News 10/5/18

Top News

Cerner announces its VA EHR modernization team, with Leidos, Accenture, and Henry Schein taking on prominent roles as expected.

In announcing the 23 members, the company stressed that it will leverage investments already made by the DoD for its nearly concurrent Cerner-powered EHR revamp. VA Secretary Robert Wilkie and Defense Secretary James Mattis have said their departments will work together to ensure their new EHR systems are implemented on a unified schedule and are capable of seamlessly sharing data with civilian and government providers.

Cerner has promised to unveil a project timeline at its user conference next week.

I reviewed the list of companies Cerner has chosen as partners for its VA implementation. These are also working on the DoD’s Cerner implementation:

• Accenture
• Leidos
• Henry Schein
• Holland Square Group (Cerner-focused implementation consultants — acquired by Alku in December 2017)
• MedSys Group (EHR consulting)
• ProSource360 (government consulting)

These are the VA-only partners just announced:

• AbleVets (government consulting)
• ACI Federal  (government IT contractor)
• B3 Group  (government consulting)
• Blue Sky Innovative Solutions (government consulting
• Clarus Group (a Salesforce-focused consulting firm that offers government technology services)
• Forward Thinking Innovations (government health IT — seems to be a two-person consulting firm)
• Guidehouse (the former PwC Public Sector consulting group)
• HCTec (health IT and revenue cycle consulting)
• HRG Technologies (revenue cycle services)
• KRM Associates (government contract health IT contractor, a small husband and wife business)
• Liberty IT Solutions (government technology contractor)
• MedicaSoft (sells an EHR, PHR, and Direct messaging services with a founder who a lot of VA work with FHIR and is founder and board chair at the Open Source Electronic Health Record Alliance)
• MicroHealth (government analytics, engineering, integration)
• PM Solutions (project management)
• Point Solutions Group (consultant staffing)
• Sharpe Medical Consulting  (health IT consulting, medical staffing)
• Signature Performance (revenue cycle consulting)
• ThomasRiley Strategies (consulting)

Reader Comments

From Plenary Session: “Re: UMass’s financial struggles. Isn’t this the kind of organization that has no business putting $700 million into Epic? Negative operating margins, historically financially strained … makes no sense.” The health system’s operating income has been all over the place, with capital renovation temporarily eating up some of its capacity. While I will defend my contention that a new EHR will amplify a provider’s existing levels of excellence (rarely moving a poor hospital to good), the mere act of choosing, buying, and implementing such a pervasive system (which requires more consensus and focus than many hospitals can muster) may either signal or create its resolve make overdue improvements. Epic also pushes its customers, steamrolling over incompetent or inertia-crippled hospital middle management with the full support of the hospital’s C-level, so don’t underestimate the motivational impact of your CEO demanding that you deliver $700 million worth of value in a rare example of holding executives accountable for true change and coordination across departments. In that regard, improved operational management and visibility may be a byproduct of implementing Epic, although it’s a shame that a software vendor that really doesn’t offer “management consulting” has to lead the charge against mediocrity. Still, hospitals happily pay to have consulting firms tell them what everybody else is doing, so at least an Epic implementation binds the organization to deliver measurable results. As much as we cheap-seaters might smirk about a health system spending hundreds of millions of dollars on software (and oh, I do), the fact is many of them are happy about their decision afterward and show improved results whether it’s Epic, Cerner, or Meditech.

From Expat Investor: “Re: Cornerstone Advisors. Allegations are that officials of its corporate owner 8K Miles forged auditor documents to move money to a sister company mostly owned by the CFO, who resigned.” The India-listed company’s external auditor also quit over the transfers between the companies, which share a CEO.  8K Miles acquired healthcare IT consulting and implementation vendor Cornerstone Advisors Group in late 2016.

From Zeke Avarice: “Re: webinars. Why would someone watch a recording, such as on your YouTube channel?” Live webinars have just one advantage, and that’s being able to ask the presenter questions. The disadvantage is that you have to be available at the designated time, you have to pay attention at what might be an inopportune moment, and you can’t fast-forward or rewind. That’s why we archive the recording  — those get more views than the live sessions due to the long tail of people discovering them after the fact. Still, we get a lot of interest in webinars (example click counts above), although the quality of the program and the speakers drive whether people actually sign up after reading the description and not everyone who signs up is able to attend (which is why we send absentees a link to the video and a PDF of the slides).

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Atlantic.net. The Orlando-based secure hosting solutions vendor provides HIPAA-compliant, PCI-ready, and cloud hosting from its state-of-the-art data centers in New York, London, Toronto, San Francisco, Northern Virginia, and Dallas. The company just won a “Best IoT Healthcare Platform” awards. Organizations choose the company – founded in 1994 in Gainesville, FL — for its 100 percent uptime SLA, its emphasis on security and compliance, and its award-winning service backed by support engineers with decades of experience, all at competitive prices. It offers the eight items required to deliver HIPAA-compliant hosting – firewall, encrypted VPN, offsite backups, multi-factor authentication, private hosted environment, SSL certificates, SSAE 18 certification, and a signed business associate agreement. Thanks to Atlantic.net for supporting HIStalk. 

Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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

Acquisitions, Funding, Business, and Stock

Change Healthcare hires underwriters for an IPO that could value the company at up to $12 billion. The prep work comes nearly a year after McKesson CEO John Hammergren said he wanted to take the company public. McKesson owns a 70 percent stake of Change, which was formed last year through the merger of its IT business and the former Emdeon.

People

The MacArthur Foundation awards Deborah Estrin a fellowship, including a $625,000 “genius grant,” for her work on determining how data generated by smartphones, wearables, and online interactions can be used for mobile health while still maintaining user privacy. Estrin is a professor of computer science at Cornell Tech and of healthcare policy and research at Weill Cornell Medicine. She directs Cornell Tech’s Small Data Lab; and founded the Health Tech Hub at the Jacobs Technion-Cornell Institute, as well as the nonprofit, open-source software architecture startup Open mHealth.

Announcements and Implementations

Frost & Sullvan names Medicomp Systems the winner of its 2018 North America EHR Optimization Technology Leadership Award for its Quippe productivity enhancement solutions for reducing documentation burden.

Datica announces GA of its Cloud Compliance Management System for developers.

Collective Medical will deliver its real-time event notification and care collaboration tools through Appriss Health’s PMP Gateway integration software, used by the prescription drug monitoring programs of 43 states.

A new KLAS report says behavioral health EHRs are one of the lowest-performing segments it measures due to slow development, vendor over commitment, and state-specific reporting needs. Still, frustrated customers are likely to keep their existing systems due to lack of money and competitive alternatives. Valeant would have topped the list (over Credible and Cerner, which has two offerings in Millennium and its acquired Anasazi) had it generated enough responses. No vendor scored above a 7 in “keeps all promises.”

Buoy Health, which offers an AI-powered chatbot, wins the Robert Wood Johnson Foundation’s AU Challenge Award for patient education. I’m not really a fan of the many available online symptom checkers and I’d like to see their results validated against a an actual visit with a clinician, but this one seems OK if you like them. Startups obsess over the problem they think exists in misdiagnosis or underdiagnosis, packing PCP offices and EDs with people who need more information, have been given bad information by the computer, or who can’t afford further diagnostic work or treatments anyway. We have endless problems with our healthcare services delivery and social policies, but not diagnosing enough symptom-free problems doesn’t top the list.

Privacy and Security

Scripps Health patient Danielle Sullivan tells the local news the health system has sent her the medical records of other patients three times in the last seven months. She has filed an HHS complaint but expects no change since Scripps hasn’t apologized and she thinks they just treat mistakes as a cost of doing business.

Other

Healthcare celebrity Atul Gawande, MD will keynote HIMSS19 on Tuesday, February 12 in Orlando.

Stat digs into the business case behind Mindstrong, a predictive mental health app that’s high on hype but low on clinically valid results. Founded by Paul Dagum, MD, the Silicon Valley startup has raised $30 million in funding and secured implementation agreements with a dozen California mental health departments, but has yet to publish peer-reviewed data that back up its claims. With the Theranos fallout barely out of the headlines, industry analysts have been quick to pump the brakes on panacea-like expectations and the company itself has said the app will be rolled out with caution.

Police in San Jose, CA use a combination of video surveillance footage and Fitbit data to charge Anthony Aiello with the murder of his stepdaughter. Investigators say her Fitbit shows her heart rate spiking, rapidly slowing down, and then ceasing at the same time neighbors say Aiello was visiting. After being confronted with the data, Aiello said, “I’m done.”

Sponsor Updates

• Frost & Sullivan honors Medicomp Systems with the EHR Optimization Technology Leadership Award for its Quippe suite of solutions.
• FDB and PetIQ develop the industry’s first veterinary medications database that will deliver codified, up-to-date information on pet medications, structured for integration into pharmacy systems.
• Elsevier Clinical Solutions will exhibit at the College of American Pathologists meeting October 8 in Chicago.
• EClinicalWorks will host its 2018 National Conference October 5-7 in Nashville.
• Healthwise and Imprivata will exhibit at the Cerner Health Conference October 8-11 in Kansas City, MO.
• Lutheran Senior Services (MO) becomes the first Netsmart customer to exchange health data with its local health system through the Carequality framework.
• EClinicalWorks and Healthfinch will exhibit at the AAFP Family Medicine Experience October 10-12 in New Orleans.
• EPSi will host its Visis National Summit October 10-12 in Amelia Island, FL.
• FormFast will exhibit at ASHRM 2018 October 7-10 in Nashville.
• CHIME interviews The HCI Group CEO Ricky Caplin.
• Hyland will exhibit at AHCA/NCAL 2018 October 7-10 in San Diego.
• InterSystems will exhibit at the DoD/VA Gov Health IT Summit October 10-11 in Alexandria, VA.
• Kyruus will exhibit at SHSMD Connections 2018 October 7-10 in Seattle.
• Surescripts honors five EHR vendors with its 2018 White Coat Award for improving e-prescribing accuracy.
• Pivot Point Consulting parent company Vaco hires Phillip Noe (The Adecco Group) as CIO.

Blog Posts

• Enhancing the User Experience with Encrypted Push Notifications (PMD)
• The Impact of Informed Consent – Part 2: Satisfaction (FormFast)
• Want to Ensure Greater Compliance? Look at Things from a Provider’s Point of View (Hayes Management Consulting)
• Top 5 Nonprofit Healthcare Organization Troubleshoots and Resolves Issue Impacting Meditech Users with Goliath Performance Monitor (Goliath Technologies)
• Clarity on Artificial Intelligence and Patient Privacy (Iatric Systems)
• 5 Keys to a Successful Healthcare IT RFP (Influence Health)
• Innovating Our Way to High-Resolution Healthcare (InterSystems)
• A Series on Chatbots: Leveraging Technology to Meet Consumer Expectations (Kyruus)

Contacts

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

EPtalk by Dr. Jayne 10/4/18

ECRI Institute releases its 2019 list of the Top Ten Technology Health Hazards. The list is created each year by assessing various factors around each potential hazard, including severity, frequency, preventability, and breadth of the hazard. Insidiousness is also considered – whether the problem is difficult to recognize and whether it could lead to downstream errors before the problem is identified.

