Morning Headlines 12/5/17

Senators McCain, Moran Introduce Legislation to Reform VA Into 21st Century Health Care System

Senators John McCain (R-AZ) and Jerry Moran (R-KS) introduce the Veterans Community Care and Access Act of 2017, legislation that would ramp up the Veterans Choice program by requiring the VA to use objective data to measure healthcare demand and availability in communities, offer access to walk-in clinics, offer telemedicine, increases graduate medical education and residency positions for employees, and improves its collaboration with community providers and other federal agencies.

Texas Medical Board Adopts New Telemedicine Policy

Telehealth vendor Teladoc drops a years-old legal battle against the Texas Medical Board after it reluctantly revised its licensing requirements to allow Texas physicians to treat patients via telemedicine without evaluating them in person beforehand.

Apple Launches Heart Study App in the US in Partnership with Stanford Medicine

Apple launches a heart health study in partnership with Stanford Medicine. The study uses sensors on the Apple Watch to detect atrial fibrillation. If the app detects an irregular heart rhythm, the user receives an alert on their iPhone and Apple Watch, a free consultation with a study doctor, and an electrocardiogram patch for further monitoring.

Mortality Quadrupled Among Opioid-Driven Hospitalizations, Notably Within Lower-Income And Disabled White Populations

A Health Affairs study finds that mortality rates for opioid poisoning hospital admissions quadrupled between 1994 to 2014, while mortality of hospitalizations due to other drugs remained unchanged.

Curbside Consult with Dr. Jayne 12/4/17

I occasionally do some work for EHR vendors. Sometimes I help with usability studies or provide an opinion on workflows. Other times it’s more straightforward marketing and communications work. I may have even ghost-written a blog or two for a company who was experiencing some clinical leadership challenges.

Given my background helping practices with system selection, one of the things I enjoy most is helping companies look at acquisitions or potential partnerships. I recently had the chance to evaluate a potential solution for a mid-tier EHR vendor looking for a patient engagement partner, and it was quite the experience.

I’m definitely a process kind of gal, so the first question I usually ask is whether I will be asked to sign a non-disclosure agreement and whether there are any agreements in place between the vendor parties that I should be aware of. Since my business is fairly vendor-agnostic, we need to make sure that anything new we take on doesn’t come into conflict with existing clients.

In this situation, the companies had been talking for some time and had been doing some work on what seemed to be a handshake basis. They seemed surprised that I would even be asking about a NDA and the fact that I thought we should have one in place. Although neither vendor is a publicly-traded company, both of them have multiple external funding sources and should see protecting their intellectual property as a priority. Once they agreed to create the needed NDA, it took several weeks to get it drafted.

In evaluating the discussions that had taken place to date (and which continued despite the lack of NDAs) most of them had been of a technical nature. There was plenty of understanding on how a potential integration would take place and the best ways to leverage interfaces vs. APIs and how to handle discrete data. There was a striking lack of discussion on whether the EHR vendor’s clients would even be interested in such a solution or how they would use it in daily practice operations. The potential partnership was being driven almost entirely by the secondary vendor, who was clearly looking at this as an opportunity to catapult their solution to the next level.

I recommended some facilitated conversations between clinical leadership of both companies so that everyone could adequately understand what a partnership might bring to the table for both companies and how the EHR vendor’s clients and their patients would benefit. I also asked for reference sites that we could contact and see how the solution was working with other EHR vendors.

As we were working to get both of these sets of discussions scheduled, someone mentioned that a pilot was already in place. Since we still didn’t have a signed NDA, I was shocked to hear that the EHR vendor had identified a client who would agree to install an unproven solution with questionable value that not only had the potential to disrupt their workflow, but also to push data into their EHR database. Even if the solution was being provided for free, just because something is inexpensive doesn’t make it a good idea.

I pushed again for the reference calls to be scheduled. The first call was less than stellar, with the provider stating that they had difficulty adopting the solution because patients didn’t want to work with people outside the practice. In a small family medicine practice, the patients generally know all the staffers, so I understand their skepticism at talking to people they didn’t know and who weren’t part of their small-town community.

My biggest takeaway from this less-than-stellar reference call was that this client should never have been put forward as a reference site. They only had a handful of patients using the solution and the process wasn’t working, to the point where the vendor was considering changing its model altogether. Why would anyone think that is a good idea to use this practice as a reference site? The second reference call was scheduled and canceled twice, and then the reference site became unresponsive. Again, not a good sign.

The potential partner continued to push us to have conversations with its clinical leadership, who continued to talk about their vision but couldn’t answer many of our questions on actual strategy and deliverables. The EHR vendor team responsible for vetting the potential partner continued glossing over the third party’s shortcomings, minimizing the clinical concerns and focusing on the idea that, “We need to strike while the iron is hot.” I was part of more than a few discussions about needing to lock in with the partner before another EHR vendor started talking to the company. However, when the conversation was steered to the actual commercial potential of the solution and the ability to deploy it to the EHR client base in a sustainable fashion, those concerns were also minimized.

The partnership continued to move forward in a nearly-unstoppable fashion, with a plan to bring pilot sites live that didn’t have support from the clinical leadership committee, the VP of implementation, or the VP of client support. There was zero documentation on the actual ROI and value proposition for clients, and the EHR vendor began to lock in on the fact that the sales team thought it was a cool solution. Since logic wasn’t giving people pause, I tried to use automotive industry examples to show the difference between “cool” and “useful” and “valuable,” but that didn’t work either.

Meanwhile, the pilot project (again, done on a handshake) was failing and it didn’t feel like there were resources on either side to try to save it. The lack of strategy was obvious, and the finger-pointing began with each vendor accusing the other of not being fully invested. The poor client was caught in the middle, with a half-implemented solution held together by duct tape and Band-Aids.

I tried to appeal to the EHR vendor to stop the madness, but the project had by now taken on a life of its own. The sales team had already gone out and identified additional prospective pilot clients who had received demos and offers of free installations, but the implementation team had withdrawn from the discussions due to lack of clarity on the project. It’s hard to implement something when you can’t figure out what had been promised or how to make it a reality.

At this point, the NDAs were finally complete, but the initiative was falling apart due to lack of leadership on both sides. Another external consultant and I continued to encourage the development of an actual business plan and commercialization strategy, but we both agreed our recommendations were being ignored.

I was glad that I had made this a time-limited contract, allowing only 120 days to work with this vendor. I was left with a sense of frustration and disbelief that two organizations could operate like this and not change course when confronted with expert recommendations if not outright failure. It felt like everyone was racing to the endpoint without a plan, which is never a recipe for business success.

When the EHR vendor asked me to extend my engagement and to help rectify issues with the pilot, I respectfully declined. I didn’t want to continue down this maddening path and am beginning to question whether I will even consider working with this vendor again.

Watching seemingly savvy business people run headlong into a mess was difficult, even though it was fascinating from an organizational psychology perspective. It made me wonder whether living in the world of speed dating and Internet hookups has spilled over into the corporate world, with the focus being on a quick connection rather than a longer courtship with appropriate discovery. At the end of the day, both companies spent time and resources on something that fell apart and probably shouldn’t have been contemplated from the beginning.

As my contract expired, they were continuing to try to patch things up. I’ll have to check back in a couple of months and see if they figured out how to take things forward or whether they continued to throw good money after bad.

Have any good stories on due diligence? Email me.

Email Dr. Jayne.

HIStalk Interviews Michael O’Neil, CEO, GetWellNetwork

Michael O’Neil is founder and CEO of GetWellNetwork of Bethesda, MD.

Tell me about yourself and the company.

I started this crazy journey called GetWellNetwork 17 years ago. I had a personal cancer experience while I was going through a graduate program for a JD/MBA at Georgetown in DC. I had one of these wonderful medical outcomes, but I had not so wonderful experiences as a patient and family. I decided to make this my life’s work and to use my limited talent to try to make it better for the next guy up.

Are we getting better at recognizing consumers as going through a health journey rather than seeing them as patients who make the cash register ring through a series of episodic encounters?

We are absolutely getting better.This starts first with awareness, then solutions and the commitment to implement them.

When we started this business, the only awareness measure and the only energy was because part of the executive suite’s bonus was tied to a Press Ganey score. Today, reimbursement changes, competition inside a market, and the ascent of the voice of the consumer have impacted the way healthcare providers operate and measure themselves. We’ve come a very long way and it’s been energizing.

Are patient satisfaction scores meaningful beyond focusing on low-hanging hospitality fruit that is only marginally related to outcomes, such as food quality and hallway noise?

The world is moving so much faster than CMS has declared these 23 questions, or whatever the number is that get measured, as part of a compliance requirement. To be honest with you, no, I do not think that the current patient satisfaction survey is the true measure of a patient’s experience. The way the world operates now, I’ll give you my feedback right now at the moment. That’s how consumers behave in restaurants, on airlines, and on their phones.

There is a total step function that’s underway in understanding how to capture, understand, analyze, and act on patient experience in the moment. The current measures are not right.

Outside of healthcare, businesses want to know about customer dissatisfaction in real time so they can fix the problem instead of losing the customer via a scathing Yelp review after the fact. Do patients have a way to push that imaginary button to get attention for their immediate clinical or comfort concern?

The cool thing is that the technologies exist today. Not only in other parts of the world, but they exist in healthcare today. The technology is in place and it’s fairly inexpensive.

The hard part of this job is change management. When a patient is at the point of care in a highly vulnerable moment and they’re telling us — through their behavior, reaction, lack of reaction, or lack of engagement – that,  “I don’t understand my meds,” is the process and the workflow in place to make sure that we can respond to that unique, one-to-one patient need in the moment? That’s where I think the heavy lift is, and has to be. 

Those workflows and systems are not all in place today. But the good news is technology is there and it is relatively inexpensive. For the organizations that have the courage and fortitude to say, we’re going to do this differently, it’s time. We can go make this happen together.

In both healthcare and IT, most customers like the individual person but not the organization that employs them. The institutional persona overrides that feeling that, “I like Bob the help desk guy or this nurse who was nice to me.” Are hospitals and practices finding a business case for at least trying to convey an appearance of organizational patient focus?

I think so. The evidence of that is pretty straightforward. I’m chairing a day of the Next Generation Patient Experience Conference in San Diego. You’ve got big investments. You’ve got chief experience officers, highly seasoned senior executives who sit on executive teams to drive strategy around this stuff. You have all kinds of new measures that the organization is being held to account on. It’s now impacting their business. They’re measuring it in terms of how patient loyalty translates to revenue and whether patients are leaving the system because they’re not having the experience we want them to have.

It has come an exceptionally long way. Competition inside these mini markets has gotten intense. You can’t walk out of a train station, pass through an airport, or get on a highway without seeing four out of eight billboards or signs for health systems. They’re competing significantly on patient experience.  

