Morning Headlines 12/28/17

Federal Exchange Open Enrollment for 2018 coverage, most cost effective saving Americans millions of dollars while improving customer service and access to care

CMS reports that 8.8 million consumers used Healthcare.gov to buy health insurance during this year’s enrollment period, down from 9.2 million last year. CMS spent $10 million on marketing and outreach this year, compared to the $100 million spent last year.

CMS to relax reporting rules for ACOs impacted by hurricanes, fires

CMS publishes an interim final rule adjusting the reporting requirements of the Medicare Shared Savings Program to provide leniency to ACOs that were impacted by natural disasters this year.

Ransomware focus limits healthcare IT progress in 2017

Modern Healthcare looks back on 2017 and concludes that the onslaught of ransomware attacks overshadowed any gains made in health IT this year.

Morning Headlines 12/27/17

RFI — Indian Health Services HIT Modernization

Indian Health Services issues an RFI seeking help developing a health IT modernization strategy as it prepares to migrate away from VistA.

Regional Variation of Computed Tomographic Imaging in the United States and the Risk of Nephrectomy

A study concludes that the overuse of CT scanning correlates with an increase in discovery of unrelated kidney tumors and an uptick in clinically unnecessary kidney surgeries.

Orlando Portale – My Year End Rant

Health IT strategist Orlando Portale calls on health IT evangelists working the speaker circuit to invest time learning how machine learning algorithms work before telling audiences that they will solve health IT’s woes.

News 12/27/17

Top News

The Indian Health Service — which is about to have the VistA rug pulled out from under it as the VA frantically couples with Cerner — issues an RFI looking for help in figuring out how it can “modernize, augment, or replace RPMS legacy health IT systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure.”

IHS’s RPMS is based on VistA.

Reader Comments

From Steve E: “Re: Stanford Children’s Hospital. The $1.2 billion facility is open and it’s impressive, with lots of technology. You should write a piece on it.” The expanded 361-bed building opened December 9. It’s a beautiful facility, as it should be for $3.3 million per bed. We take a different approach in the US in building elaborate campuses for which we all pay with no promises that outcomes will improve. Patient satisfaction scores will rise because of amenities, although those aren’t any better of a predictor of long-term quality of life than impressive lobbies filled with crystal awards. I freely admit my cynicism about our profit-motivated healthcare non-system. 

HIStalk Announcements and Requests

The 82 percent of meeting attendees who sneak looks at their phones are most likely checking email or their calendar, although a few admit to being drawn to non work-related distractions such as news sites, Twitter, Facebook, Instagram, or Snapchat. THB says shiny object fascination is an addiction that can be cured only by confiscating everybody’s phone at the start of a meeting. Bored Amy observes that everybody at her company is so swamped that multi-tasking to keep up with email is mandatory, while MasterBlaster probes deeper into the “just in case you’re needed” meeting invitations where people are just sitting in the room on standby as the core meeting progresses just fine without their involvement.

Too many meetings are held just because they are on a recurring schedule, often bloated with an ever-expanding roster of marginally involved attendees who can’t escape after being added to a single agenda and never removed from the list. There’s also the age-old meeting problems that make participation frustrating: nobody takes charge, there’s no agenda or action items, nobody puts a stop to pontificating and factless chatter, and specific to-do assignments are not made even though it’s assumed that the next meeting will be held on the appointed calendar day. In that regard, self-gratification by phone may be a reasonable defense mechanism. It may be that just getting together without a specific purpose adds value in keeping everyone updated, but the odds aren’t good.

New poll to your right or here: which winter holiday do you consider to be your primary celebration? I’m happy to observe any holiday and I admit that I’m pleased rather than annoyed when someone wishes me Happy Holidays, Happy Kwanzaa, or Happy Anything Else instead of the traditional Merry Christmas — I’ll take all-too-rare best wishes from strangers any way I can get them. “Merry Christmas” is kind of weird anyway, grammatically speaking – when do we use the word “merry” otherwise? As a contrarian, I enjoy wishing people a John Lennon-style “Happy Christmas” just to stir them from their holiday coma with socialistic suspicion.

An anonymous reader sent a donation to DonorsChoose, which with matching funds will provide math materials for the kindergarten class of Mrs. A in Black Creek, NC.

I was binge-watching the engrossing “Halt and Catch Fire” on Netflix when I was struck by this strange but mostly unrelated fact, which I will present as a trivia question that you won’t get right without cheating. In what city was Microsoft founded, the same city in which Amazon’s Jeff Bezos was born?

Last Week’s Most Interesting News

• A newly submitted House bill would allow clearinghouses to sell patient data.
• Drug overdose deaths cause US life expectancy to drop for the second year in a row.
• Greenway Health files plans to lay off 120 of its Georgia-based employees in moving some functions to Tampa.

Webinars

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

Government and Politics

I was curious about former Rep. John Fleming, MD — appointed early this year to the newly-created ONC position of deputy assistant secretary for health technology reform — since I have heard next to nothing about him. I emailed my ONC contact on Christmas Day and got a quick reply,  which is either admirable or sad that both of us were keeping an eye on work email on the holiday. Fleming is leading workgroups on burden reduction, usability, and quality measures and I see he’s written some “Health IT Buzz” blog posts.

Other

Industry long-timer Orlando Portale says too many self-appointed AI pundits are expounding on a topic they know nothing about, which is unfortunately not uncommon in the “big hat, no cattle” world of health IT:

There remains a great deal of confusion from self-professed digital health evangelists and conference bloviators who don’t grok how AI/machine learning actually works … I suggest learning how to code or teaming with someone who does. Build something, otherwise your prognostications are without merit. To my physician friends on the digital health speaking circuit: AI/machine learning is a science, no different than the courses you had in med school. Treat the field with the same deference … Consider redirecting time wasted on Twitter cutting and pasting articles about other people’s work toward building something useful.

A study finds that excessive CT scanning turns up a lot of unrelated kidney tumors (“incidentalomas”) that are over-treated by removing the kidney, exposing the patient to more harm than benefit. This is yet another example of where our excessively fine-tuned diagnostic capabilities (which are getting more sophisticated by the minute as technology such as AI advances) lead clinicians down an expensive and sometimes patient-endangering rabbit hole. We need proven, affordable prevention and treatment strategies for already-detectable and clinically meaningful conditions, not companies that are anxious to profit from the consumer misconception that new diagnostic capabilities will improve societal health. Only outcomes matter. We could also use one where just being exposed to it carries its own significant danger via medical errors, overtreatment, and a frequent disconnect between science and practice.

Tanmay Bakshi, a 14-year-old IBM Watson programmer, is convinced of the value of AI in healthcare. He’s working on a project to help a disabled woman communicate through a neural network that models her brain. He developed his first IOS app at age nine, has published 150 YouTube videos to teach young people about technology, consults with major corporations, and has delivered keynote and TEDx presentations.

Sponsor Updates

Blog Posts

• Tech Blog: Virtual Desktop Infrastructure – Drivers, Security, Costs and Benefits (Huntzinger Management Group)

Contacts

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

Morning Headlines 12/26/17

Theranos gets $100 million in debt financing to carry it through 2018, with some caveats

Fortress Investment Group, a New York-based private equity firm, issues a $100 million debt financing round to Theranos, subject to hitting product and operational milestones. CEO Elizabeth Holmes reports that the new funding provides the company “sufficient liquidity through 2018.”

Health insurer Oscar nears $1 billion in revenue

Next year, Oscar Health anticipates hitting 250,000 subscribers in New York and California and revenue of $1 billion.

Family doctors call for guaranteed access to EMR data for research and quality improvement

The College of Family Physicians of Canada, along with the Canadian Primary Care Sentinel Surveillance Network and the University of Toronto Practice-Based Research Network, are lobbying against EHR vendors over information blocking tactics that are preventing clinicians from accessing data.

Morning Headlines 12/22/17

Fortified Releases 2018 Horizon Report Detailing Healthcare Cybersecurity

Fortified Health Security releases its 2018 report on cybersecurity in healthcare in which it predicts double-digit increases in breaches and new variants of the WannaCry ransomware attack making rounds.

