate its patient portal into EMR applications.
Ten years ago:
Microsoft wants to buy 5 percent of Facebook for $500 million, thereby valuing the three-year-old, teen-heavy social networking site at $10 billion.
QuadraMed closes its Misys CPR acquisition.
Bassett Healthcare (NY) selects McKesson for additional products for its four hospitals and 23 community health centers.
The market for physician financial information systems is expected to grow from $3.5 billion in 2006 to an anticipated $6.22 billion by 2013.
Susquehanna Health (PA), the first facility to go live on both Soarian Clinicals and Financials, has signed on with Siemens for additional technology and service solutions.
Last Week’s Most Interesting News
HHS Secretary Tom Price, MD comes under fire for his use of private jets for job-related travel.
CMS Administrator Seema Verma announces that the agency will pivot its Innovation Center to offer providers new ways of delivering care.
Tenet Healthcare sale rumors heat up with HCA rumored as a frontrunner to acquire several Tenet hospitals.
British Colombia Health Minister Adrian Dix launches an independent review of Island Health’s $178 million Cerner Millennium implementation.
Equifax suffers fallout from its botched attempts to provide post-breach customer service.
Webinars
September 28 (Thursday) 2:00 ET. “Leverage the Psychology of Waiting to Boost Patient Satisfaction.” Sponsored by: DocuTap. Presenter: Mike Burke, founder and CEO, Clockwise.MD. Did you know that the experience of waiting is determined less by the overall length of the wait and more by the patient’s perception of the wait? In the world of on-demand healthcare where waiting is generally expected, giving patients more ways to control their wait time can be an effective way to attract new customers—and keep them. In this webinar, attendees will learn how to increase patient satisfaction by giving patients control over their own waiting process. (Hint: it’s not as scary as it sounds!)
October 19 (Thursday) 12:00 ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD CMO, Salesforce; and Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect; director, National Center for Primary Care; and associate professor, Morehouse School of Medicine; and Gary Palgon, VP, healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Leonardo DiCaprio invests in MindMaze, a Swiss startup that has developed virtual reality technology to help amputees and stroke victims regain movement. The company, which is looking to expand beyond healthcare into entertainment and media, seems to have found a fan in the actor, who has expressed interest in how its software can help make movies more interactive.
National Decision Support Co.’s CareSelect-powered clinical decision support products are now in use in all 50 states.
People
ROI Healthcare Solutions promotes Stacy Bennett to VP of human resources.
Zelis Healthcare names Timothy Wilde (UnityBPO) CTO, Thomas Kloster (Inovalon) CFO, and Edward Fargis (Personal Touch Home Care) chief compliance officer and general counsel.
Announcements and Implementations
NRC Health develops a hospital-focused consumer loyalty index to help providers attract and retain patients.
Decisions
Bluffton Regional Medical Center (IN) will switch from McKesson to Cerner in 2018.
Harney District Hospital (OR) will go live with Epic in April.
Mercy Hospital (IA) will switch from McKesson to Cerner in October.
Plains Memorial Hospital (TX) switched from TruCode to 3M Encoder last November.
These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
Government and Politics
ONC eases EHR Certification requirements for vendors in an effort to reduce regulatory burden on health IT developers. First, ONC has revised certification test procedures so that vendors can “self declare” that their products meet 30 of 55 certification criteria. Second, ONC plans to exercise “enforcement discretion” when it comes to conducting randomized surveillance of health IT products.
HHS instructs employees to complete video training on the dangers of leaking information – a move also being carried out across the departments of education, commerce, and the EPA.
Colorado’s new Medicaid claims reimbursement system comes under fire when Colorado Hospital Association data reveals that it has yet to pay several hospitals and health systems $211 million. Operated by DXC Technology, the system has struggled since launching in March, rejecting claims from hundreds of providers due to what state officials have called operator error.
HHS will shut down Healthcare.gov for maintenance from midnight to noon nearly every Saturday during open enrollment, plus during overnight hours on the first day of the enrollment period. Government officials contend the maintenance is routine, though several media outlets have pointed out it is in excess of what occurred during the Obama administration.
Innovation and Research
Google profiles the ways in which biomechanical engineer Anne-Christine Hertz is using Google Street View to help dementia patients travel down memory lane.
In England, Microsoft sets up an AI-focused healthcare department at its research facility in Cambridge that will focus on developing predictive analytics tools. Public health informatics professor Ian Buchan will head up the new department.
