News 7/27/18

Top News

IBM Watson Health’s supercomputing abilities in the area of cancer treatment once again come under fire as Stat uncovers internal IBM documents showing employee and customer concerns with the software.

“Unsafe and incorrect treatment recommendations” for cancer have been blamed on Watson’s training — by IBM engineers and a team of physicians at Memorial Sloan Kettering Cancer Center (NY) – that used hypothetical instead of real-life cancer cases.

A Jupiter Hospital (FL) doctor complained to IBM, “This product is a piece of s***. We bought it for marketing and with hopes that you would achieve the vision. We can’t use it for most cases.” (the irony being that a hospital that admits buying Watson for its marketing value complains about the company’s overzealous marketing).

A previous Stat report found that IBM started marketing the oncology product before it was ready and without subjecting it to clinical studies, also noting that Watson doesn’t meet the definition of AI since it doesn’t actually learn, it only relays the treatment preferences of MSKCC in what is little more than a virtual consultation. Oncologists also reported that while Watson provides them with background information such as journal articles, it doesn’t directly help them make a decision or tell them anything they don’t already know in regurgitating the hospital’s own training data. It also suffers from lack of clear-cut medical evidence that makes many oncology decisions difficult to turn into algorithms.

MD Anderson Cancer Center (TX) cancelled its Watson partnership in February 2017 also spending three years and $60 million trying to create an oncology advisor similar to the one MSKCC is developing.

IBM Watson Health confirmed in early June that it had laid off an unspecified number of employees, mostly from its expensive acquisitions Truven, Merge Healthcare, and Phytel.

Reader Comments

From A Good Walk Ruined: “Re: Sutter Health. Heard that the Sutter board met Wednesday morning and let CIO Jon Manis go because of its $25 million recent downtime. I’ve also heard that the CFO and COO were let go.” I reached out to Sutter, who confirms that SVP/CIO Jon Manis (photo above), IS Chief Operations Officer Stuart James, and Director of IS Finance Randy Davis have left the organization for unstated reasons. Serving as interim CIO will be Chris Van Pelt, who I believe still works for PricewaterhouseCoopers. Sutter’s Epic and telecommunications systems went down for more than a day in mid-May at its 24 hospitals, which the health system said was due to activation of a data center fire suppression system.

From Careening Corvette: “Re: Medhost. Lists an open position for chief information security officer after having their share of security problems in the past 24 months.” The job sounds like the one William Crank has held, but he still lists it on his LinkedIn.

From Eligible Bachelor: “Re: Recondo. Appears to be buying the former Advisory Board PayNav client base from Optum 360. PayNav was a white label for Recondo products. Terms not disclosed, transition of 57-58 clients beginning immediately.” Unverified.

From Joel Martin: “Re: physicians and EHRs. I spent many years working on Epic optimization, especially for inpatient and ambulatory physicians, and most of the complaints about time and user friendliness are actually about regulatory, financial, and other compliance requirements. Very few of the issues they disliked were actually attributable to the software other than poor defaults for orders. Even note documentation, by far the biggest time spent, is really about a financial decision of the organization to shift cost away from transcription that all EHRs can accept. Individual healthcare organizations and the system as a whole have shifted enormous amounts of work onto physicians over the past 20 years. The EHR enabled a lot of that shift, but is not the cause, and the best EHR possible cannot undo this reality.” I agree with Joel, who’s now with HealthX Ventures– it’s like blaming TurboTax instead of Uncle Sam for the unpleasantness of paying taxes. The worst aspect of the EHR is that it gives non-clinicians a sly way to impose their will on doctors anonymously via software requirements, turning medical documentation into a Pavlov’s Dog experiment in which dollars pop out as a reward for doctors clicking boxes someone wants clicked that don’t necessarily benefit patients and instead steal a big chunk of their allotted encounter time. Healthcare is the only industry that requires its highest-educated, lowest-supply professionals to perform data entry work, keyboarded into submission by executives who wouldn’t be caught dead using a computer while speaking to someone (ever see a CEO’s sumptuous desk hogged by a computer monitor?) I’ve mentioned my $60-per-month all-inclusive concierge PCP, who doesn’t use an EHR and who instead conducts an unhurried, richly nuanced conversation with me, free of the pressure to click, stare at a screen, or wonder if he’ll have his payment denied by a bored insurance company clerk ready to pounce on a mistyped field. The biggest mystery to me is why doctors allowed insurance companies and then hospitals to elbow them out of their own profession and turn them into regularly whipped slaves, or more accurately, why they don’t bolt en masse right now, skim the cash-paying patients, and let the rest of the system crash and burn so we can start over.

Webinars

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Acquisitions, Funding, Business, and Stock

Home DNA testing company 23andMe will sell the data of its 5 million customers to pharma giant and just-announced $300 million company investor GlaxoSmithKline for developing new drugs, raising the question of why consumers shouldn’t be paid – even in the form of a rebate — when a for-profit company they’ve paid for services sells their health data to another. 23andMe, which says its consent allows such sharing and requires consumers to opt out otherwise, also acknowledges that it’s doing its own drug development. Meanwhile, Canada’s border patrol is reportedly accessing ancestry websites to determine the nationality of those being considered for deportation.

Atlanta-based billing company Patientco raises $28 million in a Series B round led by investment firm Accel-KKR.

Medical information sharing startup Ciitizen prepares for a private beta program with $3 million from Andreessen Horowitz. Founder and former Apple health technologies director Anil Sethi sold a similar company, Gliimpse, to Apple in 2016.

Up to 1,500 Epic employees begin filing individual overtime claims — some dating back to 2012 – after a Supreme Court ruling that prohibits them from filing as a group. The company settled a similar overtime case with employees in 2014 for $5.4 million.

Google patents headphone technology designed to capture a user’s body temperature and alert them to changes that may indicate the onset of illness.

Financial technology vendor Flywire raises $100 million in a Series D funding round. The company – which offers universities, healthcare organizations, and business the ability to accept online payments in the customer’s own currency – operates OnPlan Health, a full-service patient billing and payment solution for hospitals. 

A Facebook warning about slowing revenue growth sends shares down 20 percent Wednesday, wiping out $120 billion in market capitalization. It’s the largest one-day valuation slide in history for a US-listed company, with the lost market value exceeding the entire valuation of 90 percent of companies in the S&P 500.

People

Lloyd Mangnall (Imaging Advantage) joins AbleTo as SVP of technology.

Healthcare-focused investment banking firm Edgemont Capital Partners hires Kojo Appenteng, MBA (Credit Suisse) as managing director, where he will create the firm’s healthcare information technology investment banking platform.