Ultimately it’s great for the patient. You need to make it better for me. I love that about the whole process.

Health system executives, even though as patients they are treated as VIPs, often leave their own hospital encounter surprised by missed meds, poor communication, and impersonal care. Can those executives get a realistic idea of how their organization is doing beyond patient survey responses?

There’s an acute – no pun intended — awareness of the industry’s need to move a quantum step forward in how we deliver care. We think of it as precision engagement. It’s like the analog to precision medicine. If the person that you have just given this magic pill to isn’t going take it — they don’t understand it, they can’t afford it, they don’t know where to get it – it doesn’t matter how good the pill is.

There’s an acute awareness that one-to-one engagement is required to deliver great care. The leaders of the provider organizations know it’s there. There’s some confusion on how to implement a precision engagement model so you can actually deliver one-to-one care at scale. It requires, as always, people, process, and technology to come together to deliver a different model of care. That’s where the challenge lies. But the awareness is there.

How do you measure the result of that patient engagement in terms of outcomes or cost?

Here’s the cool thing about precision engagement as a transformative strategy for healthcare delivery. The measures are already there, already in place, and already required. Organizations are measuring patient satisfaction, readmission rates, the number of falls,  and how many people are leaking out of their system and going somewhere else for their care.

The question is, if you implement a new precision engagement model of care, does the needle actually move on those measures?  It’s not about creating new measures. The measures are sitting there right in front of them and  that’s what’s on their dashboards. What we haven’t seen is, what are the breakthrough approaches in delivering care that  move those measures in a significant way to make you the leader in the market and make you have the best outcomes clinically? 

That’s where we believe there’s great promise. The infrastructure of measurement for impact on patient or precision engagement is there. It’s now about implementing breakthrough programs and watching the change actually happen by hard work.

We’re learning the power of social media commercial or political messages when they target users based on inferred characteristics from their Facebook likes or their responses to a a seemingly innocuous quiz. How can that power be used to improve health?

This is where the greatest promise is. It’s not just the clinical data and the claims data. The third leg of the data stool is patient-directed data. What is my situation at home, at work, and with my family?

Imagine if my mom’s provider knows that she needs to get to her rehab appointments, but I’m leaving on an international business trip. We probably could deliver a better dimension of care for my mom to keep her from having a fall and ending up in a hospital. What you’re saying is dead on. The capabilities are sitting right in front of us, adding a third leg to the data stool to deliver one-to-one interventions based on that person’s capacity to engage in their care at that particular time.

We can’t assume that all patients are the same. How do we make sure that we use the patient’s preferred method of communication and that we don’t bombard them with information that doesn’t pertain to them?

It’s taken us two and a half years, but we started with a 56-question survey that of course nobody would ever fill out. Through a bunch of clinical research, we have it down to 18 questions that assign a PEI score, a Person Engagement Index, that measures the capacity to engage across a couple of domains.

One of those domains is “technology use in my care.” Another is psychosocial. Imagine you and I are the same demographic and we both had a total knee replacement, but I scored a 27 on technology use and you’re an 89. Our provider can put you on a digital coaching program to have a great outcome, but for me, they had better visit me three times at home.

The possibilities are to be able to put a marker on every patient we ever touch, add that third leg of data to the data stool and deliver it to providers in real time so they can prescribe interventions that are relevant to me. My ability to follow my plan of care when I’m not in your skilled hands is literally the key to healthcare. That’s what we’re chasing at GetWellNetwork. Can we arm our provider partners with a new, unique data element that allows them to deliver the amazing care that they want to deliver on a one-on-one basis? It’s there today to be able to do it.

Is the term “patient engagement” misused?

A lot of terms are misused. All you need to do is walk the floor at HIMSS. Every year there are three or four buzzwords and all of a sudden, 3,000 companies claim to do them well. Like anything else, we need to look under the covers. These kinds of things are not small investments. Not necessarily of just money, but of time and focus.

It’s too easy to lump all this stuff into patient engagement. Patient engagement is not changing my visiting hours. Patient engagement is understanding down to the individual level what each patient wants their health for, not assigning their clinical indicators. What do I want my health for? Use that as a motivator to get patients to activate around their care, then use our amazing skill and infrastructure as clinicians to motivate and engage patients in their realm so they can be better active participants in their care.

The term patient engagement is overused. It has become mundane and generic. The whole world claims to do it. The easiest aspect of patient engagement is lighting up yet another app on the app store. That is not patient engagement. It’s important to understand the depth and the change management component to this work. It’s hard work. It takes a long time. You can’t sleep on it, because our patients need it and they need you to do it well.

Do some apps or approaches use methods that are overly paternalistic vs. participative?

What you just said needs to be literally reversed. Let me start by asking you what you want your health for. I would tell you,  “As a 46-year-old cancer survivor with two daughters who are 14 and 12, the most important thing in my life is to be able to walk them down the aisle when they get married. There’s nothing that I wouldn’t do to take care of myself to give me the best chance for that to happen.”

If I start my healthcare dialog with my new primary care doctor on that level, I bet you damn well there’s a lot better chance — when he or she talks to me about my cholesterol level, about my diet, about my exercise regimen, about my stress level — that I activate into that protocol. More likely than if you just tell me to download an app that will tell me me what to eat every day. 

Changing this to starting with, “What do you want your health for?” and delivering care in service of that person’s life goal instead of their A1c3 score will ultimately help change care.

How can standardized questionnaires be used to incorporate consumer self-assessment of health and wellbeing?

We are seeing a lot more of that. We refer to these as patient pathways. The clinical delivery model has been driven forever off of clinical pathways and those are great. These are clinical protocols for heart failure, diabetes, asthma, total knee, bariatric surgery, or being a new mom. The clinical pathway is the foundation by which evidence-based medicine is being practiced by the clinician.

The analog to that is the patient pathway. What is the patient’s role along that clinical path that we should be paying attention to? That starts with the patient setting their own goal. If we marry — more consistently and holistically — patient pathways to clinical pathways and respect that both have to happen to have the best outcome, it will truly bend the cost curve and change the care model forever.

Where do you see the company’s future?

On the corporate strategy side, we’ve been a buyer, not a seller. We’ve acquired three companies in the last three years to add to our capabilities. There are incredibly smart and bright entrepreneurs building incredible tools. Distribution in healthcare is very, very difficult and has allowed us to be buyers in that realm to expand our capabilities.

We’re seeing are two incredibly exciting areas of expansion of our impact. One is simply cross-continuum. We started this business off of a personal hospital experience at Johns Hopkins in Baltimore. The first 10 years of our business was simply making the hospital experience more efficient, more effective, more enjoyable, and more impactful for patients during that four days.

What we learned very quickly — but not quickly enough now that we’re focusing so much of our time on it — is that this four-day stay is such a small part of the patient journey. One area of expanded impact for us the last two years and certainly the next 10 years is to get outside the walls of the hospital. How do we help a new mom, a total knee patient, or a diabetes or asthma patient navigate their life journey through their health to optimize their impact on their lives with the trusted help of their provider in their community?

The second area is international. We didn’t know, nor did our board and our investors, whether this work would translate globally. We picked the Middle East two years ago as our first international market. They’re building a lot of new hospitals and acquiring and implementing a lot of US health IT, so they were at HIMSS and and we knew a bunch of these folks and they knew us.

We just launched our first site in Saudi Arabia and our first site in Abu Dhabi. I was just there last week walking the halls to watch this work impact the nursing staff, the physicians, the patients and families halfway around the world that most of us here in the United States only see on CNN. These amazing people want the same thing we do. They want great, personalized healthcare for themselves and their families that they can trust. That when you show up, people know who you are and treat you on a one-to-one basis and treat you as if you are family.

So the two areas where I believe we’ll have expanded impact over the next 10 years will be cross-continuum — more like serving populations and not just hospital patients – and doing this work globally.

I’m humbled by the amazing folks I have the chance to work alongside every day in these organizations. They are doing a very, very difficult job in a complex business world and clinical world. Doing this work is the most intellectually challenging thing you could ever imagine because the industry is hard. At the same time, the work you do is touching your college roommate’s son. It’s not work. We are honestly blessed to have the chance to go do it.

Do you have any final thoughts?

Every single one of us in this industry is also a patient. Our family members are patients. Our commitment to taking an active role in our health journey is one of the absolute keys to our life fulfillment. It becomes less about whether or not your blood work comes back positive versus the fact that you have taken an active role in your own health journey to pursue your life goals. That has been such a rich learning for me, for my own life journey and company journey. To watch that impact more people has been one of my life’s greatest joys. I encourage us all to take an active role, because when we don’t, the system can chew us up.

Readers Write: Report from AWS Re:Invent

Report from AWS Re:Invent
By Travis Good, MD

Travis Good, MD, MS, MBA is co-founder and CEO of Datica of Madison, WI.

AWS Re:Invent has become one of the most important technology conferences of the year due to the sheer size of the Amazon Web Services cloud and the rate of technology innovation announced. The influence of the conference on health IT has grown over the years as well.

Cerner

There was not an industry-shattering Cerner announcement as was rumored in the CNBC article the week prior. Cerner held a session focused on a few interoperability topics that was well received by the deeply technical audience. But nowhere during its session, nor the daily keynotes, was the announcement made. We bumped into a few Cerner individuals at the event who all commented that they are excited about the future capabilities of AWS’s international regions. International expansion is a priority lately across many health IT vendors and it appeared both Cerner and AWS have similar ambitions based on the Cerner conversations we had at the event.

The amount of money Cerner makes on managed services (which can be largely interpreted as hosting) and support and maintenance (which one can presume has a large amount of hosting-related support) dwarfs the company’s revenue from licenses and subscriptions. The international market is the greatest area of growth for its core revenue model, but international data centers are exponentially harder to build and maintain yourself vs. co-location in the US. Cerner has built and maintained its  own data centers nationally.

There are legs to the rumored CNBC story as well as credibility to the other rumors around population health-related partnerships, but the best insight from Re:Invent we can lend is that any rumored partnership is much more about hosting management than it is about APIs or cloud-based data interoperability.

Compliance

Without question, compliance and security were the two most important topics at the conference. Simply charting the messaging from vendors demonstrates the point: at least twice as many vendors were touting compliance and security management tools, while at least half as many vendors were there to market developer empowerment tools. It’s like the cloud grew up to an enterprise option in the last 12 months.

This is also backed by our observation of the number of C-suite attendees at the event. Supposedly the attendee count jumped from 30,000 last year to 45,000 this year—a number and rumor that was floated often throughout the conference. If true, from our vantage point, the 15,000-person increase was a major jump in “suits” who were there to evaluate how to make this cloud thing work rather than developers who are already leveraging the cloud for projects.