US life expectancy falls for second straight year — as drug overdoses soar

Life expectancy in the US fell for the second year in a row, the first time life expectancy has dropped two-years in a row since the 1960s. The opioid epidemic claimed 63,000 lives in 2016, a 21 percent year-over-year increase in overdose mortality.

Healthcare Management Consulting 2017

KLAS releases a report analyzing the performance of healthcare management consulting firms.

News 12/22/17

Top News

Despite appearances, Medhost wasn’t hacked this week, the company says. The cyber intruder penetrated Medhost’s domain registrar (not its actual server or site) and then redirected visitors to a new webpage claiming he or she had stolen patient data. The company did a nice job explaining what happened and getting the site restored as quickly as the propagation of the restored DNS allowed.

Lesson learned for anyone running a website: use a complex domain registrar account password and turn on two-factor authentication if they offer it. I changed mine this morning.

Webinars

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

Acquisitions, Funding, Business, and Stock

Silicon Valley, meet Bubble 2.0 (and possibly the need for SEC Oversight Part Zillion): the juice manufacturer behind Long Island Iced Tea changes its name to Long Blockchain Corp. even though it admits that it is only beginning to look at blockchain with the vague idea that it might be something cool. The news sent micro-cap shares soaring 200 percent.

A previously dismissed shareholder rights law firm’s securities class action lawsuit against Quality Systems, Inc. is reversed on appeal, with the law firm claiming that Quality Systems/NextGen touted increasing revenue through February 2012, at which time the CEO sold his shares at a high price just before the company lowered guidance and reported lower net income. Above is the QSII share price chart from January 2012 through today, with QSII (dark blue, down 65 percent) vs. the Nasdaq (light blue, up 147 percent).

Sales

USF Health (FL) chooses Kyruus to help its access center match patients to providers.

People

Nordic promotes Michelle Lichte to EVP of client partnerships.

Gary Gartner, MD, MS (Allscripts) joins NextGen Healthcare as VP of clinical solutions.

Announcements and Implementations

A new KLAS report looks at healthcare management consulting (click the graphic to enlarge).The most-trusted partners of respondents in each consulting firm category (cross-industry, healthcare-specific, focused healthcare-specific) were Deloitte, Premier, and Optum. KLAS hasn’t sent me any report announcements since early 2014, so in checking their site to see how the company has grown, I note that it lists 12 executives and a 24-employee research team.

Government and Politics

A newly submitted House bill would allow clearinghouses to sell patient data in a reincarnation of previous bills that were suggested by lobbyists for Experian, The SSI Group, and Availity. Clearinghouses would not be considered HIPAA business associates or covered entities, and like providers that can use patient data without individual consent under the nebulous umbrella of treatment, payment, and operations, would not be required to seek authorization from patients and would be allowed to charge patients for providing copies of their own data. Unlike providers, they would also be allowed to sell data. Hat tip to Politico for turning this up.

The just-passed tax law will affect non-profits that include health systems, hitting them with a 21 percent excise tax on each salary of $1 million or more among their five highest-compensated employees who don’t provide medical services. Also affected will be universities (because of their highly paid presidents and sports coaches) and religious organizations. Given historical health system indifference to high salaries and the enforceability of existing employment contracts, the most likely outcome is that they will just figure out how to bill insurers and patients more to cover their new cost of doing business.

Privacy and Security

Fortified Health Security’s 2018 cybersecurity report finds that nearly all of its web and network penetration tests allowed access to patient information, while 33 percent of systems could be compromised due to incorrectly configured Citrix, VMware Horizon, and SSL VPNs. A rather shocking 72 percent of networks tested were at risk because of weak passwords. It recommends that organizations:

• Maintain and enforce security policies and procedures.
• Keep an updated inventory of devices that store, process, or transmit electronic PHI.
• Use strong security engineering when rolling out remote access solutions and web applications that store patient information in a SQL database.
• Enforce creation of strong passwords.
• Consider implementing systems data loss prevention, security incident event monitoring, and intrusion detection.
• Encrypt data at rest.
• Don’t get indifferent about patch management even though it’s a never-ending slog.

Technology

Wired magazine covers CareCoach, a $200 per month human-powered, tablet-presented simulated pet avatar that monitors high-need and elderly patients by checking in, offering medication reminders, and providing a bonding experience. It’s a good idea, although the avatar’s synthesized voice and inherent processing delays are hard to overlook.

Apple finally admits what many IPhone users have suspected – iOS intentionally slows down older iPhones. Not to sell users a newer model, but to prevent the old phones from shutting down because of deteriorating battery capacity. The takeaway: consider replacing your battery to speed your phone back up  instead of spending $1,000 on a replacement.

Bloomberg reports that Apple is developing electrocardiogram capability for its Watch in which wearers will touch two fingers from the opposite hand on the watch’s frame, possibly helping detect arrhythmias. Apple is behind since AliveCor’s Kardiaband add-on band for the Apple Watch is already FDA approved to capture EKGs.

Twitter continues to kill off its only virtue — mandatory brevity — by allowing its users to stitch together a string of tweets. I haven’t seen proportionately more user brilliance in the expansion of the 140-character limit to 280, no different when people who just couldn’t bear to edit their magnificent thoughts started attaching pictures of words that would not have fit otherwise.

Other

Sixty-three thousand drug overdose deaths in 2016 caused US life expectancy to drop for the second year in a row, the first time that has happened since the early 1960s.

A cafeteria worker at Advocate Trinity Hospital (IL) who says “you don’t have to wait until you get rich to help others” spends $5,000 to buy toys for pediatric patients at Advocate Children’s Hospital. In this tenth year of her project, she will donate half the toys to children in Puerto Rico. 

Dilbert, like “The Simpsons,” somehow remains relevant and edgy after many years.

Sponsor Updates

• Protenus publishes its November Breach Barometer.
• Liaison Technologies rolls out a single user interface for access to its Alloy integration and data management platform.
• HealthLoop will integrate its automated care plans and check-ins with patient activity and behavior analytics from Sherbit.
• A new release of Harris Healthcare’s Novus Meds medication reconciliation application offers mobile physician access and embedded drug knowledge, developed with Hunterdon Medical Center (NJ)
• CloudWave employees collect toys for United Way.
• Conduent will open a global technology and innovation hub in Raleigh, NC.
• LogicStream Health publishes a new case study featuring Tampa General Hospital, “Decreasing C.diff Rates Through Appropriate Testing with a Clinical Process Improvement software platform.”
• Mazars USA will donate $100,000 in 2018 to nine charities that will work to fight hunger.

Blog Posts

• InterSystems Healthcare Leadership Conference: Sun, sand and the future of health IT (InterSystems)
• Gunnison Valley Health Significantly Improves Revenue Cycle Time with ABILITY | EASE All-Payer (Ability Network)
• How Will the CVS-Aetna Merger Transform the Patient Care Landscape? (Redox)
• A Data-Inspired Future? You’re Looking at It (Liaison Technologies)
• In Mammography, History Matters (LifeImage)
• How providers can bridge care gaps caused by social determinants of health (Meditech)
• The Relationship between Artificial Intelligence and Healthcare: Why It’s Complicated and Why Robot Doctors Aren’t Our Future (Medicomp Systems)
• Is Your Revenue Cycle Ready for the New Year? (Navicure)
• 3 solutions to easily comply with shifting healthcare laws and regulations (Experian Health)
• Healthcare IT Trends to Watch in 2018 (PokitDok)
• How Will the CVS-Aetna Merger Transform the Patient Care Landscape? (Redox)
• Spread Holiday Cheer with These 6 Salesforce Carols (Salesforce)
• Two Bundled Payment Models Recalled by CMS, Others Still in Effect (The SSI Group)
• Save 15 Hours of Phone Time Each Week (Solutionreach)
• Quality improvement: more than just HEDIS (Verscend Technologies)
• Here’s to a happy, health New Year! (Voalte)
• The power of effective clinical communication (Vocera)
• 13 Benefits of a Pilot Project Before Buying (West Corp.)

Contacts

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

EPtalk by Dr. Jayne 12/21/17

Usually things in the healthcare IT world are relatively slow from Thanksgiving through the early part of the New Year, as vendors save their best efforts for HIMSS. At the same time, hospitals and health systems make sense of new federal regulations and changes to insurance contracts while patients try to figure out new coverage along with new deductibles, networks, and more.