Announcements and Implementations

Healthcare data science company Apixio launches HCC Auditor, an AI-powered solution that helps health plans and providers perform internal audits of their risk adjustment payment data.

HBI Solutions develops predictive algorithms to help providers identify patients at risk for opioid abuse.

Centura Health (CO) implements health data exchange software from ESO Health to give its 17 emergency departments real-time access to EMS data.

HealthSparq adds timelines and insurance-specific cost estimates for patients who use its HealthSparq One transparency and guidance platform.

Agilon Health will use HMS Essette care management software for its PCP customers.

Sales

• Indiana HIE will deploy Diamater Health’s data interchange, clinical data quality, and e-clinical quality measures products.
• Columbus Regional Healthcare System (NC) selects Avaap to implement its new Cerner CommunityWorks software.
• Hartford HealthCare (CT) will implement data integration and analytics and reporting software from Innovaccer across its 70 ambulatory facilities.
• Flagler Hospital (FL) selects clinical variation management software from Ayasdi.

Government and Politics

CMS’s proposed outpatient reimbursement takes aim at hospitals that have bought physician practices to take advantage of a billing loophole that allows them to immediately raise prices by declaring the practice a hospital outpatient department (a practice closed to new conversions since 2015, but with existing sites grandfathered). The proposed change would mandate site-neutral payments to eliminate that advantage. The American Hospital Association responds quickly in saying that CMS doesn’t understand how hospitals operate.

CMS reverses its decision to suspend the Affordable Care Act’s risk adjustment payments, citing the need to keep payers from becoming insolvent or withdrawing from the market.

Other

An investigation by USA Today into maternal deaths during or just after childbirth reveals a chilling lack of attention to patient safety protocols, resulting in the preventable deaths of 700 women each year. A review of hospital quality records from facilities in New York, Pennsylvania, and North and South Carolina found that less than half of maternity patients were treated for dangerous blood pressure levels; of those that were treated, less than 15 percent received recommended care.

Sponsor Updates

• EPSi employees donate to local food pantries in honor of Global Impact Day for Hunger Relief.
• Medicomp Systems releases a new video, “Enhanced Patient Outcomes with Quippe: Phoenix Children’s CDI Story.”
• Elsevier will offer its STATdx online radiology diagnostic decision support tool through MModal’s Fluency for Imaging speech recognition and workflow management system.
• EClinicalWorks will exhibit at the 2018 FACHC Annual Conference July 29-August 1 in Fort Lauderdale, FL.
• FormFast will exhibit at the FHIMA Annual Convention July 29-August 1 in Orlando.
• The InterSystems IRIS Data Platform is now available in the Google Cloud Platform Marketplace.
• Kyruus will exhibit at the Virtual Health Care Summit July 30-August 1 in Boston.
• AdvancedMD updates its AdvancedInsight financial reporting solution to include enhanced data visualization and cross-browser capabilities.
• Indiana Health Information Exchange continues its collaboration with Diameter Health after successfully piloting the company’s Fusion, Analyze, and Quality applications.
• Optimum Healthcare IT publishes an infographic titled “2018 Health Data Breaches Fast Facts.”
• Meditech Senior Government Affairs Manager Barbara Hobbs joins the HIMSS EHRA Executive Committee.
• Healthfinch makes its Refills Lite e-prescribing solution available to AthenaClinicals end users.
• Audacious Inquiry hires Danny Krifcher (Aledade) as CFO, Marnie Basom (Health Management Systems) as senior director, and Kate Ricker-Kiefert (Amelia Mayme Consulting) as director.
• Parallon Technology Solutions receives the HDI Team Certified Pinnacle of Excellence award for its commitment to customer service.

Blog Posts

• The New Future of Data Automation: What Role Will Alexa Play in Tomorrow’s EHR Integrations? (The HCI Group)
• How to Accurately Troubleshoot Citrix ICA Network and Connectivity Related Issues (Goliath Technologies)
• Digital Patient Engagement and the Connection to Patient Experience (Healthgrades)
• QPP Proposed Rule for 2019: An Overview (Impact Advisors)
• The Duplicate Disconnect (Imprivata)
• How Healthcare Marketers Can Win Over Skeptical Millenials (Influence Health)
• It’s Time to Increase Cybersecurity Efforts (Optimum Healthcare IT)
• EHR upgrades will be on everyone’s mind this August, so let’s talk about it. (Nordic)
• Is CDSS a Life Saver? (InterSystems)
• ATLAS 2018 Breakout Track – Positioning Access as a Strategic Imperative (Kyruus)
• Three Challenges with Managing Physician Offices’ Remote Access to Your Network (Iatric Systems)
• How to use reporting to become a home health top performer (Meditech)
• Bringing a Smart Room to Life: A peek behind the curtain at MUSC’s new children’s hospital (part 2 of 3) (GetWellNetwork)

Contacts

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

EPtalk by Dr. Jayne 7/26/18

The American Medical Informatics Association announces the launch of its Fellowship program (FAMIA)  for recognition of professional achievement and leadership in applied informatics. The FAMIA designation will be inclusive, recognizing physicians, nurses, pharmacists, and others working in the realm of clinical informatics. Fellowship candidates must demonstrate eligibility in education, certification, experience, AMIA membership, and AMIA engagement as well as through peer recommendation and commitment to future activity in clinical informatics.

I’m qualified except for the AMIA “engagement” part. I wonder if being the anonymous face of clinical informatics for thousands of readers would qualify under the “other contribution by petition” category? Applications close September 3 and require a $200 application fee.

New Medicare cards are on the way, with mailings complete in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia. Patients in those states who haven’t received their cards can sign into www.MyMedicare.gov to confirm the mailing and print a card. I still get questions from practices that are confused about what to do when the new cards start coming in, so make sure your organization has a plan and that it’s well socialized.

Physicians who participated in the 2017 Merit-based Incentive Payment System (MIPS) program are now able to review their CMS-calculated scores and feedback reports. Penalties and incentives based on the data will impact Medicare payments for services rendered in 2019. Providers who have concerns about their performance data can request a targeted review from CMS. Common reasons for review include errors in data submission; physician eligibility issues; problems with the alternative payment model participation list; or issues with previous eligibility.

For a long time, my laptop would give me trouble when I tried to use the camera during conference calls, so I got in the habit of not using it. It’s probably a good thing, since my work-at-home schedule sometimes involved prolonged wearing of pajamas, followed by workout clothes, followed by wet hair. I did get my camera issues resolved and have been trying to make a point of having more of my calls with video.

