May 22, 2017Digital HealthComments Off on Telemedicine Benchmark Survey Points to Increasing ROI and Improved Outcomes
Digital health updates are written by LoneArranger, an anonymous industry insider.
A recent survey conducted by Reach Health on the status of telemedicine initiatives at healthcare organizations identified that these programs are evolving from specialty offerings to mainstream services.
Survey participants represented a broad mix of healthcare organizations. More than half of the 436 respondents were from teaching hospitals or systems, with just over a quarter from non-teaching hospitals or systems and slightly over 10 percent from physician practices. Around a third (31 percent) of the organizations have revenues of $1 billion or greater, 21 percent have revenues between $50 million and $1 billion, with just under half (48 percent) at the low end of the scale with under $50M in revenues.
Patient-oriented objectives including improving patient outcomes, improving patient convenience, and increasing patient engagement and satisfaction were the most common objectives for telemedicine programs. Reducing the cost of care also ranked consistently high across objectives.
The overall priority of the telemedicine program at an organization, as ranked among other provider priorities, had a strong correlation with success. Telemedicine programs with a dedicated program coordinator or manager are also 20 percent more likely to be highly successful.
Reimbursement, both government and private, continues to create the most significant obstacles to success, accounting for the top four unaddressed challenges to telemedicine. Challenges related to EMR systems also create significant obstacles to success, accounting for three of the next four unaddressed challenges. Interoperability and integration issues continue to pose significant challenges.
Telemedicine platform features were rated by respondents based on their value to an organization. Three of the top six platform features were related to telemedicine data, including clinical documentation, ability to send documentation to/from the EMR, and ability to analyze consult data. All of these features were rated as critical or valuable by nearly 80 percent of respondents.
Over half of participants indicated their telemedicine platform was primarily purchased or licensed from a vendor. In general, larger organizations are more likely than smaller organizations to build systems internally. However, the survey results indicated that the mix of build vs.buy is highly consistent across the spectrum of organizational sizes.
Two-thirds of the survey participants indicated their telemedicine solution is a standalone system, and not integrated with their EMR system. Only 10 percent indicated their EMR system serves as their telemedicine system. This is beginning to change as vendors improve integration capabilities, but not rapidly.
Over the past three years that the survey has been conducted, there is a clear transition toward enterprise level programs instead of departmental initiatives. A key driver is improving ROI with several primary motivators, including improving patient satisfaction, keeping patients within the health system, securing reimbursement, enhancing the reputation of the organization, and increasing provider and staff productivity.
Activity has increased across the board and for all settings. However, active E-visit programs grew by 40 percent in 2017 and general practice initiatives also showed strong growth. Maturity levels of programs vary. Service lines requiring access to specialists, especially those in increasingly short supply, are maturing more rapidly than the more generalized service lines. Over 70 percent of the survey participants operate telemedicine programs within the boundaries of a single state.
Comments Off on Telemedicine Benchmark Survey Points to Increasing ROI and Improved Outcomes
A local paper covers the Erie County Medical Center’s (NY) recent ransomware attack, in which hackers likely executed a brute force attack to identify the password needed to access the hospital’s system, after which they manually encrypted system files and then demanded a $44,000 ransom.
Medical University Hospital (SC) will stop paying its providers based on the profitability of their department and start using an RVU-based system, a change that has is unpopular within the local physician community.
May 21, 2017NewsComments Off on Monday Morning Update 5/22/17
Top News
A Buffalo News report describes the ransomware infection of Erie County Medical Center (NY), from which the hospital has still not fully recovered six weeks later. The hospital declined to pay the $44,000 demanded because it had backups, users could look up patient information from the HealthLink HIE, and administrators worried that the hackers might not restore its files even if the hospital paid up.
The hospital thinks hackers used a brute force password attack to gain control of a hospital Web server a week before the attack, then manually logged on looking for files to encrypt. Clinical systems weren’t restored until a month later.
A hospital-provided screenshot of the ransomware message suggests that the malware is Samas, in which hackers use a variety of tools (including login-stealing malware) to gain credentials and install programs that use Active Directory to propagate the malware to all attached devices.
MedStar Health fell victim to Samas in March 2016 days after both Microsoft and the FBI issued public warnings of its threat. The malware requires online access to just one vulnerable server, often one that’s running unpatched Red Hat JBOSS middleware.
Reader Comments
From Identity Thief: “Re: CHIME’s patient ID challenge. Is anyone questioning its usefulness? The $1 million winner has to provide their solution to the market free of royalties, which means they can’t use any underlying technology that isn’t free. Also, the challenge is based on authentication rather than identity assurance. From NIST, ‘authentication’ implies confirmation of the patient’s presence using authentication factors, while ‘assurance’ means verifying that the person presenting those factors is in fact who they say they are. The solutions of the finalist appear to focus on using tokens (most likely biometric) to authenticate themselves. But before a token can be used, there is a need to identify the patient via inspection of their documents, verifying via a third party , or conducting KBA activities. The FY17 Omnibus legislation requires a strategy that is more than just the pervasive use of an authenticator. It requires a way to roll out a program nationally for all patients and to link a known patient to all of their records from any location in which they have received services. We should question whether a winning authentication solution truly solves the patient identity problem. In my opinion, it does not.” I agree that someone would need to physically verify a person’s identity in issuing their authentication token, but then there’s the question of how a different provider would connect to that information collected elsewhere (perhaps it would be self-contained, like a fingerprint profile stored on a smart card.) As you said, positive identification doesn’t necessarily imply data sharing, but that doesn’t seem to be part of the conversation despite the NIST definition. I would be happy with a solution that would (a) prevent identity fraud; and (b) give hospitals a single ID that would eliminate patient merges and that would link all of a patient’s information even just within that one organization’s systems.
From Arm Twister: “Re: Athenahealth. They say they have 35 MU attestations using their complete inpatient solution, but CMS shows only 17 inpatient attestations. Also, is it really Athena that’s being used to attest? HIMSS Analytics shows that most of Athena’s 25 sites are still running RazorInsights for registration, scheduling, and patient billing, so wouldn’t they also be running at least parts of the Razor clinical package, too?”
From Bushie: “Re: Athenahealth. Is it undervalued as the activist investor says?” Value is whatever the buyer thinks it is, but certainly the company has struggled to meet longstanding high-flying expectations as investors begin to question its slowed growth, management changes, forays into marginally related business lines that are defended by deeply entrenched competitors (inpatient), slowing post-HITECH EHR sales, and erratic investor guidance and resulting performance. I would also question, as I have from the day the company announced its IPO, if there’s too much of a Jonathan Bush cult of personality among fanboy equities analysts and whether Athenahealth is really a tech high-flyer vs. a boring business process outsourcer that just sends scanned paper to teams in India for manual entry. The stock price jumped after last week’s announcement that Elliott Management had acquired a 9.2 percent stake (and Wall Street firms predictably applied their impressive 20-20 hindsight to immediately upgrade their share price targets), but that’s probably more of a kneejerk reaction to the assumption that change is inevitable. Carving up the business into parts that are more valuable than the whole doesn’t seem likely and I don’t see opportunities to gain unmet synergy. I suspect the biggest fear out there is that JB will be pushed out and Athenahealth will be left as just another mature, sometimes struggling, not all that interesting industry player whose arc flattened out short of expectations. Quite a few EHR companies looked smart when the government was paying for EHRs in its $40 billion cash for clunkers program, but nearly all of them are scrambling frantically to pivot into population health, analytics, or revenue cycle to prop up their businesses that weren’t prepared for the inevitable scale-back required once the HITECH fired had been extinguished and doctors realized that the EHRs they hated pre-HITECH weren’t any more likable just because someone else (you and I) paid for them. I’ll turn to readers – is ATHN undervalued, what changes should it make, and what companies might like to buy some or all of it?
From Carry On: “Re: HIMSS. What are they paying Steve Lieber these days?” The newest IRS Form 990 I can find is for the fiscal year ending 6/30/15, when he made $1.1 million, a number that’s sure to swell dramatically this year as his retirement benefits are paid out. HIMSS paid more than $400K that year to Carla Smith, Norris Orms, John Hoyt, Jeremy Bonfini, and Alisa Ray. I would enjoy dissecting the HIMSS 2015 990 form if anyone has it – it’s apparently not online anywhere like the older ones.
From Lengua Taco: “Re: VIPs. I was surprised to read that hospitals treat VIPs differently.” You must never have worked in one. My first eye-opening experience was when, as a recent graduate turned hospital department head (unimpressively – it was a crappy, for-profit rural hospital) the awful second banana executive nearly lost his mind upon hearing that the mother of our big-money ophthalmologist was being admitted. He cleared all the rooms around hers, mobilized the dietary people to make special meals well beyond their culinary capabilities, and bossed around the nurses and techs to make sure they tiptoed about deferentially and didn’t screw up clinically (which as any hospital person knows actually makes mistakes more likely in replacing well-honed routines with new exceptions). In hospitals, everyone is treated the same in the ED, but once they are admitted and are found to have connections, money, or power, they are elevated from economy class to first (which, like the best table at McDonald’s, still isn’t that great). Wealthy, demanding local businesspeople and politicians don’t share semi-private rooms with the unwashed rest of us, nor do celebrities or Middle Eastern oil sheiks who might get their own entire floor. I doubt their clinical outcomes are any better, though, just their accommodations, a free pass to break hospital rules, and the endless middle management fawning over their magnificence.
