Morning Headlines 8/17/17

Docs, Hospitals Respond to CMS Retreat on Bundled Payments

CMS announces plans to eliminate several Obama-era bundled payment programs designed to test the impact of bundling some cardiac and orthopedic health services payments.

Healthcare data breaches caused by hacks are on the rise

Cyberattack-related data breaches at healthcare organizations have increased 162 percent so far in 2017, according to data from OCR.

Questions About The FDA’s New Framework For Digital Health

Health Affairs analyzes the FDA’s new Digital Health Innovation Plan.

Express Scripts to limit opioids, concerning doctors

Pharmacy benefits manager Express Scripts intends to limit the number and strength of opioid drugs prescribed to first-time users as part of a broad effort to curb the opioid epidemic.

Morning Headlines 8/16/17

The Effects of Terminating Payments for Cost-Sharing Reductions

The Congressional Budget Office issues a report forecasting the financial impact that halting federal payment of cost-sharing subsidies to insurers selling plans on public exchanges will have, concluding that premiums would climb 20 percent in the first year, and continue to raise slightly more in years later.

Children’s Hospital of Philadelphia to Lead New Pediatric Data Resource Center for Research in Childhood Cancer and Structural Birth Defects

The NIH is funding a big data project led by the Children’s Hospital of Philadelphia and the Center for Data Driven Discovery to discover causes of pediatric cancer and structural birth defects.

Bolton NHS Foundation Trust selects Allscripts to enhance care and clinical engagement

In England, Bolton NHS Foundation Trust has selected Allscripts Sunrise EHR.

Physicians Healthsource, Inc. v. Allscripts-Misy’s Healthcare Solutions, Inc.

A physician practice, described by an obviously annoyed presiding judge as “a professional class-action plaintiff”, has filed a class action lawsuit against Allscripts for sending junk faxes without opt out instructions.

News 8/16/17

Top News

The Congressional Budget Office scores the expected impact of the White House’s threat to stop paying Affordable Care Act-mandated cost-sharing reductions:

• Insurers would pull out, leaving 5 percent of the country with no access to exchange insurance.
• Premiums would increase 20 percent in the first year.
• The federal deficit would increase by $194 billion through 2026.
• The number of uninsured people would increase slightly in 2018 but then start moving slightly lower in 2020.

CBO qualifies its prediction based on how and when the White House stops making the payments, which the President has incorrectly described as “insurance company bailouts.”

The big takeaway is the deficit estimate. Paying premium subsidies based on income actually saves the country money.

CBO adds that President Trump’s CSR threats alone have already driven premiums up since insurers are required to request approval for their 2018 prices now.

The House of Representatives sued over the ACA’s cost-sharing reductions in 2014, arguing that the payments are illegal since Congress never appropriated the money to fund them. That case remains open.

Reader Comments

From Keelhauler: “Re: cloud computing. Thought you would enjoy this.” I did, thanks.

From Surprise!: “Re: Allscripts. Layoffs today of around 60 worldwide. Some senior people had their positions eliminated. Pretty eventful couple of weeks with the Paragon and NantHealth stuff.” Unverified, but reported by several readers. I reached out to the company’s media contact, who responded, “Allscripts does not discuss rumors or speculation,” which leaves the rest of us to do so without its participation.

From Life’s Changing the Ocean Floor: “Re: [health IT site name omitted]. Seems to be dead.” Sure does. Googling turns up no user outrage or fond reminiscing, which suggests that its demise was not untimely.

From Pacifico: “Re: Caradigm. LinkedIn shows that several top execs, salespeople, and security team members have left. GE is taking over, cutting headcount and leveraging shared services.” Unverified. I compared the company’s September 2016 leadership page to the current version – the 13 executives are now down to seven, of whom two are new.

From Gaslighter: “Re: market share by hospital size. Were those numbers for US hospitals only? Wondering since Meditech has a significant presence in Canada.” Blain Newton of HIMSS Analytics, who provided the count, says the numbers cover only domestic hospitals.

From Supine on the Sand: “Re: market share by hospital size. The most meaningful stat is the 500+ bed hospitals since they often take smaller hospitals with them when they choose a vendor, which is why Meditech and Siemens (Cerner) have lost hospitals. Number of beds is most important since it equates better to the number of people – particularly doctors – who use the systems. Meditech is in big trouble because it has no ambulatory presence and Cerner, too takes a hit with ambulatory. Epic is much stronger than Cerner because of its 500+bed dominance and its ambulatory market share. I would love to see market size by beds and by ambulatory doctor count.” I mentioned your interest to Blain and he’s going to analyze EHR vendors by total beds and total physicians, so watch for that. I think Meditech can maintain its relevance for those hospitals that can’t manage the complexity or afford the cost of Epic or Cerner, but I agree that Meditech waited too long to conclude that the offering of partner LSS – which Meditech later bought – wasn’t the integrated ambulatory answer many of its clients and prospects were looking for. All three companies have common traits: they offer single-platform products for nearly every hospital service, they rarely acquire companies (“never” in the case of Epic), and they run on a single database. Those characteristics seem obviously desirable with 20-20 hindsight, but were lost on now-lagging competitors who were busily milking their cash cows, buying and nameplate-integrating anything that moved, and waltzing with Wall Street.

From EclipsysGal: “Re: Chad Eckes. Glad to see an IT leader move into the CEO role.” Chad takes the CEO role at Pinnacle Dermatology, a private equity-backed dermatology practice in the Midwest that hopes to expand to 100 locations. He has served time as CIO of Cancer Treatment Centers of America and EVP/CFO of Wake Forest Baptist Medical Center (NC).

From Vaporware?: “Re: MHS Genesis pilot sites. I found this testimony from March that says interoperability at Fairchild is through the legacy JLV portal via logging into AHLTA. Future plans include moving the legacy portal into Genesis. Fair to take that as a ‘no’ on CommonWell?” I’ll invite knowledgeable readers to chime in since I don’t know much about the DoD and the planned interoperability with the VA once they’re both on Cerner. It may be that workarounds are necessary until Genesis is live at all DoD facilities.

From Eco Chambers: “Re: nonsensical terminology. I submit ‘ecosystem’ or ‘hyper-convergence.’ Where does this stuff come from?” I suspect someone (probably folks aspiring for cleverness in their books or articles) spends a lot of time coming up with words they hope will spread virally. Unfortunately, that sometimes happens, replacing perfectly serviceable and accepted words with cute new ones that only a marketer could love. 

HIStalk Announcements and Requests

I thought my old Plantronics USB headset was failing since my new laptop wouldn’t recognize it (it wasn’t failing, as it turned out – I fixed the problem by deleting and reinstalling the latest version of the motherboard’s audio driver). I wanted a more comfortable headset since I often listen to music for hours while writing HIStalk and remembered that the best one I’ve owned was a gamer version. My solution: the fantastic EasySMX PS4 for $18.99 (for some reason, it’s gone up to $28.99 since last week). The driver-free headset’s deep ear cushions eliminate room noise while pumping out impressive bass from its 40mm driver with a cool option to vibrate as well, which I like. I’m rocking out to the much richer sound.

Listening: new from former Oasis singer-songwriter Liam Gallagher, whose Lennon-like brilliance is tempered by bizarre behavior that should make him a top pick in the rock dead pool. I’m also enjoying the immensely talented Sia, who is suddenly a global superstar at 41 (you’ve surely heard her stunning tropical house hit “Cheap Thrills” or “Chandelier”) after writing songs for other stars and battling personal demons.

The healthcare relevance of the folks HIMSS chooses for keynote speakers often puzzles me and Magic Johnson is no exception. His accomplishments, as far as I can tell, were (a) surviving HIV when most other patients didn’t, and (b) getting rich off basketball and the business deals he struck after he retired (I’ll skip his awful 1998 TV talk show, whose low quality and alarmingly short tenure was eclipsed only by the pitiful late-night efforts of Chevy Chase and Pat Sajak). At least he has directed some of his attention toward social causes and that alone will probably make his speech interesting. He’s on the agenda for Friday of HIMSS week, with the absence of most of us dearly departed attendees providing an intimate setting for those stalwarts can never get too much time at conferences or in my least-favorite city.

Thanks to HIStalk sponsors EClinicalWorks and ZappRX for upgrading their Gold sponsorship to Platinum.

Thanks to Nuance, which apparently dropped their long-held HIStalk Founder sponsorship by mistake and have reconnected as Platinum since their original spot had already been snapped up by the time they realized it.

Webinars

August 17 (Thursday) 2:00 ET. “Repeal and Replace McKesson’s EIS.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The brutally honest and cynically funny Frank and Vince will analyze the Allscripts acquisition of McKesson’s EIS business. They will predict what it means for EIS’s 500+ customers, review what other vendors those customers might consider, describe lessons learned from previous industry acquisitions, and predict how the acquisition will affect the overall health IT market. Their 2014 webinar on Cerner’s acquisition of Siemens Health Services has generated over 8,000 YouTube views.

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

Acquisitions, Funding, Business, and Stock

Credentialing technology vendor Silversheet raises $5 million in Series A funding, increasing its total to $10 million. I interviewed CEO Miles Beckett, MD just over a year ago since I was fascinated that he created the “lonelygirl15” web series that ruled YouTube in 2006-2008.

A Goldman Sachs report says Amazon’s initial healthcare ambitions may involve partnering with a pharmacy benefits manager to optimize prescription ordering and delivery. The report also speculates that Amazon could provide patient monitoring and telemedicine visits via its Echo that would then allow patients to order the drugs prescribed. It also says Amazon could be interested in using the patient data it collects to cross-sell products, which wouldn’t be the day’s best privacy news.

Google buys Seattle-based Senosis Health, which was developing apps that use smartphone sensors for diagnosing newborn jaundice, reduced lung function, and low hemoglobin levels. Those apps have yet to earn FDA’s marketing clearance.

Medication management technology vendor Swisslog Healthcare makes an unspecified investment in managed telepharmacy solutions vendor PipelineRx. 

Personalized health behavior change technology vendor Happify Health raises $9 million in funding.