As such, compliance and security was the buzz amongst serious enterprise and healthcare buyers, while the general zeitgeist amongst developers was machine learning and artificial intelligence. But, as we all know, health IT is always woefully behind!

HIPAA, HITRUST, GDPR, GxP, FedRamp, and others were the topics we continuously heard discussed. Interestingly, there are so few options to help truly manage these complex compliance frameworks on AWS. Ultimately, the sentiment we gathered across the healthcare landscape is no one is really helping, especially with HITRUST, GxP, or GDPR. No one had a true GDPR message or product. (Datica will be GDPR ready in Q1 2018.)

AI, ML, and AWS Services

John Moore from Chilmark Research once told us that he goes to Health 2.0 to see what’s going to happen and HIMSS to see what’s already happened. Re:Invent has similar characteristics as Health 2.0.

The pace of innovation and accessibility to digital health developers is so fast that the products and changes to health IT are going to become ever more rapid despite the industry’s best efforts to slow it down. The sense that the AI revolution is just around the corner was one of the strongest observations from Re:Invent. That more AI tooling is being made available to health IT developers on AWS’s cloud means that better products more adeptly addressing patient care and reducing costs are going to come at an ever faster pace. It’s going to be an interesting next few years.

Morning Headlines 12/4/17

CVS agrees to buy Aetna in $69 billion deal that could shake up health-care industry

CVS announces an agreement to buy Aetna for $69 billion.

Former GE CEO Immelt Talks Uber, A.I., and a Rejected Bid for Epic

Jeff Immelt recounts several health IT-related anecdotes from his time as CEO of GE, including one when he passed on acquiring Cerner because he though the $2 billion price point was too expensive, and another in which he met with Judy Faulkner in hopes of acquiring a portion of Epic, but was quickly shown the door.

Trinisys Acquires MICA Health

Nashville, TN based Trinisys announces that it has completed the acquisition of MICA Health, a data archiving vendor that supports ambulatory EHR migrations.

Monday Morning Update 12/4/17

Top News

CVS will buy Aetna for $69 billion.

Unanswered questions:

• Will the federal government approve the deal given its reluctance to allow big insurers to buy each other, especially since CVS has a strong pharmacy benefits management business in CVS Caremark and both companies have specialty pharmacy operations?
• How will CVS structure the combined companies to use its newfound vertically integrated clout?
• How will CVS’s pharmacy relationships with competing insurers be affected?
• What actions will diehard competitor Walgreens take or what acquisitions might it consider?
• Was the proposed acquisition driven by Amazon’s interest in the prescription drug and/or durable medical equipment business or will this transaction increase that interest?

HIStalk Announcements and Requests

Black Friday shoppers hit Amazon hard for electronics, with Best Buy landing an anemic second and the other online retailers sucking wind.

New poll to your right or here, for male readers: do you fear that past incidents could result in a new sexual harassment claim being made against you? The poll is anonymous, as always, and your comments are welcome. Recent headlines triggered me to review my past to make sure I wasn’t forgetting something that could have been misconstrued, leading me to think that others are similarly hoping they surface no repressed memories of previous impropriety.

Next week’s poll will ask women if they’ve experienced work-related sexual harassment or assault. Note: I considered making both of these polls gender-nonspecific, but my assumption is that most of the examples are male-on-female and I didn’t want to dilute the denominator.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

This Week in Health IT History

One year ago:

• The House passes the 21st Century Cures Act.
• A CDC study finds that the number of families struggling to pay their medical bills dropped 22 percent in five years due to an improving economy and those newly insured via the Affordable Care Act.
• Allscripts acquires Australia-based Core Medical Solutions.
• China-based investors finalize their acquisition of Lexmark and announce plans to quickly sell off its software business, including the former Perceptive Software.

Five years ago:

• “Tricorder” company Scanadu announces plans to release consumer tools for vital signs, urinalysis, and saliva testing by the end of 2013.
• Reuters reports that several private equity firms have submitted revised takeover offers for Merge Healthcare.
• Constellation Software acquires Salar from Transcend Services, which had itself been acquired by Nuance.
• Vitera closes its hardware support business.
• Athenahealth announces plans to acquire Harvard’s Arsenal on the Charles complex in Watertown, MA for $169 million.
• CDC reports that 40 percent of office-based physicians use an EHR with at least basic functionality.

Ten years ago:

• Philips announces plans to acquire medical alarm and notification vendor Emergin.
• Dennis Quaid and his wife sue Baxter Healthcare for the Cedars-Sinai heparin overdose of their newborn twins.
• Siemens announces Invision 27.
• An entrepreneur offers a $10 million prize for developing software that can map the genetic codes of 100 people in 10 days for $10,000 or less per genome.

Last Week’s Most Interesting News

• Caring Voice Coalition, a drug co-pay charity, says it will likely shut down after HHS OIG finds that it sent patient data to its drug company supporters.
• Nuance turns in better than expected quarterly results as the actual financial impact of its June malware attack was less than it projected.
• Siemens Healthineers announces plans to go public on the German market in the country’s largest IPO in 20 years.
• Athenahealh names its third CFO of 2017.
• A newly unsealed lawsuit claims that Indiana hospitals falsely attested for $300 million in Meaningful Use money by failing to promptly provide patients with copies of their medical records.

Webinars

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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

Here’s the recording of last week’s webinar titled “Making Clinical Communications Work in Your Complex Environment,” sponsored by PatientSafe Solutions.

Acquisitions, Funding, Business, and Stock

Nashville-based data management vendor Trinisys acquires Mica Health, which offers ambulatory EHR decommissioning services. Former Mica President Mike Justice will apparently stay on as Trinisys VP of business development.

Former GE CEO Jeff Immelt made some interesting comments on a conference stage last week:

• Companies offering healthcare point solutions are in for a rough ride since door-to-door sales in healthcare take 10-15 years.
• Immelt thinks AI will influence radiology practice, but says no great companies will focus exclusively on that.
• His shortest meeting ever (at five minutes) was driving to Epic and pitching the idea of GE buying part of Epic to Judy Faulkner, who simply replied, “No. No interest.” I can’t imagine a CEO in any industry who would have the brass to tell the CEO of GE to hit the bricks.
• GE considered acquiring Cerner, but didn’t think it was worth the $2 billion figure being bandied about (the company’s market cap has since risen to $23 billion). CERN’s market cap hasn’t been that low since early 2005, so GE’s acquisition interest must have been before then but after Immelt took the CEO job upon Jack Welch’s retirement in 2000.
• Hospital CEOs are still clueless about health IT and aren’t generating ROI, with the original goal being connectivity rather than value creation. He thinks they’ll gain interest in improving patient outcomes and value.
• Immelt said companies that started venture funds “have stunk at it,” admitting that they have been “company killers.” In healthcare, of course, GE’s direct acquisitions – which weren’t usually top-rated companies in the first place – gave it the “elephants’ graveyard” moniker as the place where previously good companies go to die.

The average healthcare CEO who lost their job due to a merger or acquisition received a golden parachute of $25 million, much less than the $37 million average from a 2015 version of the same report. Dismissed trench warriors presumably were paid basically nothing for being cut loose through no fault of their own even though their need for income was probably much more acute than that of the aristocracy. 

Decisions

• WellStar West Georgia Medical Center (GA) will switch from Meditech to Epic in 2018.
• St. Luke’s Hospital Cardiothoracic Surgery (MO) will switch from EClinicalWorks to Cerner Ambulatory EHR in July 2018.

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

People

New York Health + Hospitals hires Kevin Lynch (LA County Department of Health Services) as SVP/CIO.

Other

Here’s Vince’s look back 30 years at what was going on in health IT in December 1987, when George Michael’s “Faith” topped the charts and “Three Men and a Baby” foretold an epidemic of poor taste.

Weird News Andy titles this article “DNR, R, DNR, EXP.” A 70-year-old diabetic man with “Do Not Resuscitate” (emphasis his) tattooed on his chest shows up at a hospital ED with an elevated blood alcohol level. Doctors considered his tattooed instructions invalid and started an IV, but covered themselves by also conferring with an ethics consultant, who told them they should honor the man’s request. The doctors wrote a DNR order and eventually also located a copy he had filed with the state’s health department. Meanwhile, the man died without further intervention.

Sponsor Updates

• Deloitte names Definitive Healthcare to its Technology Fast 500 list of fastest-growing companies.
• Logicworks announces support for AWS Guard Duty, a new machine learning-based security service.
• Reaction Data publishes “Ideal Medical Imaging Trends 2017.”
• Surescripts will exhibit at the AHIP Consumer Experience & Digital Health Forum December 5-7 in Nashville.
• T-System President and CEO Roger Davis receives Dallas Magazine’s Excellence in Healthcare Award for achievement in medical technology.
• Huron releases a new video, “Transparency Empowers Healthcare Consumers.”
• Mazars USA expands its New York office with the addition of Elliot Horowitz & Company.

Blog Posts

• How to Leverage Big Data for Patient Care Management (Definitive Healthcare)
• What’s the Most Frustrating About EHRs? (Medicomp Systems)
• Introducing Patientco’s new COO, Mike Hersh (Patientco)
• Reducing Front-Desk Turnover (Navicure)
• Hospice: Hope in the Changing World of Healthcare (Netsmart)
• Save money and boost revenue with online self-service: Cincinnati Children’s Hospital case study (Experian Health)
• Giving Thanks (PatientSafe Solutions)
• Meeting MACRA’s call for care coordination through better communication (PerfectServe)
• 5 Future Marketing Trends of 2018 (Salesforce)
• The Future of Healthcare: New Obstacles and Ongoing Challenges (The SSI Group)
• The Most Legendary Doctors in Television History (Solutionreach)
• How to navigate RAPS-to-EDS revenue expectations (Verscend Technologies)
• Making interoperability a reality. (Voalte)
• 7 Tips for Secure BYOD in Healthcare (Vocera)
• 3 Benefits of a Managed SMS Provider You May Not Have Considered. (West Corp.)
• How Employee Wellness Programs can Leverage Technology (WiserTogether)
• It’s Time for a Pulmonary Hypertension Digital Revolution (ZappRx)
• Healthcare’s new era: Why administrative healthcare data is key (Conduent Health)

Contacts

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

Morning Headlines 12/1/17

Drug Charity May Shutter After U.S. Faults Pharma Influence

Caring Voice Coalition, a big pharma-funded charity setup to help patients pay their prescription drug co-payments, will likely shut down after an OIG investigation finds that the charity was providing drugmakers detailed information on whether their charitable contributions were going to their own customers, which ultimately allows them to raise the prices of their drugs for insurers, while insulating patients from the immediate out-of-pocket effects.

