EPtalk by Dr. Jayne 12/14/17

When we think about healthcare IT systems, I think most of us probably overlook some of the quasi-healthcare vendors that patients have to deal with to handle their medical bills. A friend vented to me about his company’s choice of a new benefits administrator, which needs to use to access his flexible spending account. This is the same company his employer used in the past, but switched to another benefits administrator last year, and is now switching back to the first one.

He received a message to establish his account to be ready for 2018, but when he tried to execute on it, he received a duplicate warning and was referred to customer support. The site then generated a password reset link, which didn’t help him due to the duplicate accounts. After opening a second help ticket, he received a secure message notification in his employee email, which required him to create a secure messaging account on the benefits website, using his work email as the user name and creating a new password.

Despite having the same login as the benefits site (as well as the same look and feel) the secure messaging portion of the site is entirely independent, and the messages he had been sent were not useful. Returning to the benefits site, he tried again to have his account unlocked, and four days later, finally received a secure message that his duplicates were resolved.

Once he was able to access the benefits site, he discovered there is no linkage to the secure messages from that side either, so users have to go in and out of two different systems if they need customer support. I’m going to go out on a limb with the idea that maybe this is intentional, since money left in flexible spending accounts is forfeit if not used. If the system is difficult to navigate, there’s a chance it will prevent employees from using their benefits.

Speaking of difficult to navigate, I tried to complete my HIMSS18 registration today since the early bird discount is ending. It kept replacing the name of my company with “DX” for no apparent reason, forcing me to log in and out a couple of times. I also had trouble getting the name badge fields to correctly show my city, since I wanted it to display Big City instead of Nameless Suburb in the field. I finally gave up and will try again tomorrow. It looks like my hotel of choice is sold out, so I’m glad I made my reservations a couple of months ago.

I’ve already started building my agenda for the week, including at least one BFF Booth Crawl. Although I’m not fond of Las Vegas, I do enjoy catching up with my healthcare IT friends. For the third year HIMSS is hosting a reception for Millennials. I’m tempted to sign up just to check it out and see how the conversations differ from the other events such as the Women’s Networking reception. I’m too old to pass for a Millennial, but I bet I could pass for a hip older coworker.

It’s the time of year when holiday cheer abounds. I was surprised to receive a notice about the American Medical Association’s “Joy in Medicine” modules and the fact that the American Board of Family Medicine is going to provide Performance Improvement Credit for providers who complete them. I’ve focused most of my Maintenance of Certification and Continuing Medical Education activities on being a competent, compassionate, and culturally-sensitive physician and have completed more than enough credits for 2017. The idea that physicians need to complete coursework to learn how to find the joy in medicine again is a sad commentary on healthcare today. The course is promoted as having tools “to guide the executive leadership teams in creating a joyful practice environment and thriving workforce.”

I gave it a glance, and it does touch on physician burnout but not on the high rate of physician suicide – I guess that wouldn’t be very joyful, but it is a reality. I’ve lost two colleagues with bright futures to suicide and agree that we need to have better support structures, not only for physicians, but for all caregivers and people trying to work in our crazy healthcare system. The module advocates creating a “wellness infrastructure” with a chief wellness officer reporting directly to the CEO or equivalent to other leaders such as the COO or CMO “and is resourced accordingly.”

It goes on to say that “this leader should ensure all leadership decisions consider the potential effect on workforce wellness.” Even though it offers a calculator to estimate the true cost of physician burnout, I don’t see this playing in most of the arenas where physicians are employed. Especially in the under-20-provider practice, it’s going to be hard to create that infrastructure. I’m working with a five-doctor group now that can’t even agree on how overnight call should be distributed, so getting them to have a conversation on workforce wellness would be quite the trick.

Speaking of pipe dreams, Aetna wants to create a healthcare hub at CVS pharmacies to help patients navigate the healthcare system. Likening it to Apple’s Genius Bar, Aetna CEO Mark Bertolini explained it as a cross between the Patient-Centered Medical Home model and a retail establishment where people can walk in and get help.

It’s this kind of over-simplification of patients’ true needs that gets my blood pumping. The infrastructure required to truly make this work is vast, and although CVS trots out its MinuteClinic retail clinic sites as part of the solution, it’s more complicated than it seems. My practice sees many patients who are beyond the narrow care protocols in place at MinuteClinic, and the referral of their patients to a second visit at Urgent Care actually adds to the healthcare system. Do we really think that CVS is going to triage customers away from its clinics to competitors, or are they going to try to expand into the primary care and urgent care space? Or do as they do, and see the patient first, then refer to a higher level of care? Will they send the patient to their primary care physician or offer to sell over-the-counter remedies? I’m hoping the former, but since retail profits are important, the balance might be tricky.

The simplicity of comparing healthcare to the Apple Store also masks the complexity of patients. Where Apple offers service on a set number of products, the number of “models” walking into a healthcare environment is infinite. Although basic processes can be put into place to handle subsets of patients and conditions, I hope CVS and Aetna folks truly engage with their stakeholders to create the model. First and foremost, this needs to be about doing what’s right for patients rather than shareholders. I’ll remain skeptical until I see drafts of their pilot plans. Or, if they’re looking for an anonymous physician blogger to give them advice, I’m available.

What do you think of the Aetna/CVS merger? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/14/17

This Startup Wants to Democratize CRISPR Gene Editing Research By Making It Free

A Venrock-backed startup called Inscripta is releasing an alternative CRISPR-Cas9 enzyme that scientists can use for free to conduct research. CEO Kevin Ness reports, “You can go right to the website, download the sequences instantly, even get a user guide.”

A health care paradox: measuring and reporting quality has become a barrier to improving it

A STAT opinion piece explores the conflicting dynamic between “patient-centered care and the administrative burdens that measurement imposes on physicians, hospitals, and health systems.”

New CDC head faces questions about financial conflicts of interest

CDC Director Brenda Fitzgerald recuses herself from decisions involving health IT and cancer detection because her and her husband are legally required to retain equity in companies involved in both markets.  Senator Patty Murray (D-WA) is questioning her ability to function in her role if she is unable to engage in conversations around cancer care, the second leading cause of death in the US.

Email is the biggest source of data breaches

A new survey finds that email is the leading cause of data breaches in healthcare, contributing to 73 breaches thus far in 2017, affecting 574,000 people.

HIStalk Interviews Eric Ritchie, COO, Minnie Hamilton Health System

Eric Ritchie is COO of Minnie Hamilton Health System in Grantsville, WV.

Tell me about yourself and the organization.

We’re a Federally Qualified Health Center that owns and operates a Critical Access Hospital and rural health center in Grantsville, West Virginia. It’s an unusual designation, only of about one of three in the country where an FQHC owns and operates a Critical Access Hospital. I’m originally from the area that we service.

Minnie Hamilton has been operating this way for approximately 21 years. We operated as a standalone clinic prior to 1996 before taking over responsibility for the recently-closed Calhoun General Hospital, which had serviced the area prior to that for the previous 30-plus years.

What are your biggest challenges in running the health system?

The biggest challenge is definitely related to our rural location. We service an area that doesn’t have a lot of industry — actually it has no measurable industry — so it is an aging population. A lot of the younger generations, to provide a lifestyle for themselves, move beyond our service area. Our average patient age goes up every year, according to the demographic.

The lack of infrastructure that comes with being in rural West Virginia makes it challenging. Your patients have difficulty getting out to get their healthcare needs satisfied. When they do come to our facility, if they need a more specialized facility or a bigger hospital, there’s always a logistical challenge getting them out in a timely manner to meet those emergent situations.

The rural location is probably our number one biggest challenge and the disadvantages that come with that. Definitely in the state of West Virginia, it’s well-documented that our infrastructure, from an IT standpoint, is challenged. We also deal with that as well.

What are your most significant IT systems?

When we selected Athenahealth as our EHR, it was our goal to try to get it all under one umbrella from an IT standpoint. Athena is primarily it. We have standalone dental software that runs our dental clinics. We also operate a long-term care facility that has its own system. Beyond that, it’s just our traditional phone system. We have a partnership with Microsoft that we leverage their Office suite free of cost because we’re a not-for-profit.

What are you doing with population or community health?

We are the continuum of care for most of our patients. We put a lot of focus on identifying, as our patient demographic ages, what their predictable needs will be in the coming years. As a facility, we have evolved over the last 20 years, as our demographic has aged, to make sure that we are providing services that prevent them from having to make that hour, hour and a half commute.

A big population in our area has diabetic needs, so we’re looking at what’s coming down the pike. A need for dialysis, more so than there is right now. That was the reason why we opened the dental clinic, to address the younger population that does exist. The long-term care was another one of those solutions.

We have a pretty simple formula. We do quarterly analysis on the referrals that we are having to send out to other facilities because we don’t provide a service. When we see a need rise up to the level affecting a measurable percentage of our population, we start exploring ideas on how to bring that service here locally, whether it’s something that we provide under our umbrella or that we simply provide space for another entity to come in and perform those services here.

You are surrounded by WVU Medicine and the trend nationally is that the big systems are getting bigger. How do you see the future of Critical Access Hospitals, both in West Virginia and across the country?

It’s very interesting and a popular topic among the Critical Access Hospitals when they get together and talk. In West Virginia, we see two predominant, large entities that are acquiring Critical Access Hospitals. WVU Medicine to the north, which is acquiring different practices up there, and then Charleston Area Medical Center to the south.

We have a good relationship with both. Right now we’re partnering with WVU Medicine, where they are sending specialists to our facility to hold office hours. They take care of the billing, so they’re not working under the Minnie Hamilton umbrella, but they are bringing much-needed services to our areas, eliminating the need for our patient population to drive extended miles to receive that service.

It really comes down to, in our experience, open communication. This is what our needs are. This is how we can help each other. Our loyalty stops at our patient population, so whatever is in the best interest of that patient population, we are going to use that as our guiding light to determine how we should move forward.

There’s always a balance where a big health system could provide resources, but they if they were to acquire the hospital, they might decide it’s not worth keeping open or they might not respect its original mission.

Based on the conversations that we’ve had with those larger entities, I think there is a real shift in the view of how a larger entity partners with a Critical Access Hospital. Our patient population is predominantly Medicare or Medicaid. That’s a financial benefit for us because of being a Federally Qualified Health Center. It doesn’t make as much sense financially for a bigger entity to become servicing a population that is predominantly Medicare or Medicaid.

What everyone is starting to realize, or at least in our experience, is that it makes more sense if we can provide the care here locally and keep that patient population close to their home place. But we are dependent on those bigger entities to provide the knowledge and the skill sets. Rather than taking over and starting to operate a Critical Access Hospital under their umbrella, I think it benefits them in the long run if they can simply be recognized as a partner to an existing Critical Access Hospital who is servicing the rural part of America. But at the same time, not overwhelming their own systems with a patient population that they can’t handle.

They want those beds. They want the ability to make sure that care is being provided. But they can’t afford to continue to expand and just increase their bed count. It makes more sense for a standalone entity like Minnie Hamilton to take care of the daily, routine illnesses or chronic illnesses that can be monitored and managed. When that special occasion comes up that exceeds our skill set, we have a direct line to a solution that can come and be a part of that care team.

The advantage big systems have is that they have other sources of revenue, while you are at the mercy of what happens in Washington, DC.