This year’s list contains some hazards that are clearly healthcare IT issues. but also some problems that healthcare has been grappling with for a long time:

1. Hackers can exploit remote access to systems, disrupting healthcare operations
2. “Clean” mattresses can ooze body fluids onto patients
3. Retained sponges persist as a surgical complication despite manual counts
4. Improperly set ventilator alarms put patients at risk for hypoxic brain injury or death
5. Mishandling flexible endoscopes after disinfection can lead to patient infections
6. Confusing dose rate with flow rate can lead to infusion pump medication errors
7. Improper customization of physiologic monitor alarm settings may result in missed alarms
8. Injury risk from overhead patient lift systems
9. Cleaning fluid seeping into electrical components can lead to equipment damage and fires
10. Flawed battery charging systems and practices can affect device operation.

Most of us are familiar with the need to address cybersecurity concerns, as we see ongoing cases of not only breaches, but ransomware attacks. However, I’m still surprised by the number of organizations that don’t keep their systems current with recommended patches and updates, or that are even on versions of software that are no longer supported by their vendors.

Other items such as alarm settings may be addressed by policy and procedure, which can be harder to institute than technological safeguards unless the organization is truly invested in a culture of safety.

Items 2 and 5 are simply gross and it seems they should be straightforward. Unfortunately, the situation is complicated by some manufactures not providing detailed cleaning recommendations or institutions using harsher cleaners than recommended, which damages the surfaces of equipment and allows absorption or sequestration of contaminants.

Retained surgical sponges are an issue that hospitals and surgery centers have tried to address through technology, including special thread in sponges that shows up on x-rays. Other technologies augment the manual counting process and can be effective if they are used correctly. These vary from special counting racks to radio frequency locator systems.

The Centers for Disease Control’s National Center for Health Statistics recently updated its guidelines regarding hurricanes. These go into effect October 1. The hurricane piece is located on pages 19-20 of the 120-page document, which I’m sure all physicians, coders, and billers will be lining up to read. It mostly addresses the ICD-10 codes for external causes – although they have been in place for years, the guidelines direct physicians how they should be used. The guidelines also address the use of Z codes, which can explain why patients presented for care, including homelessness, inadequate housing, poverty, and lack of availability or inaccessibility of health care facilities.

Speaking of CMS, a recent blog by administrator Seema Verma addressed the topic of “Better Data Will Serve as the Foundation in Modernizing the Medicaid Program.” Essentially, CMS is seeking to demonstrate how the ever-growing Medicaid budget is driving better health outcomes. CMS is also looking for ways to “improve program integrity, performance, and financial management in Medicaid and CHIP.” CMS has identified core sets of quality measures that will be used to monitor outcomes, although reporting is voluntary at this time. It admits that reporting is burdensome and has tried to mitigate the burden through the Meaningful Measures initiative, noting future intent to “leverage existing and more automated data reporting systems to generate these Medicaid measures on behalf of states, thereby reducing reporting burden while also improving data consistency, comparability, and comprehensiveness.”

That’s a buzzword bingo winner right there. Theoretically, isn’t CMS already receiving the data through individual provider reporting as part of Meaningful Use? Wouldn’t that allow CMS to aggregate the data rather than having states submit it? I’m not in the details on Medicaid MU very much any more, but maybe someone who is can shed a little light on this for me. All I know is that as a practicing clinician, fewer of my peers are accepting Medicaid patients and those who are have generally stopped booking new patient visits, leaving a continuing gap in care delivery and pushing patients to the emergency department.

Flu season is officially upon us, with positive cases being reported even though the 2018-19 season is not yet being named on the CDC website. We’re seeing plenty of cases in my practice, along with a particularly nasty influenza-like illness that walks like the flu and talks like the flu but comes out negative in testing.

Our urgent care volumes during last year’s flu season were largely driven by patients who either couldn’t get in to see their primary care physicians or who didn’t want to go to the emergency department due to potential wait times, overcrowding, and perceived lack of service. We’ve hired several new providers and a small army of paramedics and scribes to help us get through the upcoming season. If you haven’t received your vaccine yet, now is the time.

We already knew it in our hearts, but I was saddened to see the Journal of the American Medical Association call out the “Southern diet” as deadly. Its main mechanism is thought to be elevated blood pressure. The study looked at nearly 7,000 people who were part of a larger long-term study of diet and lifestyle. It tracked weight, blood pressure, cholesterol levels, alcohol use, income, and exercise habits along with symptoms of stress and depression. The study notes, “The largest statistical mediator of the difference in hypertension incidence between black and white participants was the Southern dietary pattern, accounting for 51.6 percent of the excess risk among black men and 29.2 percent of the excess risk among black women.” Hispanic and Latino individuals were excluded from the study.

I looked in the full-text article as well as in the references for the link to the “Southern diet score” they used but didn’t find it. I’m curious how my own diet stacks up – I do love a good fish fry with cheesy potatoes and apple cobbler.

Email Dr. Jayne.

Morning Headlines 10/4/18

McKesson’s Change Healthcare hires IPO underwriters: sources

Sources report that Change Healthcare has hired underwriters for a 2019 IPO that could be valued at up to $12 billion.

Technology Innovators, Experienced Systems Integrators Join Cerner in Mission to Modernize Veterans’ Electronic Health Records

Cerner announces that the core team it will work with on implementing the VA’s new EHR will include Leidos, Accenture, Henry Schein, AbleVets, plus 20 additional businesses.

California doctors now required to check database before prescribing painkillers

A California law goes into effect requiring physicians to check the Controlled Substance Utilization Review and Evaluation System (CURES) before writing prescriptions for controlled substances.

Readers Write: Recapturing the Best Part of Best-of-Breed

Recapturing the Best Part of Best-of-Breed
By Meg Aranow

Meg Aranow is CEO of Edaris Health of Boston, MA.

Early on in HIT, departmental systems were the only computer-based clinical and business solutions we had. Often built and sold by teams that came directly out of the operational areas and bringing experiential credibility, these solutions spoke the language of the department leaders who were making the purchasing selections. The more relatable they were, the more significant their market share.

Later, with reputations solidified, these vendors began to capitalize by broadening their horizons into related areas, offering suites of applications to handle adjacent functions, such as all labs sections, not just blood labs, or all finance departments, not just AP/AR.

Then came the perfect storm that really engaged us all in the allure of the enterprise systems. First, computerization became the expected standard and big-budget centralized IT departments took root. Second, the market responded with R&D money and new investment capital. Third, healthcare costs and patient safety became everyday news and the idea of health consumerism grew. As timely, accurate shared data seemed the holy grail for both quality and expense control, the lure of single fully integrated systems became irresistible.

The decisions seemed easier 10 years ago. That was when the primary definition of an enterprise was its physical boundaries. There wasn’t much talk about IDNs and integrating freestanding surgery centers, urgent cares, or SNFs.

Now, even as we seek to integrate the data that ensures quality, safety, and expense control within the walls of our institution, we are simultaneously pushing care outside the walls to be handled in places that have less overhead and are easier for patients to navigate. There’s a tightrope to walk. We can’t trample on the very workflows that have created those higher margins and faster throughput at the lower-cost locations. If we make them behave as the rest of the enterprise does, we may lose the very things that made them attractive business assets and popular care destinations for patients in the first place.

As interoperability standards have become de rigor, there are options of where to draw the perimeter of the enterprise system and where to allow – or even encourage – deep support of site-specific workflows without compromise. That is, workflow support as once delivered by narrowly-focused departmental systems.

Customized workflow support is the new best-of-breed. With mature interoperability standards in place, we do not have to sacrifice tailored, intuitive workflow support for the sake of integrated data, decision support, and analytics. There is no reason not to have it all.

HIStalk Interviews Chris Klomp, CEO, Collective Medical

Chris Klomp is CEO of Collective Medical of Draper, UT.

Tell me about yourself and the company.

Collective Medical is a Salt Lake City-based developer of collaboration software. I started working on the company with two of my best friends from Boise, Idaho. We grew up together and we all went to Brigham Young University together. Two of us studied computer science and I was the token business guy. I went off to Bain & Company and then Bain Capital for roughly a decade.

One of our moms, Patti, is a social worker in the emergency department. She had been working on complex patient care coordination, particularly for patients who move across emergency departments. She had hypothesized that not only was this happening, but that a subset of those patients was probably opioid-seeking. Nobody talked about that 15 or 20 years ago, so she was pretty prescient on the ground.

The guys didn’t want to go work for “the man.” Patti, who is a pretty intimidating and awesome lady, told them to “build a computer program” for what she was doing in a circulated Word document and they did. They won a couple of business plan competitions and decide to take it out to the world. It took a lot of years and a lot of bootstrapping, but off we went.

My dad was a physician who told me that healthcare is the highest calling, so that’s what I wanted to do in some form. I had a bit of circuitous path, but I found my way back and we’ve been doing that since.

Collective Medical builds collaborative care networks. We help disparate stakeholders across the continuum — emergency, inpatient, skilled nursing facilities, mental health stakeholders, and even health plans and ACOs with their care managers – become aware when a patient needs them, particularly those vulnerable members who have figuratively fallen. We then unify their records collectively and help pick that person up.

How do you see the company fitting into the interoperability landscape?

We’re attacking from a different direction. I’m not sure I would even classify what we do as carte blanche interoperability. Interoperability is principally concerned with moving data from Point A to Point B. There are a number of pathways by which that’s taking place.

Health information exchange has made tremendous advancements, particularly in the last several years, in linking communities together to unify a care record. There’s a lot more work still to be done, but they’re making great strides. You have the networks like CommonWell and Carequality that are doing that with CCDs and certainly have ambitions to do more. You have platforms like Epic Care Everywhere that are, in some regards, even more advanced in how they link data from Point A to Point B and unify that into a single patient record.

The world is focused on these opportunities for good reason, but it’s a necessary but insufficient condition of driving coordination across an otherwise highly fragmented set of providers in a landscape. We have data silos and we need to unify those. We should have a single patient record that isn’t replicated with duplicative tests or because a patient goes from one site of care to another. However, it’s highly unlikely that the entirety of the country is going to be comprised of organizations like Kaiser, Intermountain, and Geisinger. Even those organizations — and I can say this because Kaiser and Intermountain are among the owners of our company — still have affiliated providers that they don’t own and that aren’t on their same record of care. They still require collaboration and coordination across those disparate providers.

You can either throw a tremendous number of expensive, scarce bodies at the problem, which isn’t scalable, or you can use technology. I’m not talking about mere notifications that an encounter has occurred, which we do, but a deeper level of collaboration. A mental health provider in the emergency department creates a crisis plan for the patient at 3:00 in the morning that involves a primary care provider who is affiliated with a multi-specialty clinic that is not connected to the health system and a Medicaid managed care manager. How do you help those individuals get on the same page and interact with the patient in sequence so that we’re not wasting resources or missing opportunities to help the patient navigate across the continuum, efficiently using the existing technology infrastructure of each organization? That’s the set of problems that we’re focused on.

Notifications are a mechanism to gain provider attention or to nudge them to intervene to mitigate an identified risk. But your phone has 15 notifications an hour popping up and most of that is noise. The more that we can increase the fidelity of those notifications and distill signal from that noise to make them actionable, the better.