VA misses deadline on Cerner contract

The VA misses its own self-imposed deadline to sign its contract with Cerner. The contract is reportedly ready to execute, but the VA needs approval from the House and Senate Appropriations committee to transfer of $374 million between existing accounts prior to moving forward, which it has not yet received.

Siemens unit set for major Frankfurt IPO

Siemens will list its healthcare unit, Siemens Healthineers, on the German stock exchange at a value of $47 billion.

Hardly anyone uses Australia’s My Health Record service

Australia’s nationwide patient portal and health information exchange service has almost no traffic, despite its $1.5 billion price tag. Fewer than 200 GP patient summaries and 150 hospital discharge summaries are accessed by healthcare providers in a given month.

News 12/1/17

Top News

HHS OIG cracks down on drug co-pay charity Caring Voice Coalition, removing its seal of approval after finding that the charity shares data with the drug companies that provide its support.

CVC, which has received hundreds of millions of dollars from drug companies earmarked for paying patient prescription co-pays, had been exposed by several former employees as fast-tracking assistance for patients that use a donor company’s drug while wait-listing those who are prescribed drugs sold by non-donors.

OIG says the information sent to the drug companies could help them raise Medicare prices by accumulating anecdotal patient-reported successes.

CVC told OIG that it will probably shut down following the ruling.

I found CVC’s 2015 federal tax forms, in which it reported $132 million in 2014 revenue (vs. $83 million in 2013), giving it a $30 million surplus for the year.

The Justice Department had previously sent subpoenas to a handful of drug companies in its investigation of patient assistance programs, after which United Therapeutics set aside $210 million in case it gets caught up in a False Claims Act lawsuit over its donations.

The Internal Revenue Service is reviewing the tax-exempt status of another patient assistance program, Chronic Disease Fund (now known as Good Days), which took in more than $1 billion of drug company money over six years, of which the charity used $35 million to pay for data processing services provided by a company owned by the charity’s founder. Good Days has filed eight lawsuits so far this year to fight IRS subpoenas.

Reader Comments

From Dollar Bill: “Re: [site name omitted.] Who finds actionable information there?” I can’t say, but the above is from Reaction Data’s independent C-level survey that asked about which sites influenced their decisions. I’ve blurred the names, but the one you’re asking about finished poorly in this and the other four categories (most-read, most-influential, most interest-generating, most positively affecting job performance, and most recommended). I immodestly note that the winner in all categories was a spare-bedroom, one-author one.

HIStalk Announcements and Requests

This week on HIStalk Practice: DaVita preps to sell its $4 billion medical group. South Carolina’s PDMP helps slash opioid prescriptions. Elderly New Hampshire MD faces non-license renewal over lack of computer skills. Google researchers develop gaze-detection software to deter snooping smartphone bystanders. Senate HELP Committee questions HHS Secretary nominee Alex Azar on drug prices. VillageMD New Hampshire selects Geneia predictive analytics for PHM efforts. CareCloud’s Polly Friend offers three key things practices should do to prep for MIPS.

Webinars

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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

Acquisitions, Funding, Business, and Stock

Nuance announces Q4 results: revenue down 8 percent, adjusted EPS $0.20 vs. $0.31, beating analyst estimates for both and sending shares up to extend a run that started in mid-November. The company says its June malware attack cost it $53 million in revenue for the quarter. NUAN shares have risen 4 percent in the past year vs. the Nasdaq’s 30 percent. From the earnings call:

• The total impact of the malware incident was just over $60 million vs. the originally expected $85 million.
• The healthcare business delivered its best net new bookings quarter in history in Q4 despite the malware attack.
• Nuance’s strategic focus will be conversational AI and analytics-based solutions.
• The company expects Dragon Medical to replace transcription as its largest healthcare revenue contributor as its HIM business continues to decline.

Siemens will take its Siemens Healthineers healthcare business public in Germany at a valuation of $47 billion, the country’s largest IPO in 20 years. The company chose the German exchange after ruling out London due to Brexit and the US markets because it wants to appeal to investors from Asia.

AI-supported diagnostic software vendor Prognos closes a $21 million Series C funding round, increasing its total to $43 million. Its target audience is drug companies, insurers, and labs. Co-founder Jason Bhan, MD used to work for Clinovations, while Sundeep Bhan co-founded Medsite.

Bizarre: three-employee medical translation training vendor MiTio files for a $10 million IPO despite having only ever enrolled 1,000 students, naming as its CFO/CIO/CTO the founder’s 16-year-old son who is “a rising star in the coding community.” The company says it won’t sell shares publicly,  but had to file for an IPO because it will give investors cryptocurrency tokens. That’s the second company I’ve seen today offering that form of investment (see the Health Wizz item below). I admit that I don’t understand that concept.

Sales

Artesia General Hospital (NM) chooses FormFast’s FastPrint, Capture, FastFlow, Content Manager, and Connect.

The Ministry of Health of the Republic of Kazakhstan will implement Elsevier’s ClinicalKey reference solution in 200 locations.

People

Nuance hires Tom Beaudoin (SimpliVity) as EVP of business transformation. He was EVP/CFO for Nuance from 2008 to 2015.

Laure Kreofsky, MHA, MBA (MedSys Group) joins Pivot Point Consulting, A Vaco Company as VP of advisory services.

Hurley Medical Center (MI) promotes Casey Bryson to CIO from the interim role.

Government and Politics

The VA misses its target date to sign with Cerner, which it originally vowed to get done in November in responding to a lawsuit protesting its no-bid selection. A VA source says the contract is ready to sign as soon as Congress approves moving the money to the correct accounts.

Announcements and Implementations

Elsevier will offer WiserCare’s Shared Decision Making solution as part of its patient engagement suite.

Glytec’s Glucommander Outpatient will be integrated with the virtual diabetes clinic of Onduo, whose parent companies are drug manufacturer Sanofi and Alphabet’s Verily.

MemorialCare (CA) opens a technology testing and training center in conjunction with systems integrator Sirius Computer Solutions. It includes the technologies need to run a 2,000-bed hospital, an isolated data center, and a simulation lab.

Health Wizz launches a blockchain-powered consumer tool for managing and sharing their medical data with research organizations and drug companies that can offer to pay them. The company is recruiting investors who will receive digital tokens.

GE launches blood collection firm Drawbridge Health, which will allow physician offices and clinics that don’t have a blood draw technician to easily draw small-volume blood samples and send them to third-party labs. I like the idea of going back to the good old days when you could get your blood drawn during your office visit instead of starting over with the DMV-level indifferent employees of Quest or LabCorp and then listening to your NPO stomach grumble while watching the Unemployment TV Network of fake judges, on-cue fistfights over infidelity, and ambulance-chaser commercials.

Tahoe Forest Health System (CA) goes live on Epic, implemented and hosted by Mercy Technology Services. 

GetWellNetwork adds Elsevier’s patient education videos to its content library.

QuadraMed and Harris Healthcare launch individual websites that cover their respective products, with QuadraMed offering its EMPI solutions and Harris Healthcare covering Affinity Patient Self-Service, Affinity ERP, AcuityPlus staffing, Team Notes, the QCPR EHR, and Affinity RCM. The Harris Health Group brands are listed above, although it should be noted that it acquired only the hospital division of NextGen and not the entire NextGen Healthcare product line or its parent company Quality Systems, whose logos appear on the page.

Deborah Heart and Lung Center (NJ) will go live on Meditech 6.1.5 today (Friday). I believe they’re upgrading from Meditech Magic.

Privacy and Security

A cybersecurity publication asks three healthcare security experts to assess the recent hospital ransomware episode of “Grey’s Anatomy,” who conclude:

• It didn’t make sense for the hacker to take down patient monitors since the hacker’s objective is to make money and the on-screen ransom note would accomplish that less dramatically.
• The attack took down phones, computers, and medical devices, which the experts say could actually happen since hospital networks are often “one big, flat, happy family” instead of being segmented or protected by internal firewalls. Still, the variety of operating systems and versions used in a typical hospital make it unlikely that everything could be taken offline by the same malware.
• Medical uncertainty due to lack of a paper backup may be realistic, although more hospitals are keeping electronic snapshots of important clinical information.
• The demanded ransom – $20 million in bitcoin at the time of the airing and $50 million today – is not realistic because nobody would pay that much.
• It’s not likely that a cyberattack could take down access control systems, as shown on the show when nobody could open the door to the blood bank.
• It’s unrealistic that the FBI would arrive in minutes and take charge as the show depicted.
• It’s not necessarily advisable to just shut all systems down, but rather to control the malware’s spread while forensically trying to learn more about the hacker.
• The TV chief of surgery made the decision to pay the ransom, which is unrealistic not only because that’s a CEO-level decision, but also because hospitals usually follow the FBI’s advice and refuse to pay.

Security researchers find that the installation script of free, web-based OpenEMR does not automatically remove itself upon completion and that the instructions don’t tell users to delete it, allowing hackers to gain administrative access and to execute PHP scripts of their own. Kudos to the developers, who released a patch within four days, made a community announcement about the vulnerability, and updated its instructions to include removing unnecessary files after installation. The system is used by thousands of healthcare facilities and users in supporting an estimated 90 million patients.

In England, a financial administrator who was worried that she was being out-earned by co-workers hacks into the hospital’s systems, looks up salaries, collects data on celebrity mental health patients, and deletes key files. The judge let her off with a suspended sentence since she argued that her deeds were to “ease her mind” rather than for financial gain.

A federal court drops child pornography charges against a California oncologist after his attorney argues that the warrant used to search his home – in which child pornography was apparently found – was invalid because the FBI’s tip from a Best Buy technician was triggered by a photo of a naked girl that was not pornography but rather “child erotica,” which is not illegal but may not be the kind of image you hope your oncologist is studying intently.

Other

Family medicine doctors from the University of Missouri School of Medicine design a prototype of collapsible accordion physician notes, comparing four models that also emphasize abnormal items.

FDA approves AliveCor’s EKG watchband replacement for the Apple Watch to warn users of possible atrial fibrillation. The KardiaBand use what it claims is AI on the smart watch to determine a specific user’s normal heart rate based on activity, then issue a warning to run the EKG function if the rate goes outside the normal range. The band costs $199 plus a $100 per year subscription. Like other “advances” that find previously undetected conditions that require expensive treatment, we’re all going to be paying for it. Going problem fishing by using data for bait isn’t usually as good for patients as it seems.

IHI/NPSF publishes “Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era.” Recommendations include developing better interoperability among EHRs used by PCPs and specialists; conducting a risk assessment of the electronic referral process using the SAFER guidelines; creating collaborative care agreements for PCPs and specialists that include how patients will be managed and communications etiquette; and developing easy ways to track referral status by patient. The impressively credentialed expert panel notes that 24 percent of malpractice claims are caused by missed or delayed diagnosis; the volume of referrals has skyrocketed and more frequently involves multiple specialists; and that patients don’t follow through on up to half of referrals. The study also observes that while EHRs have potential to improve the referral situation, they generate a lot of ignored noise and a lack of evidence-based guidelines makes it tougher.