This year, the early November release of CMS updates to the 2018 MACRA Quality Payment Program, along with the Physician Fee Schedule, seem to have energized the provider community to ensure that they understand the rules that they’ll be operating under in 2018. Healthcare organizations are scrambling to make sure they are ready for initiatives such as the Comprehensive Primary Care Plus (CPC+) program and year-long reporting for various quality programs.

On the vendor side, there has been increased activity supporting clients in the above areas. I’ve seen a handful of vendors announcing their required APIs along with their plans to support the transition to new Medicare beneficiary identifiers. Others are highlighting enhancements to CCD exchange.

Compared to the last several years, vendors seem more likely to publicize the changes they’re making to their systems. Where some focus on enhancements and updates, others are increasingly transparent about defect identification and fixes. In the wake of the Department of Justice action against EClinicalWorks, one has to wonder whether vendors are hoping that transparency will save them from potential whistleblower actions or client claims.

In addition to supporting their clients, vendors are well into the pre-HIMSS run-up. They are refining their messaging and getting ready to put their best feet forward as they work to recruit new clients and to retain existing clients who are constantly looking for the next big thing to solve their workflow woes. I’ve heard from several firms that conduct marketing research – they’re looking for physicians to participate in projects that sound like they are being conducted on behalf of EHR vendors. At least two of them seemed to be for new product launches and I hope I’m able to see what companies are planning before we get to the HIMSS exhibit hall.

I had the opportunity to learn about a startup’s product this week and was impressed by what I saw. The company’s founders come from an industry far away from healthcare. Although many “outsider” companies have thought it would be easy to crack the healthcare nut and have received a rude surprise, this group comes from an extremely data-intensive industry and they have a fresh approach. I’m looking forward to seeing how they prepare for HIMSS and whether their approach to patient engagement will play to healthcare purchasers in the way they hope it will.

A reader emailed after my last Curbside Consult that talked about the challenges patients face when trying to figure out prescription pricing and whether they should use their insurance coverage or pay cash for prescriptions from us. He asked if I had ever seen GoodRx. Although it provides real-time information and price comparisons across pharmacies, it has some of the same issues that make patients question whether they should get their medications from us – namely that GoodRx doesn’t run prescriptions through insurance.

For patients who are looking to meet a family deductible or get out of the Medicare donut hole, it’s not going to help with the bigger picture of those expenses unless their payer allows them to submit receipts and credit the cash expenditures towards the deductible. I also failed to mention that our home grown cheat sheet in the office includes data on pharmacy hours, which is indispensable for any patient trying to get their medications filled after 4 p.m. in our area. I haven’t used GoodRx in a while, but will make it a point to give it another go during my next clinical shift.

It will be challenging to predict how the patient cost curve will bend following changes to the provisions of the Affordable Care Act once the current tax legislation makes it through the process. Although supporters are trumpeting the repeal of the individual mandate for insurance coverage, that doesn’t appear to happen immediately and some subsidies will continue. I would expect costs to rise as people opt out of individual coverage, leaving only sicker people in the pool.

Additional challenges will come to families who receive funding for child healthcare through the CHIP program, whose federal funding stopped September 30 and hasn’t been reauthorized. This is a popular program with bipartisan support, and states are running out of reserves with a forecast of half being out of money by the end of January. Alabama is no longer accepting new patients into the program and Colorado and Virginia have told parents to start looking at private insurance options. Of course, there’s also the threat of a government shutdown looming, so when this will all be untangled is anyone’s guess.

For many organizations, this is the time for holiday greetings and service projects. InstaMed launched its “10 Days of Giving” program, running a toy drive for patients at the Children’s Hospital of Philadelphia and delivering 930 toys.

I looked for blurbs from other vendors and was surprised at how little I found on public websites. One vendor detailed their efforts to collect clothing for the earthquake in Haiti in 2010, and another had a corporate philanthropy blog that hadn’t been updated since 2016. A couple of corporate responsibility webpage links returned “page not found” messages.

I know vendors are out there doing good things and would love to report on them. Many hospitals (especially pediatric facilities) have wish lists for gifts in kind and would be happy to receive your donation. My local hospital is looking for not only toys, but things like ear buds and sports team shirts for teen patients. If you’re looking for an opportunity to give, please also consider Mr. H’s Donors Choose program. I’m amazed by the generosity of our readers, and as the daughter of a retired teacher, I know how much those donations mean not only to the students, but to the educators.

I would love nothing more than to have my next piece be full of stories of holiday giving.

Email Dr. Jayne.

Morning Headlines 12/21/17

Important Update: Domain Registrar Account Compromised

Medhost reports that the account used to register its Medhost.com domain was compromised during a cyberattack Tuesday, but assures customers that all internal systems have remained under the company’s control throughout the incident. The company is reiterating that patient information has not been compromised.

Aledade raises $23 million in new funding round

Aledade, the health IT startup founded by former National Coordinator for Health IT Farzad Mostashari, MD, closes a $23 million venture round led by Venrock and Biomatics Capital Partners, bringing its funding total to $97 million since its 2014 launch.

What This Computer Needs Is a Physician Humanism and Artificial Intelligence

A JAMA Viewpoint article is cautiously optimistic about the potential for AI to improve EHR usability, but urges developers to include front-line physicians in the design and deployment of these tools, noting that, “Even though the EMR may serve as an efficient administrative business and billing tool, and even as a powerful research warehouse for clinical data, most EMRs serve their front-line users quite poorly.”

We’re A Bunch of Expensive Financial Clerks

Brent James, MD, Vice President, and Chief Quality Officer for Intermountain Healthcare, imagines a next-generation EHR that lets clinicians pull core clinical and billing functions into their own customized, activity-based workflow designs. He goes on to say “Epic is dead, Cerner is dead, in their current form. It’s only a matter of time.”

CIO Unplugged 12/20/17

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

First Days

This is the first of a four-part series on key considerations and action items during your first 120 days in a new job.

They say the typical executive will switch positions 5-7 times during his or her career. How can you ensure a smooth and effective transition? This series is intended to compliment what others have written over the years with some fresh perspective. In this post, I will start with recommended actions during an oft-ignored time period: the 30 days prior to your start date.

30 Days Prior

After you have celebrated your new role with friends and family, you have to get to work. This is a challenging transition time, as you must first honor your commitments and obligations to your current employer while also carving out time to focus on your pending role. Your primary commitment and loyalty remains with your current employer. However, if you can find some time to invest in your pending gig, it will pay dividends.

Family Time

I recommend incorporating a one-week break between the two roles to reconnect and refresh. This is an important to time to take a break and immerse yourself in family. Starting a new role is an intensive process requiring extensive start-up time. You will only regret the time you didn’t take off.

Corporate Communication

Work closely with your new organization’s corporate communications team to ensure that your internal announcement is pristine. The announcement establishes others’ first impressions of you, so it’s critical to make sure it is on point. Your picture should be in your Sunday school best. Your quote needs to be specific and visionary. Timing can be sensitive. Continue to show respect to your current employer by consulting with them on the timing of the announcement.

Information Gathering

I prefer to enter a new role fully informed and armed with a plan. Leverage your network to learn everything you can about your new employer and role. While gathering information, you have the opportunity to strengthen relationships with your new team.

In my last transition, I was fortunate to have several weekly meetings in advance to have my new team bring me up to speed on everything from politics to history to challenges, strengths, and opportunities. Your vendor network can also provide a complimentary third-party external perspective. The more you know about your pending employer, the more effective you will be and the easier it will be to earn the respect of your team.

Team Communication

Leadership transitions can cause unnecessary anxiety for your direct reports and division. Conducting weekly leadership meetings will go a long way to addressing both. Spend more time sharing on a personal level versus business. Being transparent can accelerate the team development process.

Depending on the culture of the new organization, consider proactive communication to the broader team. You may want to send an email detailing your background and some personal information that they would not otherwise be privy to from the official corporate announcement. If timing works out, an introductory town hall type of speech with Q&A can be helpful. The more you communicate, the more accurate the rumors.