You really are. That is a burden carried by all Critical Access Hospitals. Even the bigger entities have that concern, but our reimbursement and our ability to remain operational goes as Congress and the legislature decide to fund the healthcare programs. We can in no way be profitable without that federal supplement. We just don’t have the volume to generate the revenue that’s required to run the facility as we have it set up now.

The alternative is that if a facility like ours ceased to exist in our service area, we’re looking at a two-hour time lapse for an emergent situation. We all know what numbers end up being when you’re taking 120 minutes to respond in an emergent situation.

Government officials, elected officials, those bigger entities all want to be a part of a solution that allows rural America to continue to be served by a staff capable of taking care of an emergency situation, as well as those that have chronic illness or the routine acute type settings. So they aren’t required to travel an hour and a half or  two hours for care.

You had some previous problems with revenue cycle management and the cost of your IT systems. What are the lessons learned from that experience?

With a smaller entity like Minnie Hamilton or many of the Critical Access Hospitals, you need to stay very current on the rules and regulations governing reimbursement. Insurance companies continue to become more and more business-like in the sense of identifying ways and criteria that all of us have to be well-versed in and know how to apply it to maintain a level of reimbursement that we have historically experienced.

One of the ways that Minnie Hamilton is navigating that right now is that we’re making sure that we partner with vendors that bring something to the table with regards to knowledge of those ever-evolving rules and regulations. We feel it’s best for us not to bear that responsibility solely by ourselves. There’s just too much at stake.

You make partnerships. You look for vendors who have a vested interest in not only understanding those rules and regulations, but helping you as the client understand those rules and how best to leverage them. Keeping you compliant with the ever-changing regulations that are being passed down annually, whether it’s MIPS, MACRA, UDS reporting, or HEDIS reporting. For us, that is the guiding principle behind identifying possible vendors and then ultimately selecting vendors. That has to be a component of that relationship.

Given the challenges your health system has, what makes you want to keep coming to work every day?

We’re fortunate at our facility because we’re smaller. Our executive team at Minnie Hamilton all grew up within 30 miles of this facility. The patients we are serving are our family members, extended family members, or friends of family members. It’s easy for me, and really all of our staff, to recognize why we do what we do and why we deal with the headaches that we deal with.

In my experience in West Virginia, even in the bigger entities, a lot of the folks that I deal with on a daily or weekly basis are from the area or are from areas that have a lot of similarities to the demographic makeup of the state. At the core, almost anyone I’ve met in healthcare started out at more of an introductory level. At the heart of it, they’re motivated solely by that moral compass of just wanting to do right by the patient population.

Morning Headlines 12/13/17

Health IT company that sued VA goes after Cerner’s patents

Following a failed legal attempt to block the VA’s no-bid Cerner deal, CliniComp is now suing Cerner directly, citing patent infringement of a 2003 patent that describes remote hosting of a hospital IT system.

Aetna wants to create a ‘Genius Bar’ at CVS, and it could forever change the way Americans access healthcare

On a recent earnings call, Aetna CEO Mark Bertolini described plans to roll out CVS-based ‘health hubs’ that would provide patient navigator services. He likens the service to Apple’s Genius Bar, and explains that in this case, employees would be “preparing them for their visits, setting up appointments, eliminating prior ops, doing all those other sorts of things to help navigate that system for them.”

Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer

An cross-sectional analyses of 32 deep learning algorithms designed to review pathology images concludes that seven deep learning algorithms performed better than “a panel of 11 pathologists in a simulated time-constrained diagnostic setting.”

NewYork-Presbyterian and Walgreens Collaborate To Bring World-Class Care Through Telemedicine

NewYork-Presbyterian will begin offering telehealth services provided by its ED doctors to non-emergency patients at local Walgreens.

News 12/13/17

Top News

CliniComp, fresh off its failed legal challenge of the VA’s choice of Cerner in a no-bid contract, sues Cerner for patent violation.

CliniComp says Cerner violated its 2003 patent for a remote hosted hospital system.

Reader Comments

From Dirty Dirge: “Re: big health system mergers. Who wins, Epic or Cerner?” I would instead ask whether the potential benefits of standardizing systems justify ripping and replacing existing EHRs when their sites cover a big swath of geography without much service area overlap. Maybe it’s OK to limit patient information exchange to the basics, like CCDs, since patients rarely seek care outside their local area. The most compelling argument would be populating a single database that can support analytics, operational analysis, research, and best practices, but that could theoretically be done on the back end with a lot of semantic data translation. The only comparably sized  model is the Kaiser’s use of Epic, but their implementation happened a long time ago; they have more focused corporate control than I would expect of newly merged health systems that can’t even name a single CEO; and Kaiser controls more of the patient experience as an insurer as well as a provider. Perhaps most at risk are Allscripts ambulatory or Meditech in sites included in the merger plans. My guess would be that the highest-priority system projects would involve administrative systems to allow executives to get a handle on their sprawling enterprises. We are really entering uncharted territory since most “huge” health systems have revenue of $2-5 billion vs. the dozens of billions that the proposed mega-mergers would create. Lower-tier vendors should take note – as hard as it already is to sell systems, it’s about to get a lot harder when you have to earn face time with a CIO who controls the IT strategy and budget of more than 100 hospitals (in comparison, Kaiser has only 39 hospitals).

Associate CIO provides these merger-related figures from Definitive Healthcare:

• Dignity Health’s 48 hospitals run Cerner Millennium.
• Catholic Health Initiative’s 153 hospitals use Cerner (61), Epic (65), and Meditech (27), also on the ambulatory side running McKesson (4) and Allscripts (21).
• Ascension Health’s 132 hospitals use Cerner except for Providence and Wheaton Franciscan, which use Epic.
• Providence St. Joseph’s 58 hospitals use Epic (37), Meditech (19), and Allscripts (3).

In terms of dominant vendor in the two proposed mega-mergers, it’s obviously Cerner over Epic (109 vs. 65 and 130 vs. 39, respectively). Here’s a fun opportunity for Definitive or HIMSS Analytics to list the major systems (beyond just the EHR) used by these health systems that are contemplating merging.

From Comprn: “Re: Lifepoint Health. RIF including multiple VPs, about 25 FTEs, due to lower-than-expected earnings.” Unverified. The 72-hospital company cut its revenue and profit forecasts in late October due to fewer-than-expected admissions for the fiscal year. LPNT shares are down 15 percent over the past year vs. the Nasdaq’s gain of 27 percent, valuing the company at $2 billion. It’s probably tough competing with systems bigger than yours that don’t pay taxes and that are equally profit-motivated.

From Trust but Verify: “Re: White House EHR meeting. A news site says [publication name omitted] broke the story but I saw it two days before on HIStalk.” Correct. An anonymous reader sent me the agenda via my Rumor Report online form and I posted the information in Sunday night’s post. Nobody else ran anything that I saw until at least Monday morning, so I’m pretty sure all mentions were triggered by reading it on HIStalk. One site that emailed me late Sunday ran their item (with the agenda that I sent them) Monday morning, but didn’t give credit. I’m also surprised at news organizations that cite one particular health IT website as a source when it’s pretty much like Wikipedia, with no original content.

HIStalk Announcements and Requests

Cumberland Consulting Group’s employee volunteer and community action group donated $1,000 to my DonorsChoose project, which with matching funds from my anonymous vendor executive and other sources funded the entire cost of these projects for high-need classrooms:

• Take-home family math activities for Ms. D’s elementary school class in Houston, TX.
• Hands-on math games for Ms. K’s first-grade class in Indianapolis, IN.
• Games for science game night for Mrs. S’s elementary school in Gautier, MS.
• Microscopes, telescopes, and science kits for Mrs. B’s elementary school class in Gulfport, MS.
• Take-home science activity kits for Mrs. M’s elementary school class in Chattanooga, TN.
• STEM kits for Mrs. M’s elementary school class in Paterson, NJ.
• STEM books and activity kits for Mrs. H’s elementary school class in Sugar Creek, MO.
• Programmable robots for Mrs. G’s elementary school class in Brownsville, TX.
• After-school science kits and supplies for Mrs. P’s elementary school class in Pocatello, ID.
• 200 sets of headphones for Ms. C’s elementary school class in Provo, UT.
• STEM project kits for family game nights for Ms. M’s elementary school class in Fayetteville, NC.
• Programmable robots and a Chromebook for Mrs. G’s elementary school class in Miami Gardens, FL.
• STEM kits for Ms. T’s elementary school class in Bronx, NY.
• STEM project kits for family game nights for Mrs. H’s elementary school class in Canyon, TX.
• Programmable robots for Mrs. F’s high school class in Glen Dale, WV.
• STEM activity kits for a student-led STEM gender and ethnic diversity project of Mrs. I’s high school class in Orangeburg, SC.
• Math and science resources for Ms. S’s first-grade class in Dayton, OH.
• Headphones for the technology lab of Ms. W’s elementary school class in Memphis, TN.

Can you please take 3-5 minutes to complete my once-yearly, one-page HIStalk reader survey? I’ll use the results to plan for 2018, but if you need even more motivation, I’ll be randomly drawing respondents to win a $50 Amazon gift card. Thank you.

Webinars

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

Acquisitions, Funding, Business, and Stock

Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.

Physician scheduling system vendor QGenda acquires ED physician scheduling software vendor Tangier.

Aetna CEO Mark Bertolini tells investors that he envisions that a merger with CVS would allow placing health hubs in pharmacies that would serve as health system navigators, especially for the 60 percent of people who don’t have a regular doctor. He says it could work like the Genius Bar in Apple Stores.

Nashville-based health IT staffing firm ALKU acquires Holland Square Group, a health IT consulting firm also based in the Nashville area. Holland Square Group is a DoD MHS Genesis subcontractor under Leidos.

Sales

OhioHealth (OH) chooses Casechek’s implant supply chain automation.

People

Hans Morefield (Experian) joins substance use disorder technology vendor Chess Health as CEO. The company’s executive chair is industry long-timer John Holton.

CTG hires Jeff Gerkin (Manpower Group) as EVP of sales.

Brett Jarvis (LinkedIn) will join Solutionreach as SVP of customer success.

Announcements and Implementations

Mental and behavioral screening software vendor AssessURhealth offers its app on the Athenahealth Marketplace.

New Jersey’s state medical society brings its OneHealth New Jersey HIE live.

Legacy Data Access will offer its 800 hospital customers a hosted, AI-powered clinical data service in partnership with Life2.

Firelands Regional Medical Center (OH) goes live on Meditech’s Web EHR.

New York – Presbyterian installs telemedicine kiosks in some of its New York-based Duane Read drugstores, making its ED doctors available to review problems that are not life-threatening.

