Monday Morning Update 2/19/18

Top News

Thursday’s meeting of the House Committee on Veterans’ Affairs covered the VA’s FY2019 budget request. Health IT-related topics:

• Committee members fretted about the appearance of privatizing of the VA in giving veterans an option to turn to community providers for timely care, the VA’s cost of which has risen dramatically with higher usage.
• Rep. Phil Roe, MD (R-TN) said the value of the Cerner contract alone in the VA’s EHR project will be $10 billion, not including infrastructure and VistA maintenance costs.
• Rep. Roe questioned whether it will ever be possible to turn VistA off. He thinks it will need to run for many years for looking up information that can’t be converted to Cerner.
• Rep. Roe said, “It is unthinkable that the VA could potentially spend billions of dollars on a project that doesn’t substantially increase the department’s ability to share information with DoD or community providers.”
• VA Secretary David Shulkin said the VA doesn’t have an EHR, it has VistA, which he says is instead “130 electronic records,” referring to the “different parts of VistA.”
• Sec. Shulkin said he paused the project to make sure that the VA can exchange information with community providers, as 36 percent of veterans are getting care in the community. He said the American healthcare system hasn’t yet figured out interoperability, but the VA can lead the way.
• Rep. Jim Banks (R-IN) questioned the rollout of a scheduling system given that the pending Cerner project has “run into trouble.” Sec. Shulkin said the VA’s Epic scheduling project (MASS) pilot will go live in Columbus, OH in March and the VA is looking forward to seeing how it works. Commercial scheduling products are being tested at three other sites.

Reader Comments

From Ticklish: “Re: opioid crisis. This article says it’s caused by a lack of interoperability. Think so?” Of course not. Short-sighted healthcare people forget that prescribed, FDA-approved opioid drugs make up just part of the available smorgasbord of narcotics, and in fact, their higher cost and reduced availability is pushing users to cheaper, more easily obtained forms that doctors and hospitals don’t control. I’m not convinced that anything can stop the use of drugs by determined people, but if there is a magic bullet, I’m certain it isn’t prescription databases, cracking down on supply, or mass incarceration. And while everybody was focusing on Oxycontin, crystal meth usage has returned with a vengeance lately with purer, cheaper product available everywhere, so now there’s that massive scourge to deal with again. Our real problem is that a huge chunk of our society (one in seven, according to the Surgeon General) finds living in an un-medicated state intolerable, apparently not really caring whether their minds are altered by depressants (including alcohol), stimulants, or both. That massive demand and the associated profit will assure a steady supply that can’t be stopped, even by admirably trying to contain opiate over-prescribing.

HIStalk Announcements and Requests

Digital health apps already have challenges with proving their worth, but here’s another problem: half of poll respondents – presumably most of them being health IT experts — wouldn’t be happy at having an app prescribed instead of a medication. Maybe the unstated problem is that the mental picture of a “digital health app” is a patient portal, activity tracker, or record-keeping system instead of an FDA-approved treatment that delivers proven outcomes.

New poll to your right or here, as suggested by a reader: What impact would a job candidate’s CPHIMS credential have on your hiring decision? Long-time readers may remember that I asked this same poll question way back in 2009 and 2010.

Readers weighed in on “What I Wish I’d Known Before … Going to my First HIMSS Conference as an Exhibitor.” This week’s question: what do you wish you’d known before taking a travel-heavy job?

Welcome to new HIStalk Platinum Sponsor Wolters Kluwer Health. Every health professional knows their medical evidence and technology brands – Lippincott, Ovid, UpToDate, Medi-Span, Health Language, PharmacyOne Source, and Emmi. Those products deliver clarity when and where it’s needed most, driving better care decisions and consistent outcomes across the care continuum. Its “Eyes Wide Open” report provides practical ways to improve healthcare delivery and outcomes. Thanks to Wolters Kluwer Health for supporting HIStalk.

Listening: new from Superchunk, angry protest poetry cloaked in masterfully crafted indie punk-pop. The Chapel Hill, NC band has never lost its relevance or fierce independence, and to my ears, has never sounded better. I saw their frenetic but somehow simultaneously laid back show live awhile back and was most struck by a fan’s shouted request for some non-Superchunk song, with the laughing reply of guitarist Jim Wilbur being, “Mac [McCaughan] won’t sing any lyrics he didn’t write, so that’s not going to happen.” That’s admirable.

Webinars

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

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call following mostly good results that were marred by much lighter bookings than analysts expected, sending shares down 7 percent Friday:

• President Rick Poulton touted the company’s acquisition of McKesson’s EIS business and Practice Fusion, saying that they give the company hundreds of new client relationships; fill several EHR portfolio gaps; create a large, actionable patient data set that life sciences and payer companies will pay for as they did under Practice Fusion; and add $300 million in annual recurring revenue, all for a net investment of $50 million.
• The sales cycle is lengthening and customers are looking harder at return on investment.
• End-of-life of the former McKesson Horizon Clinicals and Series 2000 product lines is March 31.
• The company is pitching its DbMotion to the VA as it transitions over several years to Cerner or whatever vendor it chooses.
• Allscripts declined to say how much Hyland Software is paying for the former McKesson OneContent content management business, but the Allscripts SEC filing seems to indicate $260 million plus assumption of certain liabilities minus other financial adjustments.

FDA approves the marketing of Viz.AI’s AI-powered CT scan analysis to notify providers quickly of a possible patient stroke for direct intervention.

Adventist Health hospitals in California will shift 1,200 IT and revenue cycle employees to Cerner, according to layoff notices filed with the state.

Sales

Presence Health (IL) chooses R1 for RCM services and will transfer 1,000 of its employees to the company.

Decisions

• St. Charles Prineville Hospital (OR) will go live on Epic in April 2018.
• Lake Forest Hospital (IL) will go live on Epic on March 3, 2018.
• McLaren Oakland (MI) will go live on Cerner in late 2018 or early 2019.

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

Orlando Health (FL) hires Novlet Mattis (Ascension Information Services) as CIO. She replaces Rick Schooler, who retired in September 2017.

Announcements and Implementations

Hartford HealthCare (CT) reports that its use of Stanson Health’s clinical decision support prevented 250 unnecessary transfusions in 45 days, providing an annualized $1 million in savings.

Columbia Basin Health Association (WA) goes live on Versus Advantages RTLS patient flow solution in its new outpatient clinic.

Research network TriNetX develops an algorithm that can deduce the line of chemotherapy treatment a patient is undergoing, helping biopharmaceutical researchers develop new therapies. 

Privacy and Security

A security researcher reports a SQL injection vulnerability in Epic’s MyChart, also noting that Epic was “quick to respond to contact and patch the vulnerability.” That’s commendable – software vendors rarely behave nicely (and often threateningly) toward strangers who are nice enough to warn them of security flaws in their products. I don’t know how Epic notifies customers and distributes the patch, but I assume it will be quick now that any interested hacker could theoretically exploit it. For non-techies, SQL injection is an old hacker’s method in which they paste an SQL statement into a web page input field – such as name or city – that the web page then executes, giving the hacker access to the underlying database (read, update, delete) without having to pass through the site’s authentication.

Other

The CEO of Medical Center Health (TX) tells the board that its Cerner implementation is one of the organization’s most pressing issues, explaining, “This was an attempt to find an ideal system. That is not a possibility. There is no ideal electronic medical system.” He says he’s worked at hospitals that use Meditech and Epic and those products have the same problems. He says Cerner blamed hospital clinicians and administrators – “pretty much everyone except themselves” – for not implementing the system correctly, but says the hospital and vendor are now working together and Cerner is providing consultants at no charge. The hospital expects the implementation to come in at $47 million, $7 million under budget.

The financially struggling, 47-bed Holy Cross Hospital (NM) says its problems are due to a problematic software rollout, its conversion to a critical access fee structure, Medicaid payment delays, and a lawsuit judgment that raised its malpractice insurance by $600,000. The hospital didn’t name the system, but they started conversion from Meditech Magic to CPSI Evident last fall. The CEO said in his presentation to county commissioners last week that he should have delayed the October 1 go-live, but realized that many of the 100 on-site vendor support staff would be unavailable for a later date. He also says he regrets conducting the critical access switch and EMR conversion nearly simultaneously, but the hospital’s underlying financial problems were in place long before either.

A Miami pediatric surgeon is charged with unlawfully accessing a computer when his former girlfriend finds out that, while they were dating, he logged in thousands of times to the streaming video feed from her in-home security cameras using hospital computers. He says she gave him the password, he was just checking into her well-being, the two cameras were not the bedroom, and she didn’t complain until they broke up and he declined to pay her the $400,000 she demanded.

I like seeing a rare non-stuffy, HIMSS-related vendor press release. Cybersecurity services provider Lunarline says it is “planning for a wild HIMSS 2018,” explaining that, “Our sales team somehow convinced the conference organizers to let us serve beer at our booth. Because, you know, there is never enough alcohol in Vegas.” The company’s website is mostly dry and unremarkable, but a few glimmers of wit shine through.

Sponsor Updates

Blog Posts

• Five Provider Wins from Installing Cupid (Optimum Healthcare IT)
• 5 ways hospitals can improve stroke outcomes (Meditech)
• HIMSS18 Parties You Don’t Want to Miss (Redox)
• 5 Copy Editing Tips Every Content Marketer Needs to Know (Salesforce)
• 5 Ways Hospitals Can Lower Claim Denial Rates (The SSI Group)
• The Healthcare Fax of Life (Summit Healthcare)
• A stitch in time. (Voalte)

Contacts

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

What I Wish I’d Known Before … Going to my First HIMSS Conference as an Exhibitor

I knew HIMSS was a big conference, but I didn’t realize that the impact would be that it is just hard to move around and accomplish a lot. You never really get to see the whole exhibit floor or do a lot of things because it just take so long to get there. Food lines are long, there’s no place to sit. It’s a complete workout. The startup pavilion has some of the more interesting companies and the big vendor booths are very impersonal. Then, when it is all over, you wonder what you really accomplished or learned and if it was worth all the trouble.

Wear really, truly comfortable shoes.

That my exhibitor badge gets me into educational sessions as well. Someone more experienced at these events helped guide me in finding helpful sessions for my area of expertise.

Very long hours on your feet. I have a pair of super supportive shoes I call “my HIMSS shoes” and I am never without them.

HIMSS is all about making and strengthening business relationships. But on the floor, you literally have about 30 seconds to get someone’s attention and earn the right to have a meaningful conversation.

As an exhibitor, it can devolve into a party atmosphere, quickly. Pace yourself.

Wear comfortable, not necessarily stylish, shoes.

Wear comfortable shoes!