Australia’s My Health Record – rollout of which cost up to $1.5 billion with annual costs of up to $300 million — is being roundly ignored by both providers and consumers, according to the government’s dashboard that shows few new voluntary registrations and that only 200 doctor-entered patient summaries were viewed by hospitals in August.

This is a fun tweet.

Here’s another great tweet I found via @healthblawg.

Big health systems keep moaning about how financially strapped they are and brag about how they’re moving away from the lucrative “heads in the beds” financial model, but Ohio State University joins a bunch of other health systems that have recently announcing huge construction projects. The cost of their much-anticipated erection – which includes an impressive 840-bed tower – has not been determined.

A study estimates that healthcare illiteracy – which includes half of Americans, according to the CDC – costs the country up to $175 billion per year.

Snapchat CEO Evan Spiegel says the factors that have driven social media – more friends, more likes, and more free content – will undermine it. He says that automated, personalized newsfeeds based on what friends are consuming — like Facebook’s — “came at a huge cost to facts, our minds, and the entire media industry.”

Weird News Andy will love this. A startup that raised millions to develop its $40-a-bottle “cognitive enhancement” concentration pill (aka “nootropics”) tries to bury the results of its own study, which conclude that the expensive product is less effective than just drinking a cup of coffee.

Sponsor Updates

• ZeOmega achieves Oracle Validated Integration of Jiva 6.1 with Oracle Healthcare Foundation 7.1.1.
• The HCI Group partners with the Dubai Health Authority as part of its Transformation Forum.
• The local paper features Healthlink Advisors consultant Claude Younger’s health-prompted feat of running marathons in all 50 states.
• Optimum Healthcare IT publishes an infographic titled “The ROI of Interface Error Management.”
• Meditech posts a video featuring ancillary department directors of Colquitt Regional Medical Center (GA) discussing their time savings from using its Web EHR.
• Bill  Spooner, founding advisor at Next Wave Health Advisors – a Huntzinger Management Company, leads sessions at the Millenium Alliance’s Assembly on healthcare provider transformation.

Blog Posts

• A Patient-Centric, Independent Clinic in Utah (EClinicalWorks)
• 5 Ways to Avoid Analysis Paralysis on Your Next Revenue Cycle Project (Hayes Management Consulting)
• 3 Tips for Being Survey Ready for HIMSS EMRAM Stage 7 (The HCI Group)
• A Nurse Gets Sepsis – What the Experience Taught Me (Iatric Systems)
• Why Blockchain Matters for Healthcare (Redox)
• Paper Consent Forms Can Delay Surgeries. Here’s How Electronic Signatures Can Help Your Hospital Avoid This. (Access)
• How to Use the New Top Care Areas Feature on Healthgrades.com to Choose a Provider (Healthgrades)
• FDA’s Biosimilar ID Requirements Fly in the Face of Cost-Cutting Aspirations (FDB)
• Inherited Liability: Considerations for Mergers & Acquisitions (Impact Advisors)
• A quick and easy intro to designing an EHR training program (Nordic)
• Is patient misidentification really such a big deal? (Imprivata)
• Consider This for Your Hospital CRM Strategy (Influence Health)
• The Time for Payment Integration in Healthcare is Now (InstaMed)
• For Precision Medicine, the Next “Killer App” is Data (InterSystems)

Contacts

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

EPtalk by Dr. Jayne 11/30/17

I enjoy following startup companies, especially those that are looking for novel or improved ways to manage complex conditions. Diabetes is not only a killer, but a significant drain on our already overloaded healthcare system, and many physicians feel there has to be a better way to engage patients to participate in the lifestyle-related parts of their care. I’ve been following Diasyst for a couple of years now and it looks like they’ve actually launched. Their approach uses a patient-facing mobile app to monitor blood sugars coupled with EHR integration to get all the data in the same place. They then use clinical algorithms drawn from work at Emory, Georgia Tech, Grady Memorial Hospital, and the Atlanta VA Medical Center to provide clinical decision support. The loop is closed by sending custom patient plans back to the mobile app. I haven’t seen a demo yet, but hope to catch one soon.

My laugh of the week was and email from the communications and marketing team at a hospital where I haven’t worked for a number of years. They were asking me for a new head shot for my profile on their find-a-physician website. They’re switching systems and my old picture apparently was too low of a resolution to be compatible. I replied and told them I was no longer affiliated with the facility and they sent an email again asking for a head shot and telling me it was my right to be included in the directory because I have “referral privileges for diagnostic testing” and that it would be free advertising for my practice.

In all the years I’ve filled out medical staff credentialing forms (both as an applicant and as a department chair), I’ve never heard of that class of privileges. When was the last time you saw a hospital refuse a patient who arrived with an order for diagnostic testing because the ordering or referring physician wasn’t on staff? Personally, I’ve never seen it, and I’ve received reports from many hospitals where I wasn’t on staff but where the patient had arrived with a radiology or lab order form. As long as the insurance card is valid and/or the preauthorization is in order, you’re usually cleared to receive services.

I asked the marketing rep what contact information she had on file for me and she replied that in the old system my profile is completely blank, which was leading her to think that perhaps the list she was given should have been vetted before she started contacting people. She rescinded her offer for free advertising after I told her that I am employed by a competitor.

My clinical employer has opted out of Meaningful Use, so this vendor blog article about why urgent cares should opt in caught my eye. For physicians and practice managers who may not know a lot about MIPS, they did a reasonable job summarizing how MACRA brought several CMS initiatives together and how practices can avoid negative payment adjustments or earn a bonus. They mention that practices with a high performance score can be “proud to share with the public.” I’m not sure how relevant this is to the average patient – despite a push for consumer-driven medicine and patient engagement, as an urgent care physician, most of our patients choose our services based on our location and hours of operation or by word of mouth. They’re not out investigating Composite Performance Scores before they come see us to get help with their poison ivy or flu symptoms.

The piece goes on to make submission seem straightforward, with no mention of the amount of data that has to be gathered or the work that has to be done beyond what is typically done in the urgent care setting. It also cites a top score as a way to “attract top talent on a healthcare landscape where every advantage matters.” In my world, we’re attracting top talent simply because we have opted out of the federal programs. Physicians are tired of dealing with initiative after initiative and just want to practice medicine. We’ve not only opted out of the madness, but provide scribes if providers want to use that documentation style. At least from the inside, it feels like we’re taking control of our situation and delivering good care at reasonable prices with a minimum of hassle. It remains to be seen how the penalties will impact us and whether our non-Medicare book of business will be impacted if competitors start advertising their MIPS composite scores.

As a physician who reads a great number of chest x-rays, I also enjoyed this article about automating x-ray interpretation. We’ve automated readings of other studies such as Pap tests, and given the number of chest films that are taken each year, it makes sense to see how we can do better. There is always a debate whether a patient has an early pneumonia or whether they just have increased bronchovascular markings. The Stanford University Machine Learning Group is tackling this, with the algorithm now outperforming radiologists in diagnosing pneumonia.

Although the data don’t mention family physicians, emergency physicians, internal medicine physicians, or pediatricians, I suspect it would outperform us as well. At our practice, each film is read by two providers to reduce the risk of interpretation errors. Having the second review be part of a proven algorithm would be a bonus. In the mean time, we’ll continue making the decisions based on our interpretation of the x-rays along with the clinical picture of the patient in front of us, which is often more important than the film itself.

I don’t envision a future with photo booths where a patient pops in for an x-ray and gets a printed script based on the algorithm, unless it can also look at nutrition and hydration status, co-morbid conditions, history of medical non-compliance, current climate of antibiotic resistance, travel history, occupation, social supports, financial status, insurance coverage, and more. Those are all the things physicians consider in making our decisions that outsiders often overlook. I’m not worried about being replaced just yet.

Email Dr. Jayne.

Morning Headlines 11/30/17

Nuance Fourth Quarter and Fiscal 2017

Nuance releases Q4 results: adjusted revenue fell to $466 million, compared to $506.2 during the same quarter last year, adjusted EPS -$0.23 vs. $0.06, beating estimates on both and driving share prices up 3.2 percent in after hours trading. In its financial statements, the company noted that costs associated with its NotPetya cyberattack totaled $53 million in Q4, less than the $65 – $75 million range it initially estimated.

Is It Time for a New Medical Specialty? The Medical Virtualist

An article in JAMA proposes creating a medical virtualist specialty that would focus primarily on providing telehealth-based services.

Medicare Part D Opioid Prescribing Mapping Tool

CMS releases new data visualizations showing geo-located Medicare Part D opioid prescribing rates from 2013 to 2015 with additional information on extended-release opioid prescribing rates and spatial analyses to identify “hot spots.”

Remarks by Dr. Gottlieb at FDA’s Generic Drug Science Day

FDA Commissioner Scott Gottlieb, MD says the agency is approving record numbers of generic drugs in its push to speed up the “approval of safe, high-quality, and more affordable generic drugs.”

Readers Write: The Challenges (and Benefits) of Anesthesia Data Capture

The Challenges (and Benefits) of Anesthesia Data Capture
By Douglas Keene, MD

Douglas Keene, MD is chairman and founder of Recordation of Wayland, MA and an anesthesiologist and co-founder with Boston Pain Care Center.

As part of the American Recovery and Reinvestment Act of 2009, hospitals and clinics were required to demonstrate conversion to electronic medical records (EMRs) by the end of 2014. However, despite government incentive programs totaling in the billions, the program initially faced a myriad of hurdles and proved harder to implement than initially anticipated. Fast-forward to nearly a decade later and the initiative is back on track, with over 90 percent of healthcare facilities using EMRs as their universal standard.

With that said, one segment of the healthcare market has lagged in EMR adoption: anesthesia care providers and the adoption of anesthesia information management systems (AIMS). Despite the critically important role the operating room plays in a hospital’s ecosystem –typically the source of about 60 to 70 percent of a hospital’s revenue – the majority of healthcare facilities have been hesitant to make substantial monetary investments in AIMS.

To bring the EMR revolution out of the doctor’s office and into the OR setting, physicians must reflect on the factors that have led to slow AIMS adoption,and consider the key features and components needed in order for physicians and administrators to overcome these implementation hurdles.

Anesthesiology departments have grappled with many of the same challenges initially faced by healthcare facilities looking to adopt EMRs. These include reluctance to share information with competitors, software from different vendors that can’t interoperate or communicate, lengthy and complex implementation phases, and the overall high price tag of such systems.