Patti’s original work involved competing hospitals sharing her Word document, which was probably shockingly collaborative back then. Is the questionable business case for broad interoperability a non-issue when the addressed problems are overuse of opiates or EDs, which are in nobody’s best interest?

The premise of our business is that bad people don’t go into healthcare. That’s true even with the big, bad health plans that sometimes get painted into a corner. I’m not suggesting that there aren’t disagreements or even mistrust in healthcare and I’m sure there can be tense moments during contract negotiations between a health plan and a health system. But our job is to find the opportunities where there’s an alignment of incentives. When good people are reminded of why they joined up in healthcare and what their true purpose is, those instincts of competition or mistrust that might lead them to not want to share data fall away. When you give them a cause or a reason to collaborate, people will rally.

Let’s say we have a low-income, low-acuity pediatric asthmatic patient who’s bouncing around emergency departments. Nobody’s looking to increase their volume by having that patient coming to their hospital. The health plan, the Medicaid ACO or MCO, and the pediatrician, pediatric pulmonologist, or emergency department physician all have a perfectly aligned set of incentives to get that patient into the most appropriate care channel, stabilize them, and help them lead a healthy life. What level of interoperability and coordination is required to restore that child to a point of health?

How will Virginia’s statewide ED collaboration project work?

Our objective is to connect healthcare at scale. Virginia is a perfect example. You have 130-some hospitals and health systems, hundreds of post-acute operators, and thousands of ambulatory providers across the state, along with Medicaid, Medicare, and commercial health plans. The state’s objective was not only to reach a level of interoperability in terms of data sharing, but even more so, to reach a level of collaboration to manage down medically unnecessary utilization, avoidable friction, or risk.

The state evaluated a number of different paths and vendors and ultimately partnered with us. In five months, we connected 100 percent of the state’s acute care hospitals. We brought on all of the managed Medicaid organizations. In the next wave, we’re onboarding skilled nursing facilities and non-Medicare and other ACOs. We’re beginning to bring on ambulatory providers as well.

The state of Virginia had phenomenal leadership and vision. They didn’t just talk about interoperability that could move data from A to B. They’re goal was real coordination. It’s called the EDCC — Emergency Department Care Coordination — initiative because it starts in the emergency department, the front door of the healthcare continuum for so many vulnerable patients. Virginia is seeking to instantiate workflow broadly out into the rest of the community. Not just through interoperability, but by actually prompting coordinated sequences of engagement of various providers across specific patient archetypes to drive resolution.

Interoperability is the base layer. Then, how do we use data to coordinate human behavior? We make it easier for them by meeting them in their workflow, not making them go look up information. They can understand which of their patients are at a place of need and coordinate with others who can help meet the needs of that individual, to lift them up and catch them before they fall.

How will the company’s momentum or direction change following the large fundraising you completed a year ago?

We bootstrapped the business for most of our history. We aren’t a non-profit, but we’ve effectively run it that way. We don’t dividend out proceeds. The principals haven’t taken raises and draw pretty nominal salaries.

Our goal now is to invest in the platform and to grow networks. Building network effect-enabled platforms is capital intensive because you need to reach critical density in a given geography to create value for the constituents there. We’ve done a pretty good job of that. We’re live in 17 states, not just with one or two hospitals, but penetrated broadly to 100 percent of acute hospitals. We’ve got a bunch more in the hopper.

We realized that while bootstrapping a company gives you tremendous autonomy to do the right thing, it’s a rate limiter to growth. Building a network effects-enabled platform hasn’t been previously done at scale in healthcare. We raised capital to accelerate our growth across the country, to deepen our technical capability with significant R&D dollars, and to gain partners who can help us think through these things since this is our first rodeo.

Our whole point is to act as a rising tide. It’s not to give any individual health system a competitive advantage — which isn’t to say they can’t find it by using our software — but our goal is to help communities lift up their most vulnerable patients. We think about the entire country as that community.

Morning Headlines 10/3/18

Waystar to Acquire Transaction Services Business from UPMC’s Ovation, Adding Enhanced Claims Monitoring Capabilities to Platform

RCM vendor Waystar will purchase the transaction services software business of UPMC-owned Ovation Revenue Cycle Services.

Enhanced Patient Matching Is Critical to Achieving Full Promise of Digital Health Records

A new Pew Charitable Trusts report on patient matching offers potential approaches that include unique patient identifiers that incorporate biometrics, placing more onus on the patient through verification via text message, and standardizing data elements.

GE unexpectedly removes its CEO

GE’s board fires Chairman and CEO John Flannery after just over a year on the job, disrupting company plans to spin off GE Healthcare.

Patients’ heavy records cost hospital $11m

Australia’s Royal Adelaide Hospital will spend $7.8 million to extend its paper records storage and delivery service, with the failure of its Allscripts implementation forcing it to store records offsite since the hospital’s floors weren’t designed to handle that much weight.

‘This system has to survive;’ UMass Memorial Health Care, $22 million in the red, plans to focus on virtual healthcare

UMass Memorial’s deficit prompts CEO Eric Dickson, MD to consolidate services and focus on ACOs, minimally invasive surgeries, and virtual healthcare.

News 10/3/18

Top News

A new Pew Charitable Trusts report on patient matching offers these potential approaches:

• Implement a unique patient identifier, but given the challenges experienced with this approach in other countries, consider powering it with biometrics
• Give patients a more active role in verifying their identity by sending text verification messages sent to to their phones
• Standardize the data elements that are used to predict a patient match, such as making email address one of the match criteria
• Use referential matching that goes beyond name spelling and potentially outdated addresses using third-party data sources such as the US Postal Service

Reader Comments

From Barely Constrained Capitalist: “Re: David Bradshaw of Memorial Hermann. Now working as a contractor for Cerner. Did we ever learn why he was fired from MH?” David’s LinkedIn says he’s working with a “large EMR solution provider” as a population health management advisor, which must pay a lot less than the $1.3 million he made last year. Memorial Hermann just announced plans to merge with Baylor Scott & White to form a massive health system that employs 73,000 people running 68 hospitals from the Gulf to the Oklahoma border. Most of the newco’s named executives are from BSW, so maybe he saw the CIO writing on the wall. Regardless, parting ways at that level is often the result of leadership or strategic changes that are not indicative of personal performance and certainly we don’t know (or need to know) the details of his departure. I think MH uses Cerner and BSW is mostly Epic and Allscripts, not that I would expect them to standardize IT systems. The footnote here might be that big-name CIO jobs are declining in number as their employers frantically merge and affiliate to flex their market power for self-enrichment. Oh, sorry, to deliver the efficiency improvements, reduced costs, and improved care that such mega-mergers always create in their maniacal pursuit of patient-focused excellence.

From Brangelina: “Re: HIMSS. You haven’t commented on their IRS tax filings recently.” I haven’t been able to locate their most recent reports, so I’ve emailed a request for them to send their Form 990 my way.

From Standard Spiel: “Re: clinical mobility poll. Check out these results.” The HIMSS-owned publication writes lengthy analyses of its online polls down to the fractional percentage point, but those typically generate only 100 or so anonymous responses that make any conclusions questionable. I usually get 200-400 poll responses to each week’s HIStalk question and even then I don’t spend a lot of time dissecting the statistically questionable results – it’s just a fun snapshot of what readers think that merits no further analysis.

HIStalk Announcements and Requests

Listening: new from The Sea Within, a new prog supergroup led by Roine Stolt and other members of The Flower Kings.

Webinars

October 30 (Tuesday) 2:00 ET. “How one pediatric CIN aligned culture, technology and the community to transform care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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

Acquisitions, Funding, Business, and Stock

At least GE’s alarming levels of suckitude weren’t limited to its now-abandoned GE Healthcare IT efforts. GE’s board fires Chairman and CEO John Flannery after just over a year on the job, seemingly shocked that he couldn’t dump ballast quickly enough to save the sinking ship he had just inherited. GE names outsider Larry Culp (who?) to replace him as CEO and board chair. Flannery shared GE Healthcare heritage with predecessor and fellow oustee Jeff Immelt, so maybe that’s not the best group to tap for leadership talent. The new guy comes from Danaher, which sells an odd mix of bioscience products (Beckman Coulter, HemoCue, Molecular Devices) and unrelated stuff like the Pantone color matching system. Above is the definitely ugly five-year GE share performance chart, in which it shed 51 percent of value while the Dow was rising 75 percent. The company’s market cap has declined to barely over $100 billion, so hopefully your employer didn’t spend a lot of cash in gifting budding executives with the how-to business books written by Neutron Jack Welch that were all the rage in the 1990s when people still admired the company. GE was among the 12 industrial giants that made up the first Dow Jones Industrial Average in 1896 and was the last of those to drop off the 30-company list in 2018. GE waved goodbye to health IT through the rear window of its submerging dump truck in April of this year, handing that business off to Veritas Capital for $1 billion. It would still like to spin off GE Healthcare, one of its few bright spots, but acquirers and investors don’t love company turmoil.

Sales

• Thirteen-hospital ProMedica will deploy PeriGen’s PeriWatch Vigilance AI-based maternal-fetal early warning system in all of its hospitals that offer labor and delivery services.
• Cleveland Area Hospital (OK) chooses Cerner Millennium under the CommunityWorks deployment model.

People

Provation, fresh off its sale by Wolters Kluwer to a private equity firm, hires Tom Monteleone (Ancile Solutions) as CFO and Jim Mullen (Nextech Systems) as SVP of global sales.

Announcements and Implementations

Australia’s Royal Adelaide Hospital will spend $7.8 million to extend its offsite paper records storage and delivery service for three years, with the failure of its over-budget, behind-schedule Allscripts implementation forcing it to store records offsite since the new hospital’s floors weren’t designed to handle that much weight. The health minister said this week that an independent committee has ruled out continuing the EPAS rollout, so it will either be overhauled or scrapped. Allscripts was supposed to have gone live four years ago at a cost of $158 million, but costs have swelled to $340 million and the rollout stalled as doctors complained that it was unsafe. The hospital might want to investigate the circumstances leading to the approval of its questionable architectural design, which looks like someone sprayed machine gun fire into an ugly airport terminal.

InterSystems announces IRIS for Health, which provides a FHIR application development framework, support for every national and regional interoperability standard, and a normalized and extensible data model. Its capability will be added to HealthShare and TrakCare products next year.

A new KLAS report covering in-home patient monitoring, released in partnership with the American Telemedicine Association, finds that of the small number of organizations surveyed (24) and the small number of patients being monitored, most are happy with their programs despite most of them not achieving key outcomes. The report notes that the line between vendor monitoring and provider outreach is blurred and that most organizations say their program pays its own way under existing capitated and bundled payment models. Legacy vendors include Honeywell Life Care Solutions, Medtronic, and Philips, while more flexible upstarts are Health Recovery Solutions and Vivify Health.

Researchers find that laws requiring prescribers or their delegates to check state prescribing databases caused a 7.2 percent reduction in patients with three or more opiate prescribers, but EHR integration is the holy grail. The authors note that interstate data sharing isn’t really necessary since doctor-shopping across state lines seems to be rare.

Mitre publishes a guide to medical device cybersecurity incident response that recommends incorporating cybersecurity standards in product selection, creating an asset inventory, defining how incident command systems can support cybersecurity issues, and creating an incident response communications plan that includes external stakeholders. I admit that I glazed over pretty early on, so let me know if you see any buried pearls.