Assessment

Between all the data points collected from interviews, related research, and information-gathering, you should have enough intelligence to make an accurate initial assessment of the organization’s strengths and gaps. Knowing what you are walking into helps to prepare.

For instance, if your new organization is based on agile philosophy, you better get up to speed before you show up. One of my employers embraced servant leadership, so I read everything I could on the topic prior to my first day. Once you have a draft assessment, run through it with your new team and manager to refine. You will need an honest assessment before you can develop an effective plan and recruit for any gaps.

Recruitment

As part of your assessment, you may learn of openings in key positions. You may discover skill gaps that will require you to bring in external talent. Much like football coaches who know that success depends on the teams around them, the successful manager ensures that she has the right leaders around her. Football coaches spend significant time recruiting prospects into open positions or where they require more depth.

This is not a human resources function. It is a leadership function. Begin the recruitment process immediately. This process can take anywhere from 90-180 days, depending on the organization and role, which is why I always encourage immediate action.

Planning

To set yourself up for success, you need to walk into your new role with your validated plan in hand. You have to hit the ground running and listening. Engage your team and have them help you create and execute your plan. This process will provide an additional catalyst for team building. Your staff will feel they’re included in the new direction and will be more engaged in the process.

Share your plan with your manager to make sure it is congruent with their expectations. Once codified, share it with your entire division. This promotes a culture of transparency and accountability. It demonstrates humility and openness.

The Next 30 Days

While the initial plan typically covers the first 90 days, your first 30 days on the job are the most critical. I’ll review some key considerations and takeaways in the next post.

Feedback

What other considerations and action items should leaders consider 30 days prior to the start of a new role?

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

Readers Write: Finding the Elusive Insights to Improve Surgical Outcomes

Finding the Elusive Insights to Improve Surgical Outcomes
By Dennis Kogan

Dennis Kogan, MBA is co-founder and CEO of Caresyntax of Boston, MA.

America’s operating rooms have an international reputation for driving surgical innovation. But they are also the setting for high variation in performance, as evidenced by the fact that 10 percent to 15 percent of patients experience serious post-surgery complications. This means millions of patients are at risk, yet insight into the root causes of performance variation remain an elusive “black box.” In the absence of this understanding, some hospitals cite the uniqueness of its patient cohorts as the primary driver of variation.

That has the unsettling ring of blaming the patient for his or her subsequent complications. Further, it raises the question of whether or not the hospital has a reliable risk stratification methodology for its patient cohorts, and if not, why not? We can predict the reason and it’s a valid one. Risk stratification at scale depends on data insights, and most perioperative data—a full 80 percent of it—is either uncaptured or unstructured.

To establish perioperative best practices, hospitals first need to harness the massive volume of data where actionable insights currently hide. With the convergence of IoT medical technology and healthcare analytics, they finally can.

Significant workflow enhancements can be made, for example, via performance analytics that consume structured preoperative and postoperative data from the EMR, surveys and patient outcome assessments. But real actionability is made possible with the addition of point-of-care data acquired within the operating room itself, largely from various connected medical devices. Combined with structured preoperative and postoperative data, this provides clinicians with both aggregated and granular data visibility. Now enabled with the clinical full picture, clinicians can focus on putting the data into action.

Circling back to risk stratification, let’s take a closer look at how this works. First, providers must document an individual patient’s risk factors. Then, using a validated risk calculator, a personalized risk assessment can be created (and communicated to the patient). Then, it should be included in an aggregation of patient risk assessments. From this collection of data, along with other data sources that include data pulled during the patient’s surgery, automated risk stratification reports can be immediately available for ICU managers to help prioritize and tailor recovery pathways. These reports could also indicate complication risk and compliance percentages versus targeted benchmarks.

All patients are inherently unique, but that doesn’t mean most of the variation in surgical outcomes or costs is unavoidable. In fact, a significant amount of variation can be reduced by meeting targeted benchmarks—say, for reducing infection, readmissions, length of stay, or even amount of pain experienced post-surgery. These benchmarks and best practices can be crystalized after aggregating and analyzing procedure and surgical documentation, such as reports, vital charts, videos, images, and checklists.

One strategy used in operating rooms around the world is to automate the collection and aggregation of operating room video recordings with key procedure data, including some of the above mentioned checklists and vitals data. Advanced technology can also retrieve surgical videos and images from any operating room integration system. Once surgery and vitals are recorded in a synchronized way, the ability now exists to identify and create a standard protocol that can go into a pre- or post-operative brief.

An additional use for this data includes streamlining post-operative report building, especially for payer reporting and internal quality initiatives. While there is a little time left to report 2017 data for the first official year of MACRA MIPS, this will be a continuing need.

Pre-operative risk scoring is sporadic at best, again, due to the lack of an ability to harness the necessary data. But the same data aggregated to create benchmarks and best practices can be used to create robust and highly accurate risk scoring to see what the possible harm could be to a surgical patient. In parallel, protocols also identified from the data can help to mitigate this risk.

In a hypothetical example, perhaps in one hospital more than 11 percent of patients undergoing non-cardiac surgery experience post-op infection. Predictive analytics reveal that the number of times certain thresholds were reached during surgery correlated with outcome measures. Evidence from this research can be incorporated into a decision support system that monitors the patient’s score and sends alerts when care plans are veering off course. Reductions in infections—and corresponding length of stay and readmission—soon follow.

Persistent opacity into root causes of variation is untenable. Quality-based reimbursement programs such as MACRA MIPS rely heavily on analytics of surgical performance, with a full 60 percent weight given to quality. Meanwhile, patients are aging and becoming frailer. This could increase post-surgery complications to an even higher rate than it is now.

Clearly it is time to innovate not just how we perform surgery, but also how we improve performance.

Readers Write: Almost Real, But Not Quite: Synthetic Data and Healthcare

Almost Real, But Not Quite: Synthetic Data and Healthcare
By David Watkins

David Watkins, MS is a data scientist at PCCI in Dallas, TX.

We all want to make clinical prediction faster and better so we can rapidly translate the best models into the best outcomes for patients. At the same time, we know from experience that no organization can single-handedly transform healthcare. Momentous information hidden in data silos across sectors of the healthcare landscape can help demystify the complexities around cost and outcomes in the United States, but lack of transparency and collaboration due to privacy and compliance concerns along data silos have made data access difficult, expensive, and resource-intensive to many innovation designers.

Until recently, the only way to share clinical research data has been de-identification, selectively removing the most sensitive elements so that records can never be traced back to the actual patient. This is a fair compromise, with some important caveats.

With any de-identified data, we are making a tradeoff between confidentiality and richness, and there are several practical approaches spanning that spectrum. The most automated and private method, so-called “Safe Harbor” de-identification, is also the strictest about what elements to remove. Records de-identified in this way can be useful for many research cases, but not time-sensitive predictions, since all date/time fields are reduced to the year only.

At the other extreme, it is possible to share more sensitive and rich data as a “Limited Data Set” to be used for research. Data generated under this standard still contains protected health information and can only be shared between institutions that have signed an agreement governing its use. This model works for long-term research projects, but can require lengthy contracting up front and the data is still locked within partner institutions, too sensitive to share widely.

What’s a novel yet pragmatic solution to ensure that analytics advancement is catalyzed in healthcare industry? We are exploring “synthetic data,” data created from a real data set to reflect its clinical and statistical properties without showing any of the identifying information.

Pioneering work is being done to create synthetic data that is clinically and statistically equivalent to a real data source without recreating any of the original observations. This notion has been around for a while, but its popularity has grown as we’ve seen impressive demonstrations that implement deep learning techniques to generate images and more. If it’s possible to generate endless realistic cat faces, could we also generate patient records to enable transparent, reproducible data science?

The deep learning approach works by setting up two competing networks: a generator that learns to create realistic records and a discriminator that learns to distinguish between real and fake records. As these two networks are trained together, they learn from their mistakes and the quality of the synthesized data improves. Newer approaches even allow us to further constrain the training of these networks to match specific properties of the input data, and to guarantee a designated level of privacy for patients in the training data.

We are investigating state-of-the-art methodologies to evaluate how effective the available techniques are at creating data sets. We are devising strategies for overcoming technology and scientific barriers to open up an easy access realistic data platform to enable an exponential expansion of data-driven solutions in healthcare.