Ground was broken this week on what would have been Cerner CEO Neal Patterson’s 68th birthday on the Patterson Health Center, a $41 million critical access hospital on the Kansas-Oklahoma border that is mostly funded by the Patterson Foundation. The facility, which combines two existing hospitals that merged on November 1, will offer a 15-bed hospital, health clinic, rehab services, a wellness center, and public green space. The family was represented by Neal’s nephew Alan Patterson:

Uncle Neal never really left the farm. He came back to Harper County just about any chance he had. Even after he was a big shot on the cover of Forbes Magazine, he came home at harvest to drive a combine, bring meals to the field, and hang out with the guys when the work was done. If you drove by the farm, you would often see him running the company from a laptop while sitting on the front porch of the farmhouse where he grew up. To me, he was a big kid who was 30 years older than me but enjoyed doing the same things I did. He was like another high school buddy would come back to visit his parents and hang out …  Neal traveled the world and he saw something troubling that most of us don’t see. He saw that small towns were in a healthcare crisis and they were being left behind. He saw that people in rural areas had poorer overall health compared to people in bigger communities. Little hospitals were not the most profitable areas of the business, nor the ones that would help ensure his company made quarterly earnings… but he did not care. He knew that good healthcare facilities and technology were important to rural communities

Government and Politics

A Wisconsin judge dismisses the revenue cycle system lawsuit that Agnesian Healthcare filed against Cerner, noting that Agnesian’s contract requires it to submit to arbitration in Cerner’s home state of Missouri instead of suing. Anesian claimed in the now-dismissed September 2017 lawsuit that a botched RCM conversion from McKesson to Cerner in 2015 cost it $16 million in revenue and $200,000 per month due to coding and billing errors, while Cerner insists that it fixed the problems in 2016.

CDC Director Brenda Fitzgerald is recusing herself from issues related to health IT and oncology because she is legally required to keep her illiquid investments in LLCs involving Greenway Health (EHRs) and Isommune (cancer detection). Fitzgerald – a former OB-GYN, Air Force major, and commissioner of Georgia’s Department of Public Health – and her ED physician husband reported assets valued at up to $16 million.

The New Yorker profiles “Estonia, the Digital Republic,” describing how the post-Soviet republic of 1.3 million people transformed itself into a digital society that embraces robots, a personalized chip ID, making nearly all business and personal information available online, giving every person ownership of data recorded about them, and a “once only” policy that pulls in existing information for everything from buying a house to seeing a doctor.  The country is reconsidering the definition of “population” by connecting virtual talent in an “e-residency” program that allows citizens of other countries to become residents of Estonia with access to digital services without ever setting foot in the country. Some snips from the fascinating article:

“I’ll show you a digital health record,” she said, to explain. “A doctor from here”—a file from one clinic—“can see the research that this doctor”—she pointed to another—“does.” She’d locked a third record, from a female-medicine practice, so that no other doctor would be able to see it …  E-ambulance is keyed onto X-Road, and allows paramedics to access patients’ medical records, meaning that the team that arrives for your chest pains will have access to your latest cardiology report and ECG. Since 2011, the hospital has also run a telemedicine system … Rita Beljuskina, a nurse anesthetist, led me through a wide hallway lined with steel doors leading to the eighteen operating theatres. Screens above us showed eighteen columns, each marked out with 24 hours. Surgeons book their patients into the queue, Beljuskina explained, along with urgency levels and any machinery or personnel they might need. An on-call anesthesiologist schedules them in order to optimize the theatres and the equipment … She logged on with her own ID. If she were to glance at any patient’s data, she explained, the access would be tagged to her name, and she would get a call inquiring why it was necessary. The system also scans for drug interactions, so if your otolaryngologist prescribes something that clashes with the pills your cardiologist told you to take, the computer will put up a red flag.

Privacy and Security

An Accenture-conducted, AMA-sponsored survey of 1,300 physicians survey finds that 83 percent have experienced cyberattacks and want cyber hygiene tips, a guide on conducting a risk assessment, and easy-to-understand HIPAA instructions. The survey’s methodology isn’t the best, however:

• Respondents were apparently self-selected and only completed an online survey.
• If only AMA members were polled (the report doesn’t say), that would be only a tiny, non-representative subset of all US doctors.
• Respondent demographics were not provided, such as the size of their practice site or whether they work for a health system.
• Half of respondents say they have an in-house security official, although the question wasn’t asked about that person’s time allocation and credentials.
• More than one-fourth of responding physicians say they have outsourced security management, but the survey didn’t ask what that means.
• More than half of respondents say someone clicked on a phishing link, which doesn’t really seem like a cyberattack unless it resulted in downtime.
• Only 37 percent reported that an employee inappropriately accessed PHI, which is surely low.

Technology

Apple will launch the IMac Pro this week at an entry price of $5,000 for 32 GB of memory and 1 TB of storage and up to $17K for a fully loaded machine, testing the limits of just how much of an Apple tax even professional users are willing to pay. It’s not an Apples-to-apples comparison, but my Acer laptop has 16 GB, 1 TB (along with a 128 GB SSDD for running Windows 10) and cheap available upgrades and I only paid a bit more than $500. Even that capacity is excessive since nearly everything I use is on the Web.

Other

Two-thirds of the few dozen interviewed patients who got their lab results via a clinic’s patient portal weren’t given further explanation, sending most of them to Google to try to figure out what the results mean. The article concludes that just displaying lab numbers on a portal isn’t enough, especially for patients with abnormal results.

In Canada, all-digital Humber River Hospital opens a Meditech-powered, 4,500-square-foot Command Centre in which staff monitor real-time incidents such as delayed care and provider workload issues. It also contains a 26-panel GE Wall of Analytics with live video feeds from patient care areas.

A just-published review of a 2016 Netherlands bake-off of 32 algorithms that analyze tissue slides to detect breast cancer metastasis finds that seven performed better than a panel of 11 pathologists when limited by typical workflow time constraints. The best algorithms performed equal to the pathologist panel when time constraints were removed. 

A review of 1,300 clinic visits finds that patients asked their doctors for specific lab tests, referrals, pain meds, other medication an average of once per visit; the doctor agreed to write the order for what they wanted 85 percent of the time; and those patients who were turned down gave the doctor lower satisfaction scores.

Javon Bea, CEO of five-hospital Mercyhealth (WI), was paid $8.38 million in 2016, far more than basically any charity or health system. The newest tax form I found was from 2014 and even then the CIO made over $750,000. Maybe nobody wants to live in Janesville, WI or work for Mercyhealth if they have to pay that much. Axios notes that even under his previously slightly lower pay, Bea earned $72 per patient day, although he told the local paper that his then-$3 million paycheck had no impact on healthcare costs even as he increased the system’s revenue from $33 million to $1 billion. 

Sponsor Updates

• Spok launches a library of stories illustrating the ROI of clinical communication technology.
• Optimum Healthcare IT completes its work as primary partner for UCI Health in its Epic Connect strategic partnership with UC San Diego Health.
• Change Healthcare SVP of Product Development and Technology Michael Wood joins the 2018 Class of the Nashville Health Care Council Fellows.
• AssesURHealth raises $2,700 for the American Foundation for Suicide Prevention as part of the Out of the Darkness Tampa Bay Walk.
• Change Healthcare will integrate Tibco’s Connected Intelligence product line with its products.
• Besler Consulting releases a new podcast, “S10 changes you should know about.”
• Glassdoor includes CoverMyMeds in its list of Best Places to Work in 2018.
• Diameter Health achieves NCQA Certification for all 2017 e-measures.
• Vyne’s Trace and FastAttach solutions earn HITRUST CSF certification.
• EClinicalWorks will exhibit at the New York Society for Gastrointestinal Endoscopy 41st Annual New York Course December 14-15 in New York City.
• The “I Love Madison Podcast” features Healthfinch VP of Finance and Operations Leah Roe.
• Technology Headlines Magazine names Intelligent Medical Objects CEO Frank Naeymi-Rad one of the 50 Most Admired CEOs of 2017.
• ConnectiveRx publishes a new white paper, “Boost prescriber knowledge and confidence using in-EHR formulary-status messaging.”

Blog Posts

• How Hawaii’s Busiest Emergency Room Went Paperless with Electronic Patient Signatures (and Your Hospital Can, Too). (Access)
• MIPS Tips (Aprima)
• What Real-Time Data Could Have Done for These Patients (Bernoulli Health)
• Why Let’s Encrypt is Our Favorite Open Source Project This Year (Datica)
• Recapping Redox’s Bold Predictions for 2017 (Redox)
• MHealth Trends Report: Patient Expectations for Healthcare Communication (CareSync)
• CIO Chat – Laura Smith, UnityPoint Health (Huntzinger Management Group)
• Measuring Value: The Real ROI of Communication Technology (Spok)
• Technology Supporting Navigation (Carevive)
• Utilizing Location Technology to Help Protect Healthcare Staff (CenTrak)
• Blockchain: What Is It and How to Build a Business Case (Change Healthcare)
• The Top Three Executable Strategies of Successful Affiliation (Leidos Health)
• Questions to Ask Yourself About Your Practice’s Billing Department (ChartLogic)
• Turning Medicine Upside Down (EClinicalWorks)
• SQL + SSRS Tip: Time Blocking (Iatric Systems)
• 6 Steps to an Effective Revenue Integrity Program (Hayes Management Consulting)
• Healthcare 2025: Digital Healthcare Platforms First (The HCI Group)
• Avoiding Hand-to-Hand Combat: M&A Survival Tactics (Huntzinger Management Group)
• Clinical Data Management Quality Solutions: Hiding in Plain Sight (Diameter Health)

Contacts

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

Morning Headlines 12/12/17

Hopkins taps Duke executive to head medical system

Johns Hopkins Health System names Kevin Sowers, current president and CEO of Duke University Hospital, as its next president.

More delays, cost overruns hit Vancouver electronic health project

In Canada, a local paper profiles the Cerner implementation at Vancouver Coastal Health, the Provincial Health Services Authority, and Providence Health Care, which executives say is now $130 million over budget and a year behind schedule.

HHS announces the winners of the HHS Opioid Code-a-Thon

HHS announces winners from its Opioid Code-a-Thon, an innovation challenge that attracted 50 teams comprised of programmers and public health advocates that worked together for 24 hours to create data-driven tools that could be used to combat the epidemic.

OIG Advisory Opinion No. 17-07

HHS OIG approves a pilot program that will allow a pharmaceutical manufacturer to fund and implement integration points between a community hospital and community pharmacists so that pharmacists would gain real-time access to patient discharge information.

Curbside Consult with Dr. Jayne 12/11/17

At times, being a consultant feels more like being a therapist than a business person. We see clients at their best and at their worst and try to help them figure out how to replicate the good times and how to avoid repeating the bad times. Some days, I really feel for the vendors trying to work with these clients.

In recent engagements, we seem to be increasingly leaned on to try to mediate between vendors and clients or at least mitigate situations that are starting to turn bad. These situations tend to illustrate a variety of organizational pathologies, whether it’s the client and vendor not being able to work well together or the client (or vendor) having internal dysfunction.

Case in point: one of my clients hired their EHR vendor to build some content for custom clinical workflows in a specialty that the EHR vendor doesn’t support. There were plenty of meetings to define the scope of the project, outline the proposed build, obtain stakeholder signoff, etc. The vendor’s team performed the build and delivered it to the client environment for testing. While the build was occurring, the client re-prioritized its projects and failed to provide any client-side resources to perform user acceptance testing on the delivered work product.

There were a lot of back-and-forth communications that were fairly ineffective and some loud chatter at the client about whether the work was authorized or whether they were going to pay for it. The vendor was at the mercy of the dysfunctional client, with time spent creating templates and the vendor now wondering if they were going to be paid.

I worked with some of the client core team to explain that their counterparts on another team had authorized the build and had generated a work order to the vendor, based on leadership requests to enable documentation tools for that specialty so they could retire their paper charts. The core team members didn’t seem to understand that the initiative was even going on, and once they were pulled in to be a part of it, they took their anger at their peers out on the vendor. It didn’t seem like the different teams at the client site were able to realize that there might be more to the story, and my team had to step in to get them talking.