Other
Kaiser Permanente CEO Bernard Tyson points out that transforming healthcare involves individual choice just as much as insurance coverage and technology:
“We need people to change the way they think about their choices when it comes to their own health and to ask themselves: ‘What is my responsibility for eating healthy foods, sleeping enough hours and exercising each day to live a longer, healthier life?’ The future of health is a new frontier with technology, research and individual choice playing an important part. Delivering better health for all means transforming an industry so when someone needs health care, it is delivered in a 21st century way that combines technology with the personal touch.”
Sponsor Updates
LiveProcess will exhibit at the Indiana Healthcare Emergency Preparedness Symposium September 28-29 in Indianapolis.
The New York Times Corner Office features LogicWorks CEO Kenneth Ziegler.
Meditech releases a new case study, “Detecting the Undetected: Meditech’s Surveillance Identifies and Prevents Infections at Valley.”
National Decision Support Co. will exhibit at Epic UGM September 25-27 in Verona, WI.
Navicure will exhibit at PDSMED Mindshare 2017 September 27-28 in Kansas City, MO.
Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the 8th Annual Nebraska Section AWHONN Fall Conference September 28-29 in Omaha.
Black Book recognizes Recondo as a leader in several RCM rankings for 2017.
Experian Health will present at the HFMA FL Fall Institute September 27-29 in Delray Beach, FL.
PatientPing is named a runner-up for best tech startup at the Timmy Awards.
Patientco will host a recruiting meet and greet September 28 in Atlanta.
The SSI Group will exhibit at the Alabama HFMA Fall Institute September 24 in Miramar Beach, FL.
SK&A publishes an updated report, “Historical and Current Rates of Physician Access.”
TriNetX will host Summit17 September 26-27 in Boston.
Wellsoft will exhibit at the NRHA Critical Access Hospital Conference September 27-29 in Kansas City, MO.
ONC eases EHR Certification requirements for vendors in an effort to reduce regulatory burden on health IT developers. First, ONC has revised certification test procedures so that vendors can “self declare” that their products meet 30 of 55 certification criteria. Second, ONC plans to exercise “enforcement discretion” when it comes to conducting randomized surveillance of health IT products.
Representatives Greg Walden (R-OR) and Tim Murphy (R-PA) send a letter to HHS Secretary Thomas Price asking for an update on HHS plan to address cyberthreats to the healthcare sector after learning that the “NotPetya” malware attack is causing lingering delays in availability of certain Merck products.
The Department of Veterans Affairs’ acting CIO, Rob Thomas, will retire from government service in October. VA Interim Deputy Secretary Scott Blackburn will replace him.
The VA has fired the medical director of the D.C. Medical Center for sending sensitive VA information from his work email to unsecured private email accounts.
Politico reports that HHS Secretary Tom Price, MD took five flights on private jets between September 13 and 15 “at a cost of tens of thousands of dollars more than commercial travel.” Price’s destinations included Athenahealth’s MDP event in Maine, the Goodwin Community Health Center in New Hampshire, and the Mirmont Treatment Center in Pennsylvania. Those organizations have confirmed that they did not cover Price’s travel costs. HHS spokeswoman Charmaine Yoest has said that those flights “were important for him to get outside of Washington, DC, talk to real people on the ground, and using the travel arrangements we did was the best way to get him there.”
Other Trump administration officials have come under fire for their lack of fiscally responsible flying. Officials are reviewing travel expenses for Treasury Secretary Steve Mnuchin, who used an Air Force jet to visit Kentucky in August and later requested a military flight for his honeymoon (allegedly for security reasons); and for EPA Administrator Scott Pruitt, who has spent a considerable amount of money on commercial flights to his home in Oklahoma.
Reader Comments
From Dave: “Re: Equifax post-breach customer service. From what I understand, if you go to the Equifax site and sign up for the free credit monitoring that they’re offering, the current terms and conditions that are agreed to by clicking through it, according to an attorney I was told about, say that you are hereby waiving any rights to participate in a class action suit. When the attorney called and asked Equifax about that, they told him not to worry and that it won’t apply in this case. Yet, they haven’t changed it and people are clicking on it. And it’s only there because of this very breach. Sounds fishy to me.”
HIStalk Announcements and Requests
This week on HIStalk Practice: KeyCare will implement I2I Population Health’s PHM technology across 16 community health centers. HRSA earmarks $200 million to help health centers expand mental health and substance abuse services. Bend Medical Clinic hopes to climb out of EHR-related financial troubles with help from Summit Health. Providers react to Jonathan Bush’s burning question. VillageMD launches in Georgia. CMS Innovation Center pursues new direction. Physician burnout becomes a vicious cycle. PRM Pro Jim Higgins emphasizes communication preferences in improving patient retention.