I’m always worried I will do something dumb because I’ve forgotten that I’m on camera, but I’ve seen enough botched video lately to know that I probably look good by comparison. This week’s highlight reel: a call with someone who immediately got up from the computer and walked away, but insisted he was there reading the materials I was showing; camera angles that gave me a great view of one client’s nasal passage; and my favorite – someone trying to take a call from his boat, resulting in plenty of squinting against the sun and ambient noise from seagulls.

I was glad I wasn’t on camera for one call (the client doesn’t do video, so I don’t feel obligated to do it, either) because I am not sure I could have kept a poker face after hearing this quote from a newly-minted VP of operations: “I assigned this to you because I didn’t know who else to give it to.” I’m betting it didn’t build confidence among his new direct reports, so we’ll be doing some coaching on that approach later.

I was recently asked to provide a reference for a former colleague as she looks for a new position. Her hospital was acquired by a large corporate organization and the entire IT team was cleaned out. She’s applying at one of the only hospitals in our region that is still independent. I was surprised to receive a web link from the hospital, leading me to provide the reference through a short survey. It didn’t appear to really provide a mechanism to provide a peer reference vs. an employer one and gave no opportunity for narrative comment. I was forced to choose “yes” or “no” to a “would you rehire?” question despite not having been her supervisor.

I suspect that the HR department involved is just using these “references” as a check-the-box step rather than using them for actual content. It’s unfortunate, because she was great to work with and I think she would be an asset to anyone, but didn’t have a mechanism to share that information.

My office pre-books their order for flu vaccine as soon as our distributor will take it and requires all employees to receive vaccination as a condition of employment. Since we’re just about six weeks out from the start of the vaccination season, I was glad to see that the CDC’s Advisory Committee on Immunization Practices (ACIP) has included nasal flu vaccine in this year’s recommendations. There are quite a few people who are reluctant to have a shot but will accept the risk of a live (although modified) vaccine up their nose.

Last year’s flu season was particularly gruesome, and I hope we have an easier time this season. ACIP also delivered new guidelines on anthrax vaccine for post-exposure prophylaxis and updated recommendations on HPV, mumps, zoster, and pneumococcal vaccines. EHR vendors, start your engines – it’s time to update your logic. EHR clients should make sure they’re taking updates so that they have the best information available in their systems. I would estimate that more than half of the clients I work with don’t take regular updates to their systems unless they’re automatically applied in the background.

I was hanging out on a conference call the other day, waiting to figure out whether my client was just late or was going to no-show. I came across this site offering lab coats “for the perfect poise” that will ensure that “customers are enabled with confidence and grace through its sophisticated but classy appearance.” They ought to be pretty enabling since they start at $178 and run to $340. I found several other sites with pricey coats, and although they were more stylish than what I usually buy, given the things that are occasionally splashed on us at the office, I think I’ll stick with my $25 version.

I’m not sure whether it was worse for him to no-show or to have to endure the call I was on next, which featured an attendee who was doing the “I’m on two calls at once” routine but had the other call on speaker so that everyone else could hear it. Unfortunately I wasn’t the host and my client thought it was OK, so I was forced to play along. I still struggle to understand how someone can think they are able to meaningfully participate in two calls.

Given challenges in staffing and an overall nursing shortage, one hospital has come up with an innovative solution for staff retention. Pediatric nurses at Mercy Children’s Hospital can opt for a “seasonal staffing” program that allows them to work nine months out of the year but maintain their full-time benefits while taking summers off. The move addresses low census issues during the summer while expanding time off to travel or care for children out of school for the summer. Hospital leaders also hope it will allow nurses to recharge and return to work with “excitement for nursing.”

Having grown up as the child of a teacher, there’s something to be said for being able to have family adventures when school is out for the summer, even if there’s a chance your mom might want to leave you at a scenic overlook because you’re a grumpy pre-teen.

What’s your favorite childhood vacation memory? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/26/18

IBM’s Watson supercomputer recommended ‘unsafe and incorrect’ cancer treatments, internal documents show

Internal IBM documents reveal that Watson Health employees and customers identified “multiple examples of unsafe and incorrect treatment recommendations” as the company promoted the software to prospects.

Some Epic workers will continue to fight for overtime pay as individuals

Epic employees working in quality assurance and tech writing begin filing individual overtime claims after the Supreme Court ruled they cannot file them as a group.

Patientco Primed to Help More Health Systems Rethink Patient Payments with Strategic Growth Investment Led by Accel-KKR

Patient billing company Patientco raises $28 million in a Series B round.

Trump Administration, in Reversal, Will Resume Risk Payments to Health Insurers

The White House reverses its decision to suspend the Affordable Care Act’s risk adjustment payments, citing the need to keep payers from becoming insolvent or withdrawing from the market.

HIStalk Interviews Jeremy Bikman, CEO, Reaction Data

Jeremy Bikman is CEO of Reaction Data of American Fork, UT.

Tell me about yourself and the company.

I’ve spent a long time in healthcare doing research and helping hospitals, clinics, and even the vendor side make better decisions. That’s what our company does. We get organizations, whether they’re a hospital or vendor, answers to their biggest problems really quickly.

What are the most-hyped and most-promising healthcare technologies?

Over-hyped is blockchain, hands down. People don’t even know what it is. It’s moving so fast. You would think that in an industry like healthcare, people would be more skeptical because we’re supposedly a more data-driven, evidence-based industry. You go to HIMSS and someone says they’re doing something with blockchain. You ask them to describe its advantages and they end up talking about the technological benefits. You ask what that means for a hospital and they can’t articulate it. How is it going to improve the bottom line, top line, patient care, whatever it is? They’ll answer it as a feature statement rather than benefit.

Most promising is, surprisingly, artificial intelligence. I say “surprisingly” because healthcare is typically last to the tech adoption game on anything that’s emerging. But we’re seeing that it’s picking up the pace pretty significantly, mainly in the imaging departments, but also expanding outside.

We launched some research around that. We wanted to keep it open ended, asking the C-suite where they saw it being used without giving them a list to choose from. Number one was virtual health services. It’s interesting that they said that since CMS just said that they will materially up the reimbursement level for telehealth, telemedicine, or I guess I’ll use the macro term virtual health. That correlates to what the hospital C-levels are saying, that AI will be the most disruptive, impactful, and beneficial emerging technology.