The ensuing conversations revealed that probably the not all the stakeholders were included in the project and that the templates might not meet the practice’s needs. Word on the street was that there was a good likelihood that the vendor was going to have to go back to square one.

What was really disturbing about this situation was the client’s assertion that it was the vendor’s fault and that the vendor should perform the re-work for free. The vendor’s customization team provided all kinds of documentation, meeting minutes, build specification signoff, etc. that showed client approval of the project as it moved through various process tollgates. But the people signing off weren’t the “right” people and the client failed to see that the problem was its own fault and not the vendor’s mistake.

The vendor tried to meet the client in the middle and offered a 50 percent discount on the services needed to restart the project and ensure the newly-identified “right” resources were involved, as a gesture of their partnership, but the client dug its heels in and refused to participate until the vendor agreed to perform the as-yet-undefined future services for free.

I can’t fault the vendor here. What the client did is tantamount to ordering something at a restaurant, eating the whole thing, and then deciding it wasn’t what you wanted or that it wasn’t any good. Even worse, instead of asking for a different entrée, you ask for the restaurant to agree to give you however many items you might want off the menu to make up for your decision, without boundaries.

From a business perspective, it doesn’t make sense, but the client continued to push it despite the vendor’s willingness to meet them halfway. The client continued to behave badly, trotting out the threat that maybe they should consider a different vendor since their current one didn’t offer the specialty in question. The vendor reacted as expected, explaining that they’ve never claimed to support that particular specialt, and had worked diligently to meet the client’s needs. The client wasn’t having any part of it, though, and continued to assert that everything was the vendor’s fault.

Since my team was hired to implement the new specialty, I had a vested interest in getting the client to get on board with what the vendor had proposed as a remediation strategy. There were several 1:1 conversations with various client leaders and managers to try to get them to understand what had happened to date in a neutral conversation without the finger-pointing and blame-laying that we might see in a group discussion. Then I tried to bring them to the table to discuss it as a team and to figure out how to move forward.

Meanwhile, the implementation timeline continued to slip as did the practice’s confidence in the ability of anyone to get them onto the system with the rest of their colleagues. The group meeting was a lesson in coaching angry people how to have a productive conversation to move an initiative forward, regardless of how they felt about it or whose fault they thought it was. I was having flashbacks to the behavioral therapy components of my residency training. We would agree to baby steps to move the project forward and then someone would say something that inflamed someone on the other side of the table and we would take two giant leaps backwards.

Eventually we agreed to have the physicians in question take a look at the workflows that had been created and identify how far off they were from the mark. Since at least one of the physicians was involved in signing off on the build, I hoped they were at least partially usable. It turned out they just needed a few tweaks and the creation of one additional workflow for a clinical scenario that wasn’t represented in the original set, and due to the small amount of work needed, the vendor offered to do it for free just to get things back on track. Still, it was a tense four weeks as we tried to work this out, and previously decent relationships were damaged without good reason.

As painful as situations like this are, as a consultant, they are our bread and butter, not only because we can help resolve the situation, but because they identify future work that needs to be done. In this case, there clearly needs to be a review of how they want to onboard new specialties and how stakeholders will be identified when custom content is requested. There also needs to be discussion about how these projects will be socialized by the leadership team to the management team and whether certain criteria need to be met for them to move forward.

We’ll see if they want to engage with a formal project in this area, but due to the budget constraints many organizations face, there’s usually not a lot of money for process initiatives because they’re sometimes considered “soft skills.” I guarantee that what they would spend on a small process project would still be less than the cost of the delays, wasted time, and loss of forward momentum exhibited here.

A new fiscal year is coming, so we we’ll see if it makes the budget.

Have any stories about “soft skills” projects your company needs but continues to avoid tackling? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/11/17

The White House will convene a meeting on EHR interoperability this Tuesday

Jared Kushner and CMS Administrator Seema Verma will chair a half-day session that addresses interoperability, authentication, and accelerating progress.

Philips expands its Population Health Management business with the acquisition of VitalHealth

The Netherlands-based, 200-employee population health management software vendor was co-founded by Mayo Clinic and Noaber Foundation in 2006.

Hospital Giants in Talks to Merge to Create Nation’s Largest Operator

Ascension and Providence St. Joseph Health are reportedly discussing a merger that would create a 191-hospital system with $45 billion in annual revenue.

Historical Perspective on Health System Modernization Contracts and Update on Efforts to Address Key FITARA-Related Areas

A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA.

Monday Morning Update 12/11/17

Top News

The White House’s Office of American Innovation will host a half-day meeting Tuesday on EHR interoperability, led by Jared Kushner and CMS Administrator Seema Verma. Thanks to the reader who forwarded the agenda, which did not include a list of invitees. Working groups will address four topics:

• How CMS, ONC, and HHS can encourage interoperability and accelerate its timeframe.
• The methods of authentication that could be used and how can the industry can be aligned to support them.
• How patients and physicians can be engaged in interoperability and how and any HIPAA issues can be addressed.
• How can the private sector can become engaged and their participation jump-started by the government’s release of claims or other data.

HIStalk Announcements and Requests

Fairly few male readers are worried that incidents in their past could result in new claims of sexual harassment. HarassedMan was pursued by a male superior and urges employers to provide clear training, policies, and enforcement procedures. HISJunkie wonders whatever happened to innocent until proven guilty and also suggests that a man who is terminating a female employee for cause think carefully about the situation.

New poll to your right or here, continuing last week’s poll: women, what kind of sexual harassment have you experienced? I found my inquiry limited by the format of a poll, so perhaps I’ll follow up with a survey to answer questions such as:

• Did you rebuff the advances, and if so, did it hurt your career?
• Did you report it to HR, and if so, was the issue resolved to your satisfaction?
• If you didn’t rebuff or report, why not?
• Have you ever provided sexual favors or accepted sexual situations — or worked with someone who did — to get hired or to improve job prospects? This is hard to ask, but it happens and encourages bad situations for others. I feel sorry for a man or woman who successfully stops an uncomfortable situation but sees their job suffer because co-workers accept it as quid pro quo.
• Are you considering taking any legal action or going public with incidents from your past?

Three dozen clinician respondents are mixed on whether hospital VIP patients have better clinical outcomes. Nearly half say yes, while around one-fourth each say the outcomes are the same or worse as in the cheap seats. I was appalled at my first hospital job in learning that my for-profit employer – whose outcomes were universally terrible, as you would expect when bean counters oversee all the clinical decisions of a badly educated medical staff recruited for obedience and volume rather than quality –cleared an entire hallway to house the hypochondriac mother of our very profitable eye surgeon. Our profit-obsessed executives convened emergency department head meetings to make sure everybody figuratively genuflected to meet her every need (I got stuck running out to get the kind of wine she preferred since our nutritional services people could barely open cans and heat up food service frozen entrees) and made rare appearances in patient care areas only because she was propped up back there like a queen. At least working for a for-profit hospital shortened the path to my disillusionment with hospitals and maybe humanity in general.

Listening: new from Bully, Nashville-based grunge rockers who sound like Hole mixed with the Breeders. The tiny female singer, who has a rather chirpy conversational voice but can really belt it out cathartically when singing, looks quite a bit like Lucy in the original “Twin Peaks.” 

Friend at Impact generously donated $1,000 to my DonorsChoose project, asking that I focus on elementary school STEM materials (which I’m quite happy to do since I usually seek those out). I applied a dollar-for-dollar match from my anonymous vendor executive plus other matching (the $1,000 donation ended up fully funding a stunning $8,200 worth of grants) for these projects in schools whose students are almost all from low-income households:

• Lab coats, goggles, science journals, and activity kits for Ms. G’s fourth-grade class in Los Angeles, CA.
• An IPad for running programmable robot kits for Ms. S’s elementary school technology club in Los Angeles, CA.
• Three video cameras for home science experiments for Mrs. S’s third-grade class in Philadelphia, PA.
• STEAM activity kits for the after-school elementary school program of Mrs. M in Springdale, AR.
• Math activity kits and games for Mrs. H’s elementary school class for the deaf and blind in Mobile, AL.
• Programmable robots for Mrs. W’s elementary school class in Cartersville, GA.
• Programmable robots for Mrs. O’s elementary school class in Garland, TX.
• STEM kits and experiment books for Mrs. A’s elementary school class in Detroit, MI.
• Six electronic note pads for Mrs. N’s elementary school class in Farmville, MI.
• Take-home math and STEM games for Mrs. F’s elementary school class in Mescalero, NM.
• A STEM bundle for Mrs. T’s kindergarten class in Dallas, TX.
• Take-home math game bags for Ms. M’s elementary school class in Bronx, NY.
• STEM games for Mr. M’s elementary school class in Milwaukee, WI.
• Weekly take-home science projects for Ms. I’s elementary school class in Oxnard, CA.

This Week in Health IT History

One year ago:

• President Obama signs the 21st Century Cures Act into law.
• The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.
• CommonWell Health Alliance and Sequoia Project’s Carequality announce plans to connect their respective systems.
• The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia to establish best practices for mobile health apps.
• SocialWellth brings back the Happtique app certification program.
• MD Anderson considers layoffs and research cutbacks after losing $102 million in the first two months of its fiscal year, with the cost of its Epic implementation being one of four factors hurting its bottom line.

Five years ago:

• Mediware acquires inpatient rehabilitation and respiratory services documentation systems vendor MediServe.
• Allscripts sues NYC Health + Hospitals for choosing Epic at what the company says is a $535 million premium to its own bid, to which the health system responds that Allscripts lacks an integrated EHR and that the company is suing to try to prop up its sagging share price.
• McKesson Paragon beats out Cerner as the #2 product suite behind Epic in Best in KLAS, while Agfa, McKesson, and Allscripts were ranked as the worst vendors overall.

Ten years ago:

• MedAssets conducts its IPO.
• Dairyland Healthcare brings in a new executive team following its acquisition by Francisco Partners.
• NextGen creates a revenue cycle management division for physician practices.
• Philips acquires ICU monitoring technology vendor Visicu for $430 million, paying 12 times Visicu’s annual revenue.

Last Week’s Most Interesting News

• FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).
• Dignity Health and Catholic Health Initiatives announce plans to merge in creating the country’s largest health system in terms of revenue.
• Advocate Health Care announces plans to merge with Aurora Health Care.
• The Sequoia Project announces that its Carequality initiative connects more than half of all US healthcare providers, with 1,000 hospitals, 25,000 clinics, and 580,000 providers exchanging 1.7 million clinical documents monthly.
• CVS announces an agreement to buy Aetna for $69 billion.
• Former GE CEO Jeff Immelt says the company tried to buy Epic but was immediately rebuffed and also considered acquiring Cerner but thought the $2 billion price was too high.

Webinars

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

Acquisitions, Funding, Business, and Stock

Philips acquires Netherlands-based, 200-employee population health management software vendor VitalHealth Software, co-founded by Mayo Clinic and Noaber Foundation in 2006. The company expands the informatics work Philips started with its acquisition of Wellcentive in 2016. Philips acquired Netherlands-based interoperability software vendor Forcare last week.

Patient payments technology vendor Cedar raises $13 million in a Series A funding round. Co-founder Florian Otto, DDS, MD, PhD was sales VP for ZocDoc before starting Cedar in April 2016.

