Morning Headlines 12/8/17

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

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

Dignity and CHI sign definitive agreement to merge

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

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

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

Using Electronic Health Data for Community Health

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

News 12/8/17

Top News

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

Announcements and Implementations

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

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

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

Government and Politics

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

Other

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

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

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

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

Fun from The Onion.

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 12/7/17

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 12/7/17

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

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

Framework for Improving Critical Infrastructure Cybersecurity

NIST publishes a draft update of its Cybersecurity Framework.

Henry Ford Health data breach affecting 18K patients

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

House lawmakers: VA Choice reform bill can wait until 2018

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

CIO Unplugged 12/6/17

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

New Math

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

New Math

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

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

Right for the Organization

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

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

Right for the Person

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

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

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

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

Replicate Yourself

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

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

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

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

Protect One Another

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

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

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

Hope

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

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

Final

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

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

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

HIStalk Interviews Richard Caplin, CEO, The HCI Group

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What consulting services are in most demand?

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

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

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

Do you have any final thoughts?

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

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

Morning Headlines 12/6/17

Advocate plans to merge with Wisconsin hospital giant Aurora

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

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

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

DeepVariant: Highly Accurate Genomes With Deep Neural Networks

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

Emergency rooms are monopolies. Patients pay the price.

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

News 12/6/17

Top News

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

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

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

Philips acquires Netherlands-based interoperability software vendor Forcare.

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

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

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

Sales

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

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

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

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

People

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

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

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

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

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

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

Announcements and Implementations

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

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

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

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

Government and Politics

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

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

Technology

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 12/5/17

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

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

Texas Medical Board Adopts New Telemedicine Policy

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

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

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

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

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

Curbside Consult with Dr. Jayne 12/4/17

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Have any good stories on due diligence? Email me.

Email Dr. Jayne.

HIStalk Interviews Michael O’Neil, CEO, GetWellNetwork

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is the term “patient engagement” misused?

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

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

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

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

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

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

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

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

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

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

Where do you see the company’s future?

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

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

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

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

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

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

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

Do you have any final thoughts?

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

Readers Write: Report from AWS Re:Invent

Report from AWS Re:Invent
By Travis Good, MD

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

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

Cerner

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

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

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

Compliance

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

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

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

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

AI, ML, and AWS Services

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

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

Morning Headlines 12/4/17

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

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

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

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

Trinisys Acquires MICA Health

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

Monday Morning Update 12/4/17

Top News

CVS will buy Aetna for $69 billion.

Unanswered questions:

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

HIStalk Announcements and Requests

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

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

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

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

This Week in Health IT History

One year ago:

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

Five years ago:

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

Ten years ago:

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

Last Week’s Most Interesting News

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Decisions

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

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

People

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 12/1/17

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

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

VA misses deadline on Cerner contract

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

Siemens unit set for major Frankfurt IPO

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

Hardly anyone uses Australia’s My Health Record service

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

News 12/1/17

Top News

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

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

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

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

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

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

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

People

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

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

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

Government and Politics

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

Announcements and Implementations

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

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

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

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

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

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

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

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

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

Privacy and Security

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

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

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

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

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

Other

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

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

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

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

This is a fun tweet.

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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EPtalk by Dr. Jayne 11/30/17

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

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

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

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

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

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

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

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

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

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