Second is machine learning and deep learning. I was surprised that CEOs of hospitals said that. We get skeptical when someone makes a choice like this, so we asked, you said machine learning, do you even know what you’re talking about? They really did. They could talk about it, saying, we have all this data, and if we could use machine learning algorithms to look at it, maybe it could help us predict the types of patients who are most likely to miss an appointment or not take a med. These algorithms could help us with medication adherence, following a certain protocol, or even with logistical issues.

On the imaging side, it was much easier for them to answer that it could help a radiologist diagnose something or notice some lesion or some problem with a vessel within an image much more quickly. That would make them more efficient and hopefully raise the clinical efficacy of the encounter and the diagnosis.

Then they brought up the nebulous interoperability, which they couldn’t describe it at all. Most of the research I’ve seen around interoperability is pretty garbage. Everybody defines it in their own way, and if they can define it their own way, then we don’t have a definition. I don’t know how you attack a problem that has a nebulous definition.

Wall Street and private equity firms are buying high-income medical practices such as dermatology and are already deep into hospitalist, ED, and anesthesia staffing. How will that change the market?

It will be interesting to see if pay-for-performance ever really takes off or some mandate from on high alters the financial dynamic whether they’ll really stay in. Do they go the way of a lot of these vendors that come in and do the hokey pokey, where their right foot’s in, their right foot’s out? You never know. That’s why a lot of healthcare organizations are professionally skeptical. They’ve learned to be about those new entrants that say they know healthcare or that buy their way in.

People buy up amazing companies and do layoffs right away. You talk to those acquired installed bases over a few years and they say, it’s all changed. Things were going really well before. I understand economy of scale, but the problem is when that they get integrated, it goes in the opposite direction. Things are getting worse. They might be getting some sort of year-over-year benefit from economies of scale, but the end users don’t.

You’re seeing the same thing with Wall Street, private equity, and others jumping in. There’s money right now and there’s inefficiency. But once they’ve squeezed as much inefficiency out as possible, then they start looking at their returns. They owe their limited partners or their investors. That’s who they serve. How long will they stay in the game? Are they in it for the long haul? I doubt it. Some are, so they will be able to make some improvements and then look at it as a long-term play.

You’ll see a lot of them getting out in the next decade or less. You can see these guys having to go private again or coming up with their own ownership groups or whatever it is. You’ll see the investors stepping out. That’s again if the government doesn’t step in, behind the scenes, and collude to help make markets happen, keep people in business, and keep themselves elected. I’m going to get really cynical if we get into the government aspect. Which I’ll certainly do, and I’m willing to fall on my sword about my opinion of government and business collusion. But enough about the HITECH Act.

What changes have you seen in the big four inpatient EHR vendors of Epic, Cerner, Meditech, and Allscripts?

Hospitals and clinics have learned that an EHR is not the panacea it was made out to be, or I should say, it was mandated to be. It certainly needed to happen, but whether it needed to happen as fast and in such a rigid way is up for debate.

\What they’re finding out is that, we put the EHR in because we were explicitly or implicitly promised that we would see a lot of improvement. Patient care would improve, and over time, our organization’s financial position would improve, all because of digitizing patient records, order entry, the MAR, and everything else. What you’ve seen — at least from the research I’ve done and research I’ve read – is that there has not been a material or even statistically significant improvement in hospital bottom lines, clinic bottom lines, or patient outcomes.

Now what are they doing? We have to create accountable care organizations. We have to coordinate patients. We have to get them in their own little sub-populations. How do we treat those patients? We had better have analytics. Do we even have a real data warehouse? Crap, now we have to go get a real data warehouse. Now we have all the data, we don’t know how to analyze it, so we had better get several analysis tools. Do we know how to do that? No, so we have to hire Accenture or Deloitte or some other firm to come in and help out.

They start realizing that for all the time and money they spent on an EHR, all they have done is that the ball got kicked into the end zone and it’s been advanced to the 20-yard line. You mean that we have 80 yards more to go? Yes. Now they’re having to look at everything else to understand that the EHR, these big clinical systems, get put in and they’re the operating system of the hospital. You have a lot more apps and a lot more things that you have to load on top of it.

That’s not the way it was sold back then. Ten years ago or so, no one was talking about having do do all these sorts of things and I’m not sure everybody knew it. When you’re a hospital trying to run your organization in dealing with state mandates, local mandates, employers, payers, and Medicare, it’s tough. You have to rely on the vendors you work with to help you out. You really do. I’m not sure the vendors really understood that it’s not just putting in the EHR. I don’t think anyone would have bought it if they realized, we’re going to spend how much of our budget? Then the upgrades are going to be all this and other sorts of stuff? That’s just the foundation now. We have to do all these other things and bear all this additional cost and labor.

It’s shocking that so much money has been spent on the space, our space. What are the outcomes? Are hospitals in better financial shape? Has putting in all this technology caused a significant improvement in outcomes — financial, operational, specifically for patients? No. You certainly had to put in these systems, but the end result has not been as super positive as everybody expected. I don’t think anyone was necessarily to blame. I don’t think Epic, Cerner, Meditech, or Allscripts went in knowing, ha, you’re going to have to dump huge amounts of money here and then load all these other solutions over time. Because I don’t think people anticipated it. We have so much more that we have to do. I really see healthcare at about the 20 or 25-yard line.

Looking back at the HIMSS conference, how are vendors approaching the market?

It’s net fishing, where you’re just throwing out instead of being precise. They’re just trying to catch it all. So many vendors say they can do pretty much everything. If you look at the HIMSS listings for vendors, you know some of them really do just one or two things, but they will list 15 or 20 because they’re just trying to catch attention.

HIMSS is something you have to do, but I’m wondering about the value of what’s going on there. I love it because you get to collaborate with everyone. That’s the best part of it. People come by our booth just to hang out, ride our bikes, and try to break a clavicle or something. They just come to talk. Most of them just shake their head because everybody does everything and it’s all becoming white noise. It’s hard to differentiate.

My recommendation to vendors is to know who you are, know your ideal customer who you can have the greatest success with, and try to be precise in your messaging to that group. Because everyone’s getting washed out. That means that only the largest of the large are going to get attention because of their sheer scale, size, and reach.

Being precise is better for attendees and eventually better for vendors. You may not get as many people coming by your booth, but you’ll get a better quality of interaction and probably end up closing more business. But taking that approach is a scary step into the dark, because everybody is saying they do lots of things and trying to get more people to come in. That confuses the message and prolongs the sale.

The most successful vendor at HIMSS seems to be HIMSS.

They bought Healthbox, which invests in tech companies. HIMSS is indirectly and directly competing with almost every one of their members. It’s confusing. They’ve done a brilliant job.