The urge to merge reaches manic levels as Ascension and Providence St. Joseph Health are reportedly talking about combining to create a 191-hospital system with $45 billion in annual revenue, eclipsing last week’s signed agreement between Dignity Health and Catholic Health Initiatives that set the short-lived annual revenue record of $28 billion. Ascension is a Cerner shop, while Providence St. Joseph Health – formed in a July 2016 merger — uses Epic, Meditech, and Allscripts.

Decisions

• Albion Family Practice (PA) will switch from Allscripts to Epic ambulatory EHR in 2018.
• Saratoga Hospital Medical Group (NY) went live with Athenahealth ambulatory EHR in Q4 of 2017.
• Munroe Regional Medical Center (FL) switched from Medhost to Cerner in 2017.

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

People

Atlantic Health System promotes Ben Bordonaro to chief administrative information officer.

Government and Politics

A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA – HealtheVet, iEHR, VistA Evolution, and EHRM. GAO also notes that the VA has requested $4.1 billion for IT in 2018. Among the 15 key VA contractors on the failed projects was Cerner, who will sell the VA its VistA replacement system. An interesting tidbit from the report is that two of the VA’s systems are over 50 years old, both of them COBOL-based mainframe systems.

Privacy and Security

UNC Health Care (NC) notifies 24,000 patients that their PHI was contained on an unencrypted laptop stolen from a dermatology practice it had acquired in 2015. The health system pledges in the announcement to do a better job of reviewing the security of practices it acquires.

Other

In England, Royal Surrey County Hospital goes back to paper scheduling after an upgrade to its Allscripts system fails. I think they are using the Oasis Medical Solutions PAS, acquired by Allscripts in mid-2014.

I ran across Medsender, a company I hadn’t heard of that promises to end 100 percent of medical record faxing or else there’s no cost to the customer. The company claims the product can be installed in 60 seconds and works with any EHR. Founder/CEO Zain Qayyum developed the product in 2014 while attending Marist College full time. 

The operating income of UMass Memorial Health Care (MA) declined 74 percent in the fiscal year that ended September 30, with executives noting a modest increase in insurer payments, its $200 million in capital projects, and a $700 million Epic implementation that has taken doctors away from their revenue-generating clinic work as they build the system.

Sponsor Updates

• Sunquest Information Systems hosts its 19th annual holiday toy drive for Aviva Children’s Services.
• Surescripts will exhibit at the Health Care Law Institute 2017 December 14 in New York City.
• A national IDN upgrades to ZeOmega’s Jiva 6.1 population health management platform.
• LogicStream Health will exhibit at the IHI National Forum December 10-13 in Orlando, and will host a poolside party December 11 from 6:30-8:30pm ET.

Blog Posts

• Redox Microservices Journey Part Two, Principles (Redox)
• 10 Last-Minute Marketing Tactics to End 2017 with Great Results (Salesforce)
• Ambulatory Surgery Center Payment and Process in 2018 and Beyond (The SSI Group)
• Year End Newsletters – Keeping Your Patients in the Know (Solutionreach)
• Bridging complex healthcare systems. (Voalte)
• 4 Ways to Reduce Call Volume with SMS (West Corp.)
• Where disease management and employee wellness overlap (WiserTogether)

Contacts

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

Morning Headlines 12/8/17

Statement from FDA Commissioner Scott Gottlieb, MD on advancing new digital health policies to encourage innovation, bring efficiency and modernization to regulation

FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).

Dignity and CHI sign definitive agreement to merge

Dignity Health and Catholic Health Initiatives will merge to create the country’s largest health system as measured by operating revenue.

Apple health exec Anil Sethi leaves to form new healthcare records startup

Apple’s health director Anil Sethi leaves to focus on his medical information sharing startup Ciitizen.

Using Electronic Health Data for Community Health

A report from public health grant-making organization De Beaumont Foundation and Johns Hopkins University presents use cases describing how public health agencies could use provider EHR data without running afoul of HIPAA.

News 12/8/17

Top News

FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).

FDA will focus its attention and medical device status on software that analyzes medical images, physiological monitoring data, sound waves, sleep apnea monitor data, spectroscopy data, and slide pathology, as well as software that uses undisclosed algorithms.

FDA says software isn’t a medical device just because it:

• Uses patient information to present treatment guidelines and drug interaction / allergy alerts.
• Offers prioritized alternatives to orders and drugs using generally accepted practices.
• Suggests an intervention or a test consistent with clinical guidelines or drug labeling.
• Makes suggestions for chemotherapy.
• Uses rule-based tools to compare patient data to practice guidelines.
• Provides tools, calculators, or protocols for TPN or enteral nutrition. 
• Provides patients with prescription reminders and instructions that are consistent with FDA labeling.
• Helps patients choose a non-prescription drug based on their symptoms.
• Is intended only for healthcare facility use.
• Allows patients to document or illustrate their conditions with their providers.

FDA also says it will not enforce its own requirement that electronic patient software be classified as a medical device if it isn’t certified by ONC.

Software that stores, converts, or displays medical images will also be moved to non-device status, but software that analyzes the images will be treated as a medical device.

Software that flags patient results based on specific parameters (such as out-of-range results or opportunities for complementary tests) will not be regulated as a medical device as long as it only performs the same interpretation that the practitioner could do themselves.

HIStalk Announcements and Requests

CompuGroup Medical and its US CEO Benedikt Brueckle donated $500 to my DonorsChoose project, which when matched with funds from my anonymous vendor executive and other sources (I found some GREAT matching, as you’ll see, $5 for each $1 in some cases) fully paid for these classroom projects:

• STEM games for Mrs. S’s fourth-grade class in Columbus, OH.
• A mobile science lab for Mrs. N’s middle school class in Bay Shore, NY.
• Ten sets of headphones for Ms. M’s elementary school class in Philadelphia, PA.
• A library of 30 fiction and non-fiction books for Ms. E’s elementary school class in Bronx, NY.
• A carbon dioxide meter and air quality mapping supplies for Mrs. E’s elementary school class in Detroit, MI.
• A STEM activity table for Mrs. S’s elementary school class in Malden, MA.
• STEM activity centers for Ms. Z’s pre-kindergarten class in Fort Worth, TX.
• Air quality meters for Mrs. A’s fifth-grade class in Greenville, PA.
• A three-day environmental science mountain camping trip for Mrs. V’s fifth-grade class in Los Angeles, CA.

Several teachers, including Ms. E, responded almost immediately: “We want to thank you for your warm heart and generosity. I can’t begin to tell you what it means to these kids to have information at their fingertips! They are kind-hearted, sweet, intelligent kids who sometimes just need a little boost and you are a part of them. Again, thank you, and we will send pictures after we get the books. Our classroom is a better place because of your awesome contribution.”

This week on HIStalk Practice: Burke Pediatrics (VA) partners with Food for Others as part of a new food prescription program aimed at ensuring patients can put healthy food on their tables. The Y builds out health IT infrastructure with HIPAA compliance, cybersecurity services. Teladoc drops lawsuit against Texas Medical Board. AJC investigation highlights physician contributions to opioid epidemic. CyberKnife Center of Miami selects Identillect. Aprima integrates DocBuddy voice recognition. HealthiPass raises $7.2 million. UnitedHealth buys DaVita Medical Group in multi-billion dollar deal.

Webinars

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

Acquisitions, Funding, Business, and Stock

Dignity Health and Catholic Health Initiatives sign a merger agreement that will create the country’s largest health system as measured by operating revenue. The new Catholic health system will have $28 billion in revenue, 139 hospitals, and 159,000 employees, operating in 28 states. The CEOs of each organization will become co-CEOs of the new system. Dignity uses Cerner, while I believe CHI runs a mix of Meditech, Allscripts, Cerner, and Epic.

I’m interested that the asset management company co-owned by Nobel-winning economist Richard Thaler – which focuses on shares that are mispriced due to irrational investor psychology – holds 2.8 percent of the outstanding shares of Allscripts, worth around $72 million. MDRX shares are up around 12 percent over the past 12 months (vs. the Nasdaq’s 48 percent) and 30 percent over the past five years (vs. the Nasdaq’s 129 percent). It’s Thaler’s theories rather than his investing acumen that earned him a Nobel — the Fuller & Thaler Behavioral Small-Cap Equity fund has performed consistently worse over several years than the Dow, Nasdaq, and S&P 500.

A Huffington Post article profiles ReHAP, an algorithm-driven system for hospitals to help hospital rehab therapists identify and prioritize patients who need their services. The co-founder is Krishnaj Gourab, MBBS, who is chair and medical director of rehab informatics and analytics at Johns Hopkins Bayview Medical Center (MD).

An Axios financial analysis of 84 large health systems finds that while their patient care margins are slim, they’re making a fortune with their Wall Street investments and M&A activity in raising their overall average profit margin to 6.7 percent on their huge revenue volumes, with the article concluding, “Large not-for-profit hospital systems now resemble and act like Fortune 500 companies instead of the charities they were often built as. They consequently hold immense financial and political power.” The analysis unfortunately and rather obviously mixes up “millions” with “billions” in the pop-up graph legends, but commendably provides the raw data as Google Docs spreadsheet. The most profitable health system is Kaiser Permanente at $3.1 billion in FY2016-27 profit, of which 38 percent was generated by its investments. To take the counterpoint, one contributing factor in the success of any charity is to accumulate enough assets to iron out the operational cash flow challenges, although people often get suspicious when those war chests swell and executives take home multi-million dollar salaries. Not to mention that the stock market won’t always perform as well as it has lately.

Anil Sethi, MS – who became director of Apple Health in 2016 after the company acquired his personal health record company Gliimpse — will leave Apple to focus on his new startup Ciitizen. Former ONC Chief Privacy Officer Deven McGraw, JD, MPH also works for Ciitizen, which helps people obtain and share information and health-related legal documents.  

Sales

Medical Society of Delaware chooses HealthEC’s population health management system and services for its 900-doctor clinically integrated network.

Announcements and Implementations

Solutionreach announces SR Schedule, which allows physician practices to offer the patients easy self-scheduling. 

Aprima integrates its EHR with DocBuddy voice-powered physician workflow for mobile devices. A hand surgeon early adopter says it saves him 45 minutes per day.

EBroselow will integrate ASHP’s AHFS DI Essentials database into its SafeDose bedside dosing application.

Government and Politics

The rate of growth of US healthcare spending slowed in 2016, but still increased by $354 per capita to $10,348 in consuming 17.9 percent of the gross domestic product.

Other

A report from public health grant-making organization De Beaumont Foundation and Johns Hopkins University presents use cases describing how public health agencies could use provider EHR data without running afoul of HIPAA.

A TransUnion report on Millennials finds that 60 percent don’t understand their health insurance benefits. They also also pay their medical bills more slowly than other generations, mostly because they entered the workforce as lower-income employees just as employers shifted more healthcare payments onto consumers and thus they don’t have the money. The report suggests that providers educate Millennial patients at the point of service, give them an upfront cost estimate when possible, and encourage them to pay at the time of service.

The Indianapolis paper profiles Chuck Dietzen, MD, medical director for pediatric rehabilitation at Riley Children’s Health (IN); founder of the non-profit Timmy Global Health; and co-founder and chief medical officer of EHR/PM vendor ISalus Healthcare.