Citrus Valley Health Partners (CA) goes live on Meditech Expanse in its hospice and home care locations, with a full system go-live planed for March 2019.

Ciox launches Smart Chart, an expansion of its HealthSource clinical data exchange and aggregation platform that uses AI and NLP to extract clinical data elements from unstructured sources.

Children’s Hospital Colorado, whose IT team is led by friend of HIStalk SVP/CIO Dana Moore, earns an Enterprise HIMSS Davies award.

Government and Politics

VA OIG is reviewing last year’s manual cancellation of 250,000 radiology orders across eight hospitals during a push to remove duplicate and outdated requests, raising concern that some of the studies might have been medically necessary or had been entered as future orders that had not expired. As an example, as many as 10 people under the direction of the radiology managers at the Tampa VA cancelled orders without consulting doctors or patients. The Columbia, SC VA topped the leaderboard with nearly 30,000 outstanding radiology orders, with public outcry pushing VA brass to vow they would clear the backlog (although maybe not in the smartest way).

Privacy and Security

The DEA is installing license plate readers on the back of those highway signs that tell you how fast you’re going, an extension of the 2008 program in which all levels of law enforcement share data from license plate readers and surveillance cameras, some of them using facial recognition technology to identify the driver and passengers. Privacy advocates (shouldn’t that be all of us?) worry that the government could be applying algorithms to the huge database for less-transparent purposes. Genetec, the company that manufactures the license plate readers, has healthcare offerings – video surveillance, access control, and license plate tracking cameras for parking lots that can be installed in access gates or on top of security vehicles to track people parking where they shouldn’t.

Other

Members of Connecticut’s Health IT Advisory Council – charged as the exclusive creator of a state HIE – are stunned to learn from a presentation at its September meeting that the Department of Social Services is continuing its previously failed efforts from 2007 to build a similar system that would not cover the whole state. Both organizations have received CMS funding.

An Annals of Internal Medicine article offers ideas to balance under-diagnosis with wasteful, harmful over-diagnosis:

1. Don’t rely excessively on lab tests, imaging, and specialist referrals to arrive at a diagnosis. Listen to the patient and trust the physical exam.
2. Acknowledge that precision medicine increases the extent of uncertainty and should not drive less-conservative practices.
3. Stop chasing symptoms that often defy a medical diagnosis or are self-limiting and instead watch for the usually-missed symptoms of problems caused by mental state, such as depression or anxiety.
4. Maximize patient-provider trust and continuity.
5. Make time to listen, observe, discuss, and reflect, which can be supported by practicing top-of-license and redesigning EHRs to support “watchful waiting.”
6. Link treatments to diagnosis, but be careful about diagnosing a condition that isn’t treatable, whose treatment can be safely deferred, or that involves a treatment that the patient declines.
7. Consider the potential harm in ordering diagnostic tests and the lack of rigor required to develop and use those tests wisely.
8. Recognize that ordering more tests may seem like a good idea for reducing diagnostic errors, but it doesn’t always provide the answers that patients and providers are seeking.
9. Don’t overemphasize early cancer detection through extensive testing that may raise false positives or result in harmful treatment by over-diagnosis.
10. Recruit specialists and ED doctors to take a stewardship role in reducing overreliance on their services.

Health economist Zack Cooper notes that both the newly installed president of the American College of Emergency Physicians and its president-elect work for companies that profit by charging patients for out-of-network services (physician staffing firms TeamHealth and Envision Healthcare, respectively). The key issue of new President Vidor Friedman, MD is to make insurers pay for ED visits as long as the patient thinks it’s an emergency, even if they are wrong. His employer paid $60 million last year to settle a whistleblower lawsuit involving an upcoding scheme and he was previously known for creating a lobbying group for “emergency medicine advocacy” that mostly involved protecting ED doctor payments under ACA.

Memorial Sloan Kettering Cancer Center President and CEO Craig Thompson announces that he will give up his board positions at cancer drug maker Merck and drug research company Charles River. A 2015 report found that Thompson was making more than $750,000 annually from the companies and presumably was also granted stock options. That article also observed that while it’s easy to look up which doctors had their $15 lunch paid for by a drug company rep, it’s harder to find such board-level relationships. A 2013 analysis found that 279 university-affiliated employees served on the boards of 442 companies, earning $55 million in compensation and owning 60 million shares of stock. Thompson was sued in 2011 by previous employer University of Pennsylvania, which claimed he used intellectual property from his Penn research to start Agios Pharmaceuticals as a Penn employee in 2007 before he left for MSKCC. Apparently the many millions MSKCC pays him isn’t enough and Big Cancer is happy to use its coffers to make it rain for him and other academic researchers who help them make obscene profits on the backs of people with cancer.

Sponsor Updates

• Redox offers access to its interoperability platform to healthcare non-profits and public health organizations that provide access to at-risk populations through its Redox Gives program, with the first beneficiary being the Wisconsin Women’s Health Foundation, which provides free health education and support programs to women and their families and will use Redox integration to streamline referrals to the state’s First Breath stop-smoking program.
• DocuTap and InstaMed partner to improve the patient and provider experience for urgent care centers across the US
• The National Hospice and Palliative Care Organization will offer its members software and services from Audacious Inquiry.
• Nordic wins a work-life balance award based on anonymous employee submissions in the large-employer category.
• Kyruus adds Stephen Kahane, MD, MS to its board.
• AdvancedMD will host its annual user conference, Evo18, October 3-5 in Salt Lake City.
• The Advisory Board publishes a new briefing, “5 insights to help you address burnout.”
• The Business Intelligence Group awards Apixio its 2018 Stratus award for AI.
• Aprima and CompuGroup Medical will exhibit at AAFP’s annual meeting October 10-12 in New Orleans.
• Arcadia congratulates its ACO customers on achieving $90 million in MSSP savings in 2017.
• Greenway Health features AssessURHealth on its podcast, “Putting Possibility into Practice.”
• Bernoulli Health will present at the Spok Connect annual conference October 9 in Scottsdale, AZ.
• Datica will present at Techstars Startup Week Seattle October 10.
• Burwood Group will present at the 2018 Healthcare Facilities Symposium & Expo October 8 in Austin, TX.
• CarePort Health will exhibit at the AHCA National Convention October 7-10 in San Diego.
• Providence Ventures Radio features Collective Medical CMO Benjamin Zaniello, MD.
• CoverMyMeds will exhibit at the Allscripts Client Experience October 3-5 in St. Louis.
• Crossings Healthcare Solutions and Culbert Healthcare Solutions will exhibit at the Cerner Health Conference October 8-12 in Kansas City, MO.
• HealthShare Exchange wins the SHIEC 2018 Achievement Award for Quality and Quality Data for its work with Diameter Health to standardize member CCDs.

Blog Posts

• Apple Improving Health, Care (Optimum Healthcare IT)
• Sleep Well: 5 Ways to Quiet Hospitals, Promote Rest, and Improve Patient Satisfaction (Spok)
• How healthcare executives can forge a stronger chain against cyberattacks (Meditech)
• Medical System Overutilization (Arcadia)
• Culture: It’s all about the people (Bluetree)
• What Really is Compliance? The Answer has Evolved (Datica)
• The cloud is ready for you – but is your security strategy ready for the cloud? (Burwood Group)
• Has the Pendulum Swung Back in Favor of Recruits in the IT Talent Market? (CTG)
• How to Implement a Successful Work From Home Program (Direct Consulting Associates)
• Dimensional Insight Book Club: Reverse Innovation in Healthcare (Dimensional Insight)

Contacts

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

Morning Headlines 10/2/18

Advisory council stunned to learn about parallel health information exchange efforts

Tasked with overseeing Connecticut’s latest HIE effort, members of the Health IT Advisory Council express disbelief and frustration when they learn that a separate state-run agency has been developing its own HIE.

DAS Health Announces Record 3 Concurrent Acquisitions

EHR reseller DAS Health acquires M E Computer Systems, MECS Billing Services, and the Aprima business of consulting firm CriticalKey.

MediQuant Receives Significant Growth Investment from Silversmith Capital Partners

Health data archiving company MediQuant promotes Jim Jacobs to CEO, coinciding with an investment from Silversmith Capital Partners.

Audit Highlights Erlanger’s Continued Net Patient Revenue Growth Of 13%; New Ventures Carried Out Despite $124 Million Uncompensated Care Expense

Erlanger Health System (TN) reports positive year-end income despite predicted shortfalls related to the implementation of its $100 million Epic system last year.

Curbside Consult with Dr. Jayne 10/1/18

I occasionally do a little bit of work for a local personal injury attorney. It’s not the big-time expert opinion work you hear about physicians doing on the side, but more of a translation service. Basically, I take hundreds to thousands of pages of printouts from EHRs and try to reconstruct a coherent timeline of what happened and who documented which data, so that the legal team can understand the facts of a case and determine whether they have something they want to take forward. At least the printouts are virtual, and I’m sifting through PDFs rather than dealing with boxes of documents delivered to my door.

I worked on a case over the weekend from a local hospital where I have never been on staff. The most striking part of the assignment was the poor quality of the records.

The case involved a “routine” outpatient surgical procedure that ended in the patient’s death. The entire episode of care lasted barely more than 24 hours, but there were six different PDFs sent, ranging from 20 pages to 370. Although all the notes and entries were electronically signed by the pertinent physicians, it was quickly apparent that the physicians hadn’t really read the notes before authenticating them. Either that, or they read them and just have a passing familiarity with the idea of matching the pronoun to the gender of the patient or ensuring that the note actually makes sense. Especially since this episode of care contained a profound medical misadventure, one would think that the attending physician (who was going to receive attribution for the case) would have made sure the key portions of the record made sense.

The hospital had numbered the PDFs from one to six, and I quickly realized that the numbering was not at all related to what one would expect in a typical chart. Each file contained a mixture of timelines and care locations (pre-operative area, operating room, intensive care) and was so confusing that I actually thought about printing the whole thing out so I could sort it into chronological order. The admission history and physical was in the middle of the third file, and the discharge summary (also known as the death note) was in the middle of the second. It probably would have been better if the discharge summary was at the end of the last file, because after reading it, I was so aggravated that I had to take a break.

Although the document was clearly identified as a death note, it also contained “Home Instructions for the Patient” and a list of “Medications You Should Continue at Home.” I imagined myself as the widow of this patient reading that and how insensitive it must have seemed to her. She had requested the records personally and provided them to the attorney after she was unable to get answers to her questions from the hospital’s risk management team.

I imagined how confused she must have been by the six files, how disjointed they were, and why she felt she needed to ask the hospital for clarification because the records didn’t make sense. I also put on my EHR hat and thought about how easy it would be to have a separate template for the death note that didn’t have those components that only apply if a patient is actually leaving the hospital.

When I finally made it to the physician notes, I noted how poorly the history of present illness (HPI) was written even though it was either dictated or typed as free text. The patient had been transferred from the operating suite to the intensive care unit after being emergently intubated and placed on a ventilator, which the HPI described as “the patient was difficult to breathe.” The patient was referred to twice as “her” and the rest of the time as “him,” the latter of which was appropriate. Another physician note said that the patient had been “electively intubated for the outpatient procedure” which was incorrect, which somewhat makes one question the accuracy of the documentation in general.