The exhibit hall is like the Caribbean, full of ports (booths) and buyers are like cruise ship passengers. The enthusiasm doesn’t always stick once they get home and visitors will confuse ports/vendors. Give them something memorable (in good way) and be prepared to present again after HIMSS if you want them to truly remember anything you showed them.

Be careful about scheduling meetings first thing in the morning after the first day. Last day first or last are the worst times for any real business to happen.

Stop at two drinks. Period. It’s possible, even likely, that key people in the industry are around you at all times, even 1 a.m. in the hotel bar. Remember that this is your career and you’re making an impression even after exhibit hours are done.

Make reservations for every anticipated meal, even if for two people, as everything will be packed. And, if invited to a meal by a vendor, verify that that vendor has a reservation inclusive of all invited attendees. I attended a breakfast at a previous HIMSS with a vendor where the rep from the vendor did not make reservations for an intolerably crowded joint and eight executives huddled around a bar-height bistro table for two in the hallway of the casino discussing the strategic direction of our partnership.

How your message gets lost in the noise and the value proposition is questionable, unless you are one of the larger vendors.

The amount of time you will be on your feet. I have HIMSS shoes, comfortable, dressy shoes half a size too big with the most cushioning insoles I could find and hiking socks.

Establish scheduled meetings before or during HIMSS if you are looking to sell (vs. touch current customers, develop business development relationships, or perpetuate your brand). It is not worth pulling anyone off the floor to learn about your product anymore since, unlike in the early days, most of the folks walking the floor are fellow vendors.

HIMSS is in a conference that companies in the healthcare information technology industry must attend even, if the value for doing so is minimal. Pulling out is a public red flag that there is a problem or at least a big change in the company. So we go and represent with minimal expectation of value, but it can be fun for the team selected to the representing.

Weekender 2/16/18

Weekly News Recap

• Drug maker Roche pays $1.9 billion to acquire oncology EHR and precision medicine vendor Flatiron Health, started just a few years ago by two guys in their 20s who were backed by Google Ventures (now Alphabet).
• Nokia will conduct a strategic review of its digital health business, which it formed just two years ago by acquiring connected health hardware vendor for $212 million, after which it wrote down most of the cost.
• Fitbit acquires app-powered health coaching vendor Twine Health with intentions of moving into chronic care management.
• HHS’s budget request would cut ONC’s budget from $60 million to $38 million, while HHS OCR would see its budget reduced by 20 percent.
• The White House’s proposed budget would give the VA an initial $1.2 billion to implement Cerner.
• The VA says Cerner passed an external interoperability review, with contract signing expected by the end of February.
• American Academy of Family Physicians gives HHS and ONC a list of specific actions it would like to see to reduce the health IT burdens of clinicians.
• CPSI takes a $28 million impairment charge due to poor revenue and high development costs of its acquired American HealthTech post-acute care product.

Best Reader Comments

A price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR sounds easy enough, but when I think of the frequent changes of PBM pricing and insurance formularies being integrated and updated in the EHRs, not to mention try to envision the extra time this would take the providers (doctors and/or nurses) to review that and discuss with the patient, I just see more time spent in the visit, not less. I’m trying to imagine my aging parent having that conversation with the doctor. (My Two Cents)

Doctors didn’t spend six years in medical school to learn how to help their patients find the cheapest pharmacy. Of course there should be transparency in pricing. But let’s not waste physicians’ time by putting more administrative work on their plates. (Debtor)

This approach – company running its own health programs — has been tried a dozen times before going back to the 1940s. They’ve even run their own clinics, hired own docs, etc. Doesn’t change much. The real irony is that the problem started when companies gave health care as a fringe bene to avoid wage increases and kept expanding benes year after year. Came back to bite’m hard. The only way a company today can really reduce health care costs is to deny expensive procedures to their employees (using whatever excuse they can come up with…same way HMOs do it). And based on 50 years of experience, I doubt they have the fortitude to do that. (HIS Junkie)

it is much easier for the President/CEO/Board to make high level, structural changes to an organization. Moves like M&A or even divestitures. Those organizational changes can be done over a timeframe of months. Restructuring the internal support systems to reflect the new organizational structure typically takes several years. Not that I’m complaining! Those C-level org changes give you a clear mandate and direction for where your business IT systems need to go. And there’s a deep well of work to be fulfilled in order to get there. However this also means that IT can fall far behind the curve of what the organization needs. (Brian Too)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. N in New York, who asked for STEM books, supplies, and take-home lab kits for her middle schoolers. She reports, “My students’ faces lit up when I showed them the materials and they could not believe that they would be able to take them home! They wanted to use the materials immediately and could not put the books down. Since the kits are in such high demand, I use a raffle system to distribute them every Friday. Students can keep the kits from Friday to Friday and they will also be used in class on Friday afternoons. This way, more students can benefit from the resources, At the end of the day each Friday, the kits will go home with different students. Thank you for supporting science education outside of the classroom. My students and I are extremely grateful and fortunate to receive funding for our Mobile Science Labs.”

I’ve been overwhelmed with LinkedIn-powered cognitive dissonance lately as I try to reconcile self-stroking descriptions of prior job performance with associated short tenures. Could a person really have driven a gazillion dollars’ worth of new sales, massively improved a product or service, or masterminded the creation of endless synergies, all in a short time? And if so, how did their former employer not collapse completely after the devastating loss of such a key employee? I’m extra suspicious when the follow-up to their lustrous performance was either extended unemployment or independent, non-specific “consulting,” suggesting that their claims aren’t surviving close examination by prospective employers.

This is smart: Wisconsin biohealth industry advocate BioForward awards seven “scholarships” that will help selected Wisconsin health IT companies cover the cost of attending HIMSS18 to make business connections. The winners are Yahara Software, Ancilla Partners, Healthio, Alithias, Spaulding Medical, Wellbe, and Physician Compass.

A reader ran across a year-old AMIA promotional video, which he or she describes as, “nothing but stock video clips string together almost at random, like it was made by an intern or new graduate hired right into the marketing department who knows nothing about the field of informatics.” It’s tough to try to explain informatics with a video, but this one is really puzzling – watch it with sound off and try to figure out why clips of someone staring at a mountain, flipping book pages in a meeting, and hugging a returning soldier in the airport would add value to the narrative that describes informatics. I blame the ever-increasing tendency of lazy readers to require pictures – even obviously irrelevant or gratuitous ones – before they will begrudgingly read or listen to a few words. Your local TV news is a good example, featuring meaningless video recycled from old stories and talking heads who were hired for looks instead of brains talking “on the scene” in front of a darkened building where a crime occurred 12 hours before.

Athenahealth’s investor presentation from this week includes a photo of company leadership, raising the obvious question: where de women at? It looks a fraternity’s yearbook photo. They have two females on their 11-member board, but otherwise, it’s all testosterone-powered. Allscripts has one woman on its seven-member executive team and zero of nine on its board. EClinicalWorks doesn’t list its executives. Cerner has two female executives of 10 and two of 10 on its board. Meditech has five females among its 12 executives, clearly a frontrunner in declining to create a no-girls-allowed treehouse. 

The Houston newspaper covers a Walmart program that sends employees who have specific, serious conditions to hospitals such as Memorial Hermann and Johns Hopkins for treatment that the company pays for entirely as a single, bundled payment. Interestingly, 40 percent of those sent to Memorial Hermann turn out to not need the surgery they were told by their local doctor or hospital that they had to have, raising the possibility of widespread inaccurate diagnosis or overtreatment.

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This is exciting and seemingly mostly overlooked. SpaceX’s Falcon 9 launch Saturday will carry two satellites that will allow the company to test the feasibility of offering Starlink global, satellite-powered broadband service. The satellites will be placed in a 300-mile low Earth orbit that allow offering gigabit-level service with latency of only 25 milliseconds vs. the long round trip (600 milliseconds) and thus slow service provided by current Hughes satellites orbiting at 22,000 miles. The Starlink plan, which calls for nearly 12,000 connected satellites, was approved by the FCC this week. Ponder both the business and societal benefit of fast, globally available, and cheap broadband service. It’s especially important, now that the FCC has killed net neutrality, to give consumers broadband alternatives that don’t involve digging up streets to lay cable. 

In Case You Missed It

• News 2/16/18
• EPtalk by Dr. Jayne 2/15/18
• HIStalk Interviews Curtis Watkins, CEO, Parallon Technology Solutions
• Readers Write: It’s Time for Drug Price Transparency
• HIStalk Interviews Bruce Cerullo, CEO, Nordic
• News 2/14/18
• HIStalk Interviews Michael Barbouche, CEO, Forward Health Group
• Curbside Consult with Dr. Jayne 2/12/18
• HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health
• Monday Morning Update 2/12/18
• Readers Write: In Defense of Bob Dolin
• What I Wish I’d Known Before … Taking a Job Selling Software to Hospitals or Practices

Get Involved

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

Morning Headlines 2/16/18

Alphabet-backed Flatiron Health is being acquired by Roche

Drug maker Roche will acquire oncology EHR and personalized medicine vendor Flatiron Health for $1.9 billion in cash, giving the company a $2.1 billion valuation that includes Roche’s previous investment in it.

Allscripts to sell OneContent business to Hyland

Allscripts will sell the OneContent document management software business it acquired as part of McKesson EIS to Hyland Software for undisclosed terms.

Nokia announces strategic review of its Digital Health business

Nokia conducts a strategic review of its digital health business just two years after it created it by acquiring connected health hardware vendor Withings for $212 million.

News 2/16/18

Top News

Drug maker Roche will acquire oncology EHR and personalized medicine vendor Flatiron Health for a $1.9 billion in cash, valuing the company at $2.1 billion including Roche’s previous investment in it.

Flatiron had raised $313 million in three funding rounds from 2013 to 2016. The company was valued at $1.2 billion just two years ago.

Nat Turner and Zach Weinberg started the company in 2012 after selling their previous advertising technology company to Google for $70 million. Google Ventures, now Alphabet, invested $130 million in Flatiron Health in May 2014. The founders graduated from The Wharton School’s undergraduate program in 2008, which would make them around 32 years old.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Loyale Healthcare. The Lafayette, CA-based company– founded in 1990 as CashNet – helps make a patient’s financial experience as positive as their clinical experience. That’s especially important as patients become responsible for a bigger portion of their healthcare costs. The company’s predictive analytics and behavioral indicators create personalized patient financial plans and workflows that allow providers to conduct honest conversations about treatment costs and payment responsibility. Patients appreciate getting the transparency and support they need to feel in control, while provides are taking the cue of successful retailers who recognize that their most valuable asset is their customer relationships. They can increase revenue, decrease staff time, and minimize bad debt while providing personalization that optimizes affordability and collections. Loyale’s patient relationship portal provides balance notification, combined statements, 24/7 self-service, online payments, and secure digital communication. Its platform applies KPIs, best practices, red flags, and analysis of patient sentiment and behavior while integrating with all leading systems. Thanks to Loyale Healthcare for supporting HIStalk.    