Dublin, Ireland-based Clanwilliam Group makes its 13th medical technology acquisition in three years in buying digital dictation vendor Medisec Software, which is a supplier to NHS.

CHOP spinoff Haystack Informatics closes an additional funding round to expand the rollout of its privacy solution, which analyzes EHR activity logs to identity potentially inappropriate user activity.

Clinical research organization PRA Health Sciences will pay $520 million to acquire Symphony Health Solutions, which resells prescription data of 280 million US citizens to drug companies who use the information to market their products to doctors.

Sales

St. Luke’s University Hospital (PA) will implement MModal’s Fluency Direct EHR-integrated clinical documentation as it moves to Epic in 2018. St. Luke’s CMIO James Balshi, MD calls MModal’s platform “cloud-based but not cloud-dependent.” 

Children’s Hospital New Orleans (LA) selects Vocera’s smartphone app for secure text messaging and hands-free communication.

Saint Luke’s Health System (MO) will expand its FormFast implementation in rolling out the company’s electronic signature product.

In England, Bolton NHS Foundation Trust chooses Allscripts Sunrise.

MIT’s student and faculty ambulatory care center chooses Cerner Millennium and HealtheIntent.

People

Libby Curtis Webb (Copatient) joins ZappRX as SVP of product.

Announcements and Implementations

Children’s Hospital of Philadelphia (PA) will run an NIH-funded project to mine big data to look for causes of pediatric cancer and birth defects, with partner organizations running several data portal, genomics standards, and analytics sub-projects that will combine clinical and genetic sequence data from several cohorts into a centralized database.

PatientPop – which offers practice-building tools – adds the ability for Google searchers to schedule an appointment directly from the practice’s Google My Business listing that shows up to the right of the search results.

Navient subsidiary Xtend Healthcare buys HIM and revenue cycle consulting firm Elipse.

A technology paper profiles Phynd, with founder and CEO Tom White explaining its provider data management solution. The company’s Phynd a Doc consumer search function is used on Duke Health’s website (above).

The Tennessee Hospital Association and Audacious Inquiry launch ConnecTN, which will share real-time ED visits and hospital admissions among THA’s hospital members and TennCare.

Apple is reportedly talking to Aetna about making the Apple Watch available for free or at a discount to the insurer’s customers, which would extend the program beyond Aetna’s wellness program that covers its 50,000 employees.

Optimum Healthcare IT opens a managed services office in Duluth, MN and is profiled in the local paper.

OpenEMR enhances its open source EMR to operate as an out-of-the-box cloud services solution using Amazon Web Services, providing benefits that include automatic scaling of computational resources for cost effectiveness, cutting edge network security, zero hardware maintenance, easy software deployment, and robust backup and recovery solutions.

Privacy and Security

The Department of Justice demands that web hosting company DreamHost turn over the personal information of 1.3 million visitors to an anti-Trump website, ordering the company to provide IP address, contact information, photos, and emails.

Technology

Microsoft defensively downplayed a Consumer Reports estimate from last week that 25 percent of its Surface tablets and laptops experienced problems – which caused CR to withdraw its “recommended” rating – but internal Microsoft documents suggest that Microsoft was fully aware that the Surface Pro 4 and Surface Book have high customer return rates. Here’s some easily-remembered advice: never buy hardware from Microsoft other than keyboards, mice, joysticks, and Xbox components. The rest of their lineup is stuff other companies sell better and cheaper (unless you still believe the Zune was a great digital media player and subscription music service).

Other

The HR SVP and an interim hospital CEO of Broward Health (FL) quit following the resignation of an SVP who had been accused of overpaying a politically connected marketing company by $1.7 million in a secret side agreement. The health system’s then-CEO committed suicide 18 months ago, after which the board ignored the candidates presented by its search firm and instead gave a fellow board member the $650,000 job. That CEO is a nurse whose only graduate degree was issued by a notorious diploma mill that has since closed.

I hadn’t seen this: Physicians Healthsource sues Allscripts under the Telephone Consumer Protection Act for sending junk advertising faxes without opt-out instructions. The plaintiff claims it received 36 faxes from 2008 through 2011 and seeks class action status. The judge labeled Physicians Healthsource as a “professional class-action plaintiff” that has filed several similar “junk fax” class action lawsuits using he same law firm and notes that fax machines have mostly been replaced by computer software, meaning that recipients expend little money or time in discarding unwanted faxes even though federal law still allows filing such lawsuits. The judge also noted that Allscripts had previously been sued by a physician’s office for the same issue and paid $600,000 in legal fees plus whatever settlement they agreed to, concluding that Allscripts “should adjust its marketing strategy a bit, or at the very least, stop sending faxes to what might be one of the more litigious businesses, in terms of junk fax litigation, in the country.” The court also notes that the maximum penalty for junk faxing is $500, but such class action lawsuits can create a windfall for the law firm as both sides pay expensive attorneys to argue over the small sum. The judge’s comments are entertaining and cynical, showing obvious disdain in the ruling above for a Congress-created law that he clearly thinks is ridiculous.

Sponsor Updates

• UnityPoint Health (IA) is optimizing its EHR build by using LogicStream Health’s Clinical Process Improvement solutions to review sepsis screenings and to compare protocol usage to evidence-based best practices in real time.
• EClinicalWorks supports National Health Center Week and the 700 Community Health Centers that use its systems. The company was also named as a Frost & Sullivan customer value leadership award winner for its RCM services.
• Kyruus will integrate its ProviderMatch for Consumers with Binary Fountain’s online patient reviews to enhance its online search directory pages.
• Besler Consulting will present at the HFS Provider User Meeting August 18 in New Orleans.
• Gartner includes Dimensional Insight and its analytics applications in three healthcare research reports in July 2017.
• IDC Health Insights includes Medecision in its HealthTech Rankings Top 50.
• Glytec CMO Andrew Rhinehart, MD discusses Glytec’s contributions to value-based reform.
• Ingenious Med will exhibit at the HFMA NC Summer Institute August 23-26 in Myrtle Beach, SC.
• InterSystems will exhibit at the Sunquest User Group meeting August 21-24 in Tucson, AZ.

Blog Posts

• Are Your Healthcare Communications Ready for the Total Solar Eclipse? (Spok)
• Embracing Differences and Maximizing Strengths (Access)
• Aprima’s Adaptive Learning Technology and the AI/Machine Learning Buzz (Aprima)
• Why There is No Up Front Pricing (Datica)
• Help with Physician Burnout and Other Challenges Physicians Face (CareSync)
• Lessons Learned from an Internship (Direct Consulting Associates)
• 2017 National Health Center Week: Celebrating the Care All Americans Deserve (EClinicalWorks)
• Are You Ready for Value-Based Care? 7 Things to Consider (Hayes Management Consulting)
• Healthcare Digital Transformation: What, Why & How? (Part 2) (The HCI Group)
• The Tension Between Healthcare Pricing and Consumerism (Healthcare Growth Partners)
• Change is Constant, How Do You Manage It? (Iatric Systems)
• Bipartisan legislation in US Congress requires e-prescribing to combat opioid abuse (Imprivata)
• 5 Ways to Grow Your Healthcare Brand with Consumer Reviews (Influence Health)
• Back to School: 5 Lessons Learned in Healthcare Payments (InstaMed)

Contacts

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

Morning Headlines 8/15/17

Google Verily Unit Acquires Senosis Health

Verily, Alphabet’s life sciences business, acquires Senosis Health, a smartphone-based medical condition monitoring app. Financial terms were undisclosed.

MIT Medical Selects Cerner’s Integrated Health Care Technology for Care of Students, Faculty and Staff

MIT Medical, which serves MIT students, faculty and family members, selects Cerner as its next EHR.

Coverage For Mental Health Via Telemedicine Soars At U.S. Employers

56 percent of US employers plan to offer telehealth-based behavioral health services in 2018, more than doubling availability compared to 2017 rates.

Curbside Consult with Dr. Jayne 8/14/17

I work all over the country, so I see both national and regional trends. For a while now, we’ve seen private equity firms sinking money into larger practices, particularly in the profitable subspecialties such as dermatology and oncology. In these larger organizations, the private equity involvement usually starts around capital expenditures, such as opening surgery centers, infusion centers, or purchasing equipment. The organizations themselves are already fairly well developed and may be looking to expand or merge with another practice, but they’re typically pretty savvy about running a business and how to interact with financial backers. Recently though, I’ve seen a couple of scenarios play out where smaller organizations have gotten themselves involved in with private equity money and the practices are clearly in over their heads.

The first organization I saw this with was a primary care group that had a decent number of physicians, but at 50 or so providers, was in no way a large group. They were located in Texas and had delusions of expanding their group statewide and had gotten some backing to do so. I was working with them peripherally through a consulting subcontract with their laboratory vendor, so was able to watch it play out from the sidelines. I watched the practice administrator threaten leadership from their EHR vendor, using phrases around their plan to “triple in size” and to become “a force to be reckoned with.”

First off, even if they tripled in size, that would put them in the 150-physician range, which their vendor doesn’t even remotely see as a “large” client. The practice had failed to realize this before making their demands for free services and free software in preparation for their growth. They also failed to understand that primary care practices rarely have the footprint or financial ability to become a force as they envisioned unless they are very large or have very tight ties to key subspecialties.

The practice administrator had sold her physicians a bill of goods and they were all buying into the illusion that someday they would be the pre-eminent primary care practice in Texas, and by bringing in some PE financing, they were on their way. The physicians didn’t understand that once you bring PE into the mix, you lose a fair amount of control because you’re spending someone else’s money. I never had the opportunity to read the agreement, but it was clear that either they gave away more rights than they understood or that the PE group was taking advantage of them.

The administrator, who is from Detroit, and the PE leader, who hailed from New York, also failed to understand Texas culture. They never could quite figure out why small practices and independent providers weren’t interested in merging with them. Having spent several years living there and dissecting the culture as a relative outsider, I could have given them some pointers.

First off, although Texas is legally a single state, when you travel around it and meet lifelong residents, you quickly realize that it might as well be multiple states. I know people who live in Dallas and Fort Worth who have never been to the other city despite them being only about 30 miles apart. For those folks, crossing that gap might as well be a trip to the moon, which is a shame when you consider what each of the cities has to offer.