The nursing notes were also interesting, with a nurse documenting that a fall risk assessment was performed and “the patient verbalized understanding” despite the patient being paralyzed, sedated, and on a ventilator, with a documented Glasgow Coma Scale of 3 which basically means the patient was nonverbal and unresponsive to verbal or painful stimuli. One can perhaps blame that one on a macro or shortcut being used, but as a healthcare provider I was embarrassed to see it. The patient also had a “weapons assessment” performed upon arriving to the intensive care unit, although I’m not sure how he could have become armed after being assessed similarly in the pre-anesthesia care unit and having been unconscious most of the time. I understand the value of checklists, but it was just one more thing clogging up the notes that didn’t make sense.

I was heartened to see that the hospital was using a virtual sepsis protocol and remote ICU services from a tertiary care center. My enthusiasm was curbed, however, when I reached the laboratory data section, which displayed the data in an extremely hard-to-read grid (above). I can’t imagine that there was much clinical input on or approval of that document before putting it into the system, and if there was, would love to have a conversation with whoever approved it to go into production. I’m sure users are reading the data on a screen with a scalable display in real time, but it’s still important to be able to have a printout that makes sense.

The attorney who sent me the case felt that there was not likely a valid claim, but had asked me to review to help provide answers to the family. Even in that context, I always review to see if there was an element of negligence or substandard care. I wasn’t pleased to see that the consent for surgery document didn’t have the patient’s name filled out or the surgeon’s name completed in the respective blank spaces. It did have a patient sticker and MRN on it, but not using the blanks as designed just makes it feel like either someone was in a hurry or someone didn’t care, neither of which are great when there has been a poor outcome.

The bright spots of the entire chart were the chaplain’s notes. They were free-text narrative, and although I couldn’t tell whether they were dictated or typed, they were cohesive and actually told the story of what had happened to the patient far better than the physician progress notes (each of which was 8-10 pages long because they contained copy-and-paste content from previous notes). The chaplain’s notes also contained detailed summaries of what was discussed with the family and their responses to the information provided. Those chaplain’s notes were probably the most solid piece of documentation in the chart and they illustrated that the clinical team acted within the standard of care after the initial event.

In the healthcare IT world, we think of projects and timelines and budgets and deliverables, but often we struggle to find the time to think about patients and their families and how those individuals would view our efforts. This family probably doesn’t think very much of the quality of records at this institution and I know the attorney doesn’t either.

As a CMIO, a patient, and a family member of patients, I’m appalled by what I saw. We can do better, and our patients deserve it.

I’d like to throw out a challenge to readers. Take a look at the documentation your systems are producing. Find a death note or a discharge summary with an outcome of “deceased” and see what’s in it. Make sure that you are producing documentation that you would want a patient’s widow or child to see. If you’re a vendor, take a look at your document production code and see if you’re contributing to the problem or helping to solve it. I challenge you to find the development budget to make these issues right if you’re the cause.

Do your users read and correct their notes, or just sign them? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/1/18

Facing Crisis, Sloan Kettering Tells Exec to Hand Over Profits From Biotech

Memorial Sloan Kettering Cancer Center tells VP Gregory Raskin, MD to turn over $1.4 million worth of biotech company shares that he personally owns, and promises to revise its commercialization and investment policies so that it will retain any proceeds accruing from the involvement of its executives instead of enriching those execs.

Diagnosing the Orion Health buyout deal: Q&A

Orion Health shareholders approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company.

Health care payments firm wants to merge with Athenahealth

Revenue cycle technology vendor NThrive (the former MedAssets and Precyse) is the previously unnamed strategic bidder that has offered to buy Athenahealth.

SingHealth COI hearing: Former IHiS CEO dismissed staff for ethical breach, didn’t probe alleged vulnerability

The former CEO of SingHealth’s IT services organization IHIS, testifying in hearings about its recent massive IT breach, says she immediately fired an employee who in 2014 discovered a security vulnerability in Allscripts Sunrise Clinical Manager and then emailed Epic to suggest using his information to increase market share.

Monday Morning Update 10/1/18

Top News

Memorial Sloan Kettering Cancer Center tells technology commercialization VP Gregory Raskin, MD to turn over $1.4 million worth of biotech company shares that he personally owns to MSKCC.

MSKCC had invested in the cancer drug company — which just went public at a share price that values the health system’s stake at $73 million — and had assigned Raskin as its representative on the board of Y-mAbs Therapeutics, for which the company gave him stock options.

MSKCC says it will change its policies so that it will retain any proceeds accruing from the involvement of its executives instead of enriching those executives.

The new policy will not be retroactively applied to MSKCC’s high-profile involvement with Paige.AI. In addition, MSKCC’s CEO will be allowed (at least for now) to continue serving on the board of cancer drug maker Merck.

HIStalk Announcements and Requests

The vast majority of poll respondents don’t want researchers or insurers monitoring their social media activities, no matter how pure their intentions. Also noted in the poll’s comments is that our approval as consumers isn’t really necessary anyway – once you’ve posted your data online, anyone can buy and sell it.

New poll to your right or here: to what extent do you use a smart speaker (such as Amazon Echo or Google Home) at home? I like the Google Home Mini that I bought for $20 last Christmas, but I admit that I haven’t done much with it beyond asking it for the weather and setting timers for cooking (it’s totally worth it for just those two things, however). Add your comment after voting to inspire me with ideas of how I can use my gadget more productively.

I’m improbably penning this from the sparse plains of Thackerville, OK. Mrs. HIStalk mysteriously announced last week, “We’re flying to DFW Saturday morning. Pack casual clothes for two days and don’t Google to figure out where we’re going because it’s a surprise for you.” Our destination turned out to be front-row seats at The Roots concert at WinStar Casino. It was as stunning as you might expect – I’m convinced that they’re the most talented, hardest-working band in the US and Black Thought and Questlove are geniuses in several disciplines. I’ll be playing their back catalog and revisiting Black Thought’s epically poetic 10-minute freestyle rap – imagine the talent required to throw out off-the-cuff, rhythmically resonant lines such as, “As babies we went from Similac and Enfamil to Internet and fentanyl.” Kudos for them for increasing the number of things I can stand about Jimmy Fallon to one. Trivia: Questlove’s father was Lee Andrews, singer for the great 1950s doo-wop group Lee Andrews & The Hearts (“Long Lonely Nights.”)

Webinars

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

Acquisitions, Funding, Business, and Stock

In New Zealand, Orion Health shareholders unenthusiastically (given the lack of better options) approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company. Orion’s other divisions (population health management and hospital software) are big money-losers and did not attract buyer interest. Orion blames its poor results on cash-strapped US hospitals cancelling orders before the company could develop a cloud-based version of Rhapsody. It also says the former Amalga HIS and RIS/PACS it acquired from Microsoft in 2011, developed by another company at Thailand’s Bumrungrad International Hospital, were more of a mess than it thought.  

The New York Post says revenue cycle technology vendor NThrive (the former MedAssets and Precyse) is the previously unnamed strategic bidder that has offered to buy Athenahealth. NThrive CEO Joel Hackney is a former GE colleague of Athenahealth board chair Jeff Immelt and NThrive owner Pamplona Capital Management could fund the deal by taking on debt.

People

Konica Minolta Business Solutions USA promotes Joe Cisna, MBA, MHA to global director of vertical solutions and digital marketplace.

Announcements and Implementations

National Decision Support Company expands its CareSelect solutions for Cerner users to include decision support for laboratory, blood management, and the ABIM Foundation’s Choosing Wisely. Cerner customers were already widely using its image stewardship program to support Medicare’s upcoming imaging appropriate use criteria.

TriNetX announces self-service precision medicine capabilities for its researcher users, adding Patient Journey Analytics, the ability for researchers to apply their own predictive model to patient data, and giving them the capability to create and monitor de-identified patient cohorts.

UNC-affiliated Nash UNC Health Care (NC) goes live on Epic, replacing Cerner to run the same system used by UNC, Duke, and Vidant. The president and CEO says the upfront costs are straining the hospital’s bottom line, but annual costs after Year Three will be the same as it was spending on Cerner.  

Privacy and Security

Michigan Medicine notifies 3,700 patients that a fundraising mailing mistake contained one patient’s name on the label but a different patient’s name on the enclosed letter. The fundraising office says it will begin using windowed envelopes to avoid future mishaps.

Other

The former CEO of SingHealth’s IT services organization IHIS, testifying in hearings about its recent massive IT breach, says she immediately fired an employee who in 2014 discovered a security vulnerability in Allscripts Sunrise Clinical Manager and then emailed Epic to suggest using his information to increase market share. IHIS did not, however, follow up on the vulnerability the employee had discovered, assuming that it was no longer a problem since Sunrise had been upgraded. An Allscripts executive complained to the CEO, who then dismissed the employee who had warned that the SCM flaw “could lead to a serious medical leak or even a national security threat.”

Las Vegas’s University Medical Center has still not changed its practices for using an “internal disaster” alert that tells first responders to send patients elsewhere a year after the Route 91 Harvest Festival shooting, where at least two shooting victims were taken to another hospital instead of UMC, which is the state’s only Level 1 trauma center. The county designed the alert so that hospitals can notify first responders about flooding or power issues, but it has no power to insist that hospitals stop using it when their EDs are at capacity.

The New York Times notes that nursing homes are closing at a rapid rate, plagued with low occupancy, changes in Medicare payment policies that favor home care, and the problem of offering a service that nobody wants until their other options have been exhausted. Medicaid’s long-term care payments have shifted from 90 percent going to nursing homes 30 years ago to 43 percent today. Aging baby boomers may reverse the trend, however, and nursing homes are retooling to chase the higher payments offered by Medicare for short-term rehab.

CB Insights perceptively covers the impact of “The Wellness Economy” in which the vague idea of healthy, holistic, experience-driven lifestyles is driving many industries other than healthcare. It predicts the waning of gyms as people (especially Millennials) purse at-home fitness, an increased focus on smart cities, repositioning of nutrition and beauty brands, and an increase in corporate wellness services, providing as evidence the funding and strategic changes companies are adopting to capture new markets.

In India, family members of a man who died during an inpatient stay accuse the private hospital of storing his body for three days afterward so it could bill them for more services.

Sponsor Updates

• The Vocera Communications Team builds bikes for the Boys & Girls Clubs of Silicon Valley.
• Lightbeam Health Solutions, Experian Health, Surescripts, and Philips Wellcentive will exhibit at NAACOS Fall 2018 Conference October 3-5 in Washington, DC.
• LogicStream Health will exhibit at the 2018 Fall Hospital Pharmacy Conference October 1-3 in Los Angeles.
• MedData, T-System, and Wellsoft will exhibit at ACEP18 October 1-4 in San Diego.
• News: National Decision Support Co. announces expanded Cerner capabilities
• Mobile Heartbeat will exhibit at the Annual PONL Leadership Conference October 4-5 in Lancaster, PA.
• WayStar will exhibit at the DocuTap User Conference October 3-4 in Denver.
• Netsmart will exhibit at the RCPA Annual Conference October 2 in Hershey, PA.
• PatientSafe Solutions will exhibit at 2018 IntegraTe South Florida HIMSS October 2 in Davie, FL.
• ShareableForms forms adds PatientKeeper’s Charge Capture tool to its tablet-based EHR.
• Pivot Point Consulting will exhibit at the 2018 CPCA Annual Conference October 4-5 in Sacramento.
• MarketWatch features Qventus CEO Mudit Garg in a profile on the future of AI in healthcare.
• ZappRx will exhibit at the Annual Pulmonary Hypertension Symposium October 3 in Oak Lawn, IL.
• ZeOmega will exhibit at Inspire 2018 – the Change Healthcare Solutions Conference October 1-4 in Phoenix.