HIStalk Announcements and Requests
Nearly 40 percent of poll respondents say the most important factor in reducing US healthcare costs is to move to a single-payer system that eliminates middlemen, with the next top choices being to control prices and increase emphasis on prevention. Frank provided a thoughtful response in saying that consumerism has worked well with cosmetic surgical procedures, won’t work as well with routine outpatient care and non-emergent elective procedures, and won’t work at all with care in emergencies, with the aged, and involving terminal illness, at least without societal upheaval. He adds that, unfortunately, most of the cost is involved in those areas where consumerism isn’t effective. He also warns that medical technology is advancing in providing expensive treatments for more Baby Boomer conditions. Cosmos says the best use of federal money is for public goods that have not not been addressed by the free market, such as disease prevention, promoting access to care and insurance, and rewarding physicians who do the right thing. Cash payer says treatment costs should be standardized to allow consumers to shop effectively.
New poll to your right or here: does your business card or email signature list a certification or fellowship credential? That issue comes up sometimes in HIStalk, where people complain that I don’t list their FHIMSS, FACHE, CHCIO, etc. My policy is that I list only academic degrees above the US bachelor’s level, with one exception — the non-US MBBS, which technically is a bachelor’s degree but is equivalent to the US MD. I also don’t list licensure, but it gets fuzzy where someone’s practice requires only a bachelor’s degree, such as a nurse, where I wouldn’t ordinarily list either the BS or the RN but there’s otherwise no good way to indicate that the person is a nurse. Sometimes I omit even graduate “degrees” that LinkedIn shows came from unaccredited (and sometimes hilariously phony) schools or that were honorary rather than earned, thus upsetting the folks who are anxious to flaunt a pointless credential in hopes nobody will notice the source.
Readers funded the DonorsChoose grant request of Mrs. A in California, who asked for a projector, document camera, USB camera, and laser printer for her middle school’s library, where she teaches math to 150 students. She reports, “The document camera and projector have improved the quality of my instruction. We will often show different strategies with different colors so that students understand that there is more than one way to solve a math problem. Lately, students have been going up and presenting their work under the doc cam, while other students ask them questions about their work. I also use the document camera and projector heavily for instruction. One particular student who has warmed to the doc cam and projector is Ramses. He loves presenting his work, and he was the first student to do so under the document camera in my 6th grade class. After he presented, students gave him ‘glows’ and ‘grows feedback about his presentation. Now other students present based on his model presentation and students are able to practice presenting their work proudly in front of their peers.”
This Week in Health IT History
One year ago:
Kansas Heart Hospital (KS) pays a hacker after a ransomware attack, but still doesn’t regain access to its systems.
Fired Practice Fusion founder and CEO Ryan Howard launches iBeat, which will offer a heart monitor and emergency notification watch.
Apple CEO Tim Cook says the company is focused on health and its entry point will be Apple Watch, which will have new sensors added.
HP announces plans to spin off its enterprise services business in a merger with CSC.
Paul Tang, MD joins IBM Watson Health as VP/chief health transformation officer.
Five years ago:
Cerner CEO Neal Patterson predicts that the company will hit $10 billion in annual revenue by 2020 and says he will probably retire before then.
Victoria, Australia ends its HealthSMART hospital software project that involves Cerner, CSC, and InterSystems after running over budget to $557 million.
HealthCor launches a proxy fight against Allscripts following the resignation of three Eclipsys-connected directors the previous month.
The VA announces plans to spend up to $5 billion to enhance VistA via the private sector and open source community.
US CTO Todd Park announces the Presidential Innovation Fellows Program.
The UK NHS announces plans to shut down its HealthSpace personal health record.
Weekly Anonymous Reader Question
I made last week’s question too specific, I think, given the small number of responses to the question of the most customer-unfriendly contract term or condition seen. I’ll just list those few responses here:
Charging maintenance fees for applications that just kicked off an implementation, as well as charging implementation and hosting fees! The ultimate double-dip rip-off.
Arrogant PeopleSoft VP refused to include any language protecting the customer should they be acquired, after all, “they are PeopleSoft”. Two years later, Oracle had them.
Non-compete clauses that inhibit people from their employment choices.
Having one vendor try to set the terms for who else I can engage with to optimize pieces of my organization. I have software I like to buy. And I have professionals I prefer to do business with for process improvements. When the software company tries to restrict my ability to engage with the professionals I trust, I view that as very unfriendly toward me.
Activist investor Elliott Management takes a 9.2 percent stake in Athenahealth.
Two highly-touted, well-funded, for-profit primary care clinic chains fail.
GQ exposes the efforts of fired Trump campaign manage Corey Lewandowski to sell access to the President, with Flow Health hiring the company hoping to reverse the VA’s termination of its data analysis contract.
Global impact of the WannaCry ransomware is muted when a security researcher finds and activates its kill switch.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Decisions
Johnson Memorial Hospital (IN) will switch from Meditech to Cerner in August 2017.
Marshall Medical Center (CA) will replace McKesson with Epic in November 2017.
St Michaels Medical Center (NJ) went live with Epic this year.
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
Melissa Bell (MedAssets) joins Inovalon as SVP of client success.
Jim Feen is promoted to SVP/CIO at Southcoast Health (MA).
Announcements and Implementations
Messaging and patient engagement technology vendor Talksoft integrates its appointment reminder app with Uber, allowing patients to click an app button to call a car to take them to their appointment.
Teladoc will expand telemedicine services in Texas following the end of its six-year legal battle with the state over the now-eliminated requirement that patient-physician relationships begin with a face-to-face visit.
Other
Doctors at MUSC’s Medical University Hospital (SC) are reportedly “livid” that the hospital will start paying them based on the number of patients they see (RVUs) instead of based on the profits of their department. The CEO says that doctors who aren’t clinically productive “are going to have a tough time. Everyone has to be accountable to this clinical productivity.,” He adds that the current system is unfair to trauma surgeons who treat uninsured patients but benefits gastrointestinal surgeons who treat mostly Medicare patients. A patient safety advocate whose son died from a MUSC medical error says, “Paying doctors by RVUs is a terrible system and absolutely antithetical to patient safety, never mind workplace satisfaction. The doctors are right to be worried. I think this is a real comment on the priorities of the current MUSC leadership.”
Erie County Medical Center (NY) confirms rumors that the cyberattack that brought its entire network, including email, EHR, and billing systems, was indeed a ransomware attack. Hospital executives declined to pay the ransom and have instead been working to restore services from backups.
DataBreaches.net is served a threatening cease-and-desist letter from Bronx-Lebanon Hospital Center lawyers after reporting that the hospital was exposing patient information due to an improperly configured server.
Activist hedge fund operator Elliott Management takes a 9.2 percent position in Athenahealth, sending ATHN shares soaring 22 percent Thursday.
The fund issued its standard language that refers to “operational and strategic opportunities” (often involving selling the company) and expresses its interest in engaging with Athenahealth’s board.
Elliott has pressured other healthcare-related companies to increase shareholder value, most recently The Advisory Board Company and Cognizant.
Reader Comments
From Justin Box: “Re: Mary Washington’s video ‘Right Hand Man.’ We’ve reposted it on YouTube.” Justin, who is SVP/CIO of Mary Washington Healthcare (VA), said the hospital initially pulled the unlisted video from YouTube after I mentioned it Tuesday since it was intended to be for an internal audience only, but has since decided to repost the original, unedited version, which is spectacular. The hospital’s marketing people did an amazing job putting it together and the hospital employees who appear in it were fantastic. This would win my HISsies Best Picture award if I had one. Here’s an even more impressive factoid from Justin – President and CEO Mike McDermott, MD, MBA came up with the Hamilton theme idea, wrote the lyrics, and took on the starring role. I’ve watched it at least 10 times so far today. In one of those IMDB-type “goofs,” listen for the Epic product name that is mispronounced.
From Aftab: “Re: Aspen Valley Health (CO). A failed Epic implementation caused a loss of millions of dollars and the RIF of dozens of long-term employees. The 20-something IT director brought in an inexperienced team with no healthcare background and farmed out the technical IT jobs to an Indian outsourcing company. There was open revolt from the hospital staff, coupled with the CEO and CIO leaving.” Unverified. The 25-bed hospital signed up for Epic at a cost of $5.4 million in October 2015, affiliating with UCHealth. I reviewed the online video minutes of the hospital’s recent board meetings to look for updates — in the March 2017 session, the board talked about choosing a new EHR from among Cerner, EClinicalWorks, and current vendor Meditech, focusing on a system that is “affordable and accessible to any practice.” The board also wants its own MPI that isn’t shared with another hospital and its own EHR build. The board also noted that Cerner and EClinicalWorks are cloud-based, while Meditech would require 50 hospital servers, but they want to make sure cloud-based systems are ready for prime time. They’ve issued an RFI and hope to be live by 2020.