St. Joseph Healthcare (ME) will eliminate 24 jobs as parent organization Covenant Health centralizes billing after completing its Cerner implementation.

Fun from The Onion.

Sponsor Updates

• LogicStream Health launches clinical process modules for sepsis, CAUTI, and VTE.
• Nordic releases a new podcast, “Consolidating your EHR after a merger or acquisition.”

Blog Posts

• The Digital Transformation in Healthcare and Life Sciences: Improve Productivity and Simplify Operations to Enable Strategic Focus (Liaison Technologies)
• Health-care bankruptcy filings have more than tripled this year (MedData)
• 5 tools designed to prevent nurse burnout (Meditech)
• 7 Insights and predictions of the future of care delivery: Dumping data, disillusioned doctors, and other dilemmas (Medicomp Systems)
• ONC Meeting Recap (Netsmart)
• What is a Health Check? (CloudWave)
• 3 tools you need to manage the modern revenue cycle (Experian Health)
• PatientPing Hosts Inaugural New England Community Event (PatientPing)
• ePatientco Visits the NYSE with the Metro Atlanta Chamber (Patientco)

Contacts

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

EPtalk by Dr. Jayne 12/7/17

A new survey from the University of Utah looks at how different healthcare stakeholders define value by querying physicians, employers, and patients. Working with Leavitt Partners, they’ve assessed how those groups view quality, cost, and service. I’m not surprised by the findings that nearly 90 percent of physicians equate quality and value, since we’ve had the importance of quality metrics drummed into us for years.

The survey found that employers focus more on cost and patients are most often looking at whether out-of-pocket costs are affordable. That’s not to say that physicians don’t consider cost – it found that more than 75 percent of us consider cost when they make treatment decisions. Unfortunately, we don’t always have an idea of what some of the procedures or medications we recommend might be billed at, let alone how 20 or 30 different payers are going to handle them and where a given patient is on his or her out-of-pocket or deductible limit.

I ran into this recently when trying to have new orthotics made. I know my insurance doesn’t cover them, so wanted to wait until January to order them when I have cash in my flexible spending account again. The physician swore my payer had changed its plan, not realizing that even though I have Big Payer’s name on my card, that I’m part of a self-insured group that uses the network but has a number of carve-outs. Needless to say, they now have my measurements on file, but I’ll be calling back in January to put the order through. They also insisted on charging me a co-pay even though I had documentation that I had met my out-of-pocket maximum this year and no longer needed to pay it, but that’s another story.

Road warriors beware: the New York Times ran a piece last week looking at the health problems of frequent travelers. It’s not just colds and jet lag any more, but obesity, high blood pressure, and more that we have to worry about. The article mentions a 2015 Harvard Business Review article that looked at frequent business travel as a cause of early aging and increased risk for cardiovascular events with more than 70 percent of business travelers reporting unhealthy lifestyle symptoms such as stress, mood issues, digestive problems, lack of exercise, and excess drinking. I’ve seen plenty of the latter in other business travelers, including a consultant who no longer does work for me due to his submission of a lunch receipt that contained four martinis while he was on site with a client.

One of the benefits of working for yourself is making your own schedule. Of course, that schedule is largely driven by the needs of my clients. I’m generally able to accommodate them, but this year I made the tail end of November and all of December a “no fly zone” in an attempt to stay home for longer than two weeks in a row. I’ve been successful, but the consulting karma has caught up with me as I’ve been inundated by clients expecting me to pull a rabbit out of the hat at the end of the year. Usually these requests are around things such as HIPAA Security Risk Assessments, when organizations realize that either they didn’t know they had to do one, they knew they had to do one but just didn’t, or the person who normally does it has left the practice. I subcontract with two vendors who are willing to handle these folks well into the eleventh hour, so I can’t complain.

This year’s end-of-year rush brought me a couple of twists. The first was a client who has decided they need to stand up a Health Information Exchange “or something like it” by the end of the year to comply with the requirements of a grant that they’ve already spent on other things. Of course, they want this done cheaply and quickly, but don’t have any resources to do it and aren’t familiar with their vendor’s current solution offerings. We spent several hours on the phone discussing the options, including secure messaging, which would be slam dunk given their vendor’s built-in workflows. They came back with the traditional excuse that their practice is so different from anyone else’s that they couldn’t possibly make that happen with the prescribed workflow. We discussed other solutions that would cost much more money and be more risky from a timeline perspective, and in the end, they couldn’t make a decision because one of the key stakeholders is out of the office for the next week. But when he comes back, they want to start immediately even though no one has his proxy or signatory authority for a contract.

The second twist was a potential client who hadn’t looked at their quality metric tracking reports for several months following the departure of a key employee. They didn’t fully understand what her role and responsibilities were, and everyone assumed that someone else was picking up the reporting. Now that they’re in the bottom part of the year, they have run the reports and the performance of several physicians is well below the benchmark. The practice determined that several workflows were in error and were shopping around to see if someone would help them modify the database to “correct” the erroneous workflows. I feel their pain, but I’m not one to putter around in someone’s database, especially where an attestation is on the line, so I took a pass.

The next twist was a rescue mission for a new client who recently upgraded their EHR. Despite warnings to the contrary, they elected to retire 100 percent of their custom workflows in favor of out-of-the-box functionality. They failed to perform any kind of user acceptance testing and didn’t require the providers to attend training, so when Monday morning arrived, it was a total calamity. They were initially looking for someone who would revert their database to pre-upgrade shape, but since they had three days of partial patient documentation in the system, that was a no-go.

I martialed some consultants and a couple of trainers to join me in an after-hours training marathon, where we tried to get the providers up to speed before Thursday hit. I’ll be in command center mode all day Thursday and Friday, so wish me luck. The staffers I brought in are delighted to have the extra hours and bonus pay in the weeks before Christmas, but I’m exhausted, and if I have to listen to one more physician complain that they hate the upgrade but they didn’t go to training, I’ll scream. On the bright side, they had already committed to some extensive governance and change leadership work starting after the first of the year, so I know I’ll have a receptive audience if they’re still standing after this week.

Seeing any end of the year madness at your workplace? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/7/17

National Health Expenditure Report Shows We Have Not Solved the Cost Problem

The latest update on health spending from CMS shows that spending grew 4.3 percent in 2016 to $3.3 trillion, representing 17.9 percent of the GDP.

Framework for Improving Critical Infrastructure Cybersecurity

NIST publishes a draft update of its Cybersecurity Framework.

Henry Ford Health data breach affecting 18K patients

Henry Ford Health System notifies 18,470 patients that someone gained unauthorized access to the email credentials to employees that would have allowed them to access patient information, including “name, date of birth, medical record number, provider’s name, date of service, department’s name, location, medical condition, and health insurer,” but not social security number or credit card information.

House lawmakers: VA Choice reform bill can wait until 2018

VA committee Chair Phil Roe (R-TN) says that the Veterans Choice program is no longer in danger of running out of funds and can wait until early 2018 before new funding legislation is needed.

CIO Unplugged 12/6/17

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

New Math

All of us serving in IT are being asked to do more with less. Given the emergence of digital tools and connectivity, there is no reason to expect less. Tools and processes are critical if we hope to enable health and wellness transformation, but leadership trumps all. When I study major blockers in my own experience, it comes down to leadership. Leaders who continue to use old formulas are what I call old math. We need new math. 

New Math

We must become selfless leaders. A selfless leader is a humble servant who puts the organizations and other individuals before themselves. They eat last. They sleep last. They give away their best. They open doors. They sacrifice. They lead by example.

Above is a picture of the then-CEOs of Texas Health Resources and University of North Texas Health Sciences cleaning human waste in the Tanzanian medical clinic we co-founded in 2011. He who wants to be first among us needs to take the last place. 

Right for the Organization

We are all proud of our domains and departments. We all love to show off our results. Super! You should be proud. But do not let pride harden your heart and cause you to stumble to the point you forget it’s about the organization’s mission and vision and not your trophy case.

Always keep the organization’s best interest first. The rest will follow. I learned over the years that the more control I give up, the more influence I gain. I once gave up my CMIO, CNIO, and BI and the IT influence did not suffer, but was multiplied many-fold. The organization prospered. It is backwards math, but it is what I refer to as new math.

Right for the Person

Sometimes we can hold on so tightly to our own people that we squeeze life from them. Let them go. If they want to stay, they will, but let them choose. We are doing our people a disservice when we don’t let them reach their full potential. Often, it drives them to leave the organization.

Instead, let’s give them room to grow with us. Nothing better to see one of your own grow and surpass you. That is a compliment. I can point to several people who served with me that are way better. Many went on to surpass me. I love it!

When someone makes a hero out of one of my peers or team, I am not threatened. I got over that long ago. Let them shine. Help them shine. Let them move on and flourish. Give away your best. The less we hold on, the less we stress. The more we give away, the more we receive.

Every time I have given away my best, someone else comes along, and we hit a new level. Another head-scratching new math principle.

Replicate Yourself

You are a gifted leader only when you replicate yourself. As good as you are, you are only one person. You are limited to one. One is too small a number.

When you replicate yourself, you open the gift of multiplicity. It is what we called in the Army a force multiplier. Instead of one of you, there are now two, and you accomplish 4x. Yep, more funky new math.

Some people like to brag about the greatness of their leadership, but the first thing I ask about is the pipeline. Yep, the pipeline of fresh talent that then infuses the company and the industry and the world. How many CIOs have you helped build?

A great test is voluntary followership. If you go to another company, how many people follow you? How many people pack their bags and follow you? Or are you one of those leaders who attend every meeting of your subordinate leaders? Are you afraid to let your directors or manager lead without you there? Tough questions, but we have to be real. How is your new math?

Protect One Another

Would you sacrifice for one another? I had to ask myself that many times as a combat-trained medic and combat engineer officer. Thankfully, I never faced battle, but I prepared as if I was getting called to the front lines. We soldiers asked ourselves all the time if we could trust our foxhole buddies. Would they jump on that grenade? Would they take a bullet from your flank?

When in public, we must be unified. We can and should respectfully fight behind the scenes to challenge one another before finalizing decisions and closing ranks. My expectation is that publicly we are one and fight for one another. If someone is bullied, you stand up. If someone is struggling, you walk beside them and carry them if needed. If someone is lost, you help them with directions. If someone is new, you introduce them and never leave them.

You give up your seat at the table. Secure leaders go out of their way to give up their seat. The more you serve and protect and seek the best in another before yourself, the brighter you shine. New math. You have to love it.   

Hope

I have great hope that those of us who are privileged to lead will become selfless. That we might tell a colleague, “Please take Mary. She is the best leader I have and she will make that new area rock.” Or, “I love my ABC division to death and it represents my heart and soul, but I can see how infusing pieces and parts into other areas is the very best outcome.” Or, “I love leading this division, but use me as change in your pocket because I’m willing to lead any area you ask.”

Imagine if we had 10 gifted leaders, all concentrated in one area. How does that benefit our patients? Alternatively, what if we took those 10 gifted leaders and strategically placed them throughout the organization? We could change the world. New math.

Final

None of us are perfect. I am likely the most imperfect and average leader there is. But I embrace change and strive to put others before myself. I see many of my gaps and get help. I am unafraid to ask for help. I am unafraid to say I don’t have any idea.