Can synthetic data be used to accelerate clinical research and innovation under strong privacy constraints?

In other data-intensive areas of research, new technologies and practices have enabled a culture of transparency and collaboration that is lacking in clinical prediction. The most impactful models are built on confidential patient records, so sharing data is vanishingly rare. Protecting patient privacy is an essential obligation for researchers, but privacy also creates a bottleneck for fast, open, and broad-based clinical data science. Synthetic data may be a potential solution healthcare has been waiting for.

Morning Headlines 12/20/17

MedHost

EDIS vendor MedHost is the victim of a ransomware attack that brought down its webpage twice on Tuesday. The company has yet to make a public statement about the attack, and its public-facing webpage has since been restored.

Humana, private-equity firms buy Kindred Healthcare for $4 billion

Humana has partnered with two private equity firms to acquire home-health care and long-term care operator Kindred Health for $4 billion.

Health IT Leader Fortifies Tech and Policy Innovation at Dell Medical School

Former National Coordinator for Health IT Karen DeSalvo, MD joins the faculty at the University of Texas Austin’s Dell Medical School where she will serve as a professor in the Division of Primary Care and Value-Based Health.

It’s Official: North Korea Is Behind WannaCry

Republican White House staffer Thomas Bossert pens a Wall Street Journal op-ed publicly attributing the WannaCry cyberattack to North Korea operatives.

News 12/20/17

Top News

Medhost’s public website medhost.com was hacked Tuesday morning, according to a cyber intruder’s message that replaced the company’s usual home page content.

The hacker demanded 2 bitcoin ($37,000), threatening to otherwise “sell the patient data and do a media release regarding the lack of security in a HIPPA [sic] environment.” Medhost offers hosted financial and clinical systems, an emergency department system, a patient portal, and a health and wellness site.

The site had returned to normal by Tuesday afternoon with no acknowledgement of the previous problem on the site or on social media. A Medhost spokesperson did not return my call in which I asked for verification of the hacker’s claim that patient data was exposed.

UPDATE: shortly after the normal home page was restored late Tuesday afternoon, the site was apparently hit again with the “this website has been hacked” message restored.

UPDATE 2: Medhost CISO William Crank reports that the problem has been resolved and no information was compromised:

MEDHOST has full control of the domain, and the restoration of the domain and associated applications has been completed. Depending upon geographic location, sites may already have full access, but it is possible that the DNS restore process could take up to 24 hours to propagate the changes due to TTL. Intermittent application impact may be experienced by end users during that time. MEDHOST wants to reiterate that there is no indication that sensitive information was comprised and the incident didn’t extend beyond the redirection of the MEDHOST DNS to a static site with the message your article referenced. We strive to provide a robust and secure platform for our clients and continue to investigate this incident and its root cause.

Reader Comments

From Athenahealth: “Re: APIs. We have integrations with over 200 innovators and a developer community of 7,000, processing 700 million calls per month. Our single-instance, multi-tenant cloud platform allows a global integration model that allows immediate access to all partners for our clients – where innovators connect once and then are activated at clients with the flip of switch. We agree that talking numbers is interesting, but more so, let’s start to talk about API usability and the downstream impact of API calls.” It’s encouraging that Allscripts, Epic, and now Athenahealth have checked in with big API usage numbers. None of these are surprising – Allscripts (in the form of the acquired Eclipsys) pretty much defined the idea of inpatient systems with “hooks” as we called them in the old days, while Epic and Athenahealth stay current in deploying modern technologies and Athenahealth’s system is based on connectivity. I’m guessing Cerner has impressive numbers although I haven’t seen them.

From Event Attendee: “Re: John Halamka’s installation as Harvard Medical School’s inaugural International Healthcare Innovation Professor of Emergency Medicine. I had the distinct honor of attending and snapped a picture of a few notable CEOs in the room – Jonathan Bush (Athenahealth), Girish Navani (EClinicalWorks), and Hoda Sayed-Friel (Meditech). It’s remarkable that they spent the morning together honoring his lifetime of achievement.”

From Earth Shatterer: “Re: Epic. What exactly is Sonnet?” Sonnet is a streamlined, cheaper, faster-install subset of Epic’s full software suite being developed that will target small hospitals and physician groups, post-acute care facilities, and some international organizations. It will be released in March 2018. Sonnet was announced at HIMSS17 along with Utility, a fast installation program that gets customers live faster with fewer modifications. Epic says Utility implementations started in Q4 2017 (it’s now Epic’s most popular implementation method) and the first Utility-implemented customers will go live in 2018. Judy Faulkner chooses all Epic product names herself and they always contain a subtle reference, in this case with the word “sonnet” as translated from Italian as “little song.” Epic has tried similar rollouts in the past, twice in a partnership with Philips in the early 2000s and another attempt a few years later using the Sonnet name that may have failed because of newly mandated Meaningful Use requirements, but this one seems like a done deal.

From Who Else Remembers?: “Re: selection consultants having a conflict of interest. This is reminiscent of the late 1980s and early 1990s when Arthur Andersen was accused of a similar bias. Back then, the cozy relationship resulted in a string of predictable yet questionable wins for Gerber Alley and Statlan. Anderson would do the selection and inevitably be granted a large advisory and implementation role post award. Notably, Jay Toole and Andersen were crisscrossing the country espousing the virtues of a best-of-breed approach that needed lots of consulting help, for which Andersen was all to eager to offer the brave buyers of these footnotes in HIT history.” It’s a longstanding question of whether consulting firms that sell system services should be asked to help customers choose those same systems, at least without first recusing themselves from earning future business related to the selection. On the other hand, health systems can hire whoever they want and are presumably acting in their best interest. You mentioned Jay Toole, and in tracking him down, I learned that Dearborn Advisors filed Chapter 7 bankruptcy and apparently closed earlier this year. For more about Gerber Alley, see Vince’s HIS-tory.

From Fanny Pacque: “Re: vendor underbidding. Epic underbids (probably to their advantage) relative to their competitors. Implementation services, additional software, etc. always come later and require direct third-party engagement. This is the tick-tock on how you get to projects that go 2-3x over budget. Example: San Francisco Department of Public Health, which is a few months out from choosing Epic and they’re already bidding out voice recognition software, revenue cycle implementation, HIM, and patient outreach. You can see why Allscripts, Cerner, and others might suggest increased transparency on this topic since they provide fully loaded proposals.” San Francisco DPH’s several Epic-related RFPs are here (on the right side of the page as part of RFP 47-2017). I would think a prospect would know to compare apples to apples in choosing a vendor, but sometimes they get so mentally locked in to their favored vendor that they don’t dig deep enough and/or their lack of EHR selection experience makes them unsuited to detect contract land mines.

HIStalk Announcements and Requests

The efficiency of DonorsChoose is always impressive to see – we funded the teacher grant request of Mrs. A in Michigan on December 10 and her students are already using the STEM kits and experiment books we provided just nine days later, as evidenced by the photos above. She reports, “My students and I are so elated that this project was funded. The excitement they showed when we unwrapped the science kits was unprecedented! I wanted to thank you again for your very generous donation. The students are now able to take science out of the science classroom and bring it in to their homes. Not only have you allowed the students to experience science phenomena, you have also allowed their families to as well! Many of my students and their families do not have access to the items that will enable them to perform these experiments and now they do! You have truly helped to create lifelong memories.”

Welcome to new HIStalk Platinum Sponsor Ellkay, which brilliantly taglines itself as “Healthcare Data Plumbers.” The Elmwood Park, NJ-based company enables interoperability, providing a data pipeline for 45,000 practices and 500 PM/EHRs and connecting hospitals, practices, labs, payers, HIEs, and ACOs using almost any system. Products include connectivity for diagnostic labs; PM/EHR integration and data migration, lab orders and results interfaces; and ACO/HIE connectivity solutions. Its CareEvolve portal and interfaces provide clinical workflow support between laboratories and the point of care, while hundreds of hospitals have used Ellkay’s data extraction, conversion, and archiving services to decommission legacy systems. Black Book included Ellkay on its list of 2017’s most disruptive health IT companies that have top customer satisfaction scores. The company’s “Our Story” page is the most entertaining and fascinating backgrounder I’ve seen and the story about why they installed beehives on the company roof roped me in completely. Thanks to Ellkay for supporting HIStalk and for entertaining and informing me with an unusually cool website.