Last call: HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide over at HIStalk Practice. Companies that are walking the show floor instead of exhibiting are also welcome to submit their information. The guide will publish the week of October 2.
Webinars
September 28 (Thursday) 2:00 ET. “Leverage the Psychology of Waiting to Boost Patient Satisfaction.” Sponsored by: DocuTap. Presenter: Mike Burke, founder and CEO, Clockwise.MD. Did you know that the experience of waiting is determined less by the overall length of the wait and more by the patient’s perception of the wait? In the world of on-demand healthcare where waiting is generally expected, giving patients more ways to control their wait time can be an effective way to attract new customers—and keep them. In this webinar, attendees will learn how to increase patient satisfaction by giving patients control over their own waiting process. (Hint: it’s not as scary as it sounds!)
October 19 (Thursday) 12:00 ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD CMO, Salesforce; and Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect; director, National Center for Primary Care; and associate professor, Morehouse School of Medicine; and Gary Palgon, VP, healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Video interpretation and telemedicine company Stratus Video opens a Center of Excellence in Dallas. The company expects to hire 200 employees from the area within the year.
Moffitt Cancer Center’s (FL) informatics subsidiary, M2Gen, will use an undisclosed amount of equity investment from Hearst to expand its cancer research efforts and data-sharing network.
The Dallas News cites unnamed analysts in an article claiming that HCA is a frontrunner to acquire some of Tenet Healthcare’s hospitals.
Sales
Christus Health system (TX) selects Influence Health’s CRM software.
People
Biomedical informaticist Neil Sarkar (Brown University) takes the editorial helm of AMIA’s new JAMIA Open publication.
Great Lakes Health Connect Executive Director Doug Dietzman will also lead Making Choices Michigan, a nonprofit focused on advance care planning that became a wholly owned subsidiary of GLHC earlier this month.
Announcements and Implementations
University of Kansas Health System rolls out speech-recognition software and EHR services from Nuance.
Baptist Health Corbin (KY) implements tele-ICU services from Advanced ICU Care.
Technology
Intelligent Contacts develops a service that helps hospital collections staff bypass lengthy hold times when trying to get in touch with payers.
Providers can now access Doximity Dialer from within Epic’s Haiku mobile app. Dialer gives users the ability to call patients from their smart phones with one touch, while guarding the privacy of their personal phone numbers.
Amazon looks to give recently revitalized Google Glass a run for its money with Alexa-enabled smart glasses, the company’s first wearable. Users will be able to hear Alexa courtesy of a wireless bone-conduction audio system, and could wirelessly tether to a smartphone. Google Glass founder Babak Parviz joined Amazon in 2014.
LiveData launches a cloud-based version of its PeriOp Manager technology.
National Decision Support Co. works with Mayo Clinic (MN) to develop a real-time decision-support tool for laboratory testing available within the EHR via the company’s CareSelect software.
ClinicTracker end users gain lab connectivity via EHR integration with Change Healthcare’s Clinical Network.
Privacy and Security
In its latest monthly update, Protenus reports that healthcare organizations experienced 31 breaches affecting 673,934 patient records – stats in keeping with the preceding seven months. Hackers were responsible for 55 percent of breaches, while insiders racked up 27 percent, pointing to a continued need for cybersecurity training.
Government and Politics
VA Interim Deputy Secretary Scott Blackburn will assume the role of acting CIO when Rob Thomas retires next month. Thomas took on the role in February after CIO LaVerne Council departed with the Obama administration.
The CMS Innovation Center asks for stakeholder feedback as it considers a “new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.” CMS Administrator Seema Verma says in a Wall Street Journal op-ed that the agency will pivot its Innovation Center to offer providers new ways of delivering care, noting that value-based programs have resulted in market consolidation and reduced competition. Comments are due November 20.
Niam Yaraghi, a fellow in the Brookings Institution’s Center for Technology Innovation, argues in a Health Affairs blog that HITECH and HIPAA are as much at fault for the nation’s EHR interoperability problems as the vendors and providers that are being blamed. He recommends enacting policies that would give providers and vendors the option of charging fees for the the exchange of medical data, a move that would “unleash the long-awaited incentives for information exchange in the healthcare industry and open the floodgates of medical data to allow patients to access, manage, and transmit their medical data as easily as their financial data.”