You wrote some funny stuff about the HLTH conference. That would not have emerged if everyone was happy about what’s going on with HIMSS. There is demand because HIMSS is this incredibly successful organization that seems like it has to grow. It doesn’t know how to stay put, so it has to acquire other conferences, do partnerships, and acquire a research company or whatever HIMSS Analytics is now. I heard many vendors say they’re not really comfortable now because HIMSS was a partner — an expensive partner, but a partner — that offered value, but now it’s encroaching into their business.

Do you have any final thoughts?

Disruption is the name of the game, far more than ever. I don’t necessarily mean technology disruption, it’s more organizational. The lines are blurring and they’re going to blur even more to where entities become indistinguishable from one another. You’re seeing hospitals launching vendors. You’re seeing vendors looking at coming up with their own healthcare organizations. You’re seeing insurance companies do different intermediaries, buying up provider organizations all over the place.

We just did research around the frustrations that physicians and nurses are dealing with. We looked at key disrupter stuff, such as Amazon or others coming in, and what hospitals and clinics plan to do about it. We found out that 48 percent of healthcare organizations have active plans to acquire other healthcare orgs, get acquired, or do a merger in the next few years, which is enormous. The level of disruption we’re seeing just within provider M&A is enormous.

I would not be surprised if you start seeing massive investments in the life sciences and drug companies into provider organizations to help shrink clinical trials and to get more access to that information. You’ve seen what Intermountain is doing. We did a huge amount of research around the generic drug company they are launching. That never happened before. That’s a seismic event. I don’t think the drug companies are going to sit back and go, OK, fine, whatever. This is a signaling of all the lines blurring and everything coming together.

It’s almost like the old company store model, where the town is owned by the company that puts up the road, hires the police force, and runs the stores. I’m going to go on record as saying that you’ll have a single entity that is a drug company, a provider org, a vendor, and a payer. You’re seeing it coming together and it’s crazy. It could be awesome crazy or it could be really bad crazy, but as we’ve triangulated all of the enormous amounts of data that we’re collecting, it’s heading that direction. I don’t know when that will happen, but it will be super fun to watch.

Morning Headlines 7/25/18

Pentagon to Increase Health Records Contract Ceiling By Another Billion

The Department of Defense will increase its EHR contract ceiling by $1.1 billion in expanding MHS Genesis to cover implementation of Cerner by the Coast Guard.

Identity Automation Announces Acquisition of HealthCast Inc.

Identity and access management technology vendor Identity Automation acquires HealthCast, which offers single sign-on and virtual desktop systems for healthcare.

Making healthcare better for everyone—including providers

Google Cloud announces that former Cleveland Clinic President and CEO Toby Cosgrove, MD has signed on as an advisor to its healthcare and life sciences team.

Scoop: 23andMe is raising up to $300M

23andMe prepares for the sale of up to $300 million in new shares, potentially driving up its value to $2.5 billion.

News 7/25/18

Top News

The Department of Defense will increase its EHR contract ceiling by $1.1 billion in expanding MHS Genesis to cover implementation of Cerner by the Coast Guard. The extra cost will also cover items included in the VA’s contract that were not present in the DoD’s agreement, according to Defense Healthcare Management Systems Program Executive Officer Stacy Cummings.

Cummings added, “A standard electronic health record baseline for the Department of Defense, Department of Veterans Affairs, and US Coast Guard will enable more efficient, highly reliable, safe, and quality care.”

The DoD’s original contract ceiling with lead contractor Leidos was valued at $4.3 billion and a total of $9 billion if all options were exercised.

The Coast Guard gave up on its attempt to implement Epic in 2015 after running $46 million over budget with no sites live. A GAO investigation blamed poor project management, insufficient governance, inadequate project documentation, lack of testing, and internal staff turnover. The Coast Guard began searching for an alternative to Epic in February 2016, reverting to paper and, according to the GAO, endangering members with convoluted processes.

Cummings said the Pentagon will publish a second evaluation report by the end of the year, following a scathing internal review from May that concluded that MHS Genesis “is neither operationally effective or operationally suitable” and not capable of managing care delivery.

The DoD also announced that the next four MHS Genesis rollout locations will be Naval Air Station Lemoore, Travis Air Force Base, US Army Health Clinic Presidio of Monterey, and Mountain Home Air Force Base.

Reader Comments

From FlyOnTheWall: “Re: Allscripts. The company’s investor page proudly boasts in a press release from last year that Rothman Ortho selected Allscripts PM to replace its ‘legacy system.’ Was not that system Allscripts Vision? Nice to see Allscripts getting into the rip-and-replace frenzy of Allscripts solutions, even though they did an RnR of one of their own products.” Unverified, but I believe Rothman was using the old Vision product of Medic / Misys, acquired by Allscripts in 2008. If that’s indeed the case, then I would categorize the announcement as misleading since it’s just swapping one Allscripts product for another, not a brag-worthy displacement of a competitor’s system.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Acquisitions, Funding, Business, and Stock

Identity and access management technology vendor Identity Automation acquires HealthCast, which offers single sign-on and virtual desktop systems for healthcare.

Former employees of the shuttered CareSync describe the company’s final days to the Hardee County (FL) Board of County Commissioners, saying they were pressured to keep patients of its chronic care management business on the telephone line for at least 20 minutes to qualify them for their monthly Medicare billing. CareSync co-founder and State Rep. Jamie Grant — who served as senior solutions architect and was cleared of ethics violations after charges that he funded the company’s startup by misusing Hardee County development grants – says he hasn’t ruled out suing unnamed parties. Co-founder Travis Bond, who employees said was removed by the board because of poor financial management, says he does not plan to pursue litigation.

Cerner has added half of the 600 Kansas City-based employees it needs for an expansion of its RevWorks and ITWorks outsourcing businesses.

University of Minnesota hopes to license an algorithm created by its medical school researchers that predicts a patient’s one-year mortality risk using EHR data.

People

DirectTrust hires Scott Stuewe (DataFile Technologies) as president and CEO. He worked for Cerner for 20 years through December 2016.

Methodist Health System (NE) promotes Kent Sona to VP/CIO.

Announcements and Implementations

A Reaction Data survey of 250 physicians finds that EHRs, regulatory compliance, and internal bureaucracy contribute most to their burnout, with patients named as the problem only 2 percent of the time. The top wished-for EHR improvements are improved user friendliness, additional dictation or scribe capabilities, and reduced time required.