Blog Posts

• In the Glamorous World of Data Science, Machine Learning, and AI, What Matters Most is the Data Itself (Liaison Technologies)
• CMS Emergency Preparedness: Training & Testing (LiveProcess)
• How API environments like Meditech Greenfield promote innovation and drive interoperability (Meditech)
• How providers can innovate to combat physician burnout (Medicomp Systems)
• Automated Indication Selection? (National Decision Support Co.)
• Finding the Courage to Ask (Netsmart)
• Highlights from Epic’s 2018 Users Group Meeting (Parallon Technology Solutions)
• A Practical Approach to Interoperability: Base the Solution on the Problem (PatientPing)
• “Where’s my nurse?”: How to empower nurses to spend more time with patients (PerfectServe)
• Apple Watch Series 4: Who Will Watch the Watch? (Sansoro Health)
• Actionable Intelligence at the Point of Care can Help Prevent Physician Burnout (Surescripts)
• Transforming Primary Care with HealthOS, A Perspective from Dr. Matthew Poffenroth (SymphonyRM)
• Bad Debt Blues: How to Keep Your Clinic Out of the Red (WebPT)

Contacts

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

Weekender 9/28/18

Weekly News Recap

• VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner
• CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring Athenahealth, but at a per-share price that carries no premium
• Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records
• CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management
• Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives
• MITRE partners with Intermountain Healthcare, the American Society of Clinical Oncology, and ASCO’s CancerLinq subsidiary to develop a set of cancer data elements culled from EHRs that will help providers make better treatment decisions at the point of care
• Ochsner Health System (LA) and LSU Health Shreveport will invest in EHR, digital health, and telemedicine enhancements as part of a new joint operations agreement

Best Reader Comments

The influence of social determinants on community wellness is influencing a surge in community-based coalitions. In support of this recognition, we need predictive analytics, patient monitoring approaches that extend beyond care navigation outreach – including all the author calls out above and more, EHR’s that have real estate for care collaboration along the recovery process, and processes in place that will take in patient provided data so that care teams can make timely decisions on treatment plans. (Lauren McDevitt)

Nice to see folks starting to understand the connection between life in general and the 15 minutes the doctor spends with the patient in the clinic. Creating a network of social services that includes the healthcare system is our only hope. We don’t want to alert the doctor! If your AI is really AI, then the machine should be able to alert the person who can take action. This could be the social worker on the care team, the entity who is holding risk on the patient, the minister, etc. You can’t take all the social services needs and dump them on the clinical team – that will just lead to more disaster. (Lee Blanco)

It was always an incorrect extrapolation to assume that because survival of a subgroup with coronary disease improves with aspirin that everybody’s survival does. You’re not pointing out a failure of evidence-based medicine. You’re pointing out a failure of medicine to follow evidence. (Robert D. Lafsky, MD)

I have to guess that most healthcare provider organizations and related EHR vendors still are not aware that in 2008, PDF became an international, OPEN standard (ISO 32000-1, Document Management – Portable Document Format – PDF 1.7). As such, PDF has been recognized worldwide as the most reliable, flexible, and feature-rich document format for information exchange because it supports and manages any type of file format, including structured data, text, graphics, x-rays, and video that are used in the healthcare industry. However, what saddens me is that for the past 10 years, healthcare provider organizations and related EHR vendors still are not familiar with the attributes of the DYNAMIC format of the PDF document (NOT the static format, with which all users are familiar, including the above user and EHR vendor). This is probably one reason why PDF Healthcare, a 2010 Best Practices Guide (BPG) supplemented by an Implementation Guide (IG) (i.e., PDF-H was never a proposed standard) was never accepted by the healthcare information technology industry. (Woodstock Generation)

I applaud your comment of “doing as doctors often do in shooting the EHR vendor messenger without realizing that it wasn’t them who made the workflow decisions” because this is the primary reason that most EHRs are not as “intuitive” or “usable” as we would like. I have frequently seen that the decision of one person or group has deleterious effect on others using the system. I’ve also seen situations where the vendor will speak up and tell the decision-makers that this would not be a good workflow and the decision remains unchanged. (Paulette Fraser)

This MSK-Paige.AI deal seems to be a case of the a total absence of governance and due process. How such a sweet deal for founders, board, and MSK to profit from slides can pass regulators is unfathomable. (AI-Bot)

The AI/ML companies need someone clinical to provide them their training cases, and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. B in Mississippi, who asked for telescopes, microscopes, and science experiment kits for her fifth grade Super Scientist project, in which a weekly “Scientist of the Week” takes home resources to complete a project with their family and then reports back to the class. She says, “It has truly been a blessing to teach fifth grade science, and with your help, they can learn so much more at the convenience of their own home. It allows them to share education with their siblings and parents. You can actually see the importance of it and the responsibility they have had with the items from this project. I couldn’t thank you enough and promise you this will bless a child for many years to come.”

An MIT researcher observes that connected home intelligence devices — such as Amazon Echo and Google Home – seem to be offsetting social isolation that is especially problematic among older adults. He notes that half of people 65 and over surveyed in the UK said their main form of company is the TV, concluding,

In the absence of a warm-blooded alternative, even a brief interaction with a “voice” that serves, interacts, and responds every time, all the time, may someday transform our collective perception of AI from that of a simple tool that “does stuff” around the house to a presence that is a real part of our social self.

Spotify adds a custom playlist generator based on DNA test results from Ancestry, making the dubious claim that ethnic heritage drives musical preferences.

Rural hospital operator LifePoint Health proposes that four of its executives divvy up $120 million in golden parachute money upon completion of its $5.9 billion acquisition by RCCH HealthCare Partners.

In the latest “marketing gone mad” example, Weight Watchers renames itself WW, claiming itself to be a “true partner in wellness” that will embrace wellness-related apps, online communities, and integration with Amazon Alexa and Google Assistant. It should come as no surprise that the announcement was made by the company’s “chief brand officer,” who babbled on about the “new articulation of the WW brand” and a new brand identity that  will “come to life across all brand touchpoints and member experiences” as the company emphasizes its expertise in behavioral science . My alternate interpretation is that Americans don’t want to pay a company to remind them they’re fat, so WW will distance itself from that unforgiving metric and instead lay claim to less objectively punitive “health.” Above is the amazingly creative and daring new logo around which all this hubbub orbits. It should be noted that when asked, the company’s president could not explain what WW stands for, and Adweek panned the new “marque” in saying WW is chasing trends from fear of being disrupted.

Renaissance man Patrick Soon-Shiong’s NantEnergy (which I hadn’t heard of among all the health-related Nants) says it has developed a low-cost alternative to lithium-ion batteries that has been deployed to several villages and cell tower sites around the world. An expert says “if this is true, it would be great,” but wants to see evidence and a test of how long the batteries will last.

In Russia, the father of a deceased 25-year-old woman erects a five-foot tall tombstone that resembles her IPhone, crafted by a company that offers” death accessories.”

In Case You Missed It

• News 9/28/18
• EPtalk by Dr. Jayne 9/27/18
• Readers Write: The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health
• Readers Write: Projects and Costs Out of Control? Take a Low-Dose Aspirin
• News 9/26/18
• Curbside Consult with Dr. Jayne 9/24/18
• Monday Morning Update 9/24/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
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Morning Headlines 9/28/18

Athenahealth fields multiple bids, but offers not much higher than current stock price, sources say

Shares of Athenahealth rise slightly after CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring the company for close to $131 a share.

‘State of the VA is better,’ Wilkie says, but not ‘good’ or ‘excellent’

VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner.

Dozens more jobs being cut at Adventist Health Bakersfield

Adventist Health Bakersfield (CA) will do away with 60 financial services jobs early next year as part of a billing and collections outsourcing deal with Cerner that has already impacted 175 employees over the last six months.

Wearables pioneer Jawbone is back with a new mission: Warning you about health problems you didn’t know you had

Jawbone founder and CEO Hosain Rahman says the company has pivoted from fitness trackers to a device-agnostic remote patient monitoring business that will act as a health check-engine light for monthly subscribers.

News 9/28/18

Top News

Shares of Athenahealth rise slightly after CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring the company for close to $131 a share.

The company’s board members are reportedly “motivated to get a deal done.”

Reader Comments

From Former Road Warrior: “Re: HCTec Partners. Checks went out this week to 2,271 current and former consultants who were not paid overtime for working more than 40 hours in one week. The total settlement was $4.5 million.” Unverified since court documents are now almost always unavailable without cost, but I can at least see that the case was settled in July.

From Fall Out Boy: “Re: hackers at Lutheran Hospital. Owner Community Health Systems provides the IT network for spinoff Quorum Health and was infected by malware via QHC’s network. CHS still has several thousand unpatched Windows 2003 servers that include McKesson Horizon applications used at Lutheran. CHS had to shut down those Windows 2003 servers to contain the malware. The upgrade project has been going on for three years now without any results.” Unverified.

HIStalk Announcements and Requests

It’s officially fall. Soon it will be the winter holidays and then HIMSS19. That means it’s time for my usual end-of-year deals for new HIStalk sponsors and webinar presenters, whereupon I look away demurely as Lorre offers inducements like a car salesperson anxious to make quota (and to re-stroke my fragile ego with such markers of industry relevance). See what it’s like being one of the cool kids who get a figurative leg up on their less-hip competitors. Now is better since it will get crazy in the less than six weeks between New Year’s Day and HIMSS19.

Webinars

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

Acquisitions, Funding, Business, and Stock

Adventist Health Bakersfield (CA) will do away with 60 financial services jobs early next year as part of a billing and collections outsourcing deal with Cerner that has already impacted 175 employees over the last six months. The majority of those were re-hired by Cerner and stayed on at the hospital. Cerner has said it will invite the next wave of laid-off staffers to apply for positions at its Missouri headquarters, though as one angry ex-Adventist employee notes, they’ll be competing with former Adventist employees from other parts of the country.

Los Angeles-based Aiva Health, which has developed virtual assistant-based patient engagement and care coordination software, secures funding from the Google Assistant Investment Program and Amazon’s Alexa Fund.

Women’s virtual health company Maven raises $27 million, increasing its total to $42 million.

Cerner will move into 38,000 square feet of office space in Rosslyn, VA to house employees working on the company’s contracts with the VA and DoD.

Jawbone founder and CEO Hosain Rahman tells ReCode that the company has pivoted from fitness trackers to a device-agnostic remote patient monitoring business that will act as a health check-engine light for monthly subscribers. The new Jawbone Health will use Salesforce’s Health Cloud to securely share customer data with providers, who it seems will then weigh in with treatment advice. The company, which has shrunk from 600 to 110 employees, sputtered out in mid-2017 after mounting financial pressures and competition, including a lengthy patent infringement lawsuit against Fitbit.