From Publius: “Re: Health Gorilla. Have you heard of them? They’re seemingly a Web-based EMR that supports electronic lab ordering. Is it used by smaller private practices?” I’ve mentioned the company a few times, labeling them as a “medical record aggregator” and secure network that allows sharing records and placing electronic lab orders. Practice price ranges from free to $60 per month. The Silicon Valley-based company – formerly known as Informedika — has raised $4.4 million, none of it recently, and hasn’t issued a press release since October 2015.
From SugerHound: “Re: Apple Watch and glucose monitoring. The rumors are more substantial than are being reported. Chrissy Farr has a great report on CNBC that cites multiple sources.” The article says Apple’s team of biomedical engineers has been developing non-invasive blood glucose sensors for several years in a project originally envisioned by Steve Jobs. They are reportedly conducting feasibility trials and figuring out how to earn FDA approval, which probably won’t come easily or quickly.
HIStalk Announcements and Requests
Readers funded the DonorsChoose grant request of Ms. S in California, who asked for non-fiction books for her third graders, with an emphasis on the environment. She reports, “My students and I have become passionate about plants! Not just any plants, but native plants in particular. The chaparral biome which surrounds our school and community is thriving with plant and animal life. Using the books that you so generously donated, my students learned about the environment, and they started a close study of their backyard ecosystem: the chaparral. Caring for the plants and becoming experts of many of the living things in our ecosystem, my students are now serving as stewards for the environment. Without your generous donation, our project would not have been able to take off.”
My “Listening” selection from three weeks ago was the new solo release of Soundgarden and Audioslave front man Chris Cornell. He died by suicide Wednesday night after a Detroit performance of the reunited Soundgarden. His last song on stage was a cover of Led Zeppelin’s “In My Time of Dying.”
This week on HIStalk Practice: One Medical opens first practice in Seattle. Vivid Vision raises $2.2 million for VR-enabled vision disorder treatment technology. US HealthWorks develops telemedicine app. MD EMR Systems, Bridge Patient Portal work on Centricity integration. CMS allocates $30 million for medical societies interested in helping to develop MACRA measures, adds four regions to CPC+ program. Premise Health will roll out Epic over the next two years.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
A Singapore-based private equity firm buys a majority position in supply chain technology vendor Global Healthcare Exchange from PE firm Thoma Bravo, which bought the business in February 2014 and will remain a minority owner.
Seattle-based primary care clinic Qliance Medical Management, which had raised $33 million from investors that included Amazon’s Jeff Bezos, shuts down. The two principal officers bought the company in March 2016 from its investors.
Clinical process improvement technology vendor LogicStream Health closes a $6 million Series B funding round.
Credentialing and compliance software vendor Symplr acquires Vistar Technologies, which offers a provider data management system.
Conversa, which offers doctor-patient conversation programs, raises $8 million in a Series A funding round led by the venture arm of Northwell Health (NY), which will also use the company’s systems.
UnitedHealthcare subsidiary Harken Health, launched in 2015 to offer health insurance combined with low co-pay visits in its Atlanta and Chicago health clinics, will shut down after extensive losses.
Amazon is considering entering the pharmacy market, according to reports, which could involve either selling drugs online (which it already does in Japan) or extending its in-house pharmacy benefits management program.
McKesson is basically out of the health IT business (or will be soon), but if anyone still cares, the company announces Q4 results: revenue up 5 percent, EPS $16.76 vs. $1.88, although that includes a pre-tax net gain of $3.9 billion related to the creation of Change Healthcare. MCK shares rose 6 percent in early after-hours trading Thursday, having beaten earnings expectations but falling short on revenue.
Sales
National non-profit behavioral health provider Compass Health Network chooses Netsmart’s EHR in a 10-year agreement.
The VA awards Document Storage Systems (DSS) a $19.6 million contract to implement its ForSite2020 patient self-scheduling system that integrates with VistA. DSS acquired the product in December 2016 with its $2 million purchase of Streamline Health’s Looking Glass patient scheduling and surgery management software, which Streamline had previously bought in its February 2014 acquisition of Unibased Systems Architecture.
Prime Healthcare will implement real-time sepsis surveillance systems from Hiteks Solutions, integrated with Meditech and Epic.
People
Robert Califf, MD — who served less than a year as FDA commissioner before the administration change — returns to Duke Health as vice chancellor for health data science and will also split time in a leadership role at Alphabet’s Verily Life Sciences, where he will work with turning health-related data into practical applications. Verily, formerly known as Google Life Sciences, has worked on continuous glucose monitors, smart contact lens, retinal imaging, and surgical robotics.
Announcements and Implementations
Visage Imaging releases its Visage 7 Open Archive solution of its enterprise imaging platform to customers in North America.
Athenahealth announces a Meaningful Use Stage 3 guarantee for its hospital customers. The company also opens San Francisco-based MDP Labs, an innovation program that offers workspace, mentorship, and exposure to potential investors, partners, and customers.
Healthgrades enhances its online scheduling system to allow health systems to display their nearby alternative providers when a given one is booked up.
Siemens Healthineers will integrate test results from its HbA1C and urinalysis diagnostic equipment with practice-based EHRs via technology from Scotland-based Relaymed, owned by Goodmark Medical of Longwood, FL.
CHIME announces the finalists in its patient ID technology challenge that will move to the prototype testing round:
Michael Braithwaite (multiple biometrics)
Bon Sy (behavior information, biometrics)
HarmonIQ Health Systems (blockchain, FHIR, encryption)
RightPatient (photos, biometrics, other data)
Government and Politics
The Justice Department files a civil fraud lawsuit against UnitedHealth Group, claiming that the insurer was overpaid at least $1 billion in Medicare Advantage payments after intentionally submitting inaccurate risk adjustment data. UHG says it tried to comply with CMS’s “unclear policies” and adds that the Justice Department either misunderstands or ignores how Medicare Advantage works.
Insurance company executives and state insurance regulators say the ACA insurance marketplaces aren’t collapsing under their own weight, but rather because of the Trump administration’s erratic management, vocal lack of support, and ongoing threats to stop payments, according to an LA Times article. In a remarkably partisan response for a federal department employee, 28-year-old Alleigh Marre — quoted as an HHS spokesperson but self-identified on her LinkedIn profile as a “Republican Communicator,” — said, “Obamacare has failed. For this reason, Republicans are reforming healthcare so it delivers access to quality, affordable coverage to the American people.” The article also notes that CMS Administrator Seema Verma told insurance company executives that the White House would continue allowing the payment of cost-sharing reductions (premium subsidies, required by law to be paid unless a court rules otherwise) if insurance companies would in turn support the Republican ACA repeal bill, a puzzling offer (even for a near-shakedown political demand) since repeal would do away with the subsidies.
Privacy and Security
Bronx-Lebanon Hospital Center (NY) and its contractor iHealth send threatening cease-and-desist letters to the author of DataBreaches.net after she let the hospital know that their patient information was exposed due to an improperly configured server, for which the hospital originally thanked her. They claim that the discovery of their apparent screw-up constitutes “hacking,” which happens often when companies are embarrassed and attempt to shoot the messenger.
Erie County Medical Center (NY) finally confirms that the April 9 cyberattack from which it is still recovering six weeks later was indeed ransomware, which had been widely speculated. The hospital declined to pay and was forced to move back to paper as its systems were slowly brought back online from backups. They don’t believe it was the WannaCry malware.
Technology
Google is applying machine learning to millions of de-identified patient records from major teaching hospitals to see if it can predict an individual’s medical events.
Google’s major announcements from its developer conference:
Google Lens, an app that can identify objects from a smartphone’s camera.
New Daydream virtual reality headsets.
Photo facial recognition that will suggest sharing images with people pictured in them and AI-powered removal of unwanted objects in photos.
A visual positioning system that will identify a precise location based on nearby objects, such as finding items on a store shelf.
The addition of calling and proactive information presentation to Google Home and the porting of Assistant to the iPhone.
In India, Aetna rolls out the first phase of its global launch of it subscription-based vHealth by Aetna, which offers unlimited PCP visits by video or telephone, diagnostic tests at home, home prescription delivery, and referrals. Patients can rate their doctor experience afterward.
FiercePharma profiles Israel-based MedAware, which uses aggregated prescription data and a patient’s own medical records to predict what drugs are likely to be ordered, improving patient safety in providing what it calls a “spell checker” for prescriptions. The CEO has astutely noted that all of that information is also attractive to drug companies that are interested in targeting their physician prospects, giving it an unexpected yet lucrative market.
Other
Boston Children’s Chief Innovation Officer John Brownstein weighs in on the language in Epic’s App Orchard agreement, which basically says that Epic can use any of the submitter’s information to develop a competing product and that Epic permanently owns any documentation that the applicant submits. In other words, it’s exactly opposite of the highly restrictive language contained in Epic’s customer contracts.
In an interesting twist on medical tourism, a nearly completed medical center in Jamaica plans to lure not only medical tourists to fly there for procedures at discounts of up to 40 percent, but also to recruit American doctors to perform the work while taking a Caribbean vacation. Critics point out that it’s been tried before, failing because doctors are too busy to interrupt their vacations and are not likely covered by their malpractice insurance when doing work outside the country.