Here’s a just-released Loyale Healthcare explainer video.

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Allscripts reports Q4 results: revenue up 22 percent, EPS $0.18 vs. $0.14, meeting earnings expectations and beating on earnings. Bookings fell far short of expectations, however, sending shares down in early after-hours trading Thursday. The company announced that it will sell the OneContent document management software business it acquired as part of McKesson EIS to Hyland Software for undisclosed terms.

Nokia announces that it is conducting a strategic review of its digital health business just two years after it created it by acquiring connected health hardware vendor Withings for $212 million. Nokia had already written down $164 million worth of goodwill related to the business in October 2017.

The Chartis Group acquires Atlanta-based consulting firm Oncology Solutions for an undisclosed sum.

Ellkay relocates to larger office space in Elmwood Park, NJ that will accommodate up to 500 employees.

Rehab therapy software vendor WebPT acquires billing and collections company BMS Practice Solutions.

Aetna defends its medical review practices following the publication of quotes from the testimony of a former medical director who said he never reviewed patient records in making coverage decision. Aetna says:

• The story was pushed by a former patient who is suing Aetna and was “conveniently” published just days before the trial was scheduled to begin.
• The medical director said in a sworn statement that he always reviewed the relevant portions of medical records, nurse summaries, notes, and the company’s Clinical Policy Bulletins.
• Aetna has paid for all of the $20,000-per-dose treatments of the patient who is suing them. That person remains an Aetna member. The only treatment interruption he experienced happened because he refused to provide blood work ordered by his doctor.

Government and Politics

A federal judge rules that the DOJ can move forward with a lawsuit against UnitedHealth that claims the payer bilked Medicare out of $1.4 billion by submitting invalid diagnostic data for Medicare Advantage plan members.

Innovation and Research

A retrospective study shows that patients who used Glytec’s Glucommander Outpatient insulin therapy management tool and self-tested blood glucose levels twice a day saw better outcomes, including a 3 percent reduction in A1c levels, than those who did not.

Other

An Allscripts client newsletter says the company’s counsel has concluded that its practice customers do not need to notify patients or OCR following its January ransomware attack.

EClinicalWorks posts a nicely done video that describes the work of Petaluma Health Center (CA) during the Northern California wildfires of October 2017.

Sponsor Updates

• AltaPointe Health (AL) adopts the Carequality framework via its Netsmart EHR.
• TeleHealth Services will deliver Healthwise’s patient education videos through its patient engagement platform.
• Medecision looks back on a successful 2017.
• Elsevier collaborates with the VHL Alliance to offer content on Von Hippel-Lindau disease at PracticeUpdate.com.
• EClinicalWorks customer Petaluma Health Center (CA) wins the 2017 HIMSS Davies Award for improving hypertension control among its patients.
• Healthwise will exhibit at the West ACE User Group Conference February 21-23 in San Diego.
• Ingenious Med publishes a new white paper, “Five Guide Posts for Transforming Health Care Systems.”
• Independent reviewer G2 Crowd names the Liaison Technologies Alloy Platform an Integration Platform as a Service Leader.
• Vyne adds new features, including a Web portal, to its FastAttach electronic claim attachment software.
• Definitive Healthcare welcomes its 1,500^th customer.
• The Obix Perinatal System  of Clinical Computer Systems, Inc. earns ONC 2015 Edition Health IT Module certification. 

Blog Posts

• The Trusted Exchange Framework and Common Agreement (Medicity)
• Revenue Cycle Optimization: 3 Benefits of Collecting Payments Upfront (The HCI Group)
• How to Meet Stricter Patient Privacy Policies with Fewer Resources (Iatric Systems)
• Imprivata – One Team in 2018 (Imprivata)
• Get to Know Your Facebook Audience (Influence Health)
• Buried in Member Inquiries Right Now? Wellness Programs Won’t Work (InstaMed)
• Kubernetes Vs. AWS ECS Vs. Docker Swarm Vs. Serverless (LogicWorks)
• CMS change to Medical Student Documentation Allowance (Effective March 5, 2018) (MedData)
• 5 ways hospitals can improve stroke outcomes (Meditech)
• Future-Proofing Your CC&C Implementation (Mobile Heartbeat)
• Do Your Patients Love Your Billing Process? (Navicure)
• Recruiting and Retaining Staff for Success (Netsmart)
• Better Integration Begets Better Healthcare at Lower Cost (Leidos Health)
• How one Nordic consultant helps serve Texas’ homeless population (Nordic)
• The Indispensable Document for the Modern Manager (PatientPing)

Contacts

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

EPtalk by Dr. Jayne 2/15/18

Lots of people are catching Olympic Fever. I’d much rather see that in the community than influenza. I’ve been catching some figure skating and snowboarding on the TVs in the patient rooms, which I much prefer to the omnipresent HGTV.

This Winter Games marks the debut of GE’s Athlete Management Solution, which sounds like a cross between an EHR and a clinical data repository with a side of SNOMED. GE Healthcare’s CTO noted, “Olympians train for many years to represent their nations at the games. Their Herculean efforts must be matched with superhuman clinical speed and quality.” I’d like to see some superhuman clinical speed in my own EHR, but would settle for seeing what GE has in store for both these games and those upcoming in Tokyo in 2020. If any readers are at GE, let me know if you can refer your favorite anonymous blogger for a demo.

Gallup and Sharecare recently released the “2017 State Well-Being” rankings. I’m not surprised that well-being is on the decline given the political turmoil we’re exposed to on a daily basis along with the pressures of social media and an unpredictable economy. No states showed a statistically significant improvement in the score, and 21 states experienced decreased well-being. The declines were driven by decreased numbers in social well-being and purpose along with the mental health aspects of physical well-being. The highest score was South Dakota with a 64.1 out of 100, followed by Vermont at 64.09. Louisiana and West Virginia rounded out the bottom. I’ll be taking a trip to the latter next summer and will let you know if the beauty of the New River Gorge improves my wellness and sense of purpose.

A reader asked me to further clarify my recent Curbside Consult comments regarding information blocking. In my travels, I frequently encounter major health systems that are guilty of information blocking, throwing up barriers in the way of patients who want to share their information. Examples include telling patients that outside physicians aren’t in the EHR directory for sharing records, refusing to send records by Direct protocol, citing HIPAA as a reason for not sending records to a consulting physician, failing to release specifically requested portions of the record, and downplaying the known interoperability features of their respective systems. Unaffiliated (read independent) providers are blocked from accessing clinical data repositories unless they sign cross-marketing agreements.

People are quick to blame EHR vendors for so-called information blocking, but in my experience, there are plenty of tools available but too many policies and procedures that discourage their use. I guess the theory is that if you make it harder for an independent consulting physician to receive your patient’s data, maybe the patient will be frustrated and choose an employed physician who documents on the shared hospital EHR, therefore solidifying the hospital’s market share.

Failing to accept labs sent from “outside providers” because of perceived compatibility issues and forcing patients to endure duplicate tests is also something I’m seeing more and more of as well. I’m proud to be an independent provider, but given my history in the world of big healthcare, I wish we could all just get along and put the patient at the center of what we do.

The Medicare Quality Payment Program attestation season is in full swing, with practices starting to realize that perhaps they weren’t as prepared as they thought. Organizations have until March 31 to submit their data for the 2017 calendar year reporting period. I’ve already gotten a couple of calls from organizations asking me to do the EHR equivalent of cooking the books, claiming that providers had the right information but just documented it in the wrong place in the EHR or maybe documented it incompletely. We’re 45 days into the new calendar year and I’m not about to manipulate someone’s database regardless of how well-intentioned they act or how much they beg.

The bottom line is that practices need to be monitoring their providers and their respective documentation habits (or lack thereof) throughout the year and catching problems early enough so that a mitigation plan can make a difference. I’ve had a couple of practices complain that their vendor didn’t have their 2017 measures packages ready at the beginning of the year, so they had nothing to run. I remind them that they could have kept running the 2016 packages to at least get an idea of the numbers since some of the measures didn’t change much, or that they can always create their own reports or use a third party to create interim reports. I know there are consultants out there that will help these clients massage their data, but I’m not eager to become one of them.

I spent Valentine’s Day with the good folks at the Marriott, but at least I had some time to read #healthpolicyvalentines and feel the love. This one from California ACEP is my favorite. I also want to give a shout out to Alexander Gaffney @AlecGaffney for sharing the best FDA labeling letter ever:

Misbranded Food:

• Your Nashoba Granola and Whole Wheat Bread (wholesale and retail) products are misbranded within the meaning of section 403(i)(2) of the Act [21 U.S.C. § 343(i)(2)] because they are fabricated from two or more ingredients, but the labels fail to bear a complete list of all the ingredients by common or usual name in descending order of predominance by weight as well as all sub-ingredients, as required by 21 CFR 101.4. For example,
• Your Nashoba Granola label lists ingredient “Love.” Ingredients required to be declared on the label or labeling of food must be listed by their common or usual name [21 CFR 101.4(a)(1). “Love” is not a common or usual name of an ingredient, and is considered to be intervening material because it is not part of the common or usual name of the ingredient.

There you have it, folks. Beware of foodstuffs made with love! In other news, chocolate is under scrutiny for its purported health benefits, with critics alleging bias through industry-funded studies. I see their point, but I do know that dark chocolate makes me smile, so I’m counting on it to help raise my personal well-being index.

Email Dr. Jayne.

HIStalk Interviews Curtis Watkins, CEO, Parallon Technology Solutions

Curtis Watkins is president and CEO of Parallon Technology Solutions of Nashville, TN.

Tell me about yourself and the company.

I’ve been in the healthcare IT industry since 1998 as a hospital IT director, vice-president of large corporations, CIO of a large health system, and deputy CIO of a very large health system. Most of my career has been on the provider side. I’ve been CEO for about three and a half years at Parallon Technology Solutions.

Parallon Technology Solutions is a healthcare IT services delivery firm. We provide EMR implementation, optimization, and full and partial IT outsourcing or managed services. We have a pretty big staff augmentation business as well, providing contract labor to health systems. Those are the three main pillars — EMR implementations, IT support, and staffing.

Is the mix of your business services changing because of provider consolidation or other new trends?

You certainly hit on one of them right off the bat. The acquisition and divestiture process, both of them. Somebody is buying something and somebody else is selling. Both sides of that equation are creating a lot of work, primarily in infrastructure refresh and EMR implementation as the hospital system is brought on board. We’re seeing a lot of activity there.