When you look at the cities that are farther apart physically, the differences are even more striking. The drive from Brownsville in the South to Texline in the north is almost 900 miles and you cross through multiple cultural traditions on the way. Parts of Texas think they’re in the old south, parts of it think they’re in the Old West, parts of it think they are in old Mexico, parts of it think they’re “big cities,” parts of it ooze small-town charm, and parts of it are just weird (Austin, you know I love you). Oh yeah, and then there’s the Gulf Coast.

To think that you’re going to be able to understand and accomplish expanding to physician practices across that broad of a spectrum within 12 months seems like a long shot. Some of us can’t even get physicians to agree across county lines, let alone across cultural divides and geographic barriers. I’m not saying it can’t be done, but it’s going to be expensive and psychologically exhausting as you try to address the distrust that people have of each other when they’re coming from different perspectives.

Eventually, the practice burned through a lot of money trying to figure out the expansion and the PE group became frustrated. In the end, they were snapped up by a hospital system that they had previously shunned.

Another group I worked with more recently was a procedural subspecialty practice in the Midwest. They had been wooed by a PE firm promising market dominance and expansion, which resonated with the practice’s leadership. Although they’re just trying to achieve regional expansion and grow from their 30-physician size, they didn’t understand that the face they were presenting to the market they were trying to conquer wasn’t a nice one.

My first exposure to them was a meeting where the head of the practice opened with expletives and started shouting at the vendor in front of the PE team. Never a good sign. This guy would go out to practices they were looking at “merging” with (code for acquiring) and behave inappropriately. I once watched him threaten prospective partners and promise that they would be sorry if they didn’t align with his group. I felt like I was in a 1920s-era gangster movie and expected to see Robert De Niro walking around the room with a bat.

I was somewhat gratified to see both his administrative and IT teams begin to ally themselves with the PE team against him. This continued for weeks and he never had a clue that the axe was going to fall until they walked him out the door. In the aftermath, the physicians feel hoodwinked, and frankly I don’t think they wanted to expand that much at all but were relatively powerless to block the actions of the administrator because of their previous corporate setup. They clearly didn’t want to give up as much autonomy as they did for the promise of being the top dogs. If they thought their schedules were oppressive before, they are certainly not enjoying the MBA-level micromanagement that is now going on behind the scenes. I don’t doubt that the practice will eventually grow, but the PE managers have a vested interest in tightening the collective belt so that they spend as little of their own money as possible.

Anyone who doubts that medicine has become a business needs only to look at these types of examples to understand what is going on. Medical schools have done a great job adding courses in patient engagement and complimentary / alternative medicine to their curricula. Now they need to add solid business courses. If they don’t, then physicians need to seek this knowledge on their own just like they would learn a new procedure or therapeutic regimen. There are plenty of smooth-talking individuals looking to work with physician groups and all too easy for them to be on higher ground.

How does your group learn about trends in practice management? Have you had private equity interest? Email me.

Email Dr. Jayne.

Morning Headlines 8/14/17

As losses mount, Soon-Shiong’s NantHealth to lay off dozens, reduce headcount by 300

NantHealth announces a fresh round of layoffs following its poor Q2 results. Some of the affected employees are being re-assigned to Allscripts as part of previously announced product acquisitions.

ONC’s Rucker hones agency mission around 21st Century Cures Act

Speaking at the Allscripts Client Experience conference, National Coordinator for Health IT Don Rucker, MD discusses the need to give consumers more control of healthcare spending, explaining “We know how to do pay-for-value as consumers when we’re spending our own money. If there’s anything Americans are good at, it’s knowing how to shop.”

Distributed Ledger Technology in Healthcare: Update from the Delaware Blockchain Initiative

The Medical Society of Delaware is working with blockchain technology company Symbiont to develop a blockchain-based solution to address the challenge prior authorization requirements pose.

Monday Morning Update 8/14/17

Top News

NantHealth shares dropped 14 percent on Friday after Thursday’s announcement of poor financial results, a 300-employee layoff, and re-acquisition of heavily devalued NH shares previously purchased by Allscripts. NH shares closed Friday at $3.49, valuing the company at $424 million.

Above is the one-year share price chart of NH (blue, down 71 percent) vs. the Nasdaq (green, up 19 percent).

CEO Patrick Soon-Shiong said in the earnings call that acquisitions had swelled NantHealth’s payroll to 1,000 employees. He says synergies, a refocusing on artificial intelligence and decision support products, and transferring some employees to Allscripts as part of its purchase of NantHealth’s patient-provider portal product will enable the 30 percent headcount reduction.

Soon-Shiong says the FusionFx product that Allscripts is buying is non-core business because the company can exchange clinical documents without its interoperability component and that “this middleware that actually talks to EMRs was merely a tool and not really core and was better in the hands of an organization with hundreds of salespeople calling on customers during EMR implementations.”

NantHealth’s FusionFx was part of its July 2015 acquisition of Harris Healthcare Solutions, which had previously acquired the former CareFx in early 2011 for $155 million in cash. That offering included HIE, patient and provider messaging, and single sign-on. 

Reader Comments

From Ciro Cumulus: “Re: the question of whether Epic is a cloud-based system. Based on your criteria, I would say yes.” CC provided this review of Epic’s offering:

• It connects via the Internet.
• The user organization doesn’t pay capital expense, just a cost per concurrent user with license fees to InterSystems.
• The standard term is five years with renewals.
• Epic uses software-defined networks and state-of-the-art virtualization across compute, storage, and network.
• Customers can scale up or down on the fly.
• Epic manages the infrastructure and applies upgrades, although with more coordination than the typical cloud provider since application software requires more testing, training, and integration review.
• Epic provides service-level agreements for performance and uptime.

HIStalk Announcements and Requests

Poll respondents are not really sure who will benefit most from Allscripts acquiring Mckesson’s EIS business, but the customers of both companies top the list. New poll to your right or here: what kind of term is “cloud-based?”

Blain Newton, EVP of HIMSS Analytics, was kind to answer my question about hospital count by bed size in providing the worksheet above. The information should dispel the notion that the inpatient EHR market is a wide-open race with many participants. My takeaways:

• Cerner, Epic, and Meditech are far ahead of the pack in terms of overall hospital count.
• Epic has nearly double the number of 500+ bed hospitals as Cerner.
• The good news for Allscripts (sort of, anyway) is that McKesson had twice as many hospitals as Allscripts pre-acquisition, but most of those are under 150 beds.
• I consider 250 beds to be the minimum size hospital to provide significant revenue opportunity and that race is all Epic (38 percent), Cerner (31 percent), and Meditech (14 percent).
• Allscripts, which was touted by a reader as being a major, competitive player that generated my original question, is not – they have just 6 percent of the 250+ bed hospital market and only 3 percent of hospitals overall vs. Cerner’s 24 percent, Epic’s 23 percent, and Meditech’s 19 percent.
• The unstated factors involve the “which modules” question — running a full suite of available products vs. just a few key systems from a particular vendor – as well as the overall trend in switching from one vendor to another. Hospitals are often all in with Cerner, Epic, and Meditech, but I suspect much less so with Allscripts given its more limited product line (although Allscripts has a strong ambulatory presence). There’s also the issue of which hospitals are running a system vs. who is paying for it and how much, which then gets into how health systems buy software corporately.
• Regardless of the slicing and dicing applied, I’ll stand by my long-held conclusion that it’s all Epic and Cerner with Meditech as the dark horse when it comes to inpatient EHRs. Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case. We need more and better competition.

It’s a slow news time every year from early August through Labor Day. After that, everybody puts their nose back to the grindstone, conferences gear back up, and a flurry of work kicks in that lasts until Thanksgiving. Until then, the news is mostly an occasional big announcement (like acquisitions and quarterly earnings reports) and a product sale every now and then.

This Week in Health IT History

One year ago:

• Karen DeSalvo, MD, MPH resigns as National Coordinator, replaced by Vindell Washington, MD but continuing in her full-time role as Assistant Secretary for Health.
• Bon Secours Health System (VA) notifies 665,000 patients that a revenue cycle optimization vendor’s mistake left their information freely discoverable on the Internet.
• Patient advocate Jess Jacobs dies.
• The FTC resolves its patient privacy complaint against Practice Fusion, which it accused of soliciting patient reviews about their doctor and posting them to its website without adequate warning.

Five years ago:

• SAIC completes its acquisition of MaxIT Healthcare.
• The Surgeons of Lake County (IL) reports that its system was attacked by ransomware.
• Arkansas Heart Hospital signs a $10 million deal to implement Siemens Soarian.
• CMS publishes requirements for Meaningful Use Stage 2.

Ten years ago:

• The first screenshots of Google Health are leaked.
• Healthcare billing company Verus shuts down following a string of system breaches.
• CompuGroup wins the bidding for taking over iSoft.
• Epic opens its $100 million, barn-red learning center as Campus 2 construction begins and the company’s revenue hits $422 million.
• Walmart announces plans to open 400 in-store medical clinics.