In addition to these obstacles, AIMS adoption faces an even more challenging hurdle: adoption inertia by anesthesia providers. While all EMR software faced some initial skepticism by healthcare providers in general, this aversion has been far more vehement among anesthesia care teams for several important reasons, and stemming from the complexity of real-time anesthesia-related documentation.

Early AIMS were difficult to learn to use and implement. They relied upon larger, expensive computers with relatively lower processing power and faced challenges with interfacing reliably with anesthesia equipment and hospital information systems. Anesthesia workflow and efficiency often worsened with the introduction of early AIMS technology.

Advances in computer technology and interface design have improved some aspects of the overall user experience. However, the drawbacks from early AIMS still linger in the minds of many anesthesia providers.

While many academic and larger surgical facilities have adopted AIMS made by the vendors of the existing hospital information systems, there are numerous community hospitals and ambulatory surgical centers that have not yet transitioned to electronic anesthesia records, based upon their smaller sizes and budgetary constraints.

As a result, many of today’s anesthesiologists and CRNAs who underwent their initial training using AIMS in academic facilities ultimately enter practices that still rely on handwritten documentation.

As economic and regulatory forces increase pressure to consider the adoption of electronic anesthesia records, teams that include administrators, information management specialists, clinical managers, and anesthesia providers are sharing the decision-making process.

As a board-certified anesthesiologist, pain management, and clinical informatics specialist, I am certainly familiar with the complaints physicians have had with AIMS. In my opinion, with the modern technologies now available on the market – and many now available at more reasonable price-points – there is no good reason that surgical facilities and anesthesia departments should hesitate to consider the adoption of anesthesia information technology. The benefits of AIMS and the potential perils of not adopting such a system are far too great to ignore.

In choosing an AIMS, the type of facility in which it will be implemented should be considered and the characteristics of the facility should be embodied in the AIMS. As an example, ambulatory surgery centers (ASCs), while among the slowest to adopt AIMS, are beginning to realize that their survival will depend upon information management.

ASCs must provide patient care with a focus on safety, quality, and operational efficiency, but often have smaller budgets to implement information technology. Therefore, a sensible approach would be choosing a cost-effective AIMS solution designed to facilitate perioperative documentation in a fast-paced anesthesia workflow environment that is focused on providing easily available data for process analysis and improvement.

ASCs also need to streamline the sharing of information from and with numerous sources, including primary care providers, surgeons, patients, and hospitals, and therefore should choose an AIMS solution that focuses on interoperability and that is easy to implement. These factors will benefit all of the ASC’s stakeholders and will lead to better patient care and assure the long-term financial viability of the facility.

From the point of view of the AIMS end users, the anesthesia care team must view the AIMS solution as benefit rather than an obstacle. Instead of placing a barrier between physician and patient as some feared AIMS would do, early adopters have found that well-designed AIMS empower physicians and CRNAs to be more vigilant with respect to direct patient care during surgery.

Instead of using handwriting to create what is sometimes partially illegible documentation during a surgical procedure, many AIMS are able to capture vital signs such as pulse oximetry, end-tidal CO2, volatile agent concentrations, and other numerics automatically, enabling providers to spend more time monitoring the patient and focusing on quality of care. The result: better data, accurate documentation of measurements, and improved patient outcomes.

Other improvements to modern day AIMS includes intuitive user experiences and interfaces, the ability to easily customize workflows, as well as increased interoperability with existing EMR systems. For AIMS users, and especially for ASCs, ease of use and system integration is of utmost importance as the success of an ASC depends on the ability to seamlessly share information back to the host system of a hospital or provider during transfer of care.

In addition to interoperability, today’s AIMS solutions are designed to mimic traditional interfaces and workflows with which anesthesia providers are already familiar. In fact, adopters of well-designed AIMS can become comfortable with their use after just a few surgical procedures.

There will always be new documentation requirements, new monitoring data that must be recorded, and new information that will need to be shared with providers. Practices that adopt modern AIMS solutions will be able to weather these changes far more easily than those who continue to create handwritten anesthesia documentation, as well-designed clinical solutions respond to these changes and guidelines in anesthesia technology, monitoring, and standards of care.

In summary, a well-designed AIMS provides a cost-effective alternative to handwritten documentation in that anesthetic records can now be based upon high resolution electronic data capture, with computer-validated information that can be aggregated into databases that form the basis for continuing quality analysis and improvement studies.

In the end, with a relatively small investment in anesthesia information technology, even the smallest community hospitals and ambulatory surgical centers can implement technology that will empower the facilities to say with confidence, “We’re doing a great job and here’s the proof.”

Readers Write: Tell Me More: Documentation Support in Telemedicine

Tell Me More: Documentation Support in Telemedicine
By Patty Maynard

Patty Maynard is senior vice president of business development with Health Navigator of La Grange, IL.

A successful telemedicine platform provides value beyond the latest technology or reduced healthcare costs. The most effective platforms focus on workflow, from resource allocation to staff education. In fact, a recent REACH Health survey showed telemedicine can improve outcomes, access to care, and efficiency.

Clinical documentation support (CDS) facilitates reaching these goals. From the chief complaint to the pre-visit, “tell us more” step, CDS can improve workflow. It captures shareable data for medical call centers, telemedicine providers, hospitals, and primary care providers. This data can simplify the pre-visit process, saving time and money. In addition, it provides patients with a familiar and comforting medical interaction, but in a digital format. CDS is part of the back-end content and workflow that make the digital health experience run smoothly.

The more information a healthcare professional has, the easier it is to make decisions. In telemedicine encounters, an easy-to-navigate questionnaire about the chief complaint or symptom can help move the process along.

Imagine knowing a patient’s chief complaint, symptoms, and demographic information before they reach the clinic. This may sound too good to be true, but modern platforms can provide a patient-facing checklist or Rapid Medical History that prompts patients to provide information. Clinicians can review a patient’s Rapid Medical History or use the CDS tool to record patient responses.

For example, a patient using a telehealth application may respond to two of five questions in a pre-visit checklist or Rapid Medical History. In a follow-up call, the clinician reviews the responses and asks any unanswered questions. The clinician then collects relevant information from a standardized CDS checklist and gives care advice.

CDS checklists also help providers ensure staff follow safe, consistent processes with patients. Checklists are especially important in crisis or high-stress situations when staff may forget details. In the long run, checklists help:

• Ensure consistent workflows
• Improve communication
• Reduce provider risk, and
• Save time.

For every chief complaint, there is related information telemedicine providers need to know. The ideal telemedicine platform should have access to content that automatically links a chief complaint to a Rapid Medical History template. A platform that connects chief complaints to a standardized list of questions can save time and improve efficiency. These custom templates can also improve accuracy of care advice.

The traditional, pre-visit process can take a significant amount of time, time that could be spent elsewhere. Incorporating CDS reduces time spent gathering patient background information and allows staff to get to the root of the problem quickly. This leads to faster, more accurate diagnoses and care recommendations. It also creates an alternative to ER or urgent care visits for low-urgency conditions, which make up a large part of telemedicine encounters. CDS can also be used to augment EHRs with data that improve patient tracking.

A standardized clinical documentation support process can transform the telemedicine experience, creating a faster diagnostic process and reducing unnecessary visits. CDS can improve patient outcomes, safety, and satisfaction by delivering a consistent experience for patients and staff. This can help patients feel empowered and gives them tools to make appropriate healthcare decisions. In short, CDS is a building block of a better telemedicine experience with more valuable data.

Moving forward, the healthcare industry will see more of this data processed through artificial intelligence (AI) like natural language processing (NLP). NLP directly relates to CDS because this “narrow AI” produces the standardized, follow-up templates for each chief complaint. These two technologies can improve all areas of telemedicine.

Some of the major areas of opportunity for telemedicine lie in services like tele-ICU, tele-psychology, and triage. CDS allows these services to deliver a richer, data-driven experience. These areas are only expected to grow, and CDS helps telemedicine providers meet patient and provider needs.

As telemedicine falls under new legislation and continues to evolve as a covered benefit, expect to see new guidance on standardization and use. CDS provides data that makes telemedicine visits valuable, fitting into value-based payment models. Telemedicine providers can expect to see increasing demand for these convenient services as employers and health systems work to provide cost-effective, accessible care.

Readers Write: HIT Talent Trends to Watch in 2018

HIT Talent Trends to Watch in 2018
By Frank Myeroff

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

What’s in store for 2018 when it comes to HIT talent? Here are eight talent trends that will help to shape the HIT workforce in the New Year.

Widespread Adoption of People Analytics

As Millennials move into HIT management roles, they’re turning to analytics much more than their predecessors as a way to better understand the effectiveness of people practices, programs, and processes. Millennial HIT managers are creating employee dashboards like Microsoft’s MyAnalytics to help people better understand how their time is spent and as a means to measure progress of organizational HIT goals and initiatives.

Cybersecurity Needs to Improve

Cybersecurity in 2018 needs to become a top priority. In 2017, the WannaCry outbreak brought serious attention to security in the healthcare industries. The security of digital health data has not kept up with its growth due to a lack of investment in people and technology, but that is starting to change. Healthcare IT hiring managers and HR executives could be in a good position to lure cybersecurity talent in 2018 because healthcare is the hottest hiring hotspot when it comes to cybersecurity.

Explosive Growth in Telemedicine Services

According to an IHS Technology Report, the telemedicine services field is expected to grow to include 7 million patient users, nearly twice what is was in 2016. Telemedicine is a huge change to healthcare because it can help extend care and reach of patient monitoring, consultation, and counseling to those individuals who cannot make it to a doctor’s office. Plus, once it reaches its potential, telemedicine will allow doctors to help more patients in less time. According to a survey done by Becker’s Healthcare, only one percent of respondents had no plans to implement telemedicine in the future. This fast growth means that HIT professionals will play an event bigger role when it comes to developing telemedicine services. By helping to create the telehealth infrastructure, HIT professionals can help make telemedicine a fixture in healthcare delivery.

Robotics and AI Represent Greatest Transformation in Healthcare Services

While this has been a high-growth area in recent years, we see it skyrocketing in 2018 and beyond. The main areas of healthcare that will benefit the most from robotics and AI are direct patient care such as surgery and prosthetics, indirect patient care in the areas of pharmacy, medical goods delivery, home health, and disinfection that will interact with people having known infectious diseases. This high demand in robotics and AI will add a plethora of new jobs in the areas of highly skilled data specialists, algorithm specialists, robotics engineers, software developers, and technicians.

Expected IoT Job Boom On Hold

The healthcare industry only saw an 11 percent boost in Internet of Things (IoT) network connections between 2016 and 2017. That ranks the healthcare industry behind four other key industries: manufacturing, energy / utilities, transportation / distribution, and smart cities / communities according to “The Verizon State of the Market” report. While IoT devices clearly offer new benefits for healthcare provider organizations, adoption remains limited due to the IoT standards, security, interoperability, and cost. Therefore, the hiring of developers, coders, and hardware professionals will not be needed to the extent previously thought.