Another big shift has happened over the last couple of years. In the wild and woolly days of Meaningful Use and EMR implementations, everybody had a lot of money and a lot of incentive to implement these systems, doing it fast and at any cost. It was a pretty easy time to be in our industry. As those systems sink in and become important to operationally support, we’ve seen the costs in healthcare systems and healthcare IT shops dramatically increase. Especially if somebody’s going from, say, legacy Meditech to Epic or Cerner. It’s a lot of operating cost increase.

Over the last couple of years, uncertainty – about reimbursement models, the exchanges, and non-clarity from the Trump administration about where hospital reimbursement is going — has created a drawback on non-essential investment in hospital IT systems. The focus is on looking at the sustainability and cost of keeping IT running.

We’ve seen a lot of opportunity present itself. We’re having a lot of discussions with a lot of health systems about how to reduce operating costs, whether by some type of outsourcing or by creating some type of shared enterprise-scaled environment. Especially when you look at small hospitals or small health systems. We view that as a big opportunity. They just don’t have the levers to pull to get the most cost-effective support mechanisms in place.

Has provider technology innovation suffered as high EHR maintenance costs eat up an even bigger percentage of IT budgets as they are cut back?

Yes. I’ve seen a shift into haves and have-nots in the health system. The medium-sized health systems, small health systems, smaller hospitals, community hospitals — most of them aren’t thinking at all about population health or business intelligence. To the extent they can get that from their package vendors, sure, but they’re concentrating on operations and looking at broader uses of data and broader uses of collaboration. Interoperability and integration have taken a back seat. That’s not a universal, but in a large number of hospitals, they just don’t have the dollars to invest in those types of tools and the resources to run them.

Are health systems using more remote contract IT workers?

Yes. It’s one of the things that we do. A mid-sized or small hospital system can take advantage of economies of scale. Our central remote team can support several hospitals at once in a shared environment. Hospitals get greater expertise as their share of a high-level person who they need only once in a while.

We put together groups of hospitals, understand their operations, and support them remotely. We’ve seen people increasingly be OK with that, especially if the company has good communication tools and the ability to talk with customers and report on actual experiences and actual outcomes. It’s more a case of having a good view of how your providers are doing as opposed to having to have them right in front of you.

Elbow support has to be there, especially for end-user support or to manage the unique things about a hospital or a health system, but I think remote support continues to be important. People are getting more comfortable with it.

How will consolidation of providers and insurers affect health IT?

You’re seeing a couple of trends there. Health systems, in particular, are trying to vertically expand their systems with LTACs and urgent care to provide more of the continuum of care for a patient across their life cycle. Providers, health insurance companies, and drug companies are starting to merge to try to gain competitive advantage in areas where they have the economies of scale to do that.

It’s really interesting to see discussions about corporations like Berkshire and Amazon. What are they going to do there? What’s in their mind as big companies and corporations try to define some part of that healthcare experience and manage more of the cost structure associated with their employee health? That’s going to be interesting. It’s really about just gaining economies of scale or getting cost advantage via strength in numbers or via some kind of shared services approach.

Do you have any final thoughts?

It’s a great time to be in the industry. A lot of things are changing. I think the most important thing is for companies to be flexible, dynamic, and be prepared to meet the needs of the hospitals and health systems as they evolve. We are well positioned to do that.

Morning Headlines 2/15/18

NJII, Dept. of Health hope to create info exchange

The New Jersey Innovation Institute will partner with the New Jersey Department of Health to develop the grant-funded New Jersey Health Information Network, an HIE that will initially go live in Newark and then expand to other parts of the state.

On-Screen, On-Demand, On-Time: The Future of Telemedicine at Penn Medicine

Penn Medicine (PA) brings its telemedicine initiatives under one roof at the new Center for Connected Care, creating one of the country’s largest telehealth hubs.

US can sue UnitedHealth in $1 billion Medicare case, judge rules

A federal judge rules that the DOJ can move forward with a lawsuit against UnitedHealth that claims the payer bilked Medicare out of $1.4 billion by submitting invalid diagnostic data for Medicare Advantage plan members.

Readers Write: It’s Time for Drug Price Transparency

It’s Time for Drug Price Transparency
By Stanley Crane

Stanley Crane is the chief technology officer of InteliSys Health of San Diego, CA.

EHR vendors face a tough challenge in deciding which new features to develop and integrate for their next release and which ones to leave on the cutting room floor. The benefits of each potential enhancement must be weighed against the costs, usually measured in programming time. Moreover, features required for Meaningful Use and MIPS must be included, making the triage even more difficult.

However, EHR companies are missing the boat if they neglect to add a feature that could have a massive impact on their clients’ patients. I am speaking here of prescription drug pricing comparisons, built directly into the EHR workflow of prescribers

We’ve heard a lot about drug price transparency lately. But the public discussion hasn’t come close to the truth.

There are vast differences in the prices pharmacies charge for the same drug from the same manufacturer within the same geographical area. For example, the price of generic Plavix (clopidogrel) ranges from $6.16 at one pharmacy in Aurora, CO to an amazing high of $150.33 at another pharmacy just a few steps away. That’s the equivalent of a gas station charging $72 per gallon for unleaded regular when a station across the street is asking $2.95. This is merely one of literally millions of examples of the absurd variation in retail drug prices.

Most doctors and patients are unaware that retail drug prices vary by so much. As a result, many patients go to the pharmacy, get hit with sticker shock, and walk out without picking up their medication. Others pay far more than they should for the drug because they’re unaware of widespread price variance.

A handful of companies now sell prescription drug price comparison tools directly to consumers. These haven’t had much impact, however. First, because not many people know about them. But also because it’s too complicated for the patient to move their prescriptions to another pharmacy.

Imagine how the situation would be different if a patient’s own doctor could tell him or her what their medications would cost at different pharmacies, regardless of whether the patient has insurance.

What our healthcare system needs today is a modern price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR. The range of prices for a particular drug would appear on the prescribing screen within milliseconds of a physician selecting that medication. Using real-time pricing data from pharmacies, the software could show the cost of that drug at the closest pharmacies to the doctor’s office or the patient’s home or workplace. None of this information is available via EHRs on the market today.

Such a solution could use the patient’s insurance information in their doctor’s EHR, as well as search health plan databases to determine a patient’s out-of-pocket cost (after factoring in deductibles, co-payments, and out-of-pocket minimums). If the patient is on the hook for the cost — either because of a high deductible, high co-pay, or because he or she is uninsured –the software could show the cash price of the medication. It could also indicate whether the cash price is lower than the co-payment under the patient’s plan, ensuring that the patient pays the lowest price each time.

At the patient’s choice, the doctor could then send the e-prescription to the most convenient pharmacy that charges the lowest price for that drug. If the price is still too high for the patient, the software could automatically analyze the selected drug against therapeutically equivalent alternatives, enabling the doctor to prescribe a lower-cost alternative, again comparing the prices at local drugstores.

Transparency in prescription drug pricing offers several benefits. Patients are likely to have better outcomes if they fill their prescriptions and adhere to their prescribed therapy. Physicians can garner higher quality scores if their patients take their meds and control their chronic conditions. Lastly, if price transparency becomes widespread, some pharmacy chains will be forced to lower their prices to avoid losing customers to lower-priced stores or chains. If that happens, the whole system benefits, including patients, plans, employers, and taxpayers.

HIStalk Interviews Bruce Cerullo, CEO, Nordic

Bruce Cerullo is chairman and CEO of Nordic of Madison, WI.

Tell me about yourself and the company.

I’m a Boston-area guy, growing up in a blue collar Italian family. Hospital secretary mom, high school janitor dad. What they taught us, since they didn’t have any money, was the power of love, education, and service to others. I’m back in the game because when I got a look at Nordic, they have a mission of service in the healthcare IT space.

In the 1990s, I led a workforce solutions provider called Cross Country TravCorps that is in the nurse, physician and allied health space. It was all about finding really great people who had a mission to service and deploying them to clients that had a need. Then Vitalize Consulting Solutions in the mid-2000s — same mission, same modus operandi, good people, mission-driven, deployed at hospitals in the healthcare IT space.

I straddle the light and the dark sides, “light” being running companies and leading companies and “dark” being private equity investing. When I was wearing my black hat, I ran into Nordic and said, this company has an interesting take on the healthcare IT consulting space. The more I learned, the more I liked. I was lucky enough to be able to invest and assume the leadership chair. So here I am, I’m doing what I like to do.

Being from Boston, what’s your perspective on Madison?

As a family-oriented guy, it’s a really nice, family-oriented place. Madison, as I’ve learned, is driven by the intellectual capital of two hallowed institutions, the University of Wisconsin-Madison and Epic in nearby Verona. I used to be the young person in all my companies. Now I’m the old dude walking down the halls. Nordic is about 850 strong, which is fairly remarkable for a company that’s only seven years old, and most of the folks are under 40 and the big population are under 35. As a 58-year-old feller, I’m like, OK, it’s a young place, it’s a dynamic place with a lot of smart people.

I think there’s a social mission here. It reminds me a little bit of Cambridge, Massachusetts. Smart people trying to do good work, and in our case, trying to do good work in the healthcare IT consulting space.

What is changing in consulting now that the peak of EHR implementations is over?

The good old days of brute-force implementation have passed. Consulting firms rode that wave. Those like Nordic that have evolved beyond that into what our clients’ needs are today and hopefully tomorrow will continue to thrive and succeed.

Nordic was once a high-quality, Epic-focused staff augmentation firm. It has involved into what we like to call a customized end-to-end solutions provider. Which is a nice way of saying that we do a whole bunch of things along the continuum that leverage the EHR and to help our clients finally get to the promised land, which is a return on a significant investment. Whether it’s optimization, rev cycle, training, population health, data analytics, and managed services that follow, those are services that organizations that are going to survive and thrive, like Nordic, will have to be able to provide clients. That’s where their needs are today.

What characteristics of a company allow it to react to such a dramatic change in market demand?

As my mother used to say, “God gave you two ears and only one mouth for a reason.” If you listen to your clients, it’s remarkable what they’ll tell you. In the case of Nordic — and again, I’ve only been the leader for two and a half years or so — Nordic has always been really good at listening to what the clients’ needs are. That’s hard enough. Then having the courage to spend some money, because it takes money to make money, so to speak, to invest.

For example, our managed service offering. If you asked me a year and a half ago, should we spend as much building out a physical plant as we have? Would the customers be ready for it? It’s amazing. All of our customers have a mandate today to do more with less. To locate the Holy Grail of better quality at a lower cost, with happy patients and happy docs. To do that, they need to take their best and brightest staff folks to do the interesting work so they don’t lose them to a competitive hospital. They’re leveraging folks like Nordic to outsource the application support — very important, but less-sexy, less-interesting work to do. That’s one of the fastest-growing parts of our business. You see hospitals adopting strategies that, up to now, other industries have had in spades, but hospitals tend to be a little behind that curve.