Weekly Anonymous Reader Question

Responses to last week’s question:

• I would love to live in Maui — mild weather, beautiful landscape, and friendly people.
• The Tuscany countryside.
• Boulder, CO.
• Fiji has the most wonderful people I have ever encountered, and it’s beautiful. New Zealand is also beautiful, has wonderful people, and is progressive. I’m buying a house in both places.
• Near my family and my (hopefully) eventual grandchildren.
• Madison, WI.
• San Francisco.
• A restored Vanderbilt mansion in Newport, RI in the summer and a hut on Little Palm Island near Key West in the winter.
• A beach house in Playa del Carmen.
• Notre Dame du Pre, France.
• London.
• Scandinavia or Holland.
• Paris.
• La Jolla, CA.
• New Zealand! Tropical beaches, rainforests, mountains, glaciers, and volcanoes all within driving distance (long ferry ride potentially required).
• Jacksonville, FL.
• Captiva Island, FL, the Caribbean island in the US.
• Denver.
• Oahu, Hawaii — slower pace of life, great weather, great people, great natural world, but still has modern world amenities.
• US Virgin Islands.
• Right where I already am – on the North Shore of Lake Superior.
• Moorea, FP.
• Curacao or the Bahamas.
• Jekyll Island, as close to Driftwood Beach as I can get.
• Alaska.
• Fairhope, AL on the bay.
• In a giant fifth-wheel, exploring the country (and probably spending a lot of time in New England and California)
• Byron Bay, Australia.
• Western Montana.
• London on the Northern or Western ends so I can still have trees around me, and since money isn’t a factor I’m going to have a little cottage on the lower Cape, maybe Eastham or Orleans. Water, but set way back so my house won’t fall into the ocean for at least 20 years.
• Coastal Southern California.
• Lauterbrunnen, Switzerland or some other spectacular Alpine town. Clean water, clean air, solar power and living life in person instead of through an electronic device.
• Florence, Italy.
• Carmel, CA.
• St. John, USVI.
• Destin, FL.
• San Diego, CA.
• Goodyear, AZ.
• Chicago downtown.
• Chapel Hill, NC.
• Paris.
• Vegas, with summer trips to the rest of the world.
• Encinitas, CA.
• Auckland.
• SoCal rocks.
• Carlsbad, CA.
• Jackson, WY.
• Boston.
• Munich, Paris, NYC.
• Redmond, OR.
• Coronado Island Calfornia. The best climate in the country year round and a beautiful beach! Can’t beat it.
• St. Maarten.
• Mobile Bay, AL.
• San Diego. Best of all worlds n the US. Vancouver for Canada.
• Hands down – Ireland (just got back – amazing), also Wyoming, Ft. Myers, FL.
• London.
• Florence, Italy near the Ponte Vecchio.
• I would live a nomadic life in a class B motor home. Then I would really more deeply experience places I’ve visited that caught my eye. Durango, CO, Travelers Rest SC, Venice FL, Seattle, WA, Saranac Lake, NY.
• With George Clooney. Before he was married and had kids.
• San Francisco or Seattle.
• The house I grew up in. There I knew happiness and love.
• San Diego.
• Big Island, Hawaii.
• Costa Rica. It’s an amazing place with amazing people. Have been there five times and am overdue for a trip back!
• Hawaii.
• Santa Fe.
• London.
• The Alaskan Bush.

This week’s question, which isn’t really work related but interesting to me personally since all work and no play makes Mr. H a dull boy:  which musical group or performer is the best you have ever seen in a live, in-person performance?

Last Week’s Most Interesting News

• Allscripts swaps its mostly devalued NantHealth shares for NantHealth’s provider and patient engagement solutions.
• NantHealth announces poor quarterly results and a restructuring that involves laying off 300 employees.
• UC San Diego Health migrates from its self-hosted Epic implementation to an Epic-hosted version.

Webinars

August 17 (Thursday) 2:00 ET. “Repeal and Replace McKesson’s EIS.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The brutally honest and cynically funny Frank and Vince will analyze the Allscripts acquisition of McKesson’s EIS business. They will predict what it means for EIS’s 500+ customers, review what other vendors those customers might consider, describe lessons learned from previous industry acquisitions, and predict how the acquisition will affect the overall health IT market. Their 2014 webinar on Cerner’s acquisition of Siemens Health Services has generated over 8,000 YouTube views.

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

Acquisitions, Funding, Business, and Stock

Nordic expands its Madison, WI office, adding space for another 60 employees. The company says the new space won’t last long as it rapidly expands beyond its 800 employees and 2016 revenue of $180 million.

Technology company The Bitfury Group and Baltimore-based AI startup Insilico Medicine will work together to develop blockchain applications for healthcare.

Decisions

• Dukes Memorial Hospital (IN) will replace McKesson with Cerner in 2018.
• Dupont Hospital (IN) will go live with Cerner in 2018.
• Carroll Hospital (MD) will replace McKesson with Cerner in 2018.
• UMass Memorial – HealthAlliance Hospital (MA) will implement Epic in October 2017, replacing Siemens.
• Bryan Medical Center – East (NE) will go live on Epic in March 2018.

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

People

Santa Rosa Consulting hires Mike Ragan (NTT Data) as chief revenue officer.

Announcements and Implementations

HIMSS Analytics expands its Logic health IT market intelligence platform with international data, increasing its coverage to 380,000 facilities in 47 countries, including 100 percent of US hospitals. 

Other

In India, the head of a state-run medical college is suspended after the deaths of 60 children in the past week – at least 30 of them on Thursday and Friday alone — that local newspapers claim were due to the hospital’s oxygen vendor cutting off the hospital’s supply after it accumulated $90,000 worth of unpaid bills. The administrator says he repeatedly warned the state that the hospital didn’t have the money to pay the overdue oxygen bills but was ignored. Witnesses say doctors handed out manual resuscitator bags to family members asked them to pump it themselves as many of them watched their children die needlessly.

In Ireland, Mater Hospital’s storage-area network fails, forcing the hospital – which is among the country’s busiest – to divert ambulances and cancel appointments.

Here’s Vince’s final HIS-tory installment on Cerner, closing out a nice look back on the company’s history.

Sponsor Updates

• Forrester Research names Salesforce Service Cloud a leader in its latest report on customer service solutions for enterprise organizations.
• Surescripts will present at ONC’s 2017 Technical Interoperability Forum August 15-16 in Washington, DC.
• T-System joins Athenahealth’s More Disruption Please program.
• Wake Forest Baptist Medical Center joins the TriNetX Global Health Research Network.
• ROI Healthcare Solutions hires Jeff Powell as director of business development.

Blog Posts

• The United States of Digital Health: Therapeutic Devices (Redox)
• Boost Your Google Ranking: 10 Tips to Get You on Your Way (Salesforce)
• MIPS Quality Payment Program Criticized (The SSI Group)
• 4 Practice Marketing Lessons Gleaned From Star Wars (Solutionreach)
• Staying Healthy While Working From Home (Summit Healthcare)
• Building on Direct: Improving interoperability and patient data exchange (Surescripts)
• Thinking inside the box with a provider decision quadrant: identifying FWA and taking action on low-risk providers (Verscend Technologies)
• Cake and Best Practices for Enterprise Imaging (Visage Imaging)
• Nurse satisfaction is at the top of every nursing leader’s agenda. (Voalte)
• Top Seven Reasons Ambulatory Practices Leak Revenue (ZirMed)

Contacts

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

Morning Headlines 8/11/17

NantHealth Files An 8-K Entry into a Material Definitive Agreement

Allscripts trades its 15 million shares in NantHealth stock for the company’s provider and patient engagement solutions,

Remote Workers Vulnerable In Disputes With Company, Say Employees

Remote transcriptionists working for Nuance are claiming that managers offered them incentives and overtime pay in exchange help working through the transcription backlog that accrued during the company’s malware-related downtime, but Nuance later refused to pay, claiming that the incentives were only approved for a small handful of highly-impacted teams.

Trump: ‘The opioid crisis is an emergency’

President Trump declares the opioid crisis a national emergency, a designation that will offer states and federal agencies more resources to combat the epidemic.

NHS England CCIO Keith McNeil resigns

Keith McNeil, chief clinical information officer for NHS England, has resigned after 13 months in the role. He will return to Australia, working as the CMIO at Queensland Health

News 8/11/17

Top News

Allscripts will trade its significantly devalued 15 million shares in NantHealth for most of NantHealth’s provider and patient engagement solutions. That includes NantHealth’s FusionFx business, unstated “components of the NantOS software connectivity solutions,” and a guarantee that NantHealth will book an unstated minimum value of Allscripts product sales over a 10-year period.

The NH shares for which Allscripts paid $200 million two years ago are worth around $50 million. The company announced in last week’s quarterly earnings report that it will write down $145 million of its investment.

NantHealth’s FusionFx was part of its July 2015 acquisition of Harris Healthcare Solutions, which had previously acquired the former CareFx in early 2011 for $155 million in cash. That offering included HIE, patient and provider messaging, and single sign-on. 

NantHealth’s Patrick Soon-Shiong personally invested $100 million in Allscripts shares in the mid-2015 deal. He is down around $8 million as MDRX shares have fallen almost 10 percent since.

Meanwhile, NantHealth announces Q2 results: revenue up 17 percent, EPS –$0.58 vs. -$0.54. The company’s quarterly losses increased from $87 million to $111 million. NantHealth said in the earnings announcement that it will reduce headcount by 300 in a restructuring that will focus on cancer machine learning systems.

Soon-Shiong’s other publicly traded company, NantKwest, IPO’ed in July 2015, with a first-day closing share price of $34.64. NK shares now trade at $5.67.

Reader Comments

From Captain Beefheart: “Re: the term cloud-based. Several publications used this term for UCSD’s move to an Epic-hosted system. Epic isn’t really a cloud-based system just because they run the same product from their data center.” Health IT has long blurred the definition once it devolved from a technical term to a marketing one, simply renaming “hosted” systems (which also include the various forms of “just a longer cord” such as Saas, ASP, etc.) as being “cloud-based,” the same way “software” became “solutions” without changing anything. Googling didn’t turn up a firm definition of cloud-based systems, but here’s my best summary that begs for more technically astute readers to weigh in, with my interpretation being that calling Epic a “cloud-based system” is incorrect even though I’m guilty of having done so in UCSD’s case without really thinking about it:

• Connection to the remote system is via the Internet.
• The user organization doesn’t pay capital expenses but rather is billed at regular intervals based on a fixed monthly expense or for metered services.
• The hosting data center uses a shared pool of infrastructure (multi-tenancy) that can be managed virtually and provisioned on the fly. It is not simply moving the customer’s servers to a more distant data center owned by someone else.
• Customers can add or decrease system capabilities (bandwidth, server processing power, storage) on their own in flexing their metered capacity to their needs.
• The host manages the infrastructure and applies updates without using the customer’s resources.
• The host guarantees service levels for response time and downtime.