When is the last time you proactively sought training or reached out to a coach or formal mentor? Self-reflect. Assess your gaps, Make a plan. Fill the gap. Wash feet. Repeat. Constantly. New math.

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

HIStalk Interviews Richard Caplin, CEO, The HCI Group

Richard “Ricky” Caplin is CEO of The HCI Group of Jacksonville, FL.

Tell me about yourself and the company.

Coming out of Thanksgiving, I feel like one of the most blessed guys in the world. I’m married to Danielle, who is an amazing wife. I have three kids – Callie is five, Rilen is three, and Brooks is five months old.

I’m an entrepreneur. I started at KPMG as a CPA and wound up in healthcare technology. My father and two sisters are doctors. I’ve been blessed to grow HCI from a small company in a friend’s townhome to become one of the largest healthcare technology consulting firms in the world.

How does HCI fit into Tech Mahindra’s plans now that the acquisition is complete?

It’s helpful to understand HCI and who we are to answer that question. We were blessed to have become one of the larger and leading healthcare technology consulting firms. But when you look at where our expertise lay, it was primarily around the digital strategy and advisory services, implementation, training, project management, and support of the electronic health record and the applications that play with that. We started to do a little bit in cybersecurity and a little bit in innovation, but when you look at where we spent the majority of our time, it was really in only maybe 20 to 30 percent of the actual healthcare IT spectrum and spend.

Fast-forward to Tech Mahindra. They’re one of the leading digital transformation and innovative, entrepreneurial, large companies in the world. I think they’ve got roughly 117,000 employees. They’ve had tremendous growth and are leading the way of some of the international firms. They didn’t have a lot of expertise in healthcare, specifically around where we played, but they had tremendous strength in digital transformation and some of the services that we offer now. That rounded out the rest of the spectrum.

When I talk with people and I share why we did this thing, in the US, a lot of the large-scale implementations are slowing. There are obviously mergers and acquisitions occurring, but a lot of the large projects will be finishing up or happening over the next couple of years. Most of the healthcare IT executives that I speak with are focused on what’s next, and of course there are tremendous pressures to do a lot more with less.

Our focus has now become, what is beyond this big project? How do we decrease operating expenses and do more with less? How do we innovate? A lot of the capabilities that Tech Mahindra brought to the table — around infrastructure, robotics, automation, application managed services, and innovation — are focused on bringing costs down and doing more with less. It brought us from us doing 20 to 30 percent of the spectrum to 100 percent of the spectrum and allowed us to do a lot of next-generation capabilities.

How are other health IT companies reacting to what sounds at least like a changing if not actually diminishing demand?

If you look at the consulting firms in our industry, most of them have at the very least plateaued or are shrinking. Very few are still growing like HCI. That’s because a lot of them were tied to these implementation bubbles. That reinforces why we did what we did. We had to change.

There’s certainly going to be implementation business in the future. I think the last statistic I saw was the implementation business is constricting at about nine percent a year. That may have expedited since I last heard that, but that’s just one small piece. That’s where we built our expertise, but that’s becoming less and less of what we do. There’s so much opportunity beyond that. That’s the exciting part, as our industry becomes more disrupted.

HCI was an early international player. Will companies that are late in developing international business succeed?

We’ve probably been international since the first or second year of doing business. We didn’t make money for a long time internationally and we invested a lot of time there. I’m skipping back to give you some history, but when we started the company, we really didn’t get going until 2011. I think we claim 2009, but we weren’t doing healthcare technology consulting until 2011. That was the height of Meaningful Use, those couple of years. 

We were always concerned. We knew it was a bubble. We wanted to do the best we could and learn as much as we could in that, but we were always focused on what was next. One of those areas was global. We probably have more clients and speak with more healthcare IT executives globally than any other firm in the world, including the big ones.

To answer your question, I think we’re at the tip of the iceberg with some of these large-scale implementations internationally. But I think the game is a little different than it was in the US. In some of these countries, you may only have two or three buyers. Maybe one, in some cases. It’s a little different than when you can go around the United States and sell to hundreds of different hospitals and health systems. Internationally, my experience has been it takes a while to build trust and relationships with a lot of these folks.

We learned some valuable lessons over the years. I won’t share all of them, but certainly one of the most important ones is that you can’t be a bunch of Americans coming to foreign countries telling them how to do things. You need to hire and develop that indigenous talent and knowledge of how they do things. You need to be able to bring in the global best practices. With that comes some of the American and British ways of doing things.

Now that HCI Group is owned by a non-US parent company, even though most of its business comes from the US, will you have to apply those same localization efforts in integrating their consultants who may not be familiar with how we do things here?

One of the important things to understand about our merger or acquisition of Tech Mahindra is that we’re a completely independent, standalone company that operates as The HCI Group. Basically nothing changed in our company. That’s why they bought us, because we understand healthcare and we have a lot of these relationships already.

They’re not influencing the way we do things. But what they are doing is giving us so much more capability to do things. Obviously our balance sheet is a lot stronger to go in as a systems integrator and take more risks and do more innovative things, so this was designed intentionally to allow us to continue to be entrepreneurial and to be their healthcare arm.

We just announced that we’re the global partner for CHIME. It’s a five-year deal. Everywhere the CHIME logo is, you’re going to see The HCI Group attached to it. It’s The HCI Group. It’s not Tech Mahindra.

Has Tech Mahindra made other healthcare acquisitions, and if so, have they let those companies continue to operate under their original names as they will do with HCI?

This was their first and only healthcare acquisition. Obviously they had some healthcare business. The healthcare business in the provider space that HCI acquired and they inherited, we brought onto our team. They have some good experience in the payer and life sciences, pharma side of things, but right now I’m just provider.

Tech Mahindra is a fascinating company. One of our sister companies that’s fully owned by Tech Mahindra is Pininfarina, the designers of the Ferrari. They also designed the new Coca-Cola Freestyle machine, the one where you can mix your own items using cherry, diet, vanilla, or Coke Zero. It’s one of the top Italian design companies in the world and Tech Mahindra bought it. I’m setting up conversations with some of the leading healthcare IT executives in the world, bringing Pininfarina in to rethink healthcare, the way you engage with the patient, and the way that’s designed. There are really cool conversations that we’re starting to have in innovation.

We weren’t looking to sell the company. We had a number of strategics reaching out to us just because of the growth, size, and scale. We had become probably the largest and fastest-growing in our industry. You always take the call and have the conversation. Who knows where it will lead? You make a new friend. It might be B2B. Certainly it’s nice to speak to people. I got to meet the CEO and vice-chairman and president of Tech Mahindra about a year and a half before this happened and we were just talking about B2B opportunities. I wasn’t overly interested in selling the company.

I founded HCI with my brother-in-law and one of my best friends, Greg Jones. He came to me one day and expressed that he felt called to go into the ministry and was going to be looking to do something else. When he told me he wanted to go to seminary school, all of a sudden these conversations became a lot more real. I had gotten to know the folks at Tech Mahindra and obviously we had a lot of other opportunities, but I felt this is where God wanted us and it was the right opportunity. Believe it or not, Greg actually started seminary a few months ago, right after we sold.

Where I was going with this is that I spent a lot of time coming from basically not knowing anything about the people of India to realizing that the people at Tech Mahindra are brilliant, from the lowest level of the company to the highest level. They’re good people. Throughout that process, I felt like I was being called to help serve the people of India, particularly the children of India. That has become one of one of my passions. I don’t know how it’s going to all work out. I know I’m spending a lot of time learning and figuring that out and meeting with some orphanages. I’m really excited to see where that can go. I feel like I’m exactly where God wants me right now.

People wonder where I’m going now that I’ve sold a big part of the company. I’m still an owner for another few years, but I’m still fairly young. With the opportunity I’ve been given with HCI Group and Tech Mahindra and now my new passion for the children of India, I’m not planning on going anywhere any time soon.

What consulting services are in most demand?

Obviously there’s a lot of pressure to do more with less. How we automate things, which could be through robotics, outsourcing, or artificial intelligence. Certainly infrastructure managed services and application managed services. Cybersecurity has been a huge opportunity and a high-growth area for us.

The most interesting conversation that we’re having with a lot of leading institutions is the leapfrog conversation. We’re having strategic conversations with leading institutions on how they can catapult to the next level. Instead of being a lagging industry, how do we lead through technology and disruptive technology? We’re having white-boarding sessions with some leading institutions.

That’s one of the beautiful things about Tech Mahindra. They bring so much knowledge and lots of startup companies and different types of things to the table. Then we’ve got things like Pininfarina. These aren’t tomorrow-type ROIs for an organization like ours, but this is where the future is and this is where we want to play.

Do you have any final thoughts?

We’re at a very exciting time in healthcare. I don’t think we’re going to recognize the way healthcare is done today in 10 years, maybe even five. We all know that change is coming. A lot of companies and health systems are leading. With the political times, we know that change is coming. With the unrest in the Middle East, we know that change is coming.

I’m really excited being a global leader in healthcare technology consulting and knowing a lot of these healthcare IT leaders around the globe, to be a platform and a catalyst for that. We may not come up with all the best ideas ourselves, but oftentimes our clients and partners will. Being that platform for a lot of them to speak, we’re sitting in an exciting and unique place.

Morning Headlines 12/6/17

Advocate plans to merge with Wisconsin hospital giant Aurora

Advocate Health Care (IL) announces plans to merge with Aurora Health Care (WI) in a deal that will create the tenth-largest not-for-profit system. Under terms of the merger, neither system will pay the other cash, and the combined health system, to be called Advocate Aurora Health, will have 27 hospitals and $11 billion in annual revenue.

More than Half of All Healthcare Providers in the US are Connected Electronically through the Carequality Interoperability Framework

The Sequoia Project announces that more than 1,000 hospitals, 25,000 clinics, and 580,000 healthcare providers are connected through the Carequality interoperability framework, representing more than 50% of all healthcare providers in the country.

DeepVariant: Highly Accurate Genomes With Deep Neural Networks

Google releases DeepVariant, an open-source deep learning tool that analyzes genome data with significantly greater accuracy than previous methods.

Emergency rooms are monopolies. Patients pay the price.

A year-long investigative study on the use of emergency department facility fees concludes that costs climbed “89 percent between 2009 and 2015, rising twice as fast as the price of outpatient health care, and four times as fast as overall health care spending. Overall spending on emergency room fees rose by more than $3 billion.”

News 12/6/17

Top News

Advocate Health Care will merge with Aurora Health Care pending regulatory approval, creating the country’s tenth-largest non-profit health system.

The CEOs would serve as co-CEOs of the new organization (Advocate Aurora Health) as a result of a “50-50 merger,” with naming two equal leaders appearing either indecisive or ego-stroking but unlikely to prove successful regardless.

There’s also the EHR challenge. Aurora uses Epic, while Advocate runs Cerner and Allscripts.