A Black Book survey finds that two-thirds of hospitals are reconsidering whether the ED information system supplied by their EHR vendor can handle efficient ED workflows and meet consumer expectations, with outsourced ED doctors being the least satisfied due to EHR training gaps, excessive clicking, and difficulty in obtaining outside patient data. ED doctors who were forced to move from a best-of-breed EDIS to an EHR’s ED module say their new system hurts their productivity (90 percent), impedes patient workflows (75 percent), and contributes to medical staff burnout (90 percent). CIOs are mostly at odds with those beliefs, favoring a single source EHR solution. The top-rated best-of-breed EDIS vendor is T-System, followed by Optum Picis and Wellsoft. Cerner, Meditech, and Allscripts were also highly rated by users. The most-desired features of both types of EDIS in order are better mobile deployment, interoperability, and patient satisfaction tools.

Government and Politics

The Senate confirms Robert Wilkie as VA secretary in a 86-9 vote.

The National Institutes of Health launches its Google Cloud-powered STRIDES Initiative to allow researchers to analyze large biomedical data sets. Meanwhile, a Google Cloud blog post says that former Cleveland Clinic President and CEO Toby Cosgrove, MD has signed on as an advisor.

Privacy and Security

A Kaiser Health News report recommends that consumers pay cash for alcohol and cigarettes while bragging about gym memberships on social media since insurers and other groups are using personal information from credit cards and other sources to create individual profiles that are then sold to companies. Buyers include drug manufacturers – which might want to buy a list of men over 50 who are experiencing erectile dysfunction – and insurers that may use the profile to predict lifespan or medication adherence. Even employers can use the information to check for a job candidate’s potential work-affecting and expensive chronic illnesses before hiring them. The article quotes Harvard fellow Adam Tanner, who wrote “Our Bodies, Our Date: How Companies Make Billions Selling Our Medical Records.”

Other

A small JAMA-published study finds that back-end speech recognition (specifically Nuance’s former EScription product) has a 7 percent error rate when creating dictated notes (operative notes, office notes, and discharge summaries), with some of those errors such as “grown mass” instead of “groin mass” remaining on the chart for weeks or sometimes indefinitely as clinicians either don’t review them promptly or sign them without double checking. The authors recommend that speech recognition errors be submitted for calculating error rates and for creating automated error detection systems.

Banner Health posts a job for CEO of its Tucson campuses just after its corporate VP/CIO announced plans to leave and the local paper published documents from a state investigation into problems with patient care, provider satisfaction, and billing from its Epic-to-Cerner conversion at the former University of Arizona Health Network hospitals in Tucson.

Google’s Nest home automation division is approaching eldercare facilities to use its products for monitoring the wellbeing of residents.

A Stanford University scientist invents a patch that measures cortisol in sweat to detect disease, measure stress, and evaluate sports performance.

Columbia University’s new Center for Precision Dental Medicine offers RFID tracking of patients and equipment, biofeedback-measured stress levels for quantifying pain, video recording of procedures, and all-digital dental chairs whose six instruments are RFID-enabled for tracking usage and sterilization. They hope to use the resulting data not only to make patients more comfortable, but to analyze provider technique to identify best practices. They also hope to to integrate their systems with EHRs to remove the silos between professions.

Sponsor Updates

• Ellkay will exhibit at AACC’s Annual Scientific Meeting & Clinical Lab Expo next week in Chicago.
• Iatric Systems will exhibit at the SHIEC Annual Conference August 19-22.
• In Ohio, the MetroHealth System and Medical Mutual become the first provider and payer organizations to digitally exchange data and documents with Hyland’s OnBase Mackinac solution.
• AdvancedMD publishes a new eGuide, “Best Practices to Improve Patient Payments.”
• Nordic posts a podcast titled “Developing a strategy for your Epic Community Connect program.”
• Audacious Inquiry names Roxanne Johanning health IT product manager.
• Arcadia will host a career open house at its Pittsburgh office July 25.
• CompuGroup Medical will exhibit at AACC July 29-August 2 in Chicago.
• Divurgent publishes a new white paper, “Medjacking: A Life or Death Issue for Leaders in Connected Healthcare.”

Blog Posts

• Is Your Practice HIPAA Compliant? (ChartLogic)
• How to Deliver On-Time, On-Budget, and On-Value Health IT Projects (Spok)
• Enhancing the Hospital Experience: Building a smart patient room (part 1 of 3) (GetWellNetwork)
• Have a new hire? This is the first meeting you should schedule. (Advisory Board)
• What can radiology learn from the hotel industry? A lot, apparently (Agfa Healthcare)
• 5 ways to transform ambulatory workflow (Bluetree)
• Is Your Practice HIPAA Compliant? (ChartLogic)
• A ‘Women in HIT’ Partner: Paving the Way for Better Patient Care (CoverMyMeds)
• CTG Exec: Managing Data Vital During Health Care Mergers (CTG)
• Effective Clinical Data Normalization Multiply Use Cases for Clinical Data (Diameter Health)
• Overcoming Data Zombies with Analytics (Dimensional Insight)
• How Urgent Care Startups Can Compete in the Land of Giants (DocuTap)

Contacts

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

Morning Headlines 7/24/18

Senate Confirms Pentagon Official To Head Veterans Affairs Department

The Senate confirms Robert Wilkie as VA secretary in a vote of 86 to 9.

Cerner adds 100 more employees on its way to hiring 600 in KC

Cerner fills half of the 600 positions it announced it would staff as part of its new CernerWorks managed services business.

Theranos Investors, Founder Holmes Resolve Shareholder Suit

Theranos founder Elizabeth Holmes settles a 2016 lawsuit brought by disgruntled shareholders who had indirectly invested in the company through investment funds.

Curbside Consult with Dr. Jayne 7/23/18

Every time CMS releases new proposed rules, I feel like the circus has come to town. The most recent offering includes 1,472 pages of bliss and is open for public comment until September 10.

I used to try to read them on my own, but found it too hard to get through them in a timely manner. I’m grateful to the people who have dedicated time to review and summarize them for the rest of us. It seems like most healthcare media outlets are trumpeting the “historic shift” for ambulatory Evaluation & Management (E&M) codes, so I decided to do a little deeper dive myself. Most recent federal proposals trumpet their aim to reduce administrative burdens, so I was curious whether they had truly found the “easy” button.

This document is a double whammy, addressing both the Medicare Physician Fee Schedule and the MACRA Quality Payment Program. There’s a whopping 0.13 percent increase in the fee schedule, which frankly I would rather have had them just keep it static than to try to explain various updates and adjustments. There are new G codes for preventive telehealth services that may be enticing for primary care physicians.