From Gene Gene: “Re: HIStalkapalooza. Wondering if you had reconsidered since we’re planning our own event and don’t want to compete.” I haven’t reconsidered. It’s a ton of work and a great financial risk for me personally without any benefit. I thought about it again a few months ago when: (a) we devised a new invitation/admission idea that would have eliminated much of the work, and (b) a company expressed interest in underwriting much of the cost in reducing my risk, but it didn’t work out. I have just one FTE (Lorre) for non-writing tasks and she spends ridiculous hours starting in early January trying to get event sponsors so I don’t go broke and arguing over who gets invited, not to mention that while we’re trying to set up and run our own little HIMSS booth, people are messaging both her and me nearly non-stop asking silly event questions or making unreasonable demands that reek of self-entitlement. RIP HIStalkapalooza, whose life reached its timely end at 10 years of age. HIMSS might actually be fun for us without all those headaches.

From Bilge Pump: “Re: Paragon. Why don’t you think Allscripts can sell it?” McKesson wasn’t having much luck selling it, so the question then becomes whether Allscripts has the sales force and channel to outperform McKesson in getting 150-bed hospitals to sign up for Paragon instead of Meditech, CPSI, Athenahealth, or even hosted Epic or Cerner systems that are admittedly overly complex for their needs. And while I admire the company’s upfront demarcation line of saying that Paragon will be pushed only for hospitals with fewer than 250 beds that offer no specialty services (of which there are quite a few), my cheap-seats experience is that vendors with overlapping products struggle with sales team infighting and confused prospects. Maybe Allscripts can move some of the Series and Star users to Paragon or the larger Paragon customers to Sunrise, but that won’t be a slam dunk – a project of that cost and magnitude requires a look at the other vendors who often win those deals and McKesson failed to accomplish that as well. They had better act quickly since the number of independent under-250 bed hospitals seems to be decreasing fast as they are acquired by health systems that mostly use Cerner and Epic. I would be interested in the customer count by bed range for all the inpatient EHR vendors if anyone has access to that information, although Cerner and Epic are playing the Electoral College-type strategy in focusing on enterprise size rather than a simple count of hospitals. 

From Denizen: “Re: Carequality. Our organization of long-term acute care hospitals was quoted $400,000 per year to onboard to Carequality as an implementer so we can get patient information from short-term acute care facilities, more than half of which run Epic. We don’t receive Meaningful Use incentives to help pay for this technology and we feel the costs are excessive given that the data belongs to the patient and it would allow us to provide them with better quality and safer care.” I contacted the non-profit Sequoia Project, which runs the eHealth Exchange, Carequality, and RSNA Image Share Validation. Their spokesperson explained:

Carequality is designed to connect networks and is not intended to be a network that providers directly join. As a result, the Carequality fees that you saw apply to the networks themselves, not to provider organizations who participate in a data sharing network. The assumption is that providers like this are already connected to a health data sharing network of some kind. If their “home network” is a Carequality implementer, then the provider should be readily able to connect to other Carequality connections. There are a number of health data sharing networks available in the market that this hospital may already be leveraging. Some of these networks are geographic-centric, such as regional and statewide HIEs. Others have a more nationwide focus, such as eHealth Exchange, Surescripts, and CommonWell Health Alliance. While still others are facilitated by the health IT vendor that the provider uses. Providers that would like to share health data via Carequality need to contact their participating network. If their network is not an implementer, they can encourage their network to implement the Carequality Interoperability Framework to dramatically expand their connectivity options.

From Non-Annoying Vendor: “Re: Stanford Health Care CIO position. Accepted by [name omitted].” I’ve emailed the person whose name I omitted for confirmation since it’s not cool to run unverified job changes. UPDATE: Verified. Eric Yablonka, VP/CIO of University of Chicago Medicine, emailed me to confirm that he will start at Stanford at the end of September. He replaces Pravene Nath, MD, who is now an executive in residence at Summation Health Ventures.

From Roman Hands: “Re: CHIME. It’s paying President and CEO Russell Branzell $500K per year, which seems like a lot for a non-profit whose revenue is less than $7 million.” Basically all of the $529K in member dues CHIME took in for FY2015 went toward Russ’s paycheck. It collected $1.6 million from conference registration and vendor advertising and $4.27 million from the CHIME Foundation. I’m not interested in doing compensation research, but one study I saw said that non-profit CEOs of organizations with budgets of $5 million to $10 million are paid an average of $100K. I remember doing some legwork years ago on Steve Lieber’s HIMSS compensation vs. similarly-sized member associations and he was certainly at the top of the chart (the current median is about one-fourth of what Steve makes). Whether either is worth the lofty salary is up to members to decide, not just in the amount of their dues, but how comfortable they are being pimped out to high-paying vendors that contribute most of the revenue.

HIStalk Announcements and Requests

This week on HIStalk Practice: The American Telemedicine Association looks for new leadership. A Chance to Change invests in telemedicine for behavioral health patients. Delaware physicians hope blockchain will speed up the prior authorization process. WellAve expands mobile dermatology clinic business. Colorado physicians up in arms over delinquent Medicaid reimbursements. ApolloMed takes a minority equity stake in LifeMD. Cow Creek Health & Wellness Center Clinic Director Dennis Eberhardt details the ways in which a new commercial EHR will better serve patients. Independent MDs express extreme dissatisfaction with MACRA. Buoy Health raises funding for symptom checker software.

Webinars

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

Acquisitions, Funding, Business, and Stock

The New York Times profiles Eko Devices, started by three UC Berkeley undergrads. The company has sold 6,000 digital stethoscopes and will this fall introduce the FDA-cleared Duo, a prescription-only version for home use that collects EKG readings and heart sounds to send to doctors. One of Eko’s founders says the product should work like “Shazam for the heartbeat” in being able to recognize unusual heartbeat patterns just like the Shazam app can “listen” to a song being played and then display its title and artist. The Duo is intended only for heart patients and will cost $350 plus $45 per month. The Duo’s main competitor will be AliveCor’s Kardia, a $99 smart phone add-on that records EKGs.

People

Justin Diehl (Healthware Partners) joins Parallon Technology Solutions as VP of Epic services.

NHS England’s first chief clinical information officer, Keith McNeil, MBBS resigns after 13 months, returning to Australia to become CMIO of Queensland Health.

Announcements and Implementations

AdvancedMD launches AdvancedReputation, which automatically emails or texts patients a one-question satisfaction poll following their office or telemedicine visit and invites those who score positively to post their feedback on the practice’s Google business profile. Those who score negatively are asked to describe their experience to be posted privately to the provider’s dashboard.

Christus Health reports its results from implementing Epion Health’s iPad appointment check-in system: collections per encounter increased 3.5 percent, patient portal sign-ups increased 300 percent, and 21,000 patients opted in for text messages. Epion CEO Joe Blewitt graduated from the United States Air Force Academy, was on active duty in the Air Force for 10 years, then spent 17 years as an Air Force Reserve pilot at McGuire Air Force Base.

Change Healthcare adds the capability of adding attachments to dental claims submissions.

Government and Politics

The Austin, TX paper reviews the state’s lawsuit against Xerox, which the state says did shoddy pre-authorization reviews for Medicaid dental services. The company hired high school dropouts and gave them just a one-hour training session. One of them responded to a deposition question about the definition of severe handicapping malocclusion, “Not a clue. Their teeth are messed up.” Records show Xerox ran the process like a high-pressure boiler room where supervisors ordered employees – many of whom worked from home and thus couldn’t even see the records that had been submitted by dentists – to “push those keys as fast as you can.” Xerox hired just one dentist to review hundreds of requests each day, with one such review being clocked at exactly six seconds. HHS OIG ordered the state to repay it $133 million for services it had paid that didn’t pass pre-authorization rules. Records show the state knew about the rubber-stamped authorizations but did nothing for several years, eventually culminating in the firing of Xerox and the lawsuit brought against the company in hopes of covering the HHS repayment.

President Trump declares the opioid crisis a national emergency, contradicting a statement made two days ago by HHS Secretary Tom Price, who said such a declaration is unnecessary. 

Australia’s government approves automatic sign-up of citizens for its My Health Record provider and patient e-health system, formerly known as PCEHR. People will have to opt out if they don’t want their information shared. The government hopes to approve interoperability standards in 2022 and to make secure provider-patient and provider-provider communication universally available the same year. The government published its national digital health strategy this week. Reports suggest that the government has spent at least $1 billion on My Health Record, which has struggled with poor patient and provider participation.

Oregon’s governor demands and receives the resignation of the head of its health authority following leaking of a document describing her planned smear campaign against a Medicaid provider who sued the state claiming that the agency’s rate-setting process is not fair.

Privacy and Security

Princeton Community Hospital (WV) is still down from its June 27 malware attack, saying it is dealing with a transcription backlog and interfaces that aren’t working yet following its complete rebuilding of systems.

Technology

CNBC covers the potential use of the Amazon Echo for helping homecare patients with medication reminders, instructions, and staying connected with family. It mentions voice startup Orbita, which offers an Amazon Alexa skill and a graphical development tool for Amazon Echo, Google Home, and other voice platforms.

Other

This should help dispel those negative perceptions of Alabama.

In South Australia, 20 percent of surveyed doctors say the government’s EPAS electronic health record is causing medication errors, critical delays, and pathology mistakes, with one-third of respondents saying the Allscripts system has caused near-misses. 

State auditors accidentally find that a struggling 15-bed Missouri hospital was apparently used as a shell company to bill $90 million worth of lab tests that were performed by other hospitals run by the same management company that installed its president as the hospital’s CEO. The auditors also found that the CEO and his company were paid nearly $1 million in the first 10 months of the agreement, the hospital paid $10.6 million to the hospital company’s lab division in just three months, and the hospital was covering the salaries of 33 phlebotomists of other company-run hospitals. The state, which is considering a corruption investigation, says decisions made by the hospital’s management and board were “astounding in their irresponsibility.” The CEO has charges pending against him in Louisiana related to a another managed hospital’s claims that he forged checks made out to another management company he owned. The state auditor says the hospital did no background checks and minimal due diligence before turning its operations over to the management company and CEO.