Continued Rise of Freelance Economy

There’s high growth when it comes to freelancers, temporary workers, contractors, and independent consultants within the HIT space. New technologies, cost factors, and a whole new generation of HIT professionals wanting to work in a gig economy are fueling the growth. Organizations should, now more than ever, look at building new strategies or evaluating what is already in place to keep these workers motivated and engaged. If they don’t, they risk losing this highly skilled talent to their competition. By 2020, it is anticipated that 50 percent of all US workers within various industries will be contingent workers.

Candidate-Driven Job Market Continues

In most industries across the US, we’re experiencing a candidate-driven job market and the HIT industry is no exception. Those who do have the right skills are in a good position to find the best job offer. They have far more power and latitude to be very selective regarding opportunities and employers. In fact, HIT professionals tell us that they have a pipeline of opportunities to choose from and are getting up to 20 recruiting calls per day. There’s no doubt that healthcare organizations are feeling the impact of the heightened competition for their attention.

Diversity in Technology Still Needed

With the retirement of the baby boomer generation in full swing, worker shortages are of great concern. The fact that the information technology field can’t seem to attract a more diverse population doesn’t help the situation. The IT workforce is predominantly white males. Even though many organizations announce diversity initiatives on a regular basis, hiring managers complain that they can only hire from the worker pool that is available. By introducing science, math, engineering, and technology (STEM) to minority students (including females) at an early age plus having a diverse group of educators throughout their schooling, the amount of diversity in the field as a whole can increase.

Morning Headlines 11/29/17

University Hospital Patient Information Was Potentially Vulnerable to Hackers

The student newspaper at the University of Chicago exposes network vulnerabilities that would allow anyone on the school’s network to access printers used within the hospital, where any hacker could access “organ donation logs, surgery face sheets, prescriptions, and even medical records.”

Here’s a good use of AI: help prevent suicide

Mark Zuckerberg announces that Facebook will deploy algorithms designed to identify suicidal ideation to connect its users with someone that can provide immediate help, rather than waiting for concerning posts to be flagged by users.

Athenahealth Files An 8-K

Athenahealth names Marc A. Levine, formerly of the JDA Software Group, as its next CFO.

UnitedHealth’s Optum Launches $250M Fund To Invest In Start-Ups

UnitedHealth will invest $250 million in early-stage healthcare startups.

News 11/29/17

Top News

A newly unsealed state court lawsuit claims that 62 Indiana hospitals fraudulently attested for $300 million in Meaningful Use money because they don’t give patients copies of their medical records within three business days 50 percent of the time as required.

Two lawyers filed the suit after testing four Indiana Hospitals with a records request. They say that none of the hospitals delivered their records promptly even though all the hospitals reported that they had done so.

Their statistics were extrapolated to other state hospitals to assume that they, too are not following through on patient records requests in a timely manner.

Also named in the lawsuit is records release vendor Ciox Health, which the plaintiffs say illegally profited from overcharging patients for their records in violation of anti-kickback laws.

Reader Comments

From Uncle Douger: “Re: HIStalk reporting bias. Have you looked at who is making those claims as article comments? I would be suspicious.” I will only say that those commenters claiming that I’m biased against any given company often use IP addresses owned by that same company. Today’s anti-journalism environment encourages anyone who doesn’t like particular facts to accuse those who present them of bias. There’s nothing I like more, however, than having my own opinion — when I actually state one — challenged and occasionally changed by rational and well-considered facts.

From Apple Alar: “Re: billion-dollar lawsuit against ECW. It’s interesting that it was filed as a class action suit rather than wrongful death / malpractice. The implications for setting a legal liability precedent for a vendor involving the content of the electronic health record would be game-changing. What about systems that send information to the EHR that is improperly presented there?” I don’t really know what to make of the lawsuit since the plaintiff made vague claims that her husband’s cancer wasn’t diagnosed because of EHR issues, but she wasn’t specific and didn’t name any doctors or hospitals as defendants. It also copied and pasted a lot of information from the DOJ’s settlement with ECW, which I took as an indication that it was a me-too claim hoping for a quick settlement from a company trying to distance itself from its $155 million payout. Attorney readers, what do you think?

From ExEpic: “Re: HIMSS compensation survey. They don’t even list Washington, DC as an option for the state or territory of residence.” I checked the survey and it asks, “In which state do you work?” in omitting DC but including an “Other US Territory” option.

HIStalk Announcements and Requests

I was reviewing the rehearsal of Thursday’s excellent webinar by PatientSafe Solutions and took note of the “wireless wellness” problem mentioned by both CIO presenters. It was a key lesson learned – every new application that would use the wireless network must be tested because some of them are poorly designed and could mess up other apps.

I like this brilliant quote as tweeted from a conference: “Palliative care is what all care would be like if we started over with healthcare.”

Webinars

November 30 (Thursday) 1:00 ET. “Making Clinical Communications Work in Your Complex Environment.” Sponsored by: PatientSafe Solutions. Presenters: Steve Shirley, VP/CIO, Parkview Medical Center; Richard Cruthirds, CIO, Peterson Health. Selecting, implementing, and managing a mobile clinical communications platform is a complex and sometimes painful undertaking. With multiple technologies, stakeholders, and disciplines involved, a comprehensive approach is required to ensure success. Hear two hospital CIOs share their first-hand experience, lessons learned, and demonstrated results from deploying an enterprise-wide mobile clinical communications solution.

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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

Acquisitions, Funding, Business, and Stock

The Boston business paper reports that while Athenahealth is selling its Bombardier Challenger 300 jet in a cost-cutting move, it will keep its second aircraft, a propeller-driven Pilatus PC-12. I was curious about the cost of the Challenger – $24 million new with an operating cost of $7,250 per hour.

UnitedHealth Group’s Optum launches a $250 million fund to invest in early-stage healthcare startups, including digital health. If you’ve started a crappy company that everybody else’s digital health fund has passed on, here’s your chance.

Bloomberg predicts a wave of bankruptcies involving hospitals and healthcare vendors in 2018, especially for disproportionate share hospitals whose funding has been cut.

Sales

The Clinical Radiologists radiology group chooses MModal for radiologist documentation, real-time physician documentation, business intelligence, critical test results management, and peer review and learning.

People

Athenahealth names Marc Levine (JDA Software Group) as CFO.

University Hospitals (OH) rehires Robert Eardley (Houston Methodist Hospitals) as CIO.

Vice-Admiral Raquel Bono, MD, MBA, director of the Defense Health Agency, accepts the HIMSS Federal Health IT Award.

John Halamka, MD will serve as editor-in-chief of the new open access, online journal Blockchain in Healthcare Today. Another site run by the same company runs ads, so I assume this one will, too.

Health coaching app vendor Farewell names former US Surgeon General Richard Carmona, MD, MPH to its board. He’s also a combat-decorated Vietnam veteran and a Special Forces medic who also earned an AA degree in nursing and accumulated many awards as a deputy sheriff and SWAT leader.

Patient engagement software vendor Relatient hires board director and venture capital operating partner Michele Perry as CEO.

Announcements and Implementations

TigerText announces TigerFlow Enterprise, a clinical communication and collaboration platform.

Unified clinical communications platform vendor Telmediq integrates the IPhone X’s Face ID authentication.

Privacy and Security

The University of Chicago student newspaper reviews the network log scans of its hospital, finding unsecured network printers that are being used to print PHI-containing forms that any hacker could theoretically access. They found Epic-issued print jobs containing organ donor information, diagnostic procedure reports, and prescription forms. The reporters also found Internet of Things devices such as cameras and sensors were accessible and sometimes controllable. In the all-too-common shoot the messenger scenario, the person who initially tipped off the reporters was identified during the university’s ensuing investigation and was “formally summoned to the Office of the Dean of Students.”

Precision medicine platform vendor LifeOmic offers customers a $1 million ransomware guarantee that covers “any financial extortion payment or service reimbursement.”

Other

A Medscape survey of 4,000 physicians finds that half have been sued for malpractice, noting that New York OB/GYNs pay nearly $200,000 per year in malpractice premiums. Sixty percent of doctors said they were either encouraged or required by their insurer to settle their case, with two-thirds of those resulting in payouts of less than $500,000. A surprising 62 percent of doctors said the outcome of the lawsuit against them was fair, but one-third of those sued said they no longer trust patients, treat them differently, or left the practice setting after the lawsuit. Three-fourths of doctors in general say the threat of malpractice influences their actions. Doctors say the best ways to discourage lawsuits include communicating more effectively with patients, screening cases for merit by a medical panel, capping non-economic damages, making the plaintiff responsible for paying the legal fees of both sides if they lose, and banning lawyers from taking cases on contingency.

An interesting graphic (click to enlarge) shows that Walmart is the largest private employer in 22 states, but also unintentionally illustrates that 12 states have a health system as their largest employer. Unlike Walmart, those systems are tax-exempt and create profits that often involve less-direct societal costs in the form of Medicare and Medicaid.

Facebook upgrades its AI tools to identify users who are expressing suicidal thoughts so they can be connected to first responders.

A Google Research Blog post says the company will work with Stanford researchers to understand how automatic speech recognition models can be used to transcribe physician notes, with a patient-consented pilot study looking at ways to reduce EHR interaction in capturing clinical information from conversations. It will use voice recognition technology from Google Assistant, Home, and Translate. A Google team just published “Speech Recognition for Medical Conversations.”

CNBC profiles Cedars-Sinai testing of AbStats, a stomach-attached wearable that analyzes bowel sounds to alert doctors that their post-op patients are capable of eating. The hospital is also testing the device to alert users that their stomach is empty so they eat only when it’s time. The inventor of AbStats is Brennan Spiegel, MD, MSHS, director of health services research at Cedars-Sinai.

A JAMIA-reported study finds that hospital Meaningful Use performance is associated with the EHR they use, with Epic users scoring higher in five of six criteria. The article – which is of the “let’s merge some government databases and see if we can find something to publish” type — duly notes that correlation does not necessarily indicate causation, as hospitals that use Epic, for example, might well have different resources and motivations than those that don’t. It also correctly notes that MU criteria have little to do with patient outcomes. In that regard, I don’t see one iota of usefulness in the study, especially since the information is hardly actionable even if valid. It also fails to note that presence of EHR functionality (as measured by certification) doesn’t do anything to meet hospital MU requirements — the hospital creates and actively enforces policies on EHR use (maybe Epic-using shops just press their doctors harder to chase MU targets). I’ve seen sites pushing sensationalistic headlines around this article and interpreting it wildly incorrectly, making it even worse and more like an Epic commercial.