Reader Comments

From Not From Monterey: “Re: hospital luxury floors. I’m reading a book by written a doctor (Jacob Appel) in which the suicidal psychiatrist main character says that in his hospital, the posh floor where the wealthy people stay is unsafe compared to the rest of the hospital since it lacks residents and med students asking questions. Would you find this character’s statement to be plausible, or better yet, backed up by data?” I’ve written before that, amenities aside, I wouldn’t want to be housed in a hospital’s VIP unit. Personalized medicine is overrated in this regard – the nurses assigned are the most deferential rather than the most skilled; they are under the thumb of hospital executives whose suck-up meddling may negatively impact care; those annoying middle-of-the-night room rounds and always-beeping monitors sometimes detect real problems; and wandering off the cookie cutter center line of care is always dangerous (like asking the kid at McDonald’s to make you a steak dinner). Hospitals are well-intentioned but dangerous places where the last thing you want is extra attention. I created a poll for clinicians with firsthand experience to weigh in and hopefully offer comments. My only first-hand experience is when my colleague, the health system’s chief medical officer, mobilized the Big House’s trauma team to address a family member’s ruptured appendix, which I declined and instead chose one of our community hospitals with no VIP attention expected or desired. 

From Ty Dolla Cosine: “Re: Aetna’s CEO. Will get $500 million if the CVS deal goes through. It’s good for at least one consumer, anyway.” CEO and HIMSS14 keynoter Mark Bertolini will leave with a $500 million parting gift, consisting of the inevitable executive golden parachute plus his appreciated stock. His net worth already approached $200 million, so the only thing standing between him and near-billionaire status is the Trump Administration’s anti-trust people in the DOJ and/or FTC, which probably means he’s fine to book the truck to haul away his loot.

Had you wisely (given 20-20 hindsight) invested your money in Aetna shares (dark blue) five years ago, you would have realized a 292 percent gain vs. the Dow’s (light blue) 84 percent. You would also be singing the praises of Mark Bertolini for making you rich as he did the same for himself.

HIStalk Announcements and Requests

I finished my initial playing around with my Black Friday-priced Google Chromecast and Home Mini. They featured Apple-like slick packaging and no-instructions setup that had me running in minutes. Chromecast can display anything from your phone that can be cast onto your TV (photo albums, browser pages, YouTube videos, Netflix, etc.)  with just a WiFi connection and the provided HDMI cable into your TV. The Home Mini has an Alexa-like conversational interface that can provide weather, news, your daily schedule,  flight departure time, time to drive to a location given current traffic, and the usual smorgasbord of jokes, games, list-making, song-singing, and music-playing with pretty good audio quality. Both gadgets offer a lot of smooth technology at a price low enough to be impulse-purchased as a toy or stocking-stuffer. I’m happy with both.

Ben and Michelle from ST Advisors supported my DonorsChoose project with a $500 donation, to which I applied matching funds from my anonymous vendor executive as well as other sources to fully fund these teacher-requested projects:

• 30 sets of headphones for Ms. B’s second-grade class in Chicago, IL.
• 35 calculators for Ms. T’s all-girls elementary academy in Houston, TX.
• STEAM supplies for Ms. C’s middle school class in Provo, UT.
• A programmable robot kit for Ms. G’s elementary school class in W. Valley City, UT.
• Science experiment kits for Ms. M’s pre-kindergarten class in New York City.
• Hats and gloves for Ms. H’s elementary school class in Omaha, NE.
• STEM activities for Ms. D’s elementary school class in Hialeah, FL.
• An interactive whiteboard for Mr. T’s elementary school class in Houston, TX.
• A document camera and speakers for Ms. K’s middle school class in New York City.

I’ve already received thank you notes from most of the teachers, including from Ms. D, who says, “As a first-year teacher, I am absolutely ecstatic! My students are going to be so excited to learn about all these new tools. I am extremely thankful for your donation towards my little learners and I’m positive that they will be too. Thank you for our early Christmas gift! HAPPY HOLIDAYS!”

Mike also sent a $500 donation, saying that he’s been out of the industry for 10 years but still reads HIStalk every day. Merry Christmas to (and from) Mike, whose donation with matching funds has made these classroom projects a reality:

• Programming books, posters, and whiteboards for Mr. C’s middle school class in New York City.
• Lap desks to replace those lost in Hurricane Harvey for Mrs. A’s fifth grade class in La Marque, TX.
• STEM activity kits for Mrs. C’s elementary school class in Havelock, NC.
• Programmable robots for Mr. V’s elementary school student-driven programming class in Cherryfield, ME.
• Five virtual reality headsets for Mrs. B’s high school class in Norfolk, VA.
• A math and science library for Ms. G’s elementary school class in Houston, TX.
• Two Bee-Bot programmable robots for Mrs. F’s kindergarten class in Los Angeles, CA.
• Puzzles, books, and glue for the after-school clubs of Ms. B’s elementary school in Camden, NJ.

Want to donate, especially if your company is willing to pony up $500 in return for a mention of their largesse? Instructions:

1. Purchase a gift card in the amount you’d like to donate.
2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

Webinars

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

Acquisitions, Funding, Business, and Stock

Philips acquires Netherlands-based interoperability software vendor Forcare.

Population health management software vendor VirtualHealth raises $7 million in a Series B funding round.

Genetic sequencing vendor Human Longevity dismisses its CEO after 11 months on the job, along with the COO, chief medical officer, and head of oncology. Co-founder and executive chairman Craig Venter returns to the CEO role. HIStalk reader Informatician tipped me off in a mid-November rumor report that the company had laid off its chief medical officer and his team of 15, at which time I noted that eight of 18 executives listed on a cached copy of its executive page from June 2017 had been removed (the number now stands at 11 of 18).

Patient education software vendor Mytonomy raises $7 million in a Series A funding round in which Philips and MedStar Health participated. The company previously pivoted from its original business of offering college preparation videos for high school students. The founders are CEO Anjali Kataria (who co-founded a drug company software vendor and then worked for HHS and FDA) and her husband Vinay Bhargava (Google).

Sales

Chesapeake Regional Healthcare (VA) will implement Glytec’s EGlycemic Management System.

Memorial Hermann Health System (TX) signs an enterprise agreement for PerfectServe’s communication and collaboration platform.

Steward Health Care will convert eight more of its hospitals to Meditech’s Web EHR.

Singing River Health System (MS) chooses FormFast Capture and ESignature, while Medical University of South Carolina (SC) will implement FormFast Capture and Mobile App. 

People

Brookfield, WI-based Insurance enrollment technology vendor Connecture hires Brian Lindstrom (Datica) as CFO. Industry long-timer Jeff Surges is the company’s CEO.

Tom Zajac (Philips) joins the executive-in-residence programs of Summit Partners and Noro-Moseley Partners.

The Chartis Group hires Tonya Edwards, MD, MMM (Impact Advisors) as principal.

Marc Andiel (Iatric Systems) joins HealthGrid as EVP of corporate business development.

Regenstrief Institute hires Jeremy Harper (The Ohio State University Wexner Medical Center) as chief research information officer.

SCL Health (CO) hires Louis Capponi, MD (Cleveland Clinic) as VP/CMIO.

Announcements and Implementations

Ability Network streamlines the Triple Check process — for skilled nursing facilities to review Medicare Part A claims prior to submission —  via new functionality in its UBwatch platform.

The Children’s Center Rehabilitation Hospital (OK) goes live on Harris Healthcare’s Novus ClinDoc linked to its QCPR EHR.

ISpecimen releases data connectors that allow organizations to integrate their LIS and EHR systems to the company’s marketplace, where those organizations can offer their biospecimens to researchers.

The Sequoia Project announces that its Carequality initiative connects more than half of all US healthcare providers, with 1,000 hospitals, 25,000 clinics, and 580,000 providers exchanging 1.7 million clinical documents monthly.

Government and Politics

Hector Ramos, the former $200,000 per year IT director of North County Health Services (CA), pleads not guilty to stealing $800,000 from the organization. Prosecutors say he submitted and approved phony invoices from two fraudulent companies he created, telling employees the invoices needed to be paid quickly to avoid a computer system shutdown. They probably should have paid more attention to his resume, which boasts of advanced degrees “earned” from known diploma mills.  

Honduran officials arrest Eric Conn, the on-the-run Kentucky lawyer who conspired with doctors and judges to earn $550 million in fraudulent Social Security disability benefits for his clients. 

Technology

Google announces the open source release of its DeepVariant genomic analysis tool.

Other

A Vox reports looks at ED facility fees, as hospitals are increasingly using higher-intensity codes to bill higher rates. The prices charged for those fees jumped 89 percent from 2009 to 2015 in raising ED costs by billions even as the number of ED visits dropped. The article profiles a man whose lifting-induced back spasms were treated by a hospital ED – the only place open — in 20 minutes at a cost of $3.50 for a muscle relaxant and over $2,400 in facility fees.

The owner of a New Jersey lab that was paid $150 million by Medicare and private insurers over eight years says he couldn’t compete against the national lab companies without bribing doctors to send him patients. His lab offered fake consulting agreements, prostitutes, sports cars, vacations taken on private jets, and Super Bowl tickets. The owner says the lab’s biggest expense was a New York strip club, where he spent $10,000 in one night to entertain a pediatrician who bragged about how many tests he was ordering on young patients. The owner spent $800,000 – less than one month’s profit from the lab — to build a pool shaped like Mickey Mouse’s ears. 

Sponsor Updates

• Healthcare Growth Partners advised Russell Phillips & Associates on its sale to Jensen Hughes.
• CenTrak donates RTLS equipment to students at Drexel University in Philadelphia.
• Dental practice management company Dentisoft selects patient relationship management technology and services from Solutionreach.
• Access partner The Last Well advances its clean water initiative in Liberia with matching grants through December 31.
• Audacious Inquiry’s CALiPR earns ONC Health IT Certification.
• Change Healthcare’s Stuart Hanson speaks at the AHIP Health Forum in Nashville.
• Elsevier Clinical Solutions will exhibit at the North Carolina Council of Community Programs Conference December 6 in Pinehurst.
• FormFast will exhibit at the 2017 IHI National Forum December 10-13 in Orlando.
• Definitive Healthcare hires its 200th employee.
• Impact Advisors publishes a new report, “Constructing an Analytics Strategy.”
• Kyruus will exhibit at the Diabetes Innovation Summit December 7 in Boston.

Blog Posts

• 3 Things to Remember When Implementing a Cerner EHR (Optimum Healthcare IT)
• Privacy Shield: Know the ropes before pulling data back across the pond (Datica)
• CMS extends value-based insurance program to 25 states: 4 things to know (Besler Consulting)
• Top Features ChartLogic Customers Find the Most Useful & Efficient (ChartLogic)
• Making Sense of Secure Text Messaging Compliance in Healthcare (Spok)
• Top Four Takeaways Reported from the 2017 Population Health Exchange (Leidos Health)
• A Brief History of How We Got to Electronic Prior Authorization (CoverMyMeds)
• Consulting for Success: The Importance of Emotional Intelligence (Culbert Healthcare Solutions)
• How to Harness the Power of Pictures in Analytics (Dimensional Insight)
• eWhat’s Missing in ‘CRM?’ Relationships. (Docent Health)
• Advanced Medical Assistants to the Rescue! (EClinicalWorks)
• Healthcare 2025: Transforming to a New Model of Care (The HCI Group)
• Prepare and Prevent Common Due Diligence Issues in Health IT Transactions: Legal Considerations (Part 2 of 6)(Healthcare Growth Partners)
• Does biometric identification have a role in population health? (Imprivata)
• Mapping the Healthcare Consumer Journey: Beyond the Patient (Influence Health)
• How Much is a Consolidated Premium Experience Worth? (InstaMed)
• Relationships Between Health Systems and Patients can Start and End with a Provider (Kyruus)

Contacts

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