A Texas Public Radio report covers the dispute between Nuance and its remote workers following its extended malware-caused downtime, during which the company’s transcriptionists say they were promised overtime and incentive pay that was later rescinded. The report reviewed the recording of a management conference call for transcriptionists in which Nuance clarified that the incentives it had offered (and that its managers had promised) were not intended for all transcriptionists, but said its message was misunderstood because its communications systems were also down due to the malware. One employee who worked more than 12 hours per day saw that her expected $3,000 extra payment ended up being just $21. The recorded call also captures a Nuance manager who explained that the error was widespread, adding, “We blew it. We completely blew it.” The article concludes that it’s tough for remote workers to react to employment conditions since they can’t band together to protest in person. They may still get their chance – several lawyers added their contact information to the article’s comments.

Sponsor Updates

• CSI Healthcare IT completes its at-the-elbow support for the Epic ambulatory go-live at Atlantic Health System (NJ).
• Meditech will exhibit at the Mid-South Critical Access Hospital Conference August 16-18 in Nashville.
• Spok announces that all 20 of the hospitals on US News & World Report’s list of best hospitals as well as all 10 of the best children’s hospitals use its solutions for enterprise healthcare communications.
• Netsmart will exhibit at the FADAA/FCCMH Annual Conference August 16 in Orlando.
• Experian Health will exhibit at the HFMA Arkansas Summer Conference August 16-18 in Hot Springs.
• PatientPing names former Medicare deputy administrator and director Sean Cavanaugh as an advisor.

Blog Posts

• Meditech’s Fetal Monitor Interface Improves Nursing Workflow at Beaufort Memorial (Meditech)
• A Constant in a Sea of Change (Spok)
• Malware got you down? Get 3 no-regrets strategies to protect your IT contracts (Advisory Board)
• Getting the “Ops” in DevOps Right (LogicWorks)
• 3 Considerations when Planning Epic Upgrades (Optimum Healthcare IT)
• As You Wish … Best Practices for Gaining Physician Buy-in for Your Revenue Cycle Wish List (Navicure)
• Home Health Rule Will Bring Big Changes in 2018 and 2019 (Netsmart)
• How to Maximize Value from Healthcare’s Digital Transformation (PatientKeeper)

Contacts

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

EPtalk by Dr. Jayne 8/10/17

My HIMSS planning is officially underway and I’m happy to report securing my preferred hotel for my preferred dates for the first time in several years. The shifted schedule (Monday through Friday) always throws me off when we’re in Las Vegas. The updated schedule now shows Magic Johnson as the closing keynote speaker on Friday, but I’m sure that quite a few of us will be departing before then.

Much of the agenda is similar to years past, but I did note the addition of a fee-based session for Thursday. “Rock Stars of Emerging Healthcare Technologies” is a $295 additional charge and purports to cover disruptive and innovative technologies. I’d be interested to see who is in the lineup, but I’m not eager to spend that much money.

I’ve been catching up on medical reading and continuing education. Many of our readers would be happy to know of a new report linking moderate drinking to cognitive health in old age, at least for some demographic groups. Although it found that patients who consumed a moderate amount of alcohol on a regular basis were more likely to live to age 85 without cognitive impairments or dementia, it’s hard to know the exact nature of correlation vs. causation. The study ran for 29 years and used the standardized Mini Mental Status Examination to gauge cognitive health. Adults with “moderate to heavy” alcohol intake five to seven days a week were twice as likely to stay cognitively intact than those with little alcohol intake. Wine-drinking tends to correlate with higher income and education levels that are accompanied by reduced rates of smoking and greater access to healthcare. The majority of study participants were Caucasian and from a middle-class suburb of San Diego.

The Agency for Healthcare Research and Quality (AHRQ) is seeking nominations for public members of its National Advisory Council. The Council advises the AHRQ Director, the Secretary of Health and Human Services, and other bodies on national health services priorities. Nominees must be willing to serve a three-year term, meeting in Washington, DC three times per year. Desired qualifications include medical practice, other health professional experience, researchers, healthcare quality experts, and health economists, attorneys, or ethicists. Additional information is available in the Federal Register.

There has been a lot of chatter in the physician lounge about Anthem’s recent statements that they will not cover non-emergency conditions when patients seek care in the emergency department. Primary care physicians who have a large number of Anthem patients are starting to worry about capacity and creating plans to care for an influx of patients. Retail clinics and urgent cares are eager to accept the overage. Anthem has piloted this in several states and is in the progress of expanding it to others.

We already see plenty of patients in the urgent care setting who could be easily treated with over-the-counter remedies, so it will be interesting to see how this impacts the patient mix in states where it is a factor. In my area, a visit to the local pharmacy’s clinic runs 40 percent less than a comparable physician office visit and about a quarter of what is charged in the urgent care setting. All are significantly less than the $800-900 typically charged for a basic visit in the emergency department.

Wearing both my family medicine and urgent care hats, the missing piece is education and triage. It’s one thing to simply tell a patient that their bill won’t be covered unless it’s a true emergency, but it would be even better if the payer spent a little bit of the anticipated cost savings educating patients and providing after-hours nurse lines where patients could seek advice. Lots of people surf the Internet for information or get their advice from Dr. Google, but education is still a great value in the long run. My insurance carrier has serious limitations on emergency visits, but offers nothing in the way of other support to triage patients to the appropriate care setting. At our urgent care, we sometimes see patients who started at the retail clinic but couldn’t be treated there due to limited scope-of-practice agreements, which leads to an additional and more costly visit with us.

There has also been a fair amount of chatter around the recent JAMA research letter about Maintenance of Certification (MOC) and Board Recertification fees. Although the medical specialty boards are supposed to be non-profits, they’re taking in significant amounts of money from examinees and those required to demonstrate participation in MOC activities. According to the research, the amount of income from exam fees is out of proportion to the amount it actually costs to administer the exams.

For those of us who are board certified in multiple subspecialties, the expenses can add up. Even for those of us board certified in clinical informatics, we are required to maintain a primary specialty board certification. This seems rather unfair to the large number of clinical informaticists who no longer see patients and might be inclined to allow their primary certifications to lapse. Current policies also exclude a number of clinical informaticists who had already discontinued their primary certifications before the clinical informatics certification became a reality.

I’m due to retake my primary boards in 2019 and figure I’ll have to take them at least twice more before I retire unless something changes. I’m not looking forward to the time commitment or to studying information that has no bearing on my practice, such as obstetrics. I failed to buy a lottery ticket for this week’s Powerball, so it looks like I’ll be in the trenches for the foreseeable future.

Email Dr. Jayne.

Morning Headlines 8/10/17

Jonathan Linkous Departs ATA After 24 Years As CEO

American Telemedicine Association CEO Jonathan Linkous resigns after 24 years leading the organization. ATA COO Sabrina Smith, MD is filling in as interim CEO until a new CEO is hired.

A Big KO to Germs: Robot Enhances Hospital Safety by Killing Infection-Causing Microbes

Saint Peter’s University Hospital (NJ) is piloting an ultraviolet wave-emitting robot to reduce hospital acquired infections in its facility.

Walgreens, CVS sued over claims co-pays were clawed back

Both Walgreens and CVS are being sued in California for letting customers pay deductibles on prescriptions covered by their insurance that were significantly higher than the actual cash price of the medication. The customers argue that they should have been informed that buying the medications outright was less expensive than paying the co-pay negotiated by their insurer.

Campaign to taint courtroom foe costs Saxton post at OHA

Oregon Health Authority director Lynne Saxton is fired after an OHA plan designed to damage the reputation of a Portland health care organization was made public.

CIO Unplugged 8/9/17

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

Brokenness in Leadership

I finished my keynote presentation for the New York HIMSS chapter and surrendered the stage back to my host. With Yankee Stadium as the backdrop, the entire day’s event had been spectacular.

Lit, I spoke about customer service. I had no intention of sharing a Top 10 list of things you could replicate in your organization to create a culture of customer service. Rather I aimed to pierce the hearts and souls of each and every person listening. If I pierced hearts, leaders might be transformed and the Top 10 action items would be created and owned by them.

I shared real stories how hearts were pierced – mine and others. Pierced hearts drove us to create, design, and deliver superior customer service, and in turn, improve clinical and business outcomes. It is one big ecosystem, I suspect, a softened heart that beats to serve and changes culture which improves outcomes. The cycle begins with brokenness.

Leaders approached me at the reception with tears in their eyes. Tears glistening on his cheeks, a battle-tested CEO shared how he never cried. But there he stood. Pierced. Changed.

One by one they stood in line, sharing how their worlds got rocked. The big question was, how could I be vulnerable to my teams, let alone strangers? How could I display raw emotion while recounting core-shaking stories? How could they get in touch with themselves at that level and with transparency?

Those are deep questions and I am not sure I have the answer. Perhaps part of the answer involves brokenness. I realize I am a broken person. I have failed as much as I have succeeded. I have been challenged in life and career. I have struggled with work, I have struggled with sport, I have struggled with kids, I have struggled with marriage. I have hit rock bottom. Hard.

I know I am weak. I also know on my own there is no way up. I am a grateful survivor. I realize the gap between my brokenness and my recovery is filled by grace. If karma is real, I am in big trouble. Really big trouble. Grace is my new BFF.

Some are too prideful to admit weakness and resist brokenness. We compete to be better than the pack and hide behind façades. We are pretenders. In pain. We don’t let others see or touch it. In fact, we bully others who show weakness. We resort to over-medication, legally or otherwise.

Ideally, we realize the need to get real and accept our brokenness. Perhaps acceptance is the start. We embrace brokenness as something bigger than ourselves. Acceptance creates capacity for gratefulness. I sometimes tear up because I am so thankful to others. I recognize that my accomplishments are not about me, but because of others.

I also learned compassion and empathy growing up. The youngest of seven, I spent significant time with my mother alone and bonded tightly. Mom suffered her entire life with chronic illness as I watched her deal with pain with a brave face. She was a servant who loved her kids and husband. Days before she traded her earthly rags for robes of righteousness, we talked about it. Why did God allow her to suffer so long? Why was such a great woman taken so early and cruelly?