Webinars

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

Acquisitions, Funding, Business, and Stock

High-profile Silicon Valley investor Bill Gurley – an early Uber backer whose startup Brighter was just acquired by Cigna – launches Stitch Health, a Slack-like care team coordination and patient engagement platform. The Connect team communication system costs from $6 to $18 per user per month depending on features. Stitch CEO and co-founder Bharat Kilaru is a 2015 Harvard MBA graduate and ran a Nashville clinic for the underserved until 2013.

Pittsburgh-based specialized outpatient clinical documentation vendor Net Health will be acquired by two private equity firms and the company’s management team.

Humana and two private equity firms will acquire home health and long-term care operator Kindred Healthcare for $4 billion, continuing the trend of insurers moving into direct patient care.

A New York Times review of proposed health system mega-mergers contains some interesting quotes:

• “Hospital executives are realizing that someone else, including an insurance company employing the nurse at a walk-in clinic or the doctor at a surgery center, wants to take over their relationship with patients — and the potential revenue that those patients represent.”
• “But many point to the promises of past mergers as reason to doubt whether the hospital mergers allow much more than an ability to demand higher prices from insurers. After the last wave of mergers that took place a few years ago, the hospitals didn’t use that opportunity to bring their costs down.”
• “The challenge cannot be underestimated in asking these massive institutions to come together and change into something radically different. You’re taking a zebra and a zebra … what they want to become is a unicorn.”

Silicon Valley, meet Bubble 2.0: SoftBank will invest up to $300 million in a dog-walking app vendor that has already raised $40 million.

Sales

Mercy Health chooses PatientPing for real-time patient care coordination.

People

Recondo Technology hires Craig Niemiec (AxisPoint Health) as CFO.

Patrick Neil Mescall, PhD (Businessolver) joins VirtualHealth as SVP of channel development.

Former National Coordinator Karen De Salvo, MD, MPH, MSC joins Dell Medical School at the University of Texas at Austin as a professor, with appointments in internal medicine and population health.

Announcements and Implementations

A survey of a few dozen hospital CIOs finds that the biggest jump in deployed mobile strategy components over the next three years will be in critical test result alerts, clinical decision support alerts, and care team assignments. Respondents also indicated that their investment in communications technologies will be slightly more driven by system integration capabilities than by end user needs.

I’ve never heard of CHIME’s 2014 spinoffs AEHIS, AEHIT, and AEHIA – which seem to have been created primarily to help CHIME to lasso new dues-paying members who don’t meet the job qualifications to join CHIME since they aren’t CIOs (security executives, CTOs, and application leaders, respectively) – but for those CHIME members who are interested, they’re waiving dues for 2018. I don’t quite understand why a prominently posted press release on the site of AEHIS (that’s the security group) is “Fujifilm Captures New Customers for its Synapse Enterprise Imaging Solutions,” but then again I don’t usually like providers and vendors sharing an association-provided membership bed even when a logical connection exists. As readers have observed, CHIME is mimicking HIMSS in seemingly trying to get bigger, more vendor-friendly, and more executive-compensating, but its members are apparently OK with that and that’s all that counts.

Government and Politics

Americans say healthcare is the country’s second-biggest problem behind the government, Gallup finds. Healthcare hasn’t been one of the top two problems since 2007, when it finished a distance second to Iraq.

Privacy and Security

White House Homeland Security Advisor Tom Bossert says in a Wall Street Journal op-ed piece that North Korea launched the WannaCry malware attack earlier this year that hit hospitals hard, adding, “Pyongyang will be held accountable.”

A Black Book survey finds that 84 percent of healthcare provider organizations don’t have a chief information security officer, 54 percent don’t conduct cybersecurity risk assessments, and 39 percent don’t perform regular firewall penetration testing. The survey also finds that few boards of directors actively discuss cybersecurity.

Yet another exercise proves that de-identifying patient data doesn’t really work, as a university in Australia (as several have done) matches up a publicly released Australia Medicare database and re-identifies patients by linking their information to other publicly available databases. The Australian government is considering laws that would make re-identifying government data illegal, which is an interesting (and not in a good way) approach.

Other

A reader whose company has nothing to do with healthcare consulting was surprised to have it shortlisted among the “Top 10 Healthcare Consulting Firms 2018,” which comes with a (free) certificate and (not free) interview reprint rights from a magazine called Enterprise Services Outlook. The magazine shares a telephone number and street address with shady magazines (CIO Review and Healthcare Tech Outlook) published by Bangalore-based marketing firm SiliconIndia. I’ve previously noted the hilarious misspelling of HIPAA on the cover of Healthcare Tech Outlook and the fact that its covers always feature males. It has published an article by UC Health CIO Steve Hess (which also appeared word for word in Becker’s Hospital Review under a different UC Health author’s name) and by other health system CIOs like Marc Probst and Dan Waltz who probably don’t even realize who they’re writing for. The magazine invites readers who “skimp” [sic] its questionable vanity content to join its august roster of contributors.

Jenn ran this fun item on HIStalk Practice: an Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own epinephrine and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”

Moxe Health founder and CEO Dan Wilson reads “’Twas the Night Before Go-Live,” an HIT-focused song parody written by Jay Rath. Jay fascinates me because in addition to having spent time with Epic, he’s a former staffer at “The Onion,” a contributor to “Mad” magazine, and has a broad background in theater and radio comedy.

Wendy from Bellin Health (WI) sent a photo of the Epic Willow team’s holiday-decorated cubicle area in the IT department that creatively adds a fireplace inside and a welcome mat out front. The coats inside prompted me to check Green Bay’s weather forecast – Tuesday was to be sunny with a relatively balmy high of 40 degrees and a low of 11, but Christmas will be biting as temps struggle to rise to zero (Fahrenheit, just to be clear).

Sponsor Updates

• The InstaMed team delivers over 900 presents to the Children’s Hospital of Philadelphia.
• Definitive Healthcare adds visual dashboards to its hospital and provider databases.
• Elsevier Clinical Solutions publishes a new white paper, “Build or Buy: Considerations when adding a new Clinical Decision Support System.”
• FormFast publishes a new case study, “East Alabama Medical Center Saves Time and Cuts Costs with FormFast’s Leading Form Design Technology & Services.”
• Healthfinch publishes a new case study featuring Valley Medical Group.
• Data analytics from Arcadia Healthcare Solutions supports a New York Times skin cancer investigation.
• T-System President and CEO is recognized at D CEO’s “Excellence in Healthcare” awards program.
• Besler Consulting releases a new podcast, “Perspectives on the Alex Azar nomination for HHS Secretary.”
• Mphasis Eldorado and Change Healthcare expand their partnership to include integration between Javelina and Change Healthcare’s payment integrity services.

Blog Posts

• 5 Tips for a Consumer Friendly Front Desk (Hayes Management Consulting)
• 6 Resolutions for a Healthier and Happier New Year (Healthgrades)
• The Evolution of Healthcare and Railways (Optimum Healthcare IT)
• eGartner to healthcare provider CIOs: Evaluate biometrics for their most important patient identification use cases (Imprivata)
• The New Healthcare CRM: Moving Beyond Marketing (Influence Health)
• A Look Back: The Top Tips of 2017 (Leidos Health)
• Red Flags You Have a Patient Access Problem (Kyruus)
• MIPS Cost Component – Three Things You Need to Know! (Impact Advisors)
• The Healthcare Platform Advantage: How to Do More With Less (Spok)
• Address All Four Parts of HIPAA Compliance (AdvancedMD)
• Agfa HealthCare proudly supports the UNICEF Emergency Fund (Agfa HealthCare)
• Q4 Industry Report: Shadow IT’s positives and negatives within healthcare (Datica)
• Amazon, CVS and Aetna: Online Medicine and the Future of Healthcare (CareSync)
• Navigate the Penalties & Bonuses of the 2018 MIPS Reporting Year (Chart Logic)
• Celebrating the Holidays with Karson and Make-A-Wish Foundation (CoverMyMeds)
• Embracing the Spirit of Giving (Dynamic Computing Services)
• How Will Artificial Intelligence and Machine Learning Impact Healthcare? (Dimensional Insight)

Contacts

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

Morning Headlines 12/19/17

CDC director tells staff ‘there are no banned words,’ while not refuting report

CDC Director Brenda Fitzgerald sent an internal email this week assuring staff that the agency would always be a science-based institution and noting that reports that the Trump administration released a list of banned phrases for the CDC, including “evidence-based” and “science-based” were not entirely accurate and would not impact the agency’s work. In a Sunday morning tweet she reiterated that “there are no banned words at CDC.”