Bizarre: Michigan suspends a DO’s license after a patient complained that her liposuction surgery was performed in an unfinished pole barn, during which the doctor poured her removed fat down a sink drain.
Sponsor Updates
Medicity and Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Texas Regional HIMSS Conference May 25 in San Antonio.
Wavelink is named as the first Spok distributor in Australia.
Medecision presents its annual innovation awards at its Liberation 2017 conference in Austin, TX.
Definitive Healthcare is recognized by Boston Business Journal for its growth and work environment.
FormFast and Imprivata will exhibit at the 2017 Spring Hospital & Healthcare IT Conference May 22-24 in Atlanta.
May 18, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 5/18/17
The National Patient Safety Foundation is holding its annual Patient Safety Congress this week in Orlando. This is the first meeting since NPSF merged with the Institute for Healthcare Improvement at the beginning of this month. I’m a big fan of both organizations, not only because patient safety is such a big deal, but because they both offer accessible and cost-effective training for practices and organizations trying to improve their safety culture.
Awards programs recognized NYC Health + Hospitals/Bellevue for their primary care diabetes program and recognized Christiana Care Health System for a care coordination program aimed at reducing readmissions. For all of us who complain about EHRs, we need to remember how hard it was to pursue these types of initiatives with paper charts. If you missed it, next year’s Congress will be held in Boston from May 23-25.
Although telehealth continues to be promoted as a way to increase access to patient care and reduce costs, it isn’t being widely adopted in the primary care trenches. Researchers from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care queried family physicians to understand their use of telehealth and what barriers exist that prevent expansion. The results were published in the Journal of the American Board of Family Medicine and indicate that although many of us are interested in providing these services, few of us are actually doing it. The survey is somewhat limited by its 2014 data; it would be interesting to see whether adoption has been driven forward given changes in technology and payment policies. At the time, however, only 15percent of respondents had used telehealth services during the year, with many using it only a handful of times throughout the year.
The most common uses of telehealth services included diagnosis/treatment (55 percent), chronic disease management (26 percent), follow up (21 percent), second opinions (20 percent), and emergency care (16 percent). I always shudder when I hear about virtual care of emergency problems, but many of the “emergency care” situations aren’t truly emergent in reality, so perhaps this number isn’t as shocking as I originally found it. Those using telehealth were more likely to be rural, have an EHR, and be in a smaller practice that was less likely to be privately owned. Respondents cited lack of reimbursement and lack of training as obstacles to use – both among those who used and did not use services. The authors recommend that residency training be expanded to include telehealth services and that payers should expand coverage.
Personally, I don’t see the latter happening. As we shift towards value-based care, it’s more likely that physicians will explore telehealth as a relatively low-cost care option, at least compared to office visits. As physicians receive bundled payments and operate under payment systems that are tantamount to capitation, they’re going to look for alternatives to bringing people in.
What remains to be seen is how well telehealth vendors will be able to integrate their solutions into mainstream EHRs and how clunky the arrangements are. I’m working with a third-party care management vendor with one of my clients and the technology itself is a major barrier to use. They actually partner with the primary care office to provide telehealth chronic care management services, which the primary care practice bills for under the Medicare Chronic Care Management codes. The vendor has nurses and care managers who review patient-generated data such as daily weights, blood pressures, blood glucometer logs, and more.
The vendor’s employees meet with patients and document care plans and progress, then send the information back to the EHR. In principle it sounds great, but in practice it’s a tangled mess.
First, the vendor offers a standalone patient portal and wants the patient to submit all their data and conversations that way. This directly competes with the practice’s patient portal and creates confusion for the patient on what kinds of questions should be sent to the office and what should be sent to the care management portal. Although the practice sends data to the vendor discretely, what is pushed back to the office to document the virtual visits and care plans comes back as an image. That means it lives in a separate place in the patient chart from all the other data that physicians are reviewing when they see the patient.
Apparently the root cause of this disconnect is the fact that the third party wanted to quickly partner with multiple EHR vendors to sell its chronic care management services, but the EHR vendors were too busy building certification requirements into their products to be able to build the kind of integration that needs to happen. Unfortunately, my client (the practice) didn’t pick up on this during the slick sales demo, and now is stuck with this hybrid approach, at least until their contractual obligations end.
They’ve stopped enrolling new patients in the service in the meantime and are struggling to stand up their own care management team, which is how I came into the picture. Their EHR has great care management content but just couldn’t handle the billing piece, so we’re working through that gap. They will fully separate from the third party in a few months and I’m confident they’ll be able to ramp up their own program. The practice may not have the same slick videoconferencing capabilities that the third party had, but they can practice telehealth the old fashioned way — via phone. This approach can still help with access issues and cost issues as well as reduction of readmissions. We’ll see how it goes.
As a side note, I’m waiting for the EHR vendors I work with to get through all their regulatory certifications and mandatory releases so they can get back to the business of enhancing usability and coding features that their users actually want. Of course, I’m not delusional enough to think that there won’t be some other burdensome pack of regulations coming right after, but there might be a window of opportunity to do some good work before it hits.
Compass Health Network (MO), a national non-profit behavioral health network, signs a 10-year agreement to implement Netsmart’s behavioral health EHR and an interoperability platform that will allow it to exchange data with local practices and hospitals.
A widely-cited BGR article reports that the next Apple Watch will include non-invasive glucose monitoring technology, a rumor that it attributes to a single, anonymous source.
The Robert Wood Johnson Foundation announces that BiAffect is the winner of its Mood Challenge, a contest soliciting ResearchKit-based studies of mood and its impact on health and wellbeing.
New York’s state Assembly passes The New York Health Act, a single-payer health insurance healthcare bill that would provide universal coverage statewide. The bill has passed the Assembly three times in the past, but has yet to clear the Senate, where the current version will now be sent.
I will turn 50 this year. A few days after my birthday in May, my daughter will graduate from Yale, the second of my two children to earn that distinction. In October, I will graduate from Columbia University’s Executive Master of Public Health program.
I guess you could say it’s a watershed year for me, one of the biggest of my life so far. We all have them. And once the celebrations are over, I imagine we’re all faced with the same question. What’s next?
Here is what I learned as I looked for answers to that question.
It’s never too late for a new beginning
Some of us might feel inclined to stop and take a breather at 50, especially once the kids are out of school. We may think we have reached a high point that we’ll never exceed in our time on earth. As for me, I’m viewing it as a new beginning.
It’s a simple construct. Fifty is half of my life. Sure, it’s a milestone, but it doesn’t scare me. I’ll admit I am tickled to be at a point in my life where I have no dependents. My son and daughter are well on their way to taking their places in the workforce and the world. While I have strong relationships with my children and see them often, there is a level of excitement, a feeling of freedom now that they are adults.
I don’t want to waste that feeling of freedom. I want to channel it in constructive ways and put it to good use.
The opportunity to focus is a gift
There is an even greater excitement in the fact that I recently began a new phase of my career, a phase that I have envisioned for a very long time. I am no longer simply an IT guy, but a healthcare professional, a CIO for a very exciting organization in NYC brimming with possibilities.
When I was a kid growing up in Turkey, I dreamed of becoming a medical doctor, so this move into healthcare feels as if I have come full circle. Our dreams get tweaked as we get older, but I like the way this one has turned out. Though not an exact match, I am still able to use my skills and experience to effect change in the healthcare sector, and probably on a much larger scale.
The transition wouldn’t mean half as much if I weren’t confident that I did everything I could to prepare myself for its challenges. That’s one of the benefits of maturity. They say good things come to those who wait, but I also believe that good things come to those who are prepared. Now I have the time, the skills, and the experience to give my new healthcare position the total focus it demands. This opportunity is a gift and I am eager to embrace it with all the dedication and energy I have.
Maturity and passion are not mutually exclusive
I’ve attended HIMSS healthcare IT conferences in previous years, but at this year’s event, something was different. Instead of observing from the sidelines, I was involved. I was invited to participate in sessions. I was a contributor. I felt respected and connected and I was able to help others make connections, too. One of these connections resulted in CHIME welcoming a new foundation member.
This ability to find the things two professionals might have in common and make a connection happen for their mutual benefit is probably the thing I am best at. While others are inspirational leaders, effective organizers,or impeccable planners, I’m a connector.
In my work with colleagues and partners, I can find win-win solutions, shape commitments between parties, challenge others to exercise their own good judgment, and solidify their trust in one another. That is very exciting to me. I heard it time and again at the HIMSS conference this year: people notice my passion. It is gratifying to be able to say that at this point in my career.
Here’s to 50
There’s a saying now that 50 is the new 30. I’m not so sure I agree. Physically, I don’t feel that much different from the way I felt at 30. But in terms of what I have learned about my industry and about myself over the past two decades, I’ll take 50 over 30 any day.
Comments Off on Readers Write: Celebrate the Milestones, But Keep Your Eye on the Road Ahead
The IT concept that you hear most about today is blockchain systems design and technology. If you have not, you will very soon. It’s a concept that relies heavily on core Internet communication tools and shared information.