Signify Research describes four ways EHR vendors can continue their growth as the EHR market matures:

• Diversify into related areas such as population health management, RCM solutions, and IT outsourcing (Cerner, for example, drives 40 percent of revenue from non-core EHR business)
• Expand the basic EHR offerings
• Sell outside the US (only Cerner, Epic, Allscripts, and Meditech have done much of this and even they are having challenges) although it’s hard to displace local vendors, making acquisition attractive
• Pursue acquisitions that drive market share expansion

Cerner expects its Cerner Health Conference to bring 14,000 attendees to KCMO October 8-11, with the conference theme being “Smarter Care.” CHC will also serve as the coming-out party for Chairman and CEO Brent Shafer as well as the resigned Zane Burke’s semi-replacement, Chief Client Officer John Peterzalek.

Virtual coaching vendor Virta Health hired some new executives this week, which wasn’t as interesting as a review of the components of its type 2 diabetes program – physician supervision, an individualized treatment plan, a personal diet and health coach available by chat, and digital health devices that collect readings in an app  (a digital scale, blood pressure cuff, and glucose testing supplies).

People

Mandira Singh (Athenahealth) joins Collective Medical as head of product.

SnapMD hires Deric Frost (Equality Health) as chief revenue officer.

The Chartis Group appoints Mark Krivopal, MD (GE Healthcare Partners) to its Performance Practice leadership team.

Nordic begins looking for a new CEO after Bruce Cerullo announces he will transition from the role to chairman of the board.

Kristi Ebong (Cedars-Sinai) joins Orbita as SVP of strategy and general manager for healthcare providers.

Sales

• Pershing Health System (MO) will install Cerner Millenium via CommunityWorks.
• CHI Franciscan Health (WA) will work with GE Healthcare to develop an AI-powered command center to better coordinate patient stays.
• Signature Healthcare (MA) selects care coordination and communication software from Medarchon.
• Cabell Huntington Hospital (WV) will implement Wolters Kluwer’s POC Advisor for sepsis surveillance.
• Geisinger will deploy Chess Health’s addiction management technology at its Medication Assisted Treatment Centers in Pennsylvania.
• Three DoD facilities will implement Vecna’s patient check-in solution.

Announcements and Implementations

UnityPoint Health–Marshalltown (IA) transitions to Epic as part of a system-wide roll out.

Centric Home Health & Hospice (TX) implements DrFirst’s Backline secure messaging software.

Olmsted Medical Center (MN) will go live on Epic this weekend, replacing Cerner CommunityWorks inpatient and McKesson ambulatory.

Government and Politics

Health Management Associates pays $260 million to settle whistle blower lawsuits related to allegations that HMA coerced its physicians into unnecessarily admitting ED patients to the hospital. One lawsuit contended that HMA set up admission benchmarks driven by cost projections rather than medical necessity, which resulted in CMS footing the bill for Medicare and Medicaid beneficiaries. Community Health Systems bought HMA in 2013 for $7.6 billion and has struggled to adjust to the acquisition, which left it $14 billion in debt. CHS sold off 40 hospitals and laid off 70 corporate IT employees earlier this year.

After 60 days on the job, VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner. Wilkie and his team are also preparing an EHR governance report for Congress. “If we don’t get the front-end of a member’s service right with the electronic health record,” he told the committee, “it really doesn’t help us when that veteran comes into our system. One of my goals is to make sure that the DoD end works.”

Other

A survey finds that 72 percent of consumers don’t think insurers should be allowed to use big data to determine insurance policy risk, 55 percent think it’s just as threatening to have insurers accessing private data as Facebook, and 18 percent would allow insurers to test their DNA if they might get lower prices. Startlingly, 8 percent said they would allow a video camera to be installed in their home and 11 percent would be OK with having a biometric tracker installed in their body if it might lower their rates. One in five respondents say no correlation exists between their health and their social and economic situations. As other surveys have found, Americans are strongly pro-privacy until someone offers to pay for their most precious secrets.

Brilliant: a Twitter user describes how she used IOS 12’s scripting-like shortcut creation tool to create a Siri-launched Mayday shortcut that sends an “I’m in trouble” text message to friends that includes her latitude, longitude, altitude, and Wi-Fi network name (to help them find her in, including if she’s in a large building or shopping mall); her phone’s battery level; her IP address; and a warning that the phone will automatically go into “do not disturb” and “low power mode” to avoid alerting whoever is threatening her that help is on they way. She just has to say, “Hey, Siri, Mayday” and her IPhone does the rest.

The Maryland Health Care Commission launches a “Wear the Cost” campaign to get people talking about and comparing the prices of procedures, which can vary wildly between hospitals. Harvard Medical School professor and pricing transparency expert Ateev Mehrotra, MD (who says he’ll gift the shirts to his health policy friends) believes the campaign may wind up being more about hospital price shaming than encouraging patients to shop around. “To date,” he explains, “price transparency initiatives that have been rigorously assessed have had little to no impact on prices in the health care system. The reason so far is few people are using those websites.”

Memorial Sloan Kettering Cancer Center quickly ditches the AI-focused “Harnessing Big Data” theme of its annual fund-raising campaign following its Paige.AI equity controversy. The campaign, which usually raises around $1 million, will instead emphasize patient care.

A radiologist who was transported by helicopter to a trauma center in Texas is left holding a $45,000 bill from national air ambulance Air Evac Lifeteam after his insurer agrees to pay just $12,000 since this particular company is not in its network and bystanders who called for help had no way of knowing that. The air ambulance company and several others are owned by private equity firm Kohlberg Kravis Roberts. Their charges are considered aviation rather than healthcare expenses, so they can (and do) charge whatever they want. The radiologist lost his arm in the accident, soon to be followed by his remaining arm and a leg courtesy of KKR. The industry’s trade group claims each flight costs an air transport company $10,200, but they have no choice but to stick insured patients for higher amounts to cover Medicare, Medicaid, and uninsured patients.

Sponsor Updates

• Parallon Technology Solutions publishes an e-book titled “7 Key Epic Optimizations Can Have a Direct Impact on Your Bottom Line.”
• Elsevier Clinical Solutions will exhibit at the American Society Clinical Pathology 2018 Annual Meeting October 3 in Baltimore.
• EClinicalWorks, Ellkay, Healthfinch, Intelligent Medical Objects, and PMD will exhibit at MGMA September 30-October 2 in Boston.
• PatientPing selects Amendola Communications to support its growth initiatives.
• Crossings Healthcare Solution develops Cerner MPage-driven Insulin Management Advisors that provide evidence-based recommendations for IV fluid management, glucose correction, electrolyte replacement, acidosis and anion gap correction, and subcutaneous insulin transition.
• Healthfinch achieves HITRUST CSF Certification.
• Healthwise will exhibit at AdvancedMD’s Evo18 conference October 2-6 in Salt Lake City.
• InterSystems will host its Global Summit 2018 September 30-October 3 in San Antonio.
• Kyruus announces a panel of leading health system CEOs at its upcoming 2018 Annual Thought Leadership on Access Symposium October 15-17 in Boston.

Blog Posts

• Listening and Developing: How Customer Interaction Paves the Way for Valuable Product Development (PMD)
• The Impact of Informed Consent, Part 1: Compliance (FormFast)
• Want to Ensure Greater Compliance? Look at Things from a Provider’s Point of View (Hayes Management Consulting)
• Patient-Risk Surveillance Reduces Disaster in Underserved Populations in Mental Health (HBI Solutions)
• Data Backup Systems: 5 Point Checklist (The HCI Group)
• Extending an Improved Patient Experience Beyond Hospital Walls (Access)
• Monitor and Troubleshoot Virtual Apps and Desktops on Different Clouds with the Goliath Performance Monitor (Goliath Technologies)
• Imprivata for Community Connect offers a cost-saving and secure solution for Great Plains Health (Imprivata)
• From One CMS to Another: Considerations for Content Migration (Influence Health)
• Is Your Healthcare Organization Prepared for the Data Tsunami? (InterSystems)
• ATLAS 2018 Breakout Track – Exploring New Frontiers of Patient Access (Kyruus)
• How API environments like MEDITECH Greenfield promote innovation and drive interoperability (Meditech)
• Exploring Healthcare in America: Which Model is Best for Delivering Quality, Affordable Patient Care? (Loyale Healthcare)
• EnTouch selected as one of the best new ideas in healthcare today (PreparedHealth)

Contacts

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

EPtalk by Dr. Jayne 9/27/18

The request period for CMS to provide a MIPS Targeted Review is open for less than three weeks. Eligible Providers who participated in the Merit-based Incentive Payment System in 2017 can review their final scores and performance feedback on the QPP website. These scores will determine whether providers receive a positive, negative, or neutral payment adjustment for Medicare-covered services in 2019.

A Targeted Review can be requested if MIPS-eligible clinicians or groups believe that an error has occurred in the payment adjustment calculations. Examples where this applies include data quality issues, eligibility issues (such as being below the low-volume threshold but being assigned a penalty) or not being treated appropriately if qualifying for reweighted scores due to extreme and uncontrollable circumstances. Based on the chatter in the physician lounge, it seems that hardly anyone is reviewing these, so they’ll just be surprised when they find out if they’re getting an incentive or penalty. If you think you should have a review, requests can be made until 8 p.m. ET on October 15.

A group of 29 participants in the CMS Next Generation Accountable Care Organization program is uniting to work with CMS to ensure continuation of the Next Generation ACO program. This is in response to some pushback against the program, which allows organizations to take on greater financial risk in return for expanded flexibility for care coordination and other services. Some organizations feel the promised savings hasn’t appeared as quickly as expected. Participants in the coalition include Dartmouth-Hitchcock Medical Center, Henry Ford Health System, Mission Health, Carillion Clinic, and Trinity Health.

The group members plan to “focus on developing elements of future payment policy, network design, and beneficiary engagement.” They also plan to share best practices and show how risk-bearing arrangements can accelerate transformation in care delivery. Next Generation ACOs were responsible for more than $61 million in savings in 2016, when there were only 18 organizations participating. That number is now up to 51 organizations, which are focusing on chronic care and disease management as well as expansion of primary care services.

Speaking of healthcare savings, a new report from The National Council for Behavioral Health’s Medical Director Institute shows that simply getting patients to take their medications as prescribed could lead to substantial cost savings and improved clinical management. It’s long been quoted that nearly half of people who are prescribed medications don’t take them as instructed. The problem is complex and involves many factors: understanding the need for medication, being able to acquire it (cost or transportation issues), understanding how to take it, and actually taking it at the right time and under the correct circumstances each day.

The institute projects a potential $2 billion yearly savings from reduced hospital costs alone, assuming that a number of its recommendations are adopted over the next five to seven years. Some of the recommendations seem straightforward, such as “better communication between physicians and patients” and improved risk assessments to determine who might not take their medications. However, under our current fractured and stressed system, even something like communication is a challenge, with little time available to actually sit with patients and ensure they understand why they need medication, how to take it, and what to expect.