What has changed as EHR vendors have deepened their hosting and IT services offerings?

Our work was changing, not necessarily because respected organizations like Epic are moving into the hosting space. They’re doing it for the same reasons that we are evolving, because the clients’ needs are evolving as well. Once upon a time, hospitals ran their own food service, laundry, and security. For very good reasons, they brought in partners who could do it theoretically better for less money. Now that they’ve spent tens or hundreds of millions of dollars on a very necessary investment, their EHR, they have to find ways to get full value from it and to reduce their ongoing operating cost. Epic is probably driven by some of the same business decisions that we are, and that is, what does the client need?

What impact have you seen from the tax law changes, including the possibility that individuals such as consultants might gain an advantage in billing under a 1099 arrangement instead of being a consulting firm’s W-2 employee?

I would say nothing directly yet. We are employee-owned and we’re privately equity-backed. That’s part of Nordic’s special sauce. All of our employees become owners of the company through our employee stock option plan or our consultant equity participation plan. What a concept — if you want someone to act like an owner, you’d better treat them as an owner. All of our folks have a vested interest in our clients’ success, because if our clients succeed, in theory, we grow. At the company level, we’re not doing anything different because every free dollar of cash that we generate, we’re plowing back into evolving our model.

We offer a “freedom to choose” employment model, which is very different than the Big Sixes or the Big Fives, whatever they call themselves these days. The international outsourcers and the Big Sixers tend to have an employed model. We offer our consultants the opportunity to be employed “in a permanent capacity.” We offer what we call fixed-term, temporary engagements. But in both of those cases, they are our W-2 employees. The people who would be most impacted by the tax law change, the independent consultants who are either 1099 or what we call corp-to-corp, are a very small percentage of our population of people and that’s by design.

What was your reaction when Tech Mahindra acquired The HCI Group? What does it mean when a big conglomerate from India buys a US healthcare IT consulting firm?

I’ve spent a good part of the last 20 years investing in companies. I’ve never had an original idea, but I’m pretty good at picking good people with a pretty good business idea. Since life is too short to work with a-holes, the “good people” part of the equation matters a lot and the work that they do matters a lot.

Most of the time, when the big gobble the medium-to-small, over time what made the medium-to-small special tends to go away. The history of healthcare IT landscape is littered with firms that were very special in their own right and became less so when they became part of somebody else’s business model.

It’s not surprising to me that the international outsourcers would like a real stake in the US healthcare IT game. It’s a pretty gigantic pie. Some of what has made them great in other sectors will make them a formidable competitor to a Nordic-like organization in healthcare.

But at the same time, how many firms have tried to get into healthcare — whether it’s Google or Microsoft or whoever — and realized, oh, it really is different? As our esteemed President said, “Who knew healthcare was so complicated?” I understand why the international outsourcers are interested in firms like HCI. Having been at this game a long time, we are choosing an independent, US-focused path.

As someone who has been both a leader and an investor in the health IT market, what are the most interesting things happening in it?

It is a time of convergence. You’ve got technology converging with infrastructure converging with innovation and converging with human collaboration. To find that Holy Grail of healthcare, which is higher quality, lower cost, happy patients and docs.

But what people forget is that convergence happened because Uncle Sam spent money and Meaningful Use dollars. The functionality of the major EHRs — Epic, Cerner, and Meditech are the three survivors — would not have happened without them. But people are really quick to criticize either the Meaningful Use Program and/or the leaders of these important EHR vendors.

The reality is, without the money and the innovation, we wouldn’t be where we are today. Health systems have what they need to develop credible digital health strategies. Up to now, you could talk it, but you couldn’t necessarily walk it. So I’m bullish. It’s that time of convergence. Finally, the CIO and the CMIO, arguably, have a real seat at the table. I get chest pain when I think of their jobs, because for them to be successful, patients, family members, clinicians, and hospital employees have to be happy. How’s that for pressure?

Summation Health Ventures is a private equity firm in LA that is funded by MemorialCare and Cedars-Sinai. MemorialCare is Scott Joslyn, the CIO there, and you know Darren Dworkin. So Darren Dworkin, the CIO at Cedars-Sinai, Scott Joslyn, and their respective CEOs have formed their own private equity firm. That’s how much convergence has occurred. You have hospitals that are not only driving innovation, but actually funding it. That’s exciting.

I’m associated with a Boston-based firmed called SV Health Investors. SV probably gets 20 business plans a month. They’re from some really smart people with really innovative ideas that a client would never spend the money on. But if they then called Summation to say, “What do you think?” and if Darren or Scott say, “Hey, great idea,” then that’s where the decision should be made. Because great ideas are great, but if no one will pay for them, you’re not going to be in business very long.

That’s a real-life example of how much convergence is occurring in healthcare. I think it’s good. We’re finally at a point where we have what we need to try to advance the cause. That’s why I got back in the game.

Do you have any final thoughts?

Actually, with your permission, I’d like to promote something that is very important. I don’t know if you’re aware, but CHIME has formed an Opioid Task Force. I’m a volunteer with that organization and I’m trying to raise its profile. The effort is being led by who I consider a very courageous guy in Ed Kopetsky, who’s the CIO at Lucile Packard Children’s. He lost a son to an overdose just a couple of years ago. He’s trying to turn a bad thing into a good thing.

Jim Turnbull, who’s the CIO at the University of Utah, and Russ Branzell, who’s the CHIME lead, came together and said, “Hey, CHIME Foundation members — what can we do as a group that’s uniquely qualified in the IT space to try to help combat this scourge?” Fifty or 60,000 people die every year of opioid overdoses. It’s like the Vietnam War every year. My thought is, to the degree that there are folks who read this interview who have a special talent, treasure, or time on their hands who can help us, we’re still looking for a few good people to join. We would love for them to reach out to the folks at CHIME to volunteer their interest.

Morning Headlines 2/14/18

Fitbit buys Twine Health in bid to become a more serious health care tool

Fitbit acquires app-powered health coaching provider Twine Health, hoping to tie Fitbit’s wearables into the management of chronic conditions.

Hospital supplier shares dive as Amazon reportedly ramps up medical supply business

A Wall Street Journal report says Amazon will expand its Amazon Business program to sell medical supplies to hospitals and clinics, sending shares of McKesson and other wholesalers down sharply.

StayWell Acquires Provata Health

Population health management and patient education technology vendor StayWell acquires Provata Health, which offers lifestyle and chronic disease management apps.

News 2/14/18

Top News

The White House’s budget request would give the VA $1.2 billion in FY2019 funding to begin its Cerner implementation, broken out as $675 million initial payment for the Cerner contract, $120 million for program management, and $412 million for infrastructure support (which includes VistA modernization).

Cerner has apparently passed the third-party review of its interoperability capabilities that was holding up contract signing. The VA says it expects to finish the deal within three weeks.

Reader Comments

From Informatics MD: “Re: AI in radiology. We pre-process CT scans using deep machine learning, imaging analytics, and clustering optimization techniques to look for evidence of strokes. If suspected, it re-prioritizes the PACS worklist so that the radiologist reads the suspected film sooner. This is particularly useful with ambulatory diagnostic imaging since the time from study to read can be longer than in the acute setting.” That’s pretty smart to use AI to move images of suspected stroke patients to the highest radiologist priority.

From Alababa: “Re: Craig Richardville SVP/CIAO of Carolinas HealthCare. Has left the organization.” Unverified, but his bio has been removed from the executive page. UPDATE: a spokesperson from the newly renamed Atrium Health confirms to the Charlotte newspaper that Craig no longer works there.

From Moody: “Re: HIMSS. I’m going for the first time. As a hospital employee, how should I plan?” Just off the top of my head:

• Arrive at least a day early to avoid the starter’s pistol rush of all the other badge-wearing attendees on the first day.
• If you don’t arrive early, do anything you can to avoid the airport cab line and the inevitable two-hour wait.
• It’s Las Vegas, so if you haven’t been there, be prepared to be shocked by the sleaze but intrigued by the tricks and big data analysis those billion-dollar hotel casinos use to keep people losing money while thinking they’re having a great time.
• Prepare to be overwhelmed with the amount of advertising real estate HIMSS sells – on escalators, floors, buses, and just about any item someone hands you. All of that contributes to ridiculous healthcare costs, but in the vendors’ defense, it apparently works.
• Dress comfortably, not to impress. You won’t be impressive by Day 2 when you are hunched over and limping from walking 10 miles in stylish but uncomfortable shoes.
• Housing choice is up to you, but I always VRBO a house or condo instead of shoehorning in with all the other badge-wearers in the conference hotels. It’s a cheap Lyft ride to the convention center. It probably costs a bit more unless you share your space, but decompressing away from the HIMSS herd is worth it, plus you aren’t stuck eating overpriced, unhealthy food and being forced to mingle everywhere you turn. Otherwise, especially if you lean toward introversion, you will find yourself sitting on the floor of unused corners of the convention center just to get some quiet.
• Expect to see only 5 percent of what’s going on. Study the program guide ahead of time to identify the potentially most valuable 5 percent. Even then, expect to be disappointed.
• Skip the keynote sessions. You can read about them even before they happen since HIMSS puts a recap from the speaker’s draft in the daily conference rag.
• Ask fellow attendees what they found valuable to see in the exhibit hall or have them message you if there’s a really good session underway that you can crash.
• The exhibit hall provides educational polarity. You can learn a lot there, but you can also waste a lot of time that could have been better spent elsewhere instead of just wandering around aimlessly.
• Walk out on any session that under-delivers and find another one. Or, skip them all and just read the slides or listening to the recordings afterward (they’re included in your registration)
• Don’t attend any educational session that features a vendor employee as a presenter.
• Talk to peers. The biggest HIMSS takeaway is often the relationships built there.
• Don’t treat the conference as a vacation blowout. Your employer is paying for your education, not to sleep in after over-imbibing.
• Don’t schedule time with a vendor. It is incredibly inefficient to be clock-watching the time you need to start walking miles to visit a vendor’s booth at a pre-arranged time. You’re the prospect – they will make time for you when you show up.
• Flip your badge over backwards if you want to walk around in the exhibit hall unmolested.
• Take your badge off as soon as you leave the convention center to avoid looking like every other HIMSS conventioneer zombie wandering around on the Strip, an easy target for scammery and ridicule by decidedly low-brow, non-HIMSS visitors.
• Don’t leave the conference thinking that you or your employer are under-accomplished compared to what you heard and saw, most of which was BS. It’s like loud-mouth Las Vegas gamblers – they will crow endlessly about their big win while failing to disclose the 100 losses that left them well into the red.
• Write up what you learned for your boss who had to approve the cost of your trip or offer to share your new knowledge with your team who didn’t get to go.
• Marvel at the fact that, like monstrous hospital buildings, the excesses of the HIMSS conference serves as a reminder that US healthcare isn’t something we selflessly do for each other as empathetic humans but is rather an enormous, impersonal business that makes a bunch of people very wealthy and a far greater number of people very poor.