When you mention blockchain, some people automatically think of bitcoin, but bitcoin is just one application of the block chain concepts and tools — it is not blockchain proper. HIStalk posted a good synopsis of blockchain last year .
Blockchain in its simplest form is a virtual ledger. A ledger that is available to all on an instantaneous basis via the Internet.
Let’s look at an example. Say I borrow $100 from my office buddy Joe. If it’s just the two of us involved and no one else cares, then he notes on his paper ledger an asset of $100, with an offsetting entry of his cash decreasing by $100. On my ledger, I note an increase in my cash balance of $100 and a liability to Joe of $100. If an auditor were to check our ledgers, they would see all four entries and all things would be kosher, or in accounting terminology, in balance.
Now assume everyone in our office cares and we all have electronic ledgers and all our ledgers communicate with one another via the Internet, thereby creating one big virtual ledger. Every time one ledger changes, they all change instantaneously. Everyone in our office would see I owe Joe $100. As I make payments on the loan (or fail to), all ledgers would reflect the subsequent activity.
Blockchain software maintains a universal virtual ledger by maintaining constant communication among all participants. All updates and transactions — whether add, change, or delete — are stored forever. Hence the full provenance of any activity is easily viewable. The number of participants is not limited and could be in the billions, limited only by agreed-to privacy and security constraints.
The implications of blockchain technology are enormous. For example; since the blockchain is always in balance (no single entity entries allowed), goodbye auditors, bookkeepers, accountants, financial intermediaries, clearinghouses, many regulators, and so on.
Some industry pundits are predicting that blockchain will transform healthcare and make the interoperability mountain into a mole hill. A deeper understanding of the healthcare landscape with its many non-technical issues makes me a skeptic.
On the business side of healthcare, the impact should be pretty much the same as in commercial business. You can expect a big impact on finance and supply chain management. Operations such as scheduling and resource management will see significant impacts. Many will happen within the next decade. Legacy systems will have a tough time adapting, more so than their adaptation to the Internet, but slowly they will adjust.
On the clinical / medical side, I predict a much longer runway before we see any real impact. There are two reasons. First, blockchain is highly dependent on definition and structure. Terminology must be consistent and procedures must be standardized. Generally Accepted Accounting Standards (GAAP) have been in place for centuries, and as they have changed over the decades, multiple oversight groups have hashed out agreed-to changes. On the supply side, UPC codes have been around for almost 50 years and go down to almost the molecular level.
Not so in medicine. A practitioner’s understanding and use of terminology and protocols is highly dependent upon where they went to medical school and who they trained under. Studies have shown that even today, after the federal government has paid out over $30 billion in EHR incentives, still over 70 percent of a patient’s medical record is entered into the EHR as free text.
The second reason is that blockchain cannot work without absolute accurate identification about the transaction initiator and the information target. Identifying the initiator is easy. The target is the person / patient and that’s another matter. Still today after decades and trillions of dollars spent on healthcare IT we do not have a unique person / patient identifier.
As I have noted in my past writings on HIStalk and other blogs, this is not a technology problem, but a political one. If blockchain is to be the savior of healthcare interoperability, as the technocrats suggest, then it’s Congress that will have to forge the most critical first link in the chain.
My prediction is that systems developers will continue to jury rig solutions around this missing link. Providers would do well to remember that a chain is only as strong as its weakest link.
GQ profiles Corey Lewandowski, a one time Trump campaign adviser that launched his own lobby firm after the election, offering access to Trump and influence across government agencies. Health IT vendor Flow Health hired the lobby firm to reverse a decision by the VA to cancel its contract, which it illegally agreed to pay $250,000 for if the decision was reversed.
Missouri’s effort to pass prescription drug monitoring program legislation died Friday afternoon after the Senate added a provision mandating use by providers, a clause the Missouri State Medical Association opposed. The bill then lost support and failed to pass by 6pm Friday, when the 2017 legislative session ended.
The National Data Guardian at the UK’s Department of Health states in a leaked memo that Google DeepMind’s use of real NHS medical records to test an app designed to diagnose kidney disease was legally "inappropriate.”
A bipartisan group of Senators introduce the Fair Drug Pricing Act, a bill that would require that pharmaceutical companies submit a report to HHS before increasing the price of a drug by 10 percent in one year, or by 25 percent over three years.
GQ publishes an article critical of fired Donald Trump campaign manager Corey Lewandowski, who tried to parlay his connections to the President after his June 2016 dismissal into a lucrative lobbying business that includes a health IT connection.
Among the clients Lewandoski recruited was Flow Health (the former GroupMD), which hired Lewandowski’s firm in December 2016 to pressure the VA to reconsider its termination of Flow Health’s contract for AI-powered patient care systems.
GQ reports that Lewandowski’s partner (who managed Ben Carson’s presidential campaign) told Flow Health CEO Alex Meshkin that the lobbying firm could reverse the VA’s decision because he and Lewandowski were personally vetting Trump’s picks for VA secretary. He also promised that the firm would allow Flow Health’s CEO to submit a list of his preferred choices for role of VA CIO, overseer of the Flow Health decision.
The article says that Flow Health proposed an apparently illegal payment schedule of a flat payment of $250,000 if the VA reversed its decision by February 17 and $100,000 if it took an extra week, later amended to reword the payments as severance fees. None of that mattered, as it turned out, because Trump chose as VA secretary David Shulkin, who had co-written the letter that dismissed Flow Health in the first place.
GQ says Lewandowski then proposed that Flow Health do an end-run around the VA by either appealing to Trump directly or by using Lewandowski’s appearance on the Sean Hannity talk show to trash Shulkin in hopes of getting him fired.
Lewandowski quit the firm – for which he was serving as an unregistered lobbyist — two weeks ago after widespread questions about his efforts to sell access to the President, which he calls “fake news” and for which he blames his former partner. Flow Health’s VA contract remains terminated.
Googling “Alex Meshkin” turns up a fascinating Bloomberg story from 2005 about the then-24-year-old’s questionable background as he formed a Nascar racing team that quickly failed.
Reader Comments
From Athenahealth Spokesperson: “Re: Diego’s questions about Athenahealth’s inpatient customer MU attestations. All 35 hospitals referenced are using Athenahealth’s complete inpatient solution, including EHR, revenue cycle and financial management, care coordination, and patient engagement services. This past year, Athenahealth submitted Meaningful Use attestations on behalf of all of our hospital clients live on AthenaClinicals for Hospitals & Health Systems as of the end of 2016.”
From Cerner Observer: “Re: Mon Health, Morgantown, WV. Hearing that its Cerner go-live has been pushed back to 2019 and they’re exploring other options.” Unverified. I couldn’t find a contact there to ask for verification. I was, however, a bit annoyed to observe that the locals are so challenged to pronounce the name of the county in which they live (Monongalia) that the health system that lives in the shadow of Epic-using WVU Medicine felt the need to officially dumb down its name to “Mon Health,” giving me visions of those rainbow-colored (and uncomfortably stereotypical) Rastafarian dreadlock hats you see for sale on vacation in the Caribbean that say “Hey, Mon, we be jammin!”
From Second Responder: “Re: anniversary date. Isn’t HIStalk’s anniversary coming up soon? I remember it’s late spring.” I started writing HIStalk in June 2003, although I don’t recall the exact date.
From Judith R. Lin-Miranda: “Re: video. It’s now a common practice for new Epic customers to introduce themselves. Mary Washington Health Care just set the standard by which all others will be judged.”The elaborate video is indeed well done, including taking some digs at Siemens/Cerner Soarian that was “cobbled together” as they were “working with a third of what Soarian promised.” The video even lobs some shots at Epic’s high cost. President and CEO Mike McDermott, MD, MBA did an amazing job in the lead role. It’s better than anything ZDoggMD has done. I would give it my “Best Picture” award if I had one.
From Gory Details: “Re: press release. Here’s ours, which you probably won’t mention since we aren’t an HIStalk sponsor.” Not true. I mention every press release that I think is newsworthy to my C-level audience, which typically includes all sales and go-lives that: (a) involve a vendor, client, and event that are all significant; (b) would interest readers who don’t follow the company; and (c) contain a link to a timely press release that is well enough written that I can quickly figure out what it’s trying to say. Otherwise, readers outside the company usually aren’t interested in fluff pieces about partnerships, self-proclaimed market momentum, and minor personnel and funding events and I’ll nearly always skip those. I’ve learned over the years that every company executive thinks all of their announcements are anxiously awaited, which is nearly always not the case. Do something newsworthy and you’ll see it on this page.
HIStalk Announcements and Requests
HIStalk readers funded the DonorsChoose grant request of Ms. W, who asked for tablets and headphones for her California kindergarten class to extend their environmental studies. She reports, “The Fire tablets have been such a great learning resource for my students. They love using them to watch ‘Meet the Environmental Defenders.’ They love singing along to the song. You can hear them chanting quietly, ‘Reduce, reuse, recycle!’ They do this over and over again. Next thing you know, that tune is stuck in my head all day long!”