Of course, technology can help with some of these, such as embedding risk assessments into the EHR or serving them up via a patient portal, but the latter assumes patients have Internet connectivity and a certain degree of health literacy. Data sharing can be used to identify non-adherence – I love the medication history in my EHR that lets me see when patients refill their medications, which can be a proxy for not taking it as directed if the dates aren’t as expected. Other solutions require more cooperation from other parts of the healthcare system, such as expanding use of long-acting injectables as compared to daily oral medications and increasing patient access to pharmacy services.

The institute cites data that one in six Americans take psychiatric drugs and notes the risks to patients not taking medications as directed. I saw this in my practice the other day with a patient who came in for fatigue and lethargy, and it was most likely a medical misadventure with incorrectly administered psychotropic medications. It took me a good 30 minutes to get to the root of the matter, which caused a backup in the clinic and skewed my productivity numbers for the day. Sitting with the family was the right thing to do, but not all clinicians are going to do it (and I doubt my emergency department-trained midlevel providers would have). The patient hasn’t had a psychiatrist for six months due to insurance issues and I ultimately wasn’t able to “fix” the problem, but at least was able to point his family in the right direction.

Most of the news coverage coming out of Washington, DC this week is swirling around the Supreme Court nomination, but I was glad to see that Congress is still at work trying to complete legislation dealing with opioids. A deal reached on Monday includes a measure to allow use of Medicaid funds for inpatient treatment of addiction. The so-called “IMD provision” (Institution for Mental Disease) lifts a ban on using those funds for treatment. The initial ban was put in place because of a concern that scarce funds would be paid to higher-priced inpatient facilities. It’s not like addiction goes away because someone is hospitalized, and since there generally aren’t enough beds to go around already, I don’t think the availability of funds is going to significantly impact utilization. It’s hard to charge for a bed that doesn’t exist. There are also waivers already granted for 15 states with waivers pending for 11 more, but that doesn’t cover everyone which explains why Congress is stepping in.

It’s hard to tell exactly what’s going on in the measure, though, because the final legislative text is not yet publicly available. According to my sources, the Senate bill lifts the ban, and the House version provides for treatment of all addiction, not just restricting it to treatment of opioids and cocaine. There is still some contention around HIPAA and confidentiality rules, with healthcare providers pushing to align the confidentiality rules with HIPAA so that clinicians could share information. It looks like the current law will stay in place, keeping additional protections for records of substance abuse treatment.

The House also blocked changes to the Medicare Part D “donut hole” that were requested by pharma. No one wants to be looking like they’re allowing pharma to benefit while allowing the proposed changes to ride the coat tails of bills targeted at the opioid epidemic. I’m sure we’ll see pharma trying to tack this onto something else as the legislative season continues.

I’ve been struggling this week due to a catastrophic outage at my hosting vendor, whose disaster recovery plan completely unraveled. Apparently it started with a server administrator who was supposed to perform a “file system trim” but mistakenly executed a “block discard” instead. Needless to say, the storage platform immediately dropped all data and crashed everyone. In a serious of unfortunate events preceding that calamity, someone had disabled the snapshot functionality, so there was nothing to use to quickly restore data. Instead, they tried to access the off-site backup server in another state, finding an I/O capacity issue that limited restoration efforts.

I don’t mind my websites being down, but it also took out my email for several days. Although I was able to reach out to key clients and pass along an alternate address, I suspect a number of people think I’m just ignoring them and have no idea what I’ve missed. The outage was long enough that most mail servers would stop trying to redeliver.

Having been on the other side of outages, my heart goes out to the admin who created the problem as well as the company’s leadership who is finding out that “trust but verify” is a lot more important than they thought. As I followed their updates (which were extremely transparent) and the customer forum, I was amazed by the number of fellow customers that had no backup of their sites and no disaster recovery plan of their own. There was talk of how much money they were losing, but no discussion of business continuity insurance or even of disaster planning. There was a lot of screaming in all caps and little realization that flooding the support center with tickets asking them to “FIX THIS MESS NOW!!!!!!” probably wasn’t helpful, especially since they were posting real-time updates to all clients.

It’s a good reminder to make sure that your data is backed up in multiple places (and not just by your vendor, but by you personally) and that also your vendor is testing their backup system and restoration process frequently. Stuff happens, and having a plan makes it a lot less painful, that’s for sure.

When is the last time you tested your disaster recovery plan? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/27/18

Maven Raises $27 Million in Series B Financing to Bridge the Gap Between Working Women and Families and Modern Health Benefits

Women’s virtual health company Maven raises $27 million in a funding round led by Sequoia Capital and Oak HC/FT.

Nordic CEO Bruce Cerullo announces long-term leadership succession plan

Nordic begins looking for a new CEO after Bruce Cerullo announces he will transition from the role to chairman of the board.

Healthcare IT Company Cerner Opening Office in Rosslyn

Cerner leases office space in Rosslyn, VA to house employees working on the company’s contract with the VA and DoD.

Readers Write: The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health

The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health
By Matt Miller, PhD

Matt Miller, PhD is vice president of behavior science at StayWell of Yardley, PA.

Advances in technology are having a significant impact on the healthcare individuals receive. Patient DNA is used to personalize treatments with precision medicine. Artificial intelligence (AI) and machine learning are speeding diagnosis and helping providers determine the best courses of action. The Internet of Things (IoT) is enabling a wide range of remote clinical applications, from medication adherence to monitoring vital functions including glucose, heart rate, and blood pressure to configuring and gathering real-time data from medical devices such as pacemakers and defibrillators.

While these technologies are powerful on their own, the combination of these various patient-specific data streams can produce an exponential impact on improving patient outcomes when merged with behavioral and environmental insights. Integration of this diverse data, through electronic health records (EHRs) and other critical healthcare systems, will play an important role in creating an ecosystem that enables providers and patients to get the information they need, when they need it. In turn, this integration of data will support the larger goals of improving population health.

Modern healthcare is well positioned to reap the rewards of recent advances in technology. Silicon and graphene at the chip level and microelectromechanical systems (MEMS) in semiconductors are in devices used every day for diagnoses and treatment, such as CT scanners, X-ray machines, magnetic imaging, ultrasound, and for monitoring blood pressure, glucose levels, and other vital statistics. These components play critical roles in sensing, data processing, and controlling machines used to monitor and treat patients. Add data science – AI and machine learning – to the mix and the industry can begin to explore new frontiers in healthcare by expanding our ability to detect and interpret patterns.

We are beginning to see this convergence of new technologies emerge in targeted use cases. Computer vision and convolutional neural networks are helping radiologists identify malignant tumors, minimizing the pain, inconvenience, and cost of biopsies. Pharmacogenomics and precision medicine are enabling researchers to identify first-line medications for patients based on their genomes and develop therapeutics based on the unique characteristics of the individual and his or her disease.

These applications are just the beginning of innovations that will redefine healthcare in the 21st century. But there may be a simpler example of how today’s data capture technology can make an equally significant impact in improving population health. This approach involves integrating behavioral, environmental, and social data directly into physician’s workflows, so healthcare professionals can have a more robust understanding of a patient’s risk factors and take proactive steps to help patients remain, or become more, healthy.

Social determinants of health (SDOH) are macro-level factors responsible for influencing health risks and health outcomes. SDOH include economic stability, neighborhood and physical environment, level of education, access to healthy food and quality healthcare, available support systems, and stress. These factors contribute to an individual’s life expectancy, mortality, healthcare expenditures, health status, and functional limitations, according to the Henry J. Kaiser Family Foundation.

Research demonstrates the enormous influence of behavior and SDOH on patient outcomes. Clinical interventions impact only 10 to 20 percent of a person’s health outcomes, while socioeconomic and environmental factors determine 80 to 90 percent, according to The National Academy of Medicine.

Consider the possibilities if a physician had access to social and behavioral information alongside lab tests, imaging results, and other background information about the patient. Not only could the doctor see that his 50-year old female patient’s glucose is high and creatinine and hemoglobin are slightly off, he could also evaluate the impact of her adherence to taking prescription medicine, stress level, and the fact that she lives in an urban food desert and doesn’t have access to regular care.

These types of solutions are already coming to fruition, in a variety of forms and functionality. Consider the offering developed by Proteus Digital Health, which combines ingestible sensors, a small wearable sensor patch, and mobile application to monitor patient health patterns and medication adherence behaviors. The objective information collected by the Proteus system enables doctors to initiate, adjust and measure treatment effectiveness, saving patients and payers money while optimizing care and amplifying outcomes.

Johns Hopkins University School of Medicine was also recently awarded a grant to continue research of the Emocha mHealth app, which tracks medication details and care management for individuals with tuberculosis, a diagnosis where strict medication adherence is essential for positive outcomes. The app connects patients and providers for Directly Observed Therapy (DOT), in which patients record themselves taking prescribed medication. The video is uploaded to a telehealth portal, where providers can confirm the medication was taken correctly and collaborate with patients on care management. Early results show that Emocha app boosted medication adherence rates by 94 percent and saved almost $1,400 per patient in treatment costs.

Using multiple data points to triangulate a patient’s condition enables physicians to deliver healthcare with a more holistic perspective. Understanding the gravitational force SDOH has on health outcomes, physicians not only can address the symptoms of disease, but can also respond to variables known to cause and/or exacerbate illness. With these types of insights, they can make more informed decisions around diagnosis, treatment and the continuum of care.

It can be a challenge for physicians to get insights into social and behavioral factors. But the move to EHRs, plus greater integration and effective data exchange through standardization efforts like Fast Healthcare Interoperability Resources (FHIR), are beginning to make these promises a reality. By capturing more data points through EHRs and having access to complete records regardless of where healthcare services are delivered, physicians will have a more comprehensive picture of patients’ background and health, empowering them to provide the care and resources to meet the unique needs of each patient.

Several device manufacturers are already offering remote monitoring tools capable of capturing patient health data at home and uploading it to an EHR for physicians to track.

For example, Boston Scientific’s Latitude Home Monitoring System enables physicians to monitor implanted devices to manage heart conditions. A five-year study of the system showed that there was a 50 percent relative risk reduction of death as compared to patients who only went to the clinic for device checks. Honeywell’s Genesis Touch collects biometric information, such as oxygen saturation, blood pressure, and weight and shares them with physicians. The related mobile app also enables video visits between patients and physicians and offers an interactive teaching tool to demonstrate techniques to manage various conditions and ensure the patient understands the treatment protocols.

Now take this integration a few steps further. Imagine,that through the power of AI and machine learning, a physician could be proactively alerted to key data points about a patient, in real time, outside of a hospital or office visit. Machine learning would identify certain thresholds that trigger the need for the physician to send a message containing educational materials to the patient, change a prescription based on data trends, or even alert emergency services.

Lessons learned from these types of just-in-time, adaptive interventions can be extrapolated to improve population health services by empowering physicians to offer data-driven recommendations to their patients.

For example, many practices may offer a universal stress reduction program to their patients. However, stress can manifest itself in a myriad of ways for different people at different times in their lives. By using the full scope of data available to understand the stressors – physical, social, and behavioral – and other factors impacting each patient, providers can do more than simply and generically “manage stress.” They can develop an intervention that helps specifically manage that patient’s unique stressors.

The future of each individual patient’s outcome is brighter when you combine the nuance and tailoring of personalized medicine with the reach of population health. Advances in science, technology, and use of SDOH brings this future within reach.