Other
“Where are helicopter parents when you need them?” asks Weird News Andy after learning that doctors in Wales put a two year-old’s cast on the wrong leg. After taking the child back to the clinic a day later, the child’s mother says clinic workers were “making out as if it was my fault for not checking which leg it had been put on at the time. I told them that it wasn’t my duty to be aware of that and point out their mistake.”
WNA shakes his head at the fact that Equifax linked to a fake customer support site that mocked the company’s breach follow-up for several days before realizing its mistake. The company’s Twitter account even got in on the action. Ars Technica reports that a security researcher developed the fake site to emphasize how easy it is to fool people into clicking on links and giving up personal details.
Sponsor Updates
EClinicalWorks will exhibit at the SFMGMA Annual Healthcare Symposium September 22 in Fort Lauderdale, FL.
Evariant makes the Marcum Tech Top 40 list of fastest growing technology companies in Connecticut.
I took time out from consulting this week to attend the first-ever Smartsheet user conference, held in Seattle. I’ve been a user of Smartsheet for some time, primarily because it makes it easy to share project plans and documents with clients in a way that I can control without having to deal with versioning issues. I like the ways people can collaborate and it just feels easier to me to use than other Web-based collaboration tools. When I heard a few months ago that they decided to host a client conference, I jumped at the chance to see what it looks like when a company decides to make that happen. I’ve heard plenty of tales from the EHR world about clients who attended the first user group for a given vendor, many of which take the “bunch of guys and a couple of cases of beer” story form.
I suspected Smartsheet had progressed well beyond that narrative based on the agenda, which included a wide variety of sessions and social events. The conference kicked off on Monday with a meet-and-greet at The Parlor in Bellevue, just a hop, skip, and a jump from the conference hotel. Pool tables and ping-pong competed for attention with Monday Night Football, along with a variety of snacks and drinks. For those of us who are perpetually jet lagged, it was a nice way to start a conference. The conference went into full swing on Tuesday with over 1,000 people in the audience for the keynote session. They brought in local DJ Darek Mazzone to introduce the crowd to the Seattle music scene and it definitely set the tone for the morning. Prior to the conference, I didn’t know anything about the company’s leadership, but found them engaging and passionate about the work they’re doing. Based on the staging and lighting budget, it was clear they had spared no expense in aiming for a first-class entry into the user conference space.
The company used the event to launch several new features, some of which were literally rolled out immediately prior to the conference kickoff. I hadn’t been aware of their mobile app before they discussed it at the keynote (not sure how I missed that little tidbit) but quickly downloaded and started testing it. After the pumped-up buzz of the keynote, everyone headed out to breakout sessions. The halls were crowded, which was a testament to the sold-out status of the conference, which seemed a little large for its surroundings. The first few breaks between sessions were crowded with videographers trying to capture footage of the crowd along with client interviews. I took advantage of one of the breaks to talk to one of the mobile developers, who was very interested in hearing what users think of his product and who didn’t give me any sass about the fact that I didn’t even know it existed until a few hours prior.
Breaks were also prime time to continue on the “swag journey,” which drew participants to various booths highlighting different product features. The swag was outstanding, with a high-quality messenger bag for everyone (although I was surprised that it didn’t have a Smartsheet logo). I bypassed some of it but did snag the conference survival kit with its band-aids and mints along with a tech case with some headphones that my teenage house-sitter will like. I took a pass on the fidget cube and tattoo stickers. The swag hunt punch-cards led to some jokes among attendees who had difficulty figuring out which booth had which swag (or whether a booth had swag at all) until they learned to “follow the hole punch crumbs.” We’ll see if that gets changed out for next year.
One conference element that I hope does get changed out is their preregistration and attendance scheme. Attendees had to preregister for sessions and then have their badges scanned for admittance to a session. If you were one of the unlucky attendees like me who didn’t receive the preregistration email, you had no idea you had to preregister for sessions, and were consigned to a second-class “standby” lane just outside the meeting room. Others who did preregister weren’t showing a green light when scanned, and were sent to the end of the standby line. The way it was handled at some sessions was less than customer-friendly, and I hoped that after a couple of rounds of this silliness the conference organizers would have tried something different. It continued throughout however, with room monitors ranging from just letting people in regardless of whether they scanned green or not, to being belligerent with attendees. I resigned myself to the standby line but was able to get into every session I wanted to attend. The bottom line though, is that for a company that talks a lot of about reducing wasted time and streamlining work, they added some major inconvenience (and dissatisfaction) for their attendees. Pro tip: Have people pre-register to get a feel for the room size you need for each session, then bump that by X percent and just let everyone in without a bunch of silly lines.