I’ve noticed a recent sneaky practice of call centers (both inbound and outbound) that place you on hold, but play pre-recorded keyboard clicking sounds so you think a human is on the line.
A reader offers a third punk band whose singer has a PhD (in addition to those I named, Bad Religion and The Offspring): The Descendents, which has been a major influence to untold bands that aren’t even punk for its 40 years of existence. Milo Aukerman left the band to complete his PhD in biology at UCSD and conducted post-doctoral research in biochemistry at UW-Madison. His nerdy caricature is the band’s mascot, rolled out in 1982 for the album “Milo Goes to College” that noted his temporary departure. Beyond all that academic talk, there’s a new hard-rocking album from Seether that’s worth a listen.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
I asked John Gomez to put together a WannaCry malware webinar with only hours of lead time because his presentations are always outstanding and informative. This one he did Tuesday afternoon is no exception. I was attentive for the whole thing, which isn’t usual for me since I have a short attention span. Thanks to John for agreeing to help get information out quickly.
Acquisitions, Funding, Business, and Stock
Wisconsin startup IDAvatars, which develops healthcare avatars powered by IBM Watson, opens a funding round in hopes of raising $2 million.
Sales
Premise Health will implement Epic in its 500 work site health and wellness centers. It apparently replaces Greenway Health.
University of Miami Health System (FL) chooses Kyruus Provider Match and KyruusOne to connect patients with providers based on their clinical needs and preferences.
The Commonwealth of Virginia and Bayview Physicians Group will integrate Appriss Health’s prescription drug monitoring program analytics software into provider EHR workflow.
People
Mark Costanza (Nordic) joins Spok as SVP of professional services.
Announcements and Implementations
Memorial Hermann Memorial City Medical Center (TX) goes live with a digital wayfinding app powered by Connexient’s MediNav.
National Decision Support Company adds appropriate use criteria for pediatric imaging to its ACR Select product.
CPSI’s TruBridge subsidiary announces its business intelligence dashboard at the company’s user conference.
Government and Politics
Social media outcry pressures Miss USA to walk back her comments from the Q&A portion of the competition in which she stated that healthcare is a privilege rather than a right, unconvincingly explaining that what she really meant is that she is “privileged” to have healthcare, but regardless, it’s a “right” for all.
Missouri’s lost its chance to stop being the only state that doesn’t have a doctor-shopper prescription database as legislation to authorize it failed Friday after the Senate added a mandatory prescriber participation clause, which was opposed by the state medical association.
Privacy and Security
HHS says in a ransomware update call that several medical devices have been infected with the WannaCry virus, but otherwise the US healthcare system seems mostly unaffected for now. Several hospitals around the world reported that they were attacked. Northwell Health (NY) initiated its incident command system Friday morning and patched 200 computers that were behind on Microsoft security updates.
In England, a leaked February letter from National Data Guardian Dame Fiona Caldicott to Royal Free Hospital’s medical director says the hospital should not have turned over the detailed records of 1.6 million patients to Google DeepMind for testing of its Streams application, saying it was not appropriate to send Google the information without patient permission since it was not related to their care.
Rutland Regional Medical Center (VT) becomes the latest in a long string of hospitals that have exposed patient information by sending a bulk email to patients using CC: instead of BCC:.
Marcus Hutchins — the 22-year-old security researcher who interrupted his vacation to stop the global spread of the WannaCry virus by discovering and activating its kill switch before it hit US hospitals – is awarded a $10,000 hacker’s bounty that he will donate to charities. He works from a spare bedroom in his house in England for US-based Kryptos Logic.
Other
Wired runs a lengthy piece describing the last creation of Steve Jobs, Apple’s $5 billion, 2.8 million square foot mother ship campus.
A graphic, moving blog post by ED physician Kristen Ott, MD explains that medical professionals use profane language outside of public spaces because they have to deal with the aftereffects of unspeakable atrocities that can’t really be described politely.
This should ring the cash registers of pharma lobbyists: three members of Congress introduce the Fair Drug Pricing Act, which would require drug companies to provide detailed cost and price records to HHS before increasing an expensive drug’s price more than 10 percent in one year or 25 percent over three years.
Australia-based surgeon Eric Levi, MBBS muses on the suicide of a Brisbane gastroenterologist, which triggered him to think about what factors lead him to his own “dark seasons” as a doctor:
Loss of control with extensive hospital call time and new physician-directed policies written by people who don’t see patients.
The impersonality of computer-assigned work, pressure to beat the timer that says tonsillectomies should take no more than 14 minutes of surgeon time, overbooked clinics, and never-ending telephone calls, all of which leave no time to reflect about life with colleagues or to spend time with friends and family. Doctors who ask for emotional support can be placed on restriction or labeled as underperforming.
Relentless administrative pressure that takes away meaningful patient engagement as medical practice transforms from a “meaningful pursuit” to a “tiresome industry” that has been “codified, sterilized, protocolized, industrialized, and regimented.”
Sponsor Updates
Point-of-Care Partners publishes a white paper titled “EPrescribing Information to Improve Medication Adherence.”
Arcadia Healthcare Solutions will speak at the HFMA Region 1 annual conference May 23 in Uncasville, CT.
CapsuleTech will exhibit at the National Teaching Institute & Critical Care Exposition May 21-25 in Houston.
Besler Consulting will exhibit at the HFMA Region 1 annual conference May 23 in Uncasville, CT.
CoverMyMeds will exhibit at the QS/1 Customer Conference May 17-19 in Atlanta.
Besler Consulting releases a new podcast, “Evaluating post-discharge cost and quality.”
CTG announces expanded portfolio management and help desk services in its Application Advantage program.
Cumberland Consulting Group will sponsor the ASO Opportunities Value Visit May 17-19 in Chicago.
Impact Advisors VP Lydon Neumann is named one of Consulting Magazine’s Top 25 Consultants of 2017.
The local business paper profiles Diameter Health and its ties to Connecticut Innovations.
White House officials refute claims that the NSA deserves any blame for the WannaCry cyberattack after Microsoft President and chief legal officer Brad Smith publish a blog post publically criticizing the agency for losing control of a stockpile of unknown security vulnerabilities, saying “An equivalent scenario with conventional weapons would be the US military having some of its Tomahawk missiles stolen.”
FDA administrator Scott Gottlieb, MD issues a memo to his staff addressing his view of the agency’s role under his leadership. He discusses the importance of continuing to drive down US smoking rates, the emergency of gene therapies, the need to reduce drug prices, and the implementation of the 21st Century Cures Act.
As a small Ebola outbreak takes hold in the Democratic Republic of Congo, Merck confirms that it has stockpiled 300,000 doses of an experimental Ebola vaccine designed by scientists at Canada’s National Microbiology Laboratory that has shown “high efficacy in clinical trials and could play a vital role in protecting the most vulnerable”
May 15, 2017NewsComments Off on WannaCry Ransomware Webinar Tuesday, May 16
Sensato CEO and cybersecurity reseaercher John Gomez will present an HIStalk-sponsored free webinar on Tuesday, May 16 at 1:00 p.m. ET titled “WannaCry Threat Intelligence Briefing.”
John will provide an in-depth analysis of the current state of WannaCry as well as a technical review of how it operates and possible go-forward cybersecurity impacts. John will also present technical and regulatory counter-measures you should consider, specific to healthcare organizations.
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May 15, 2017Dr. JayneComments Off on Curbside Consult with Dr. Jayne 5/15/17
I had a rare opportunity this month to do something I haven’t done in a very long time: support a go-live. A friend who owns another consulting company reached out to me to see if I could help her out with the launch of a new EHR client when one of her consultants had to back out due to a family emergency. I had a bit of a lull in my schedule, so I was happy to oblige, especially since it happened to be one of my favorite cities. The idea of grits made by people who actually know what they are doing was enough to seal the deal.
I’ve supported the EHR in question before, but not for a couple of versions. She sent over her training documentation as well as the training records for the users at the location where I’d be covering. The end users had been through quite a bit of training along with role play and simulated patients with real-time coaching for eye contact. They also were planning a soft go-live the week prior, where end users (including providers) would be entering their visits after they left the exam room.
The plan was that by the time the actual go-live occurred on Monday, everyone would have documented at least 30 patient visits and would be ready to go. Each user had to not only attest to the fact that they did the visits, but my friend had consultants going through the charts to ensure that it was done correctly and to remediate anyone who appeared to be struggling.
I arrived Monday morning to a very calm office where everyone seemed comfortable with what was about to happen. Patient visit schedules had been adjusted, giving a 15-minute break after every three patients to allow the staff to catch up. Charts had been abstracted for upcoming visits based on a rolling schedule, and for same-day and next-day appointments, they were being loaded in real time.
Of course, the providers had spent some time cleaning up the charts for patients seen in the last six months so that abstraction could be simple data entry rather than a complex game of “hunt the data.” The practice also spent the last year adjusting their scheduling processes and panel sizes to ensure they were not trying to operate way above capacity. Some physician panels were closed and others shifted to move patient volume to where there was capacity.