HIStalk Announcements and Requests

I finally got around to looking into encrypting the site, which is becoming the standard across the Web. That’s done – SSL encryption is in place, so your browser will indicate “https” and will show the closed lock in the address bar. As a reader notes, you can now enter a comment without wondering if your employer might intercept it (so hey, might as well).

Webinars

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Acquisitions, Funding, Business, and Stock

Fitbit acquires app-powered health coaching provider Twine Health, hoping to tie Fitbit’s wearables into the management of chronic conditions. Or perhaps the synergy involves two companies that eschew the use of properly capitalized words in their logos. Twine Health had raised $10 million in funding.

A Wall Street Journal report says Amazon will expand its Amazon Business program to sell medical supplies to hospitals and clinics, sending shares of McKesson and other wholesalers down sharply. Amazon could make a fortune shorting stocks in sectors that it then rumors it will enter.

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StayWell, a population health management and patient education technology vendor owned by drug maker Merck, acquires Provata Health, which offers lifestyle and chronic disease management apps. Provata Health raised a single funding round of $1.4 million from NIH in August 2015 and doesn’t seem to have done much since mid-2016 except try to create a virtual reality meditation product. StayWell acquired health app vendor MedHelp in October 2017.

Cerner files its employment agreement with new Chairman and CEO Brent Shafer with the SEC. He gets $11 million in stock options, a $4 million stock option grant, a one-time grant of $3.7 million in restricted stock units, use of the company’s jet, relocation expenses, $800K in annual salary, and a $1.2 million annual bonus target. His golden parachute calls for two years’ worth of salary, average bonuses, and health insurance coverage.

California launches an investigation into Aetna following the testimony of a former company medical director that he never looked at patient records when deciding to approve or deny care. He added that he had to make decisions about medical conditions that he knew little about. Aetna says its clinical review process is sound and the medical director’s job is to follow the company’s Clinical Policy Bulletins in reviewing the medical records that it must obtain manually from patients and doctors. The former medical director says nurses reviewed the patients’ records and gave him recommendations that he managed online without ever calling the nurse. He is amply credentialed, however (now running a one-person family medicine practice) so I imagine he was doing exactly what Aetna expected or ordered.

People

Clinical trials technology vendor Bracket hires Mike Nolte (Influence Health) as CEO.

Announcements and Implementations

Providence Health & Services will offer its patients and health plan members in Oregon online exams for non-emergent conditions, with patients who complete an online questionnaire receiving an emailed treatment plan within one hour. Providers respond seven days per week between 8 a.m. and 7 p.m., with the encounter covered in full for health plan members or $20 otherwise. The technology is provided by Bright.md.

Providence Express Care created a great graphic explaining its care options, including the new SmartExam.

A Black Book report looks at EHRs across 23 countries in a 7,500-respondent survey, finding that:

• Most international users say their systems lack connectivity with other providers and question whether the definition of an “interoperable” system even exists.
• More than half of respondents in Europe, the Middle East, and South Asia plan to move away from siloed EHRs to more US-style offerings that include data exchange and care coordination.
• Countries being held back by a lack of national infrastructure, policy, funding, or privacy rules include Japan, China, Qatar, Brazil, Taiwan, India, and Russia. The best-positioned ones include New Zealand, Denmark, Israel, Singapore, and Netherlands.
• Top-ranked vendors include Allscripts (South Asia, UK); Cerner (Oceania, Middle East); InterSystems (Nordic Europe), ChipSoft (Western Europe); and Orion Health (Canada); Everiss NTT Data (Latin America), and Neusoft (China).

Lancaster, PA-based Connexion Health launches its walk-in, touchless, app-powered health assessment kiosk. According to its website, the kiosk “uses advanced AI to integrate a myriad of sensor data streams that independently would be incoherent. It syncs data derived from a laser, multiple cameras, IR, and microphones to provide incredibly precise analytics. More importantly, Connexion OS apps can enhance their capabilities with a unique, proprietary AI that allows them to guide people to better overall health outcomes.” The company was incubated by AI-focused Aspire Ventures. Target markets are sports teams, employee health, and healthcare providers.

Government and Politics

The White House’s proposed budget and HHS’s budget request document contain some interesting line items:

• ONC’s budget would be cut from $60 million to $38 million, with its focus being interoperability and provider burden reduction.
• HHS OCR would see its budget reduced from $39 million to $31 million.
• Medicare and state Medicaid would be given some ability to negotiate drug prices
• Post-acute care provider costs would managed with a payment system based on clinical needs rather than the site of care
• Off-campus, hospital-owned physician practices would be paid at the same rate as other practices.
• Prior authorization would be required for physicians who order services in excess relative to their peers.
• The Independent Payment Advisory Board would be repealed.
• The reporting burden and arbitrary requirements for use of EHRs would be eliminated.
• MIPS reporting would be simplified.

Other

A 2,000-respondent healthcare leadership survey sponsored by Change Healthcare finds that 80 percent of payers are addressing social determinants of health for their members. Half of respondents think lack of digital health tool adoption is caused by security and privacy concerns.

China’s Ping An Technology describes the healthcare-related AI projects it is working on:

• Interpret CT scans to reduce workload and improve accuracy
• Use facial recognition for patient identification to reduce fraud and to allow patients to grant access to their medical records.
• Use facial recognition for clock-in of healthcare workers to reduce fraud.
• Create a vaccine record app for people in poor and remote areas that uses facial and voiceprint recognition.
• Develop intelligent disease prediction and screening models.

Jay Rath pens a “Valentine for HIMSS and HERSS.”

Sponsor Updates

• Huntzinger Management Group will expand its cybersecurity support in a partnership with Delta Risk.
• PerfectServe will integrate its team collaboration platform with QGenda’s physician scheduling software to accurately deliver calls and messages.
• Vocera delivers its one millionth Badge communications device to Memorial Sloan Kettering Cancer Center.
• Besler releases a new podcast, “How Hospital-to-Hospital Transfer Policies Impact Billing and Coding.”
• CarePort Health CEO Lissy Hu, MD will present at the CHA Post-Acute Care Conference February 16 in Redondo Beach, CA.

Blog Posts

• Introducing Container Services: Deploy Custom Docker Images onto Datica (Datica)
• How Physicians Can Deal With & Avoid Negative Online Reviews (ChartLogic)
• Leaders of Innovation: Lesley Solomon of Dana Farber Cancer Institute (Redox)
• Healthcare’s Tipping Point (Mobility for All) (Spok)
• Gearing Up for HIMSS18 in Las Vegas (CoverMyMeds)
• How Will Blockchain Technology Impact Healthcare? (Dimensional Insight)
• An Analysis of ICD-10, CPT, and E/M Coding Trends Over Five Years (DocuTap)

Contacts

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

HIStalk Interviews Michael Barbouche, CEO, Forward Health Group

Michael Barbouche is founder and CEO of Forward Health Group of Madison, WI.

Tell me about yourself and the company.

I’m a husband and I’m a dad. We have three kids. If you have answers on managing teenage social media, I would appreciate it. My wife is a practicing general internist. I run a company based in Madison, Wisconsin named Forward Health Group. We’re in the analytics space. Some might call it population health.

Our solutions work. I’m proud to say to you and to your readers that we have the platforms that today are helping to fix healthcare and deliver the outcomes that all stakeholders are seeking.

Has interest in the company increased following the recognition in KLAS’s recent population health management technology report?

You bet. Let me state a foundation point for this company. We look at the market and say, these EHRs are important. We need to build upon them. We need to make them successful. A big driver for us was always around clinician engagement. We saw clinician trust as this gateway to the ACOs and to the hospitals.

I can’t sugarcoat it. This is going to be an amazing transition for all of us in the US healthcare system. We will go through a reimbursement change. The feedback we’re getting, though, from groups like KLAS that you mentioned, affirms what we’re seeing. Our clients are having success. They are able to pioneer in their markets where they want to go. We love it. It’s great.

We have this energy-filled relationship with every one of our sites. We say, what are we going to solve today? What are we going to go after? The challenges that they face – other than the normal ones on the financing side and on the growth side – are still around the same things we’ve been talking about – the data. It’s messy. What do we do with our technology? How do we get it into the workflow?

The KLAS report validates, and certainly our experience with our clients reveals, that we’ve helped them figure that out. We have helped them figure out how to maximize – in their world, their own pieces – how to do this right. How to do this efficiently. How to have a strong impact on the outcomes of their patients.

What does that mean in real life?

We have this long-time client – a very rural delivery network, poor, underserved populations, lots of challenges. Sparse access to specialists, scant resources to hire additional staff. It’s the sort of system you might not expect to become the poster child of EHR success. The EHR is truly working for the care teams, not the other way around. As one of our physicians at this site always says, “We count the things that count.”

We installed PopulationManager three or four years ago, and because of very clean data and clinician-understood analytics, they’ve advanced their key metrics through the roof. Colorectal cancer screening almost doubled to over 60 percent, which if you do the math on a largely rural, mostly African-American population, greatly reduces the risk of colon cancer. That’s a lot of prevention in the population when there is limited access to screening services.

It goes on. Greatly improved pneumococcal vaccine rates, but also diabetes control, hypertension control, and more. They’re doing all this by leveraging the data we deliver to improve the data capture and the workflows in their existing EHR platform. They are making such a difference in patients’ lives. That’s pretty cool.

The KLAS report concluded that EHRs aren’t very good at population health management. As a not-huge company, how do you use that information to find new business?

The first thing that I would say to any prospect is, what data are we talking about here? Invariably they’ll speak about an EHR or two or three. But what’s so powerful for many of our clients today is claims data.

I’m an old claims guy from the 1990s. I was a shaggy-haired data guy running claims data. Claims data is enormously important to every health system, but they don’t know how to use it. It’s so important. We’ve naturally expanded to the health plan market because they’re sitting on this untapped asset of rich data.

We say to any prospect, look, you can’t get there, anywhere, with just one of those buckets of data. The EHR is rich. It’s enormous. It’s a data source unlike any we’ve had. But if we don’t bring in other clinical data, other outside labs that you haven’t yet interfaced, and, most of all, if you haven’t brought in the claims data, you’re not going to get anywhere.

The value proposition for us is straightforward. Let’s talk about your market opportunities. Talk about your market pressures. We weave together clinical and claims so we can make sense of their performance in a manner that they can leverage the data, take action, and ultimately drive outcomes.