Some sessions featured a sketch artist creating story boards during the sessions, which was fascinating to watch if you were lucky enough to get a seat in the front. My favorite session was one on collaborative work, led by Margo Visitacion of Forrester Research. She addressed a lot of issues that I cover in some of my change leadership courses, including helping people understand the new ways that work is done today and how knowledge workers operate compared to traditional work methods. My second favorite session featured Amy Sovereign from the City of Detroit discussing how their Program Management Office uses Smartsheet in their Lean Six Sigma efforts. The presentation format was more of a fireside chat, but with vibrant photos of the city projected on the big screen as they talked. They’ve done some interesting things with the technology including end-of-shift debriefing surveys when they deployed body cameras to the police department. She got several chuckles from the audience, talking about people who are “allergic to Lean Six Sigma” and how much people love their paper. I also enjoyed her comments about making sure that you have buy-in before deploying new solutions, because you “don’t want to put technology in a catapult.” It’s vivid images like those that can captivate an audience.
I was less-than-captivated by another session where the male panelist was introduced with all of his credentials and accomplishments, and the female panelist was introduced as “the lovely Miss Jane Doe.” I’ve never heard a man in a professional setting introduced as “the handsome Mr. John Doe” so I’m not sure why that is acceptable, and I wasn’t the only person it grated on. This phenomenon has actually been studied before, and I would encourage presenters and moderators to take a gander at the paper before preparing your next set of introductions. The session was also marred by horrible feedback between the speakers and the microphones and a constant humming, so I didn’t get much out of it. Speaking of ruining the audience experience, I’m not sure why people still think it’s OK to answer phone calls in the middle of the session and talk all the way down the aisle and out the door. Nor do I understand why someone would do a conference call in the hallway on speakerphone and not with headphones, but I saw that at least twice.
The lunch breaks were designed to be networking sessions, and on Tuesday I wound up at a project management-themed table with people from all kinds of companies. I don’t want to unmask my secret identity by saying who I sat with, but people I met at various points were from Target, Centene, Oregon Health & Science University, Comcast, MGM Hotels and Resorts, health systems, hospitals, EHR vendors, Microsoft, DocuScan, local school districts, municipalities, Salesforce, and more. It was a great conversation and very gratifying to hear about the way some of these groups were solving the same problems I run into with my clients. Of course, explaining my vague-sounding consulting firm always garnered some interesting looks.
Tuesday’s client event was at the Chihuly Garden, and on the hour-long bus ride (love that rainy rush hour Seattle traffic!) I met some fun people who had some great advice for doing different things with Smartsheet. The event featured not only the glass, but food and drink from various local vendors along with seafood, pasta, and an all-potato buffet with parmesan French fries, tater tots, kettle chips, potato skins, and a baked potato bar. The dessert tables had been picked clean by the time I figured out they were in a separate little greenhouse area, so I missed out on the eclairs. The featured cocktail included moonshine from 2Bar Spirits, but I steered clear.
Wednesday’s keynote included a panel of Smartsheet leaders taking audience questions, followed by Captain Chesley “Sully” Sullenberger, who I found riveting and one of the best of the many professional keynote speakers I’ve seen over the years. If you’re looking to be inspired to greater things such as duty, honor, dedication, and service, he’s your man. He had some great insights into how people and technology interact, along with the true nature of innovation – changing before you’re forced to. I do have to say though that watching the recap of Flight 1549’s journey at the beginning of the speech was haunting. I’ve made plenty of life or death decisions in very short timeframes with patients on the table in front of me, but I can’t imagine being in his seat with 155 passengers on board and figuring out a solution that saved everyone. He recounted how hearing the flight attendants shouting “Brace, Brace, Brace” to the passengers functioned in a sort of cheerleading capacity to help him through the situation. He highlighted the performance of his team during the incident and how everything in their careers before that helped prepare them for the situation. One of his statements really resonated with me as he discussed how 208 seconds has come to define his entire career as a pilot. I thought about that several times the rest of the day – if we had three minutes that would define our careers, what would that look like?
Overall, I was happy with my choice to attend, although the registration fee plus a couple of nights of Seattle-area hotel rates put a dent in my budget. Smartsheet did a great job with their inaugural client conference and I’m looking forward to seeing things grow. They’ve certainly come a long way from their startup in a little yellow house in Kirkland, WA.
Seema Verma - that’s quite a spin of “facts” good luck.