The practice had been live on the practice management side of the application for a few months and also had been scanning all inbound and internally created paper (including visit notes) as well as receiving lab results via interface since the first of the year. There was very little reason to need a paper chart at the time of go live, although the practice planned to pull the chart for three patient encounters (whether in person or by phone) before archiving.
After the first couple of patient visits, I began to wonder why I was there. Although some might think the pre-live activities were grossly over-engineered, they did exactly what they were designed to do, which was to make the go-live successful.
At the end of the day, the providers were asked how they felt about their schedule and the amount of blocked time and they felt they could open some additional patient visit slots for Tuesday. Tuesday also went off without a hitch, with nearly all providers opting to continue to reduce the number of blocks on their schedule for documentation time. By Thursday afternoon, everyone was running a full schedule and seeing patients reasonably on time.
Overall, providers lost very little volume during go-live week because they were extremely well prepared. The workflow I saw in the exam rooms was good, with providers being able to interact with both the computer and the patient through reconfigured exam rooms or other adaptations. It was about as textbook of a go-live as you could ask for.
I was able to spend some time debriefing with my friend on Thursday night before heading home on Friday. My big question was how much time was spent up front to ensure the smooth go-live, especially considering the amount of training, role play, patient simulations, chart clean-up, etc. She had been tracking it pretty thoroughly and the average time commitment per provider was around 60-70 hours. That included 14 hours of system training, time needed for soft-live chart notes, time spent resolving data issues during chart clean up, additional role playing/coaching, and other activities. The only thing she didn’t have an accounting for was time spent in regular staff meetings where the EHR project was discussed.
Depending on how you think about it, 60-70 hours may or may not seem like a lot of time. When you talk about losing nearly two weeks of potential patient-facing hours, it seems like a lot. But when you hear about practices that “never got back to full productivity” despite years on an EHR, it seems like a small investment.
I think the more unquantifiable factor here was the smoothness of the go-live. There were very few chaotic times and no moments of terror at my site, and by report, none at other locations, either. Things were extremely smooth and you can’t put a price on the value of that when you’re talking about the mental health of your providers and frontline staff.
My consulting buddy, who prides herself on her “white glove” service, has follow-up assessments scheduled weekly by phone for the first month and then onsite at the 30-day, 60-day, and 90-day marks. If the practice starts to struggle, she’s going to know about it.
I look at some of the EHR vendors out there offering go-live within a week or two and I wonder how well that really goes in practice. I imagine that if the practice was fully optimized and the paper charts were all in good shape, it might be possible. But for practices that are going live on EHR this late in the game, I would think that’s less common since many net new purchases are from practices that are only being dragged into technology adoption through penalties.
I’d be interested to hear from readers in the implementation space. What do your experiences look like at this stage of the game? Can you really get practices live in a couple of weeks and have the adoption stick? What happens when you leave?
The WannaCry ransomware attack that quickly spread to computers across the globe, including 48 NHS hospitals, is halted after a cybersecurity researcher, noticing that the malicious code routinely pinged an unclaimed domain, registered the domain in his own name, inadvertently halting the spread of the attack.
MedSolutions CareCore agrees to a $54 million settlement with OCR, putting an end to the fraud lawsuit brought against the company after it authorized thousands Medicare and Medicaid payments for procedures without validating their medically necessary.
In Canada, Island Health announces that it will no longer support alternative workflows for the nine internal medicine doctors that have refused to use the recently implemented, $174 million Cerner EHR, citing patient safety concerns over its CPOE system.
Silicon Valley-based health insurance startup Clover Health secures a $130 million Series D investment round led by Google Ventures, bringing the three-year-old startup’s valuation to $1.2 billion.
One year after going live on Epic, three physician leaders from Massachusetts General Hospital pen an opinion piece in a local paper arguing that the administrative burden caused by poorly designed EHRs software is compromising the diagnostic abilities of providers and driving good physicians into early retirement.
An unprecedented ransomware attack affects 48 of England’s 248 trusts in waves of infections that spread globally on Friday. All but six trusts say they have returned to normal operations after they were forced to divert ambulances, cancel appointments, revert to paper, and order employees to unplug network cables from PCs and telephones.
The WannaCry ransomware, which demands a $300 ransom per infected Windows machine, initially affected computers primarily in Russia, Ukraine, and Taiwan. It uses the EternalBlue exploit that was made publicly available by hackers in mid-April. At least one hospital in Canada said it was threatened by WannaCry, but its antivirus software blocked it. Two hospitals in Indonesia were also hit as well as one in Taiwan and another in Scotland.
Microsoft issued a Windows patch to protect against the exploit in March, but many machines worldwide have not been updated. NHS is still running many Windows XP PCs, for which Microsoft’s extended support and security updates ended in 2014. Microsoft has responded to the attacks by providing an unprecedented public security update for Windows XP, Windows 8, and Windows Server 2003 to address WannaCry. Both Kaspersky and Bitdefender antivirus programs already protected against it.
The Russia-based hacker group that claims responsibility for the attack says it used cyber tools that were stolen from the US National Security Agency.
A 22-year-old security researcher apparently stopped the worldwide spread of WannaCry when his tests revealed that the malware was accessing an unregistered Internet domain, which he then registered to perform further testing. In doing so, he found that the ransomware stopped activating itself around the globe. The researcher theorizes that the hackers used the domain as a “kill switch” to prevent experts from analyzing in a sandbox environment. However, he cautions that the hackers could simply change the domain name the program checks, making it imperative that Windows PCs be brought up to date on patches.
A PC can be infected via a hyperlink spread by a phishing email, a web link or advertisement, or a document link.
John Gomez of Sensato offers these tips for health systems:
Apply the SMB patch (MS17-010) to all Microsoft systems.
Close ports 22, 23, 3389, TCP 139 and 145/UDP 137 and 138.
Test backups and store them offline.
Warn users not to open attachments.
Restrict access to file-sharing sites.
Review ransomware response protocols.
HIStalk Announcements and Requests
Eighty percent of poll respondents are not happy that the House passed the American Health Care Act. Frustrated says people should actually read the bill instead of parroting the opinions of others, adding that no healthcare system can survive if only sick people sign up and both the ACA and AHCA address that. Just a Nurse Analyst wonders about the backroom deals that were struck to pass it and questions the zeal to undo anything President Obama did regardless of the impact on Americans. Cosmos says every step of the process lacked moral discipline and integrity – the headlong rush and repeated attempts to repeat the ACA, the backroom negotiations, voting without CBO analysis, and a two-vote majority that suggests compromises undeserving of the resulting White House victory party. Malvern says that our healthcare cost of $10,000 per person each year can’t be solved by attacking coverage and premiums alone. Disgusted says it’s the most cynical, heartless pieces of legislation ever, especially the Medicaid cuts and the requirement of continuous coverage to have pre-existing conditions accepted. Printgeek thinks it’s a shame that the two political parties can’t even initiate a dialogue about healthcare. Bill says at least AHCA eliminates the word “affordable” as Congress finances access by increasing the federal deficit. HITgeek says healthcare requires a community health insurance risk pool to spread the cost of involuntary events, adding, “I am sick and tired of compassionless insurance, abetted by politics, being the gatekeeper for US healthcare.”
New poll to your right or here: What’s the most important factor in reducing US healthcare costs? The presence of the word “most” means I’m not oblivious to the desirability of an easy-out “all of the above” response, although I provided an “other” box in case my mental checklist of options is incomplete.
We funded the DonorsChoose grant request of Ms. L in Michigan, who asked for Chromebooks, headphones, and academic software subscriptions for her fourth grade class. She reports, “I am a fourth grade teacher on paper, but in reality, I teach students anywhere from a first grade to a fourth grade level. This poses a very real challenge that both my students and I deal with head-on. Technology is one way to successfully mitigate this particular hardship and thanks to you, our class was able to get the technology we need to be successful! Students have grown tremendously through these online platforms; we track and celebrate their progress weekly! It also makes students feel that they are valued. They have something BRAND NEW, that people whom they will never meet gave to them. That sense of value and feeling appreciated is HUGE and cannot be overstated. Thank you, thank you, thank you for making our class feel important!”
This Week in Health IT History
One year ago:
Theranos says 2014-2015 lab test results from samples it ran using its proprietary Edison analyzer should not be trusted.
The VA releases a software development kit for its open source Enterprise Health Management Platform.
Competing Missouri HIEs argue over connectivity, member charges, and unnamed special interests.
Five years ago:
Partners HealthCare announces plans to implement Epic at a cost of $600 million.
Greenway Medical Technologies is the largest percentage gainer on the New York Stock Exchange, with shares up 20 percent since the company’s February IPO.
NextGen parent Quality Systems acquires EDIS vendor The Poseidon Group.
3M makes its Healthcare Data Dictionary available worldwide at no cost.
California’s HHS moves oversight of the Cal eConnect HIE to the Institute for Population Health Improvement.
Allscripts appoints Paul Black to its board.
A report finds that one-third of prescriptions are being sent electronically.
Fairview Health Services admits that it was getting extensive negative feedback from its employees about the strong-arm collection tactics of Accretive Health.