Our initial focus in this market was around harvesting, curating, and presenting very clean, very trusted clinical data. But in the back of my mind, we were not maximizing claims data. We would incorporate claims into our builds and populate measures and metrics for our clients based on claims data as a source, but there was a richer solution to uncover.

Beginning in 2012, we began to sketch out a new path for claims data. The move to value-based reimbursement, no matter the final form of any CMS program, would place a richer emphasis on the performance and really the behavior of the clinical network. Think of where the country has spent the last 15-20 years building out the revenue cycle. Value-based care and contracting requires an x-ray vision lens on how that network is actually behaving, where the inefficiencies occur, where the care is not coordinated.

We built that x-ray vision. In 2017 we softly launched a very cool new visual platform that addresses the problem of our time. Whether you want to call it leakage, or keepage, or steerage, it is happening. We view this as a lens on the patient’s care journey. We named the platform PopulationCompass because so much of a patient’s care journey occurs outside the four walls of their PCP’s clinic. Which also means the care is often outside of the PCP’s EHR. Your clinically integrated network’s flows, in and out, come into very clear visual focus. Risk-bearing delivery systems are going to need a compass to find their way around out there.

Do you think providers know how sloppy their data is and how hard it is to move it around in a meaningful way?

I cannot begin to tell you how eyes have opened in the last three or four years. Years prior, we had some intuitive tools, some beautiful visualizations that were basic and simple. I call them poor man’s QlikView. We thought the user was a medical assistant or a nurse or whatever.

But now you can’t get into a conversation with any system without immediately being challenged on data quality, data completeness, and other data integrity things. When we first started hearing those questions in the field, we were jumping up and saying, “Hey! Who told you about all of our speaking points?” It’s wonderful. It’s refreshing. We teach all of our clients about data quality. Teach them about this beautiful asset in their electronic record and say, we’re going make this thing hum.

We’ve got sites — and I’m just tickled by this — visited by the NIH and CDC so they can learn how they’ve improved outcomes so quickly. Trying to learn so these big organizations can help the country learn to maximize health IT. They say, how the heck are you screening this many people in this rural area where there’s no access to colorectal cancer screening? Well, for some of our clients, we have mapped 187 different nooks and crannies where we can find a hit on a colonoscopy or a FIT test or what have you in their EHR. And that number will only go up. We’re weaving in data from the three different health plans to say, somebody was screened over here at this other hospital. “You need to get that properly registered in the patient’s record in the EHR.” Continually helping them narrow in on this smaller and smaller cohort of patients that they need to target and that they need to bring in.

It’s refreshing and exciting as heck to have a prospect challenge us and say, “You know what, buddy? Our data’s a stinking mess. How are you going to make sense of it?” That’s where we stand up and thrive.

Where do you think we are in the trajectory to value-based care?

We’re in a period that we haven’t had for quite some time. I will call it a period of the least uncertainty we’ve probably had in 10 or 15 years. The move to value is certain. The path to value is fraught with unknowns.

I can tell you candidly from my observations from working in multiple markets that the delivery systems, the health systems are not at the forefront. They’re struggling with this. It’s difficult. And by the way, they’re still making too much money on fee-per-service. So what do they need to change?

We’re seeing more and more that market pressures are being introduced. Health plans are getting more anxious and getting more involved. We’re involved in numerous incentive programs, Medicaid waivers, and other market shifts. The pressures are growing, but the delivery systems are not making rapid progress.

This is probably the most exciting time that we’ve ever had as a company. We are now positioning every one of our clients to take action. We tell them, “You don’t get to wait around. You signed up. Now step up. We’re working together. We’re going to play offense here. We’re going to be the aggressor.”

We have clients that are meeting with the biggest of the big, hairy health plans, the scariest national ones of all. And saying, “Hi, I’m from an FQHC and I want to set incentive terms with you.” Do you know what the response is every time? “Let’s meet quickly.”

We tell the health plans that the gating item is the claims data. Send us the claims so everyone can go to the meeting and talk to about how attributions are all screwed up. About how assigning a bunch of patients in a vacuum isn’t working. About how prior auths are occurring in all the wrong places. And by the way, these are the quality incentives that we should be looking at. And by the way, these are the diabetes patients both sides should support and the health system needs your help managing them.

What we see right now is a window, probably three to five years, where health systems can call a meeting with their health plan partners, roll up their sleeves, and say, let’s do this together. Let’s sit at the table. Let’s talk about what our priorities are. Let’s figure out how to coordinate the improvement journey.

Will the announced healthcare cost reduction focus of Amazon, Berkshire Hathaway, and JPMorgan struggle with getting data out of potential partners?

I’m a Minnesota native, I grew up in the Twin Cities. I went to grad school there. The Minnesota Business Group on Health was talking about this stuff in the early 1990s. I welcome it. I’m excited.

Tell the Amazon folks they should give us a call. We’ve solved it. We want to visit with them and tell them how to do it. JPMorgan as well will be very interested. This is an important event, along with the craziness about Apple’s recent announcement, which isn’t so crazy. The data is still a mess and we’re not aggregating the data and using the data to drive decision-making to drive the markets.

The Amazon, JP, and Berkshire announcement represents a stake in the ground, a shot across the bow to a lot of the incumbent analytics players. The reports you’ve been sending them in the three-ring binders? They’re not right. We can tell you they’re not right, because when we look at the data and we peel it back, we are able to identify risk and identify exposure in a way that says, “This list right here of 61 people? That’s what you guys need to be working on.” Anything that helps us see the purchasers exert more and more interest and influence in demanding outcomes is for the better. I’m glad they’re here.

Do you have any final thoughts?

We’re optimistic about the future for our clients. We’re excited that they have the opportunity to go after change in this value world and do what’s right for their organizations. And, do what’s right for their insureds or their patients and have at the forefront a focus on improving patient outcomes.

We’ve known for decades that we need to go there. We’re excited to see that happening, day after day, for all of our clients.

Morning Headlines 2/13/18

VA wants new budget line for commercial health record

In his 2019 budget proposal, President Trump earmarks $1.2 billion for the VA’s new EHR, including $675 million for the contract with Cerner, $412 million for infrastructure support, and $120 million for program management.

HealthStream Announces Divestiture of its Patient Experience (PX) Business to Press Ganey Associates

Healthcare learning and performance improvement systems vendor HealthStream decides to sell its patient experience business to Press Ganey for $65.5 million in cash.

Congressional Budget Pact Includes Telehealth Sweetener

President Trump signs into law a funding bill that will expand telemedicine access for ACOs and Medicare Advantage plans, and allow for reimbursement of telestroke care and home dialysis.

Banner Health ‘underestimated’ scope of computer conversion in Tucson

State officials in Arizona look into patient complaints about Banner Health’s conversion from Epic to Cerner at its Tucson hospitals, including delays with patient processing and prescriptions.

Curbside Consult with Dr. Jayne 2/12/18

I was heartened this week to see the American Academy of Family Physicians engaging with ONC in an attempt to “reduce clinician burden from health information technology.” AAFP has been meeting with CMS and ONC as part of the Patients over Paperwork initiative, and submitted what amounts to a wish list of items to discuss at a follow-up meeting later this month.

The letter opens with commentary about the regulations that physicians are subject to are “daunting and often demoralizing.” AAFP cites lack of standardization among payers, whether public or private, as a significant challenge.

The letter cites family physicians as possibility participating with 10 or more payers, which is a significantly smaller number than what we see in our community. In my family medicine heyday, I was contracted with nearly 35 payers, including Medicare and Medicaid for two states. Just the credentialing paperwork alone was mind-numbing, and the actual paperwork that needed completion to actually care for patients was soul-crushing. Every plan had a different pre-authorization form, certification process, and appeals framework. Although I was part of a large health system, my personal office staff spent a significant amount of time dealing with it since we had no centralized resources to assist.

AAFP refers to their wish list as “consensus principles on administrative simplification” and many of them seem like common sense measures. First, they call for CMS and ONC to work with Congress to reduce the reliance on healthcare IT usage measures. Their point is that programs such as MIPS are already measuring quality, cost, and practice improvement, so measuring the usage of IT systems is no longer necessary. AAFP calls for policies that mandate health IT use to be assessed to identify “evidence of benefit and burden in real-world practice prior to their implementation.”

I agree with this request wholeheartedly. Many of the requirements found in these programs seemed like a good idea to the people who designed them, but when they’re placed into practice, they fall flat. An example is the requirement that physicians send certain percentages of prescriptions electronically, including controlled substances. There was no corresponding requirement to mandate that pharmacies update their systems, resulting in delays for physicians who wanted to use the technology and frustration for those whose service areas didn’t have adequate pharmacy adoption. Requiring certain numbers to be met also doesn’t take into account the preference of certain patient populations who want a hard copy of the prescription to take with them.

Many of my older patients didn’t trust electronic prescribing or had experienced delays or misadventures with it previously, and simply wanted paper prescriptions. Even if I tried to e-prescribe and then print a backup copy for the patient, the way our EHR calculated the transactions, I would still be on the hook for a printed prescription. Meeting my patients’ needs and preferences for care put me at risk for a penalty, which just seems wrong.

One of the more hot-button requests in the AAFP letter is a request that the CMS Documentation Guidelines for Evaluation and Management Services (E&M Coding) be overhauled. It notes that, “adherence to E/M Documentation Guidelines consumes a significant amount of physician time and does not reflect the workflow of primary care physicians.” They cite the creation of the Guidelines for the paper world as being part of the problem, and that the Guidelines don’t take into account how EHRs support care and documentation.

They go as far as asking that guidelines for new and established office visits be eliminated for primary care physicians. That’s certainly a big ask and personally I don’t see it happening, but I’m glad they’re trying. I’d love to see the guidelines at least modified to allow for different types of documentation to “count” for coding points. For example, when my patients come in with rashes, I’d love to be able to drop in a couple of pictures of the rashes and call it a day rather than trying to find the right checkboxes to click to try to describe a rash in a way that may not convey what I saw. Under the current requirements, I can drop that photo in, but I still have to use words in order to get billing credit.

My favorite request in their list is a request that the Medicare Program Integrity Manual be updated “to allow medical information to be entered by any care team member related to a patient’s visit” and that it be changed across the board for all Medicare contractors, Medicaid programs, and private payers. We’ve been living in a world with arbitrary boundaries where staff can document the Review of Systems but not capture any History of Present Illness (HPI) data, even if the patient volunteers it. Of course, this is if your employer follows a strict interpretation of the rules, which many do. Other practices may allow staff to collect HPI data and have the rendering provider review it, which saves time and effort, but I see that less commonly.