We never realized the answer, but at the end I whispered in her ear that her quiver full of successful kids, grandkids, and great-grandkids was a testimony of her significant legacy. In her suffering we observed grace and learned empathy. My heart pierced multiple times in her journey.

As I gained experience serving in hospitals, I began to see patients in the normal course of work. Here I was, healthy, while around me was sickness and death. As an anesthesia tech, I assisted in many procedures, including the harvesting of organs. I watched parents surrender their child’s body to medicine in hopes a tragic suicide would bring life to others they could never know.

I passed gurneys that seemed empty except for the body hidden underneath drapes. I experienced poignant reminders that life is fragile. I understood my service was to make people well while also ensuring the dignity of death. Even as I write this, my mind is full of memories. How can I not cry?

Leadership. Through life and circumstances, we become hardened. Work can be tough and family tougher. Life happens. Even the most supple arteries get clogged. Yet to be effective, our hearts must remain pliable and soft.

For me, volunteering weekly in hospitals keeps my heart pure and the blood flowing. Seeing sick children in particular touches me. I regularly shadow clinicians and hide tears. Patients. I have to see patients. They pierce my heart. They re-orient my focus.

As leaders, we must remain vulnerable and transparent. We must demonstrate that it is OK to cry. Emotions are strength, not weakness.

Demonstrate brokenness. Become a vehicle of mercy and grace to others. Once you embrace your brokenness, you are able to lead others through theirs.

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

Morning Headlines 8/9/17

Epic Move: UC San Diego Health Transitions to Cloud Technology

UC San Diego Health announces that it will transition away from traditional data centers and move its EHR to an Epic-hosted cloud environment.

Evolent Health (EVH) Posts Q2 Loss as Expected, Revenues Top

Evolent Health shares fall 17 percent Tuesday, after reporting a Q2 loss and announcing that it was considering a second IPO, in which it hoped to raise $175 million.

Offering A Price Transparency Tool Did Not Reduce Overall Spending Among California Public Employees And Retirees

A Health Affairs study measuring the impact of offering health services price transparency tools to employees, finds that, “only 12 percent of employees who were offered the tool used it in the first fifteen months after it was introduced, and use of the tool was not associated with lower prices for lab tests or office visits.”

The Man Who Wrote Those Password Rules Has a New Tip: N3v$r M1^d!

Former NIST employee and author of a specification establishing best practices for password security admits that mixed-case passwords that contain special characters are not nearly as secure as longer, phrase-based passwords that are easy to remember but hard to programmatically hack.

News 8/9/17

Top News

UC San Diego Health (CA) moves from its self-hosted Epic system to an Epic-hosted, cloud-based system, the first academic medical center to undertake that particular migration.

UCSD says it is shifting away from running its own hosted centers to cloud-based systems because of cost and reliability. The Epic switch involved 10,000 workstations and integration of 100 third-party applications.

UC Irvine Health will move to UCSD Health’s Epic cloud-based instance in November 2017.

UC San Francisco announced a $10 million grant in late July that will fund a project to mine the combined Epic databases of all five UC medical centers to discover new insights and possibly find new uses for existing drugs.

Reader Comments

From Sister Sledge: “Re: Allscripts. One of the rags ran a map of where McKesson EIS had customers, claiming that geography matters to a vendor and that Allscripts will benefit from gaining more customers in the West. Think so?” I don’t think so. Geography can affect sales, but only for companies that have clear momentum and neither McKesson nor Allscripts have ever had that. My prediction is that Cerner, Epic, and maybe Meditech will benefit most when those customers start looking for replacement systems. It’s not at all similar to when Cerner bought Siemens Health Services and could offer them a lifeline from their rapidly sinking systems to a market-leading one. Allscripts can boast about a higher customer count or wider geographic reach, but a lot of those customers are likely to defect in the next few years as the Cerner and Epic train keeps rolling over everything in its path (accelerated by big hospitals buying smaller ones) and the acquisition encourages those former McKesson customers to review their positions. The direction of change in customer satisfaction post-acquisition will predict a lot. MDRX shares are at the same price as they were in mid-1999, so stock performance won’t create much confidence – Cerner shares are up 322 percent in the past 10 years, McKesson shares are up 167 percent, and the Nasdaq index is up 136 percent, all while Allscripts shares were losing 52 percent of their value. 

From Lucille Two: “Re: Epic’s response to Politico’s article about Joe Biden. Don’t you find Epic’s PR statement a bit confusing, saying that the VP was ‘consistently polite and positive’ unless it’s to cover their tracks? Wouldn’t Biden’s staffer, who has no reason to disparage him, know him well enough?” Politico excerpted comments from a video made at a conference’s fireside chat by Greg Simon, now president of the Biden Cancer Initiative, who said the VP and Epic CEO Judy Faulkner got into a heated exchange over why Biden might want his own full medical record. I wasn’t there and Simon was, but my observations from watching him tell the story on video are:

• Simon seemed a bit swaggering and over-the-top in the video, which left me feeling that his comments were more of an entertaining story for the in-person conference audience rather than a trustworthy, verbatim discussion of what was said by others in his presence.
• Simon’s tone in the remainder of his remarks was clearly anti-EHR vendor. I got the feeling that the Biden story was his chance to take a shot at them. 
• The conversation between Biden and Faulkner he described took place nearly seven months ago, resulting in zero reaction until the conference video from Simon’s session was published.
• Simon’s background: aide to VP Al Gore, lobbyist, charity founder, drug company executive. He’s long been a critic of the lack of data-sharing in healthcare, but he originally seemed to blame providers rather than EHR vendors in saying, “The technology of sharing has increased exponentially, but the willingness to share has not.” 
• Others in attendance (it was not a private meeting) have not corroborated Simon’s account, and in fact have said the meeting was, as Faulkner said, cordial and polite.
• Even accepting Faulkner’s supposed comments at face value, it’s a leap to assume that her message was dismissive, paternalistic, or defensive about patients accessing their data. Tone is everything and her supposed comment that Biden wouldn’t be able to make sense out of an Epic EHR data dump is generally accurate, although perhaps Biden took offense thinking he was being spoken down to.
• The bottom line for me is that it’s much ado about nothing regardless of whether Simon’s recap is accurate. It was a fun story for a couple of days, but not necessarily accurate or indicative of any particular trend or practice, especially in the absence of commentary from Biden himself. If he were that riled up, he’s had seven months to say so.

HIStalk Announcements and Requests

I notice that Rolling Stone has a profile of singer-songwriter Khalid mentioned on the cover of the current issue, mostly because I recommended his music in January 2017 with my summary, “Mark your calendars for six months from now – Khalid is going to be big.” 

Webinars

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

Acquisitions, Funding, Business, and Stock

Pharmacy supply chain technology vendor Swisslog Healthcare acquires Talyst Systems, which offers medication management solutions to acute care and long term care facilities. 

Evolent Health reports Q2 results: revenue up 89 percent, EPS –$0.13 vs. –$0.25, beating revenue expectations and meeting on earnings. News of the company’s plan to launch a $175 million secondary public offering  sent shares down 17 percent in early after-hours trading Tuesday.

Sales

Connecticut Children’s Hospital chooses InstaMed’s healthcare payments solution.

Toronto-based Baycrest Health Sciences selects Caradigm’s single sign-on and context management systems.

People

Stephen Grossbart, PhD (Stephen Grossbart and Associates) joins Health Catalyst as SVP of professional services.

Ingenious Med hires Girish Pathria (Visiant) as VP of products and insights and names Nancy Cunningham (Accord Services) as VP of implementations.

Susan Steagull (Novant Health) joins VCU Health System (VA) as CIO.

Announcements and Implementations

Fresno Surgical Hospital (CA) goes live on FormFast’s electronic signature solution in its Meditech environment.

Privacy and Security

The now-retired NIST manager who in 2003 was ordered to quickly develop password-setting guidelines says he was wrong about recommending that passwords be required to conform to bizarre rules that require mixed-case letters and special characters. New NIST guidelines recommend that passwords be created from long but easily-remembered phrases. Analysis found that a password like “correcthorsebatterystaple” would require 550 years to crack, while an old-rules version such as “Tr0ub4dor&3” could be broken in just three days. The guidelines also say that passwords need not be auto-expired, with users forced to change their passwords only if they are known to have been compromised.

In India, a hospital IT director and one of his former employees are arrested for stealing hospital data required for accreditation and selling it to other hospitals.

Other

A study of all US opioid prescriptions issued over a nine-year period finds that doctors who graduated from low-ranked medical schools prescribe a lot more opioids than those who attended top-tier programs, concluding that physician educational outreach might help with overuse. Based on the graph above, it looks like osteopaths (DOs) are a much bigger problem than just about everyone else, including foreign medical graduates, although that wasn’t the subject of the study. I’m not sure I buy the conclusion, however, since it would be interesting to also look at number of years since graduation and the practice location — I would bet that many graduates of top-ranked schools tend to practice locally afterward and have a different kind of peer group and big-hospital oversight that happens mostly in major teaching hospitals with employed doctors. The bottom-ranked schools, in case you are as interested as I am, are Drexel, University of Nevada, Michigan State, West Virginia University, and University of South Carolina, which might be especially concerning if your doctor finished at the back of the pack of his or her graduating class.

Oopsie.

A researcher observes with some alarm that post-Millennials are “on the brink of the worst mental health crisis in decades” because they spend all their free time on Snapchat or texting instead of physically interacting with people, with a steep drop-off in time spent with friends even though virtual interaction leaves them less happy. Those who proudly document their activities on social media also cause everybody else to feel left out or to obsess over how many “likes” they earn. In a somewhat related article, a small study finds that AI-powered analysis of Instagram photos (color, comments, likes, posting frequency) is much more accurate at diagnosing depression than face-to-face doctor visits.

Giving employees a healthcare price transparency tool didn’t reduce overall spending, a study finds, noting that only 12 percent of the employees even bothered to look at it. The price tool saved an average of 14 percent of the cost of advanced imaging studies, but only 1 percent of those patients consulted the tool before having the test performed.