A JAMA op-ed piece proposes – not very convincingly – the creation of a “medical virtualist” specialty, with the proposed required training including “webside manner,” competency in conducting virtual examinations, and including families in virtual visit. It’s not clear why those specific competencies should not be included in regular medical education or as a certificate (no different than learning to use a particular EHR) rather than carving out yet another self-serving, expensively maintained medical specialty.

The local paper notes that the CEO of Novant Health (NC) has had a 93 percent salary increase since 2012, with total 2016 compensation of $3.4 million. SVP/CIO Dave Garrett was paid $990,000.

Microsoft CEO Satya Nadella says in his new book that he learned empathy after the 1996 birth of his son, who has cerebral palsy:

On one of his son’s hospital ICU stays shortly after Satya Nadella became CEO, the Microsoft executive noticed how many devices in the room were running Windows and were connected to the cloud: “It was a stark reminder that our work at Microsoft transcended business, that it made life possible for a fragile young boy. It also brought a new level of gravity to the looming decisions back at the office on our cloud and Windows 10 upgrades. We’d better get this right, I remember thinking to myself.”

The surgeon treating the minor tongue condition of a five-year-old asks the mother if she wants her daughter’s ears pierced while she’s under anesthesia, so she says OK. The daughter leaves with a repaired tongue, a pair of earrings installed, and an extra $1,900 bill for “operating room services” that her insurer refused to pay. Children’s Hospital Colorado demanded that she either write a check or deal with its collections agency, but eventually waived the charge. Meanwhile, one of the piercings was off center and had to be redone at a mall kiosk, which set her back another $30.

Sponsor Updates

• Netsmart recognizes its employees in honor of Giving Tuesday.
• Ivenix will demonstrate its infusion system at the ASHP meeting in Orlando December 3-7.
• The Washington Stat Health Care Authority certifies consumer decision aids from Healthwise for knee osteoarthritis and hip arthritis.
• Nuance launches its AI Marketplace for Diagnostic Imaging.
• Change Healthcare will work with healthcare AI vendor Zebra Medical Vision to apply AI to radiology solutions
• Endpoint management software vendor Igel will integrate its product with Imprivata’s OneSign SSO after joint work at Parkview Medical Center (CO).
• AdvancedMD Cares makes 600 quilts for three Nashville charities during its Evo17 conference.
• The Boston Globe includes Definitive Healthcare in its list of Top Places to Work in Massachusetts for 2017.
• MModal extends its Speech Understanding technology to the PACS desktop in a unified workflow.
• Conduent Health publishes a new e-book, “Patients’ Attitudes Regarding Healthcare.”
• Forbes features Kyruus co-founder and CEO Graham Gardner, MD in its look at how AI and digital will shape the future.
• Arcadia Healthcare Solutions sponsors the Millenium Alliance Healthcare Payers Transformation December 7-8 in Nashville.
• Besler Consulting publishes an analysis of the 2018 OPPS Final Rule.
• Change Healthcare announces a strategic relationship with Google Cloud.
• ChartLogic publishes a new white paper, “Evaluating Your Next EHR’s Support.”
• CoverMyMeds will exhibit at the American Society of Health System Pharmacists Midyear Conference December 3-7 in Orlando.

Blog Posts

• Interface Error Management (Optimum Healthcare IT)
• How and why you should implement an antimicrobial stewardship program (Meditech)
• The Power of Unexpected Kindness (Access)
• #RSNA17: Happy birthday to you, Agfa HealthCare (Agfa HealthCare)
• The AWS re:Invent Ultimate Guide for Makers of Digital Health Products (Datica)
• Skilled Nursing Facility Incentive Helps Hospitals (CarePort)
• Learning About the LPN Job Description (CareSync)
• Improving Neoadjuvant Breast Cancer Therapy Rates Uptake with Education and Technology (Carevive)
• Part 1: Top 12 Strategies for a Successful Implementation (Casenet)
• Manage Resident Wandering – Sundown Syndrome and How it Affects Senior Care (Centrak)
• How to Avoid Penalties for 2017 MIPS Reporting Period (ChartLogic)
• Prepare for a Seasonal Increase in Prior Authorization Requests (CoverMyMeds)
• Salary History: What you can & can’t ask based on recent changes in laws across the country (Direct Consulting Associates)
• Value-Based Care: The Future of Healthcare (Diameter Health)
• How Analytics and Technology can Reduce Physician Burnout (Dimensional Insight)

Contacts

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

Morning Headlines 11/28/17

Two St. Joseph County hospitals accused of false claims, kickbacks

A $300 million lawsuit filed in Indiana alleges that 62 Indiana-based hospitals defrauded the government when they attested to Meaningful Use but, in practice, repeatedly failed to provide electronic copies of medical records to its patients within 3 business days.

Judge: 84-year-old doctor who doesn’t use computer can’t regain license

In New Hampshire, a judge rules that 84-yer-old Anna Konopka, MD cannot renew her medical license. She claims that state regulators forced her to give up her license over her unwillingness to use a computer and, as a result, her inability to comply with the state’s mandatory PDMP policies.

Prediction of Acute Kidney Injury with a Machine Learning Algorithm using Electronic Health Record Data

An AI algorithm designed to detect early onset of acute kidney injury outperforms current detection protocols, leading researchers to conclude that a “machine-learning-based AKI prediction tool may offer important prognostic capabilities for determining which patients are likely to suffer AKI.”

Rotunda Hospital Officially Moves Away From Paper-Based Records

Dublin-based Rotunda Hospital, the oldest continuously operating maternity hospital in the world, goes live on Cerner, replacing paper-based workflows.

Curbside Consult with Dr. Jayne 11/27/17

Conventional wisdom dictates that healthcare IT projects shouldn’t schedule a go-live on a holiday weekend due to resource constraints and time off. I was called by another consulting company to see if we could provide some go-live support resources for a hospital that decided to break the mold. Although our focus is largely ambulatory healthcare IT, I work with people who have extensive experience with both inpatient and outpatient systems, so I decided to bite. Especially with it being a holiday situation, the pay being offered was definitely attention-grabbing.

My consultants have been prepping for this for several weeks, viewing recordings of the hospital’s training sessions so they could see exactly how the system was configured and how the users had been trained to use the system. This is important when you’re a third-party go-live resource. Often clients elect not to deploy part of a system or to modify the functionality, which can result in issues when you suggest that the end users access a feature they can’t actually use. Ensuring your go-live contractors understand how the system is actually going to be deployed is a key responsibility for client leaders who decide to outsource their Day 1 support. I’ve seen this overlooked in the past and have learned to insist on it when my team is involved.

The videos were thorough. Nursing staff received about 16 hours of training, including some overlap into the provider workflows so that they could assist with supporting community physicians who may not use the system as frequently as hospitalists and other full-time inpatient providers. Physicians were supposed to attend about eight hours of training, and although they were required to be at both half-day sessions, I received report that there wasn’t a lot of enforcement of participation or a required demonstration of mastery before they would be issued their production passwords.

We were warned to be able to support specific providers more heavily than others and were given their names and specialties and typical rounding times. I haven’t experienced that in the past – usually resources are assigned to a particular nursing unit or another location where provider documentation takes place and are expected to just help people on the fly. This was the first time I had a “hit list” of people who might have issues and I thought it was a great idea.

Since the original consultancy was responsible for the communication with the hospital, they arranged all the logistics for who would be stationed at various parts of the hospital and made sure they had a mix of contract resources at the larger care delivery areas. I’ve seen this split out before, where one subcontractor would cover this floor, another would cover the next, and so on. I thought their mixing of the resources across the various units was a great way to hedge their bets, especially since they knew there may be some resource challenges with it being a holiday weekend.

Still, everyone was a bit nervous going into things, since you never know what a Thanksgiving weekend might bring. Typically, physician offices are closed the Friday after, which shifts volumes to the emergency department. There may be a lull on Saturday and then it usually picks up again as people who were trying to wait until Monday decide they can’t wait anymore.

Of course, there’s also the Holiday Heart Syndrome, which can lead to cardiac irregularities when people overdo it during the Thanksgiving and Christmas eating seasons. Sometimes non-healthcare people are surprised when we talk about these kinds of volumes and trends in planning and people casually throw out their stories of being in the emergency department or working urgent care during major days off.

My best story was working on labor and delivery on Super Bowl Sunday as a resident. Within 45 minutes of the end of the game, we were swamped, with all 19 labor rooms full and overflow into the antepartum unit. Women had remained laboring at home so as to not disturb viewing of the game, then headed right to the hospital as the clock ticked down. Several babies were born within 30 minutes of arriving at the hospital, which is cutting it close if you were planning for epidural anesthesia or using the birthing pool. I had volunteered to work that day since I wasn’t a huge football fan and didn’t have other plans, but made a point to mark my calendar for the next two years so that I didn’t experience that level of back-to-back deliveries again.

Our go-live officially occurred on Friday morning while many people were out doing their Black Friday shopping or spending time with families. There were no elective surgeries scheduled and very few outpatient procedures, providing an overall reduced volume through the hospital. I suspect there had been more than a few “early” discharges for patients who didn’t want to be in the hospital for Thanksgiving, either opting for skilled nursing or home health as a way to leave the wards early. Patients rarely want to spend a holiday in the hospital, so I’m sure the insurance folks were happy. Based on some of the admissions I saw on Friday, there may have been a few people who went home too early, which of course isn’t good for those readmission metrics.

Friday was largely uneventful, with most of the staff being full-time hospital employees and seeming to have been fully present for their training. The community physicians started rounding again on Saturday, but were scattered throughout the morning and early afternoon, making support easy. From an at-the-elbow perspective, we were relatively redundant, but it was good to have multiple people ready to pitch in should the need arise. Assuming budget permits, I’d always rather it be that way then having physicians fighting for someone to help them. Sunday was much of the same, although some different hospitalists rolled in to start seeing patients since their work weeks run Sunday through Sunday. Many of the hospitalists have worked on multiple systems, so this was barely a blip for them.

I headed out Sunday night, leaving a couple of my consultants to help with targeted support for the community physicians on Monday. This is of course where the rubber meets the proverbial road, where providers who may not have been as invested in training as they could have been start arriving on the floors and taking care of patients. The hospital had some great cheat sheets deployed to the workstations both in paper and electronic form, not to mention the go-live contractors, who will be on site in full force Monday through Wednesday wearing their hot pink tee shirts so users can find them. They’ll start tapering off after that, with the hospital planning to support with only internal resources starting Week 3.

I haven’t personally staffed a hospital go-live in some time, so it was a nice experience, and doubly so being at a place where things were over-orchestrated to the point that they were uneventful. Not every go live is like that, for certain. We’ll see if my team has any good stories to share later in the week, but I would love to hear some go-live stories from the trenches.

Have a good story? Leave a comment or email me.

Email Dr. Jayne.