Weekly Anonymous Reader Question
I’m delighted that my anonymous reader question surveys are getting so many responses that they don’t fit nicely into the Monday Morning Update. I’ve posted the two most recent sets of results at these links:
This week’s survey: What is the most customer-unfriendly term or condition you’ve seen in a healthcare software contract that the customer approved? This would be a good opportunity to warn others about items they shouldn’t accept.
Meanwhile, if you have ideas for future surveys, let me know – it’s an easy way to learn what your peers are seeing or thinking.
Last Week’s Most Interesting News
ONC appoints Genevieve Morris, MA (Audacious Inquiry) to Principal Deputy National Coordinator for Health Information Technology.
Memorial Hermann Health System (TX) pays $2.4 million to settle HIPAA charges after naming an arrested patient in a press release.
Specialty EHR vendor Modernizing Medicine raises $231 million in funding.
A contractor’s error exposes patient records of Bronx-Lebanon Hospital Center (NY) to the Internet due to a misconfigured backup.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Google parent Alphabet invests $130 million in San Francisco insurance startup Clover Health, raising its total to $425 million and valuing the company at more than $1 billion. Clover manages claims for just 25,000 Medicare Advantage customers in New Jersey and competes against much larger insurers, but says its forte is mining patient data to identify potential problems that can be addressed via a Clover-managed home visit or other intervention.
Decisions
Memorial Hospital of Lafayette County (WI) will switch from Medhost to Epic in November 2017.
Kaweah Delta Health Care District (CA) will replace Cerner/Siemens Soarian with Cerner Millenium in November 2017.
Haxtun Hospital District (CO) switched from NextGen Healthcare to Athenahealth in April 2017.
Platte Valley Medical Center (CO) will go live with Infor human resources in May 2017.
These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
People
Allscripts promotes Dennis Olis to interim CFO following the resignation of Melinda Whittington, who is leaving the company for unstated reasons after just over a year on the job .
Government and Politics
MedSolutions CareCore – now part of specialty benefits manager EviCore — will pay $54 million to settle an HHS fraud lawsuit in which the company authorized Medicare and Medicaid payments for procedures it had not validated as medically necessary. The company admits that its executives monitored a dashboard of medical review cases, and when the list got too long, ordered clinical reviewers to approve requests for prior authorization even though nothing had changed, which the Department of Justice says resulted in improper payment in up to 300,000 cases. EviCore was rumored earlier this month to be reviewing a sale of the company or an IPO, with its $300 million in 12-month EBITDA valuing it at up to $4 billion.
A former podiatrist pleads guilty to defrauding Medicare of $6 million by implementing an EHR in his 16-state long-term care practice to generate false patient documentation that would earn payments, such as falsely describing toenail conditions as “painful to such a degree as to affect ambulation and balance.”
Privacy and Security
The local paper reports that Erie County Medical Center (NY) is still trying to recover its systems more than a month after an apparent ransomware attack.
Other
The New York Times questions advertising drugs directly to consumers – legal in only two countries, the US and New Zealand — in noting TV commercials for a drug for an uncommon neurological condition for which it can stop uncontrolled crying or laughing. It notes that the commercial will likely pique the interest of overly emotional people well outside the drug’s target market who will pester their doctors to prescribe them the $700 per month drug.
Interesting: Dexter Holland – singer/songwriter of punk rock band The Offspring for more than 30 years – earns his PhD in molecular biology from USC with his dissertation titled “Discovery of Mature MicroRNA Sequences within the Protein-Coding Regions of Global HIV-1 Genomes: Predictions of Novel Mechanisms for Viral Infection and Pathogenicity.” As a clearly Renaissance man, he also has his own brand of hot sauce, is the former owner of a record label, and is a certified flight instructor who made a solo trip around the world in 10 days. Dr. Holland isn’t the first punk rocker to earn a PhD – Bad Religion founder Greg Graffin earned a Cornell doctorate in zoology and has taught and written on academic topics.
In Canada, Island Health tells nine internists who are refusing to use its Cerner-powered EHR because of patient safety concerns that they will no longer provide other doctors to enter their paper orders electronically. The CEO of Island Health says it’s OK that ED and ICU doctors haven’t used the systems – citing similar concerns – because they never fully transitioned to the EHR, but it’s too late for the internists to go back to paper. One of the protesting doctors, who is also president of the hospital’s medical staff, says the decree puts him in a difficult position because “it has the effect of barring me from practicing … without actually suspending me.”
Weird News Andy says that even though Sir Winston does not approve, he suggests ICD S01.22XS. In England, cocaine users are “getting Winstoned” when they use new, stiffer five-pound bank notes bearing the image of Winston Churchill to snort their drug of choice, leaving them with nose cuts.
Sponsor Updates
Gartner names Salesforce a leader for the ninth consecutive year in its Magic Quadrant for the CRM Customer Engagement Center.
The SSI Group will exhibit at the HFMA Spring Joint Conference May 17 in St. Louis.
TierPoint will host a grand opening for its Dallas-Allen data center on May 18 in Allen, TX.
The Chartis Group publishes a white paper titled “The Impact of the American Health Care Act on Children’s Hospitals: Preparing for the Road Ahead.”
TransUnion publishes a new white paper, “Uncompensated Care is on the Rise.”
Conduent reports first quarter 2017 financial results.
ZirMed publishes a new infographic, “ZirMed Denials by the Numbers.”
At a CIO’s request, I asked former and current CHIME members who have either quit or thought it to explain why.
I was once a CIO member years ago. Great networking and exchange of ideas. I became vendor, and after several years, pulled out. It became a pay-to-play with diminishing value. Let me tell you, even the sponsor companies don’t like it much.
It’s become a mini-me of HIMSS.
Vendors are running the show and there is no sense of working to better the industry.
CHIMe used to be an exclusive group of of IT executives and limited number of foundation members (vendors and consultants). Now it’s a mini-HIMSS dominated by vendors, with limited value for all participants. I’m not sure what CHIME’s mission is any more.
Way more time spent with the Foundation members than with fellow CIOs.
It has become so vendor-heavy and the membership drive now allows most anyone to join.
As a CHIME Foundation member for 12 years, I am disgusted with the direction both CHIME and HIMSS are going. It has become a”Russ Branzell “let’s look as much like HIMSS as we can” show. Quantity is more important than being a true CIO venue, having invited people as far down as the director level. I talk to a lot of CIOs who are no longer attending CHIME because of their new focus on money rather than collaboration. As a vendor, I no longer get the same value and am paying a lot more money for decreased value. I still feel I have to belong, just like HIMSS, because absence in noted more than presence.
Just like HIMSS, all about collecting vendor money and less about colleagues teaching and learning from each other. It is overwhelming being a CIO and have to deal with eight vendor staff to each one of us.
As long as CHIME works to keep the vendor contacts at the highest executive levels (Carl, Judy, etc.) it is fine. Complete openness and transparency is needed to give confidence that it exists to serve its members and not enrich its leaders though lucrative associations and spin-off ventures.
I’ve been involved in HIMSS and CHIME for many years, but have limited participation due to the vendor involvement. This has changed the focus for both organizations from members to vendors.
The move away from being a CIO-focused organization to having a variety of members, especially vendor firms.
It has taken on the same mentality as HIMSS — expand the focus to more vendors and non-CIO types. I attended HIMSS for the education sessions and the focus moved away from them. I attended CHIME for networking and CIO sessions to learn what others were doing. Sorry to say this has grown so much it does not work any more. It does not matter to me anyway because I have retired. There is a group of CIOs that formed HISEA. I could not join because a competitor CIO was already a member and that rules out many. But the concept was centered on presentations of great new ideas for other CIOs.
They are selling access to us. It felt a bit more subtle in the past, but is not that way and feels far more commercial.
I don’t like the Fall Forum. Too many vendors, the focus groups are a waste. It is clearly a business, not a professional society. Too bad.
Seeing declining value from participation year to year.
I was booted from CHIME after being a long-time member because I became employed by a healthcare vendor instead of a healthcare provider. I understand the rules, but there are plenty of old timers who are still members even after they went to work on the vendor side because their company has the massive funds to become a CHIME foundation member. So two reasons why I wouldn’t rejoin CHIME even it they would let me: 1) CHIME negates your years of healthcare provider experience once you go to work for a vendor, and 2) they purposefully exclude many vendors from the foundation by charging a huge amount of money for that privilege. I think that CHIME has done great work in the past, but I hate to see it become so commercialized and HIMSS-like.
The leadership seems more committed to growing members and expanding rather than serving the needs of the current membership.
Not providing value.
Insufficient value from membership.
I am considering it. The Fall Forum was the highlight of the year for networking with fellow CIOs and the Foundation firms. The last event I went to, the experience had dramatically changed. Now vendors have booths and instead of one or two people from a Foundation firm, there are MANY. Likewise on the CIO side. There are associate members that may number greater than the number of actual CIOs in attendance. This has moved from a very effective, intimate industry leader gathering to a mini-HIMSS. And who needs that? CHIME is clearly focused on growing revenue, just like HIMSS. I hope HIMSS selects a new leader that can actually save HIMSS from itself and that CHIME leadership watches closely and learns.
Seema Verma - that’s quite a spin of “facts” good luck.