We are so blessed in healthcare IT to have access to a $3,480 report written by obvious experts.

In Egypt, 10 doctors launch an operating room-themed restaurant that claims its food is safer because of the medical training of the owners.

Sponsor Updates

• Aprima will host its annual user conference August 18-20 in Dallas, TX.
• Besler Consulting releases a new podcast, “Preparing for the Social Security Number Removal Initiative.”
• Optimum Healthcare IT publishes a white paper titled “Epic Upgrades are Epic Events.”
• Nordic publishes a podcast titled “Why change management is critical to a successful EHR transition.”
• EClinicalWorks announces that users of its EHR have exchanged two million documents in the past 12 months through the Carequality Interoperability Framework.
• Dresner Advisory Services honors Dimensional Insight with its Industry Excellence Award for business intelligence expertise.
• Glytec showcases the impact its therapy management software along with connected device systems has on insulin management at the American Association of Diabetes Educators conference.
• Healthfinch VP of Operations and Finance Leah Roe will speak at Forward Fest Madison August 17-24 in Wisconsin.
• Influence Health announces the speaker lineup for its Influence! Healthcare Consumer Experience Conference September 27-28 in Orlando, FL.

Blog Posts

• Why Can’t We Put Our Cell Phones Down? (Direct Consulting Associates)
• ONC Approves NCQA’s Alternative Electronic Clinical Quality Measure testing method (Diameter Health)
• The Downside of Data Science (Dimensional Insight)
• Experience (and Relationships!) Impact Our Health Outcomes (Docent Health)
• Changing nutrition habits to boost community health (EClinicalWorks)
• Rapid reviews and recognition are all the RAVE (Infor)
• Top Ways Meditech is Committed to Interoperability (Meditech)
• Redefining Awareness Month Success – Strategies for More Effective Breast Cancer Awareness Campaigns (Evariant)
• Overcoming 3 Healthcare Data Analytics Challenges with Intelligent Analysis (Hayes Management Consulting)
• Archiving: Your Healthcare Cybersecurity Strategy (The HCI Group)
• Hospital and Healthcare IT Survival Guide for the Post-EHR Era (Iatric Systems)
• How are Your Employees Motivated in a Crisis? (Impact Advisors)
• Community Hospital Anderson Ensures Positive Patient Identification (Imprivata)
• The Need for Speed in Healthcare CMS (Influence Health)
• The True Cost of Paper for Payers (InstaMed)
• Precisely Speaking – Part 2 (InterSystems)

Contacts

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

Morning Headlines 8/8/17

Internet-based EHRs gaining some customers but still a small segment

Modern Healthcare reports that cloud-based EHRs are increasing in popularity due to a perceived advantage in staffing and cybersecurity.

Anthem takes harder line on ER visits

In an effort to reduce unnecessary ER visits, Anthem warns its customers that it may start denying non-emergency ER services, leaving patients with the bill.

A shift in the fitness wearables market spells trouble for Fitbit

Fitbit’s share of the wearables market dropped from 27 to 16 percent in the last year, as Chinese consumer electronics manufacturer Xiaomi continues to expand its marketshare.

Tenet Reports Results for the Second Quarter Ended June 30, 2017

Tenet Healthcare Corporation reports Q2 results: revenue dropped 1.4 percent to $4.8 billion, resulting in an overall net loss of $56 million. Adjusted EPS –$0.17 vs. $0.40. Tenet also lowered its forecasted annual revenue, citing low patient volumes, which sent stock prices down 10 percent in afterhours trading Monday.

Curbside Consult with Dr. Jayne 8/7/17

I’ve been working on a project involving laboratory interfaces for a mid-sized multispecialty practice that is trying to integrate with multiple local hospitals. They’re valiantly trying to stay independent, which is quite a challenge given the rampant consolidation that is going on in nearly every healthcare market.

The practice’s leadership figures that if they interface with the hospitals in addition to the reference labs they already send to, it will make it easier to manage patients regardless of where they are admitted. As they were putting together this plan, however, they didn’t understand the complexity of working with organizations that aren’t entirely focused on earning the practice’s laboratory business like the national reference labs are.

Since the practice’s previous interface projects took 30 to 45 days, they assumed that working with the hospital would be the same. They also assumed that the hospital laboratory representatives who regularly come to the practice to tell them about new tests would be able to assist them in navigating the entire process, not realizing that those reps were more sales agents than true account managers.

The first surprise came when Hospital One told them it would be a minimum of three months before they could even talk about a timeline for starting a lab interface project, so they would have to stay on paper for the foreseeable future. It would be a fairly straightforward process to create a printable laboratory requisition so we could move the practice away from the hospital’s carbon-paper form and into EHR-based ordering. However, the lack of an interface had already created a significant amount of extra work for the nursing staff who was expected to manually key all lab results that were related to reportable clinical quality measures.

Even though we couldn’t fix the interface problem, I helped them create a new workflow for keying the results, which involved their medical records staff in addition to the nursing staff, so the workload could be better distributed. Cross-training is always a good thing, and assuming adequate training and quality assurance review, there was no reason why the medical records staff couldn’t be part of the workflow. Still, given the nature of the one-off workflow to key results, compared to the interfaces with the reference labs, I didn’t foresee the practice sending any more orders to Hospital One than they had been with handwritten orders.

Hospital Two was a significantly more accommodating, probably in part due to the fact that the practice hadn’t been sending business to its lab previously. Although they didn’t have available staff to assist with a bi-directional interface project, they were willing to set up a results-only interface that would at least allow discrete results to come into the patient chart without the staff needing to be involved.

Unfortunately, the client’s EHR handles this type of situation by creating two orders in the patient chart — one for the actual order and one that is created when the unsolicited result hits the system. This leads to extra work because someone has to reconcile the orders and match them up, and it would leave the practice with the same amount of extra work as the first hospital. When I mentioned the inconvenience and asked if they were willing to help us implement a workaround that would function as a semi-solicited interface, they were eager to hear about what it would take.

Having done it with other clients, I knew the hospital’s lab system was capable of holding the client’s internal accession number, and that keying it on each order would solve the problem. Usually only about half the hospitals I interact with are willing to do this, often citing the risk of error or the magnitude of the extra work for their lab staff. However, this facility jumped at the chance to see if they could make it work in order to obtain a piece of the practice’s business.

They were so eager to move the project forward that they agreed to send someone to the practice to key in the orders for testing so that the practice didn’t have to hardly expend any resources. Once the orders were keyed, they resulted them promptly, faster than almost any hospital lab I’ve ever worked with. The entire testing phase took barely more than a week and they resolved any issues that were found by the end of the next business day. I have to admit, it was a dream project and the entire thing was done in less than four weeks.

Many of us in healthcare are a tiny bit superstitious (never say the word “quiet” in the emergency department) so I knew that given the success of the project with Hospital Two that the next project was likely to be a nightmare. My vague suspicion grew into actual worry when I met the IT project manager the hospital had assigned to the interface project. I could sense the rarified air around him as soon as I walked in the room and had to suffer through his overly complicated explanation of what an interface project entails. I think he assumed that as a physician I didn’t know anything and he totally missed the part where the practice administrator explained that I was their consultant and had assisted multiple clients with interface projects.

He went on for a good 20 or 30 minutes that seemed like a lifetime, talking about all the important work the hospital IT team would be doing to make the interface happen and how little the lab and practice teams would impact the process. When I finally was able to jump in and explain my experience and the practice’s goals and objectives, I was treated to a rainbow of colors on his face as he went from angry red to bilious green to white. I think it had honestly never occurred to him that anyone on the practice side could have a clue how things should be done.

Since he claimed he didn’t have a sample project plan to review with us, I provided him with my own, which produced an outstanding level of pallor as he realized he wasn’t going to be able to put one over on us. We asked him to review the proposed timeline and comment on it and he said he would be able to get back with us in the next couple of weeks. That’s never a good sign, but I couldn’t tell if he was actually backlogged or just being passive aggressive. As time went on and he haggled about everything from the selection of components for the test scripts to the way in which labs would be resulted, I knew it was the latter. The project has been stalled in every imaginable way, with various resources being unavailable or on vacation at various times despite the hospital having agreed to a project plan and timeline.

The practice’s pleas to hospital leadership have fallen on deaf ears. This week I’ll have to have a serious discussion about halting the project. We’ve been using too many resources with little return, and if this is how a hospital acts when a practice wants to send them their business, I doubt they’ll be responsive if there are issues. The other hospital’s semi-solicited interface has been working like a dream, and to the end users, it functions just like the reference labs’ bi-directional interfaces. There are a couple of kinks for the practice’s IT staff every now and then, but overall, it’s been a big success. There simply isn’t much reason to continue working with a competitor hospital that just puts roadblocks in the way.

It will be interesting to see whether the first hospital ever circles back to us or whether a halted project will bring the third one in line. I suppose some hospitals are simply so big that they forget about their base, or maybe leadership just lets certain constituencies run amok. I can’t say that healthcare IT will ever be dull and am grateful that organizations like this create job security for people like me.

How does your hospital earn business from independent practices? Email me.

Email Dr. Jayne.

Morning Headlines 8/7/17

Allscripts announces second quarter 2017 results

Allscripts reports Q2 results: revenue increased 10 percent to $426 million, adjusted EPS -$0.85 vs. $0.05. The company announced it would write off $145 million of its $200 million investment in NantHealth, due to NantHealth’s poor stock performance.

Siemens, DHS warn of “low skill” exploits against CT and PET Scanners

Siemens warns customers of four software vulnerabilities in its molecular imaging systems that would allow hackers to gain remote control of the systems.

WannaCry hero Marcus Hutchins could face 40 years in US prison

The cybersecurity expert that stopped the WannaCry global cyberattack has been arrested in the US, where authorities say he helped create and sell malicious software that targeted bank accounts. He faces up to 40 years in prison if convicted.

‘Pharma bro’ Martin Shkreli found guilty of 3 of 8 charges, including securities fraud

Martin Shkreli has been found guilty of defrauding investors of his two hedge funds and paying them back with stock and cash that he stole from his biotech company, Retrophin.