Highmark, Penn State Health officially sign off on partnership deal

Highmark finalizes a $1 billion partnership with Penn State Health that will establish a Central Pennsylvania health network that will use Highmark’s insurance data and Penn State’s delivery network to build a cost effective care delivery model.

ONC launches tool to collect patient demographic data

Responding to reports that a vast majority of medical errors occur because of erroneous patient data, ONC and the CMMI Institute release the Patient Demographic Data Quality framework, a collection of best practice recommendations on collecting and improving patient data.

FDA takes more aggressive stance toward homeopathic drugs

The FDA is taking a tougher stance on homeopathic drugs, specifically those containing potentially harmful ingredients or being marketed for cancer, heart disease, or opioid and alcohol addictions.

Curbside Consult with Dr. Jayne 12/18/17

I worked my last clinical shift of the year this weekend. We had several families come in for care and nothing stresses the system like trying to work up two parents and four preschoolers at the same time, especially when vomiting is part of the picture. There’s a nasty gastroenteritis going around (aka “stomach flu”) along with actual influenza, so I spent most of my day in a mask and cover gown, marinating in alcohol foam every free minute I had.

I had a scribe for a couple of hours during the worst part of the surge, and although we had never worked together, we felt like old friends by the time the shift was over. He’ll be headed off to medical school next summer and was interested to hear about my clinical informatics work in the couple of blocks of downtime that we had. He had spent a couple of years in West Africa, first doing economic development work and later working in a rural hospital, but had never heard of the specialty.

He had some great stories (and even better pictures) of his time with a general surgeon whose skills spanned everything from plastics to OB/GYN due to lack of colleagues. My scribe had spent some time as a first assistant during multiple surgical procedures and figured it would give him a leg up when he gets to medical school. Since he’s been accepted to several highly-competitive schools, he’ll have to fight off dozens of fellows, residents, interns, and students to get to the operating table, but hopefully his knowledge will get him noticed. If there are any cases involving hyena attack victims, he will definitely be able to contribute.

Having a scribe during a record-breaking shift is more than just having someone to help click the boxes. It can mean reminders to include directions you didn’t happen to verbalize when talking to the patient or having an extra set of hands to call around to pharmacies to see who has any Tamiflu left.

We did see several situations where the cost of that particular antiviral medication was out of control, with one family being quoted $750 per patient to have a script filled that typically retails for $120 in our area. The use of Tamiflu is somewhat debatable, but many patients want it in hopes that it will shorten the course of influenza or help protect them from a contagious family member. Most of the local pharmacies were out of pediatric formulations weeks ago, so trying to find it for a child was nearly impossible.

Since we have in-house, cash-only medication dispensing, we’re pretty savvy to the price of drugs because patients typically ask whether it’s going to be cheaper to get it from us rather than using their insurance. Depending on co-pays and deductibles, we’re largely competitive. Often patients who pay cash for their prescriptions are better off getting their medications from us – for one common generic pneumonia drug, we’re nearly $25 cheaper than the local big-box store.

Price transparency is important for many of our patients, and we found over the past year that trying to get the information through our EHR was a nightmare. The cost information, which was scaled by number of dollar signs, wasn’t detailed enough for our patients to make decisions. It was based on average wholesale pricing and didn’t take into account co-pays, deductibles, or pharmacy benefit manager incentives. We keep our cost information the new-fashioned way, on an intranet document that’s basically the equivalent of taping up a cheat sheet at the care team pod.

It would be great if we could get real-time cost information for our patients and then they could make the decision whether they want to purchase their prescription from us because it’s cheaper, or whether it’s worth paying a little more to have it immediately and not have to make another stop.

Sometimes they choose to have the script sent to the pharmacy and then call us back a few hours later, asking if they can come back and pick it up at the cheaper price. This illustrates the challenges we face with patient engagement – we’re empowering them with more information than they’ve had in the past, but sometimes it’s not all the information they need or it might not be correct. I know as a patient having had multiple arguments with providers about the fact that I shouldn’t be paying co-pays the rest of the year and few of them being willing to honor the payer letter that I carry around, that it’s not just about prescription coverage. (Incidentally, I hope the practices that refuse to trust my “don’t charge this patient a co-pay” letter enjoy processing my refund requests, because I make them as soon as I see the Explanation of Benefits.)

If we aren’t able to provide good information on the smallest decisions, it’s a leap to expect people to make decisions on larger health concerns without experiencing stress and uncertainty. I think this is why some patients trend back towards the old days of physician paternalism, where they want a provider to tell them what to do. Or better yet, what the provider himself or herself would do when confronted with the same situation. Having those kinds of conversations requires rapport, which requires interaction over time and the building of trust, which are difficult to do in this era of six-minute visits and fragmented care.

Although the care team approach should theoretically help, in some cases I’ve seen it make things worse as the patient has to now build trust with multiple care team members rather than just with the provider who they’ve chosen (or been assigned) as their primary care physician.

I did have a couple of patients this weekend who specifically said they were at the urgent care because their insurance companies sent letters saying that emergency department visits would no longer be covered for non-life-threatening issues. Fortunately, none of them were emergencies and we were able to handle them. On the flip side, we had patients whose definitive care was delayed by choosing urgent care over a higher-acuity setting. We’re not the best place for actual heart attacks and we just increased your time from symptoms to angioplasty. Same for stroke, when the golden hour really is golden.

I didn’t get a chance to get into the psychology of why they came to urgent care rather than the ED since I was too busy taking care of their ambulance transfers and ED handoffs, but I’m always suspicious about cost being a factor.

I’m hoping that the New Year brings wisdom to our policymakers and greater patience for everyone in our healthcare system, from patients to providers to payers to politicians. I’m skeptical about the last group, but after all this is the season of hope, so I’ll send happy thoughts their way.

What are you looking for in the New Year? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/18/17

UPDATED: Tampa health IT company lays off 120 in Georgia

An Atlanta business paper updates a story it published on Greenway Health’s layoffs last week, clarifying that the EHR vendor is only closing its Atlanta offices but will keep its Carrollton, GA offices open.

McKesson unit wins $400 million U.S. defense contract: Pentagon

McKesson wins a $400 million contract to provide DoD a digital imaging network.

John Halamka Celebrated as Inaugural International Healthcare Innovation Professor

BIDMC CIO John Halamka, MD is named International Healthcare Innovation Professor byHarvard Medical School.

Cigna Acquires Brighter, a Leader in Digital Engagement of Health Care Consumers

Cigna acquires patient engagement vendor Brighter. Co-founder Jake Winebaum comments, “We set out to use technology and consumerism to improve the health insurance experience and reduce unnecessary costs. Our experience with Cigna as a partner over the past two years has proven that those goals can be accomplished.”

Monday Morning Update 12/18/17

Top News

The Atlanta business paper has corrected its story that stated Greenway is closing its Atlanta and Carrollton, GA offices, now indicating that only the Atlanta office will close.

The company is moving some functions from Carrollton to Tampa, but a spokesperson says 500 employees of Greenway Revenue Services and other customer-facing functions will continue their work in Carrollton.

Greenway will also hire another 100 revenue cycle management employees for that location in the next few weeks and is actively hiring for its Tampa office.

The Georgia WARN act site indicates that the Atlanta office will be closed and 24 employees laid off, while the Carrollton layoff involves 96 Greenway employees.

Reader Comments

From Portland Liquid Sunshine: “Re: Cambia Grove. The director, program director, and others have left in the past few months. The new director has no background in innovation.” I don’t know anything about the Seattle healthcare innovation and investment workspace, but comparable offerings elsewhere have struggled.