Our enthusiasm is curbed, though, by the continued insistence on EHR support for Appropriate Use Criteria for Advanced Diagnostic Imaging. That’s a measure that has been created, delayed, stayed, and revisited for the last several years and now will start in January 2020, with a year-long testing period but no enforcement. Providers can apply for hardship exceptions if they have poor Internet access, EHR vendor issues, or uncontrollable circumstances. CMS is relaxing a bit in allowing AUC tasks to be performed by ancillary personnel rather than requiring the provider to do the work, so that’s a good thing. It will be interesting to see how much of a difference the use of AUC really makes. In my market, we’re already well trained by commercial payers so that we don’t order tests that aren’t indicated.

The Accountable Care Organization programs received an update, with some measures being retired and a new one added. I didn’t spend too much time on the ACO part of the rule, since it’s expected that CMS will release a separate ACO regulation in the near future. I jumped to the part about outpatient E&M coding, which wasn’t as exciting as I expected. Providers will have the choice to document and code their visits based on the current schemes (formulated in 1995 and 1997) or through either a framework around time and medical necessity, or one around medical decision making. Rather than the distinct charges we have now for visits under the 99202-99205 and 99212-99215 codes, a blended rate is proposed.

Not surprisingly, there is a shift towards the lower end of the range rather than a shift towards the higher end, and for those of us used to performing and documenting high-level visits, it will be a cut. This may be made up for by the reduced documentation requirements, but for providers used to maximizing their use of macros, personal defaults, and templates, the perceived reduction in work isn’t going to make up for a more than 10 percent reduction in payments. If you’re not optimized on your EHR or don’t document efficiently, it may be a boon, but not for every practice.

As far as MACRA, MIPS, and the Quality Payment Program, CMS is just shuffling things around again. Advancing Care Information has been renamed Promoting Interoperability, and additional providers are being invited to the party: physical therapists, occupational therapists, clinical social workers, and clinical psychologists. From a quality perspective, all-cause readmission is being added as a measure for groups. Quality reporting will remain full-year, despite provider groups lobbying for a change.

Quality measures that CMS has identified as ineffective will be dropped, potentially saving physicians $2.3 million. Additional quality measures will be added, including four that address patient-reported outcomes. Reporting for Improvement Activities will be 90 days, however, along with Promoting Interoperability. Use of Certified EHR Technology that complies with the 2015 edition is mandatory. Within the Promoting Interoperability category, new elements are available for Prescription Drug Monitoring Program (PDMP) query, verification of an opioid treatment agreement, and expansion of electronic referral loops by receiving and incorporating information. Vendors will need to incorporate functionality to track and report on these elements, and I suspect that many do not currently have that capability.

Security Risk Analysis remains a required element. I continue to find practices that think that this is somehow the responsibility of their EHR vendor and who don’t understand that it’s the covered entity’s responsibility, with EHR vendor compliance being only one piece of it. Organizations are required to assess how they handle Protected Health Information in a variety of different settings, whether in person, on paper, on the phone, etc. which may or may not have anything to do with the EHR. If you don’t know your organization’s plan for Security Risk Analysis, it might be worth a discussion.

As was true previously, participation in an Advanced Alternate Payment Model such as an Accountable Care Organization means a practice doesn’t have to keep track of all the changes in the Merit-based Incentive Payment System (MIPS) model. The APM track is definitely where CMS wants providers to be, adding a 5 percent bonus for them. CMS is also pushing providers to be ready for programmatic updates on a regular timetable with its move to combine QPP with the Physician Fee Schedule. If this holds, providers can plan for updates to both in July and November instead of playing the waiting game.

Still, each time a new rule or proposed rule comes out, the chatter in the physician lounge increases. In my market, we’ve seen a number of established clinicians opt out of Medicare and even more choose to move to cash-based practices whether they involve retainer / concierge fees or not.

My practice remains firmly opted out of MIPS although we accept Medicare patients without restrictions. It remains to be seen whether there will come a time that the penalties outweigh the extra work that will be required to avoid them. So far, we’re diversified enough that it’s not an issue. As I work with practices that don’t have the luxury of non-participation, I’m thankful for that day a couple of years ago when we disabled the “Meaningful Use Content” checkbox and our lives got quite a bit easier.

Given the published comment period on this proposed rule and the typical CMS schedule, we’ll know in a couple of months whether any parts and pieces will be thrown out or modified. Based on this proposal compared to all the feedback that has been submitted on other proposed rules, I’d bet there aren’t too many material changes.

What is your take on the proposed rule for MPFS and QPP? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeremy Pierotti, CEO, Sansoro Health

Jeremy Pierotti is co-founder and CEO of Sansoro Health of Minneapolis, MN.

Tell me about yourself and the company.

I grew up in Madison, Wisconsin. I went to school out East, then worked in healthcare policy in Washington, DC after college. I then moved to Minnesota for graduate school. Despite promising my wife that we would be here for only two years, that was 1996, and we’ve been here in Minnesota for 22 years.

We started the company in 2014. We knew that the next generation of digital health solutions would require data liquidity. We thought we had an innovative way of providing advanced data exchange between health IT applications. I had no actual skills since I’m not a physician and I can’t code, so when I showed my partners how to move a PowerPoint slide backwards and forwards, they told me I should be CEO.

How widely are APIs being used in healthcare?

We’re seeing them adopted at an accelerating pace. We’re excited by it. I’ve always believed that in healthcare, we adopt treatment technology eagerly and deploy it pretty rapidly. New information technology has been adopted more slowly. But now we are counting on digital health solutions to help us deliver better outcomes with lower costs, higher patient satisfaction, and higher provider satisfaction. Recognition is now widespread that this will happen only with secure, seamless exchange of data between applications. In manufacturing, retail, logistics, and financial services, that’s all done through APIs. We are seeing more rapid adoption of that in healthcare, too.

Do EHR vendors make it easy for customers to integrate their products with those sold by other companies?

To some extent, yes. Most of the major EHR platforms have API or developer programs. Some are more robust than others. It depends on the business strategy of the company and the other demands that are on the company. A lot of regulatory requirements have been placed on EHR vendors over the last 10 years. That has consumed a lot of engineering and product development time within those teams.

Our goal at Sansoro is to provide a universal API so that great developers and great healthcare software companies can write to a single API standard. Then we will handle the nuances of getting the data out and putting the data back into the EMR. As a developer, you don’t have to learn the different APIs and the different integration approaches of each vendor.