The original E&M guidelines also don’t fully address the requirements of patient documentation when scribes are used, and whether documentation can be performed differently depending on the training and education of the scribe. For instance, if I have a registered nurse scribing for me, I may get more detailed documentation than if I have a less-trained scribe, because the nurse may pick up more specifics from my descriptions. A patient care technician might enter my statements verbatim (I often speak in lay terms to patients when I explain their exam findings) where a nurse may translate these descriptions to accepted medical terminology.

AAFP also calls on CMS and ONC to go after those who are guilty of information blocking. Administrators, listen up: when you’re ready to go after some major health systems, give me a call. They’re the biggest offenders in my metropolitan area and the EHR vendors don’t have anything to do with it. It’s all about controlling your referrals and managing your ACO and not about enabling patient choice or sharing of clinical data. Too bad there’s not a whistleblower clause since  maybe I could retire early.

The letter evokes the myth of interoperability, where many of us are exchanging reams of irrelevant information that we don’t have time to wade through. Even though I haven’t been a family physician for years, I still appear in many patients’ records and receive C-CDA documents on a frequent basis. Most of them are unintelligible, and one local hospital is guilty of including every medication the patient has ever been on, which I imagine makes medication reconciliation nearly impossible for the receiving party.

The letter notes the need for consistent data models created by clinicians rather than by legislators or software engineers. I deal with several EHR vendors that don’t even really have a data model of their own, which is amazing to me in this post-Meaningful Use age. When data comes in from another vendor, it creates a mess that is hard to sort out and adds considerable junk to the patient chart. It also notes the need to continue to harmonize clinical measures, so that physicians don’t have to report data that is similar but not identical to different payers.

Other factors mentioned should be no-brainers in this day and age, such as removing the need for physicians to fill out new forms for items like diabetic supplies when a patient switches brands. Especially if we are trying to allow patients to be empowered and make choices about cost of drugs and supplies, having to write for “WonderGlucose Harmonious Precision Extra” as opposed to “glucometer test strips” is silly.

The letter closes with a request for CMS and ONC to reach out to Steven Waldren, a family physician who is the Director of the Alliance for eHealth Innovation. I had a chance to meet Dr. Waldren a couple of years ago at HIMSS and he’s a knowledgeable physician with a good head on his shoulders. For some reason, however, I don’t suspect that his phone is ringing off the hook with regulators asking how they can help. I’m interested to see if other specialty organizations follow suit and whether we see any changes.

What would you do with your free time,should E&M coding be eliminated? Email me.

Email Dr. Jayne.

HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health

Lissy Hu, MD, MBA is co-founder and CEO of CarePort Health of Boston, MA.

Tell me about yourself and the company.

I started the company as I was pursuing a joint MD/MBA at Harvard. I had always been interested in healthcare, but I became very interested in some of the more foundational problems around healthcare. I was in the hospital. I was seeing patients get discharged and come back in 30 days from nursing homes, where we had no visibility into the quality of care. All I knew was that there was a lot of variation in quality of care.

I left medicine to build CarePort to address some of the variations in post-acute care, to help patients make more informed decisions about the types of care that they can choose from. Also, to provide more visibility to their caregivers as they transition, often multiple times, across different nursing homes, home health agencies, and hospices. A lot of people,  even in the healthcare industry, don’t realize that these settings are an integral part of the healthcare system.

From the hospital’s point of view, what are the most common transitions of care to post-acute care settings and what challenges do patients and families experience?

Patients get very little information about their post-acute care options, of which the two most common are skilled nursing and home health. Generally what happens in a hospital is that someone hands you a list of names and addresses and you have to pick. The case managers who are supposed to be guiding you are hamstrung by the vagueness of regulations around how they can get involved in patient choice. They are afraid to recommend one provider over the other. That’s something they really can’t do.

For a long time, we didn’t have much information about the quality of post-acute care providers. Patients were making important decisions literally based on just a name and an address. Most of them were choosing purely based on geographic proximity.

What you see in the Medicare data is that there is huge variation of quality of post-acute care providers. Just to give you one example, the average home health 30-day readmission rate is around 28 to 30 percent. But when you look at the bottom quartile of providers, it can be double. Even after you risk-adjust for different patient populations and all of that, you still see variation. It’s important when patients and families are making these decisions to think carefully and to have that information, because it can have a big impact on their recovery course.

What accountability do hospitals have for what happens when the patient moves to a post-acute care setting?

For a long time, there was no real accountability. In a fee-for-service world, you’re focused on throughput and trying to get your patients out in a timely manner. People started to think about post-acute care with the advent of readmission penalties. As we’ve moved toward bundled payments, accountable care, and risk-sharing with commercial plans, people have looked at those types of arrangements where they’re at risk. They have started to think about not only where they are discharging their patients, but also how they are doing in those settings.

Five years ago when I started this company, I would walk into a hospital and ask them, have you thought about your post-acute care strategy? It was crickets. Even doctors would say, all throughout medical school, I didn’t learn much about post-acute care or what that even is. Nowadays, when I walk into a hospital and we’re talking about their post-acute care strategy, it’s in the top three or five things that they’re thinking about. How do we have better control and management of our patients who are in this intermediate level of care who aren’t ready to go home just yet?

Should hospitals who claim to be managing population health have some control over what happens in post-acute care facilities? Are they expanding that idea into owning or managing those other providers?

The question of who owns the patient is a hot topic in population health right now. I think it’s the responsibility of the hospital to offer guidance in choosing that post-acute care provider. It’s not really much of a choice if you’re just giving the patient a list of names and addresses. At worst, it’s just totally uninformed and almost random. Hospitals have the responsibility to guide that choice and make sure that the patient is set up for success. That they’re going to a facility with lower readmission rates, higher star ratings, and all those factors that folks should be looking at when they’re choosing a post-acute care provider.

For ongoing management of the patient, it depends on who is bearing the risk for that patient. From what we’ve seen, hospitals that are engaged in ACOs or bundled payments are staffing out with care coordinators who are managing that patient across different settings. They need to have information from these nursing homes or home health agencies in real time about how those patients are doing. We make sure that the patient is set up for success, but we also continue tracking them once they’re in the post-acute care setting.

A lot of people don’t even know that nursing homes have EMRs. When I was initially talking to hospitals about giving them tools to track their patients in real time rather than just having retrospective data, a lot of them were skeptical. They thought that nursing homes were on pen and paper. We had to validate early on the hypothesis that most skilled nursing facilities are on some type of system, and often cloud-based systems where you can build APIs and pull this data rather than having these painful, one-off integrations that sometimes you encounter in healthcare.

How do you describe the benefits of your product to hospitals?

I emphasize that they need to have visibility into what’s happening to their patients in post-acute care from a readmission perspective. Also from a cost perspective, because if 40 percent of their Medicare patients are going into some type of post-acute care setting, that’s a big tranche of patients and they need to have that visibility from a readmission perspective. There are wide variations in how long people are in skilled nursing facilities. The average cost per day in a skilled nursing facility is between $500 to $700, so it’s a big chunk of change. Also to prepare themselves, as they are managing larger and larger patient populations, for having a sense of how their network is performing from an analytics standpoint and having that holistic view.

What patient information do skilled nursing providers and hospitals want to exchange?

I see this almost like a two-sided network. You need the engagement of the hospital, but you also need the engagement of the post-acute care providers to want to share that data.

When I was starting this company, one of the things I wanted to validate and test was the willingness of a skilled nursing facility or home health agency to share data with the hospital. It wasn’t a completely clear-cut answer. From what I had seen in the hospital, there was definitely some trepidation in sharing their own data. When we went out and spoke with a lot of these post-acute care providers, one of the things that they said to us was that they are being asked for specific care protocols to take care of ACO patients, for example, in a certain way. Often they have no idea who those ACO patients even are.

We need to add value, not only to the hospital, but to the skilled nursing facility and home health agency. We can collect data on when a patient is admitted, when they’re discharged, and some of the clinical factors, like the medications that they’re on in the nursing home. We can pass that, for example, to a hospital care coordinator. But at the same time, while the post-acute provider is not paying us, we add value by giving them things such as the name of the patient’s care coordinator and whether they are an ACO or a bundled patient. We add value to both partners.

How has the Allscripts acquisition affected the company?

It wasn’t something that we were looking for. It’s not like I started this company and had it in my mind that it was going to be acquired in a couple of years. We had supportive investors who were willing to put more money into the company, so we had multiple options. This is my company, my baby, and I wanted to make sure that whatever the decision was would set us up for long-term success.

When I jumped out of medicine, it wasn’t because I didn’t like taking care of patients. I saw this as a problem that needed solving. I was passionate about it and I wanted to make an impact. I didn’t want to just get sold. You hear stories of products getting shelved and never seeing the light of day again. It was important to me that we were able to operate independently and that there was strategic value in the acquisition that would allow us to scale quickly.

I could have gone two ways. I could have raised a boatload more money, hired out a sales team, and sold on my own to hospitals, health systems, ACOs, payers, and all that. Or, here was Allscripts, which has a product called Allscripts Care Management, which was formally known as ECIN before they acquired it. This product was in 1,000 hospitals and 70,000 post-acute care providers – SNFs, home health, LTAC, rehab, transport, and DME – are receiving referrals from it. We were encountering it over and over again as that nexus between the hospital and the community. When I thought about scaling this product, it provided a real strategic advantage for us to be able to link up with this discharge planning product. Because the other thing I hear constantly in hospitals is, I don’t want to go to another platform. If I’m using this for discharge planning, I don’t want to log into another platform.

From a user perspective, the discharge planning product sends the referral from the hospital to the post-acute care provider and CarePort bookends that process. We help with the selection and then we continue to track that patient. From a platform perspective, it made a lot of sense. That being said, most of our customers are Epic or Cerner. We’re fairly EHR-agnostic in terms of our client base.

Do you have any final thoughts?

This is a really exciting time to be in healthcare. People are finally paying attention to this whole area of post-acute care that for a long time was largely ignored. I’m hopeful that with these payment changes and the focus in post-acute care, we will finally be able to deliver to patients a better post-acute care experience. It is a critical part of their recovery and I’m glad there’s an awareness around that. I’m glad there are financial incentives around that. I’m really excited in terms of where the next five years is going to take us as an industry.

Morning Headlines 2/12/18

HealthInsight and Qualis Health Announce Intent to Merge

Medicare and Medicaid-focused population health management companies HealthInsight and Qualis Health will merge later this spring.

AAFP Outlines Steps to Reduce Administrative Burden

American Academy of Family Physicians asks HHS and ONC to reduce the health IT burden of clinicians with a series of recommendations it plans to reiterate during a meeting with CMS later this month as part of the Patients over Paperwork Initiative.

MD settles with computer contractor over Medicaid failures

Computer Sciences Corp. pays an $81 million settlement to the state of Maryland for its failure to build a new computer system for the state’s Medicaid program per its 2012 contract.