From Associate CIO: “Re: UIC, Epic, and Cerner. The main issue that Cerner has (and I am surprised that Allscripts isn’t protesting as well as they finished third) is that the state of Illinois has a very strict procurement process. Final bids have to be all-inclusive, which Cerner’s was, but Epic’s was not since it included only licensing. The cost of Epic could end up being twice that offered by Cerner.” I extracted and summarized Associate CIO’s comment left on last week’s post since it interests me a lot.

From Slick Willie: “Re: UIC, Epic, and Cerner. The project was baked as soon as UIC hired Impact Advisors because (a) they always choose Epic, and (b) they always help with the implementation of Epic. Cerner has valid points.” Unverified. Statistics would  prove how often an Impact Advisors-led EHR selection results in an Epic decision and a follow-up implementation contract, but I assume that only the company could provide those numbers and I don’t expect that to happen unless the state of Illinois requests them as part of its review of Cerner’s protest.

From Aaron Iota: “Re: API transaction counts. Does that really matter?” Not to me. Prospects and observers should focus on: (a) whether open APIs are offered and to what outside systems; (b) which third-party vendors are using them; and (c) whether the APIs are meeting customer needs in giving them functionality they would not have otherwise had. A high transaction count simply validates that the APIs are functional and capable of scaling. It’s also true that customers of EHR vendors that offer a broader solution will find less value in APIs to outside systems that they may not require. High API usage means that the market wants interoperability and is getting it, which is the biggest takeaway. It might be interesting also to know whether the EHR vendors are charging for those services since “available” doesn’t necessarily mean “free.” 

From In the Know: “Re: Athenahealth. This is a little old news (October), but I don’t remember you mentioning it. Another Athena exec is gone as now-former CMO Todd Rothenhaus has been replaced by Kevin Ban. Seems like the only one left from one year ago is JB, and I wonder for how much longer?” It’s mostly a new management crew with the exception of Paul Armbrester (chief product officer since 2015) and Paul Merrild (SVP of sales since 2011).

HIStalk Announcements and Requests

The most common forms of on-the-job sexual harassment reported by poll respondents are inappropriate public comments, unwelcome touching, and seductive behavior. The comments are enlightening — if not entirely encouraging — with regard to male behavior. Perhaps the “glass half full” takeaway is that few respondents reported outright sexual assault or the insinuation that their hiring or advancement was predicated on their sexual submission. Note: please don’t misinterpret those percentages – the poll targeted only those who have been sexually harassed and multiple choices were allowed, so that 36 percent “degrading comments” figure means that one-third of the votes (not of participants) involved it. In other words, it is not correct to infer that 36 percent of all female readers have experienced degrading comments at work.

New poll to your right or here: which do you surreptitiously check most often on your phone during meetings? I’m always curious what drives people to tune out of meeting participation and instead steal sly glances at their phone held just below table level (as though the other attendees can’t tell that they are either screwing around with their phone or contemplating their crotch). Is it being invited to a meeting that you didn’t really need to attend, tuning out when you have nothing to contribute, or just being helplessly lured to the distraction machine that is so readily available?

Consider giving some closure to 2017 by completing my one-yearly reader survey. The results help me plan for 2018, and even though I can’t implement every suggestion or idea and I don’t make decisions by committee, there’s never been a year that I didn’t use quite a few suggestions to reapportion my HIStalk time. I’ll also randomly draw some responses from folks who will get a $50 Amazon gift card.

RIP Pat DiNizio, the 62-year-old Smithereens singer / songwriter who died last week at 62. I shall play the fabulous “Behind the Wall of Sleep” and “Blood and Roses” in his memory.

Reader Vicki made a generous donation to my DonorsChoose classroom project fund, which with matching money from my anonymous vendor executive and other sources fully paid for these teacher grant requests:

• A robotics construction kit for Ms. C’s second grade class in Asheville, NC.
• Math and science games for Mrs. T’s elementary school class in Merrill, MI.
• Science kits for Mrs. C’s elementary school class in Hamilton Twp, NJ.
• A microscope, safety goggles, and an elementary mixtures science kit for Ms. T’s elementary school class in Washington, DC.
• A Rube Goldberg Machine engineering kit for Ms. Ms. H’s sixth grade class in Blaine, MN.

Last Week’s Most Interesting News

• Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health.
• Greenway Health announces the layoff of 120 employees and the closing of its Atlanta offices as it moves some operations to Tampa.
• For-profit oncology operator 21st Century Oncology will pay $26 million to settle DOJ charges that it submitted fraudulent Meaningful Use documentation and paid its doctors to refer patients to its lab and radiation businesses.
• CliniComp sues Cerner for infringing on a 2003 patient right after it loses its challenge to the VA for choosing Cerner in a no-bid contract.
• The White House leads a half-day introductory meeting on EHR interoperability.

Webinars

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

Acquisitions, Funding, Business, and Stock

Ability Network raises $545 million in debt financing.

Cigna acquires health plan digital engagement platform vendor Brighter. The price was not disclosed, but the company had raised $49 million in funding and had apparently pivoted from its original business of offering an online marketplace for discounted dental care.

Sales

The Department of Defense chooses McKesson to provide a $400 million digital imaging network.

Decisions

• Memorial Hospital (IL) will switch from Meditech to Cerner in January 2018.
• Mountain View OB-GYN (PA) will replace EClinicalWorks with Epic’s ambulatory EHR in 2018.
• Medical Specialists of St Luke’s (MO) will replace EClinicalWorks with Cerner’s ambulatory EHR in June 2018.
• Fillmore County Hospital (NE) will move from NextGen to Cerner’s EHR in 2018.
• Cass County Memorial Hospital (IA) went live with Epic in November 2017.

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

People

John Halamka, MD, MS is installed as Harvard Medical School’s first International Healthcare Innovation Professor, where he will focus on emergency medicine.

Announcements and Implementations

Microsoft announces a private preview of an AI-powered healthcare chatbot project, with partners including Aurora Health Care and UPMC.

Geneia will integrate its cost and quality analyics solution with Salesforce Health Cloud.

Other

In South Australia, a clinical hematologist from Royal Adelaide Hospital – testifying at a coroner’s inquest into the deaths of several patients who were underdosed on chemotherapy – warns that a problematic Allscripts rollout has caused the planned 2009 implementation of electronic chemotherapy ordering to remain on hold, exposing patients to the risk of error-containing handwritten orders.

Weird News Andy says there’s a very dark comedy somewhere in this story. Organizations that offer doctors hands-on training sessions involving cadavers sometimes hold them in hotel ballrooms – including those of Disney, Hilton, and other big names — with a few sheets of plastic laid over the carpet to catch the inevitable spills and flying bone fragments. Reuters reporters saw cadavers being delivered via the hotel’s main passenger elevators, gore-covered doctors wandering hallways trying to find someplace to wash their hands, conference organizers setting up snack stations near the cadavers, and vacated ballroom trash cans overflowing with bloody materials and used syringes. Doctors are cutting downstairs and amateur porn auteurs are filming in the rooms, so don’t crawl on the carpet or use the comforter as a blanket.

Sponsor Updates

• Liaison Technologies leads the market in data regulatory compliance with its award-winning Alloy platform.
• Huffington Post profiles TriNetX.
• ZirMed’s Crystal Ewing joins the WEDI 2018 Board of Directors.
• PM/EHR vendor Chart Talk will offer its users patient engagement and communication capabilities from Solutionreach.

Blog Posts

• Henry Ford Adds More Choosing Wisely Alerts (Stanson Health)
• Red Flags You Have a Patient Access Problem (Kyruus)
• You’ve got a good radiology solution. Here’s how to make it great.(NVoq)
• Revenue Integrity: Improving Financial Stability (Impact Advisors)
• Patient Needs and Retail Healthcare (The SSI Group)
• 4 Practice Marketing Lessons Gleaned from Star Wars (Solutionreach)
• RSNA 2017: Visage’s Top Five (Visage Imaging)
• A chief resident’s tips for smartphone communication in an academic hospital. (Voalte)
• How mobile devices are impacting patient satisfaction (WiserTogether)
• Prior Authorization: Healthcare’s Biggest Bottleneck? – Part 1 (ZappRx)

Contacts

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