I saw you your site that Emissary doesn’t update EHR tables by scripted inserts or updates, but instead uses the vendor’s back-end service to preserve their validation logic. What are the use cases for updating the EHR database and do other methods do direct database updates?

I don’t know whether other companies are doing direct table inserts. Our team is a collection of experienced health IT personnel who know how to create safe application. We’ve all been working with health IT for 20, or 30 years per person. Our approach has been to use the back-end services to make it a safer process. We also get to take advantage of the work that’s already been done by the EHR vendor in terms of the updates.

Examples of what we allow for writing data to the EHR would be discrete observations, documents, and notes. Pretty straightforward stuff, but important. In most provider systems, the EHR is the system of record, so it’s important to get key data into the EHR itself. That’s the operating system for a provider.

Our secret sauce is doing the hard work of mapping the data structures of all of the different EHRs that we support into a unified data model. That’s the holy grail. That’s why we can provide a single API in which an engineer can read data from different vendor platforms and write data back to different vendor platforms without having to know the nuances and differences between those vendor platforms.

What are the most-request API integrations and also the most-desired that aren’t yet available?

We see three common use cases across our customers and prospects.

One is pretty simple. We want to pull patient charts. We typically will have to do an extract, run a database report, or send personnel into the clinic or hospital to print out the chart or print it to a PDF. Being able to pull that chart for quality reviews, medical necessity reviews, and release of information — just being able to pull the basic patient chart — is a standard need and use for our APIs.

The second is for advanced analytics. Basic patient chart information, but with additional information. What clinic or department was this patient in when this procedure was performed? What is the provider’s background? Then combine historical information with real-time information to create a dashboard back to the provider in real time, with insight about the possible best treatment for this patient or how the patient’s condition is improving or deteriorating. Real-time analytics, pulling both historical data and data that’s up to the minute from the EHR or from other data sources to provide those exciting insights for clinicians for administrators.

The third and broadest use case involves workflow improvement. Probably 200,000 prior authorizations are submitted every day in the United States. You print out a bunch of information from the patient’s chart, fill out a prior authorization cover sheet by hand, and fax it into the payer. Then the payer has a person who adjudicates that prior authorization. Often, the the approval will be snail-mailed back to the provider. Not really up to 21st century speeds.

Workflow improvement is using our integration platform to listen for orders, determine if those orders require a prior authorization based on the patient’s insurance, and if so, grab only the data that’s needed from the chart to adjudicate that prior authorization, and then push the approval number back into the patient’s chart. All without any further human intervention. Once the provider places the order in the EHR, the rest happens automatically. That’s a great workflow improvement that saves hours for every prior authorization request.

Another great workflow improvement involves unified communications. Lots of companies provide communications tools that augment the EHR tools, whether it’s Vocera, Voalte, PatientSafe Solutions, or Spok. There’s a pretty good list of vendors that have great tool sets. Enhancing those tool sets to send those messages to the right clinician with appropriate context. Here’s a lab result for the stat order you placed, but in addition to this lab result, we’re going to include the last three results for that same lab test so you can put this result in context. Also, here are the patient’s most recent vital signs and here’s the medication list.

As a provider, you’re not getting a call from the lab with the lab result and then having to log into the EHR to find all that information manually. Instead, it’s delivered to you on your smartphone. As a clinician, that saves you a lot of time and allows you to make a decision faster about the appropriate treatment for that patient.

The FHIR standard is even further entrenched now that Apple is using it to populate Health Records. How does FHIR fit into the overall needs for interoperability?

We believe in a “FHIR and more” approach. Our integration platform, we believe, provides the most complete and comprehensive integration on the market today. But we understand that there’s a role for FHIR.

The challenge with any standards group is that it takes time to develop those standards, and that’s totally understandable. The other thing we’ve seen is that those standards are a paper-based or an electronic specification, but they don’t always get implemented in the same way by each vendor. You can look for a single FHIR resource and find that different vendors implemented it in different ways. You would need a different code base for using the same FHIR resource from one vendor to another.

We believe that FHIR has an important role and Apple has shown that you can do some interesting things with it. We’re working with customers that may be able to use FHIR for some of their needs, but they have other needs as well. We are able to provide APIs that fulfill needs that the FHIR working groups haven’t gotten to yet or that haven’t been deployed by the vendors yet.

There is no “one size fits all” solution for data exchange. We know from our growth over the last few years and from the continued interest that we have from new customers that there’s a demand for FHIR and more.

Do you have any final thoughts?

The next generation of software that will be part of the digital health revolution demands data liquidity. When you have free flow of data, it’s fascinating what you can accomplish.

The easiest analogy that I draw is to the smartphone. As a platform integrating your location and the ability to send messages, the smartphone has enabled whole categories of industries to develop. Take ride-sharing, for example. That never would have been developed.

As we start to break down the barriers among health IT applications and create the ability for them to exchange data, we’re going see a similar explosion in the creativity and innovation around health IT software. We are excited to be able to support that. For all of us, it will mean a better patient experience, lower costs, and better outcomes. That’s what we’re all trying to achieve.

Morning Headlines 7/23/18

NHS to receive £487m technology boost

In England, new Health Secretary Matt Hancock pledges his support for NHS modernization and announces $640 million in new technology funding.

Samsam infected thousands of LabCorp systems via brute force RDP

LabCorp is close to fully restoring its systems after they went offline in a July 13 ransomware attack.

Banner Health’s Tucson computer conversion yielded reports of medical errors

Banner Health’s $45 million conversion to Cerner caused medical errors and staff frustration, although hospital officials said delays in patient registration, lab ordering, and medication ordering and delivery didn’t harm patients.

SingHealth’s IT System Target of Cyberattack

Singapore says hackers stole the information of one-fourth of its population, 1.5 million people, in an attack involving its SingHealth clinics.

Monday Morning Update 7/23/18

Top News

In England, new Health Secretary Matt Hancock pledges his support for NHS modernization and announces $640 million in new technology funding. He touted virtual visits, barcode tracking, and electronic medication ordering.  

HIStalk Announcements and Requests

Poll respondents say Epic has the best CEO. HISJunkie says Meditech hasn’t grown, Brent Shafer is too new to judge, and Allscripts is a mess. Tripp Tart voted for Judy Faulkner in admiring her for keeping the company free of shareholder influence. Former Community CIO votes for Howard Messing since he also kept Wall Street out of the picture and is creating company growth again, while Epic’s growth is mostly due to its hospital customers acquiring more facilities.

New poll to your right or here: would you be OK with insurance companies using your harvested social, financial, and lifestyle data to approve and price your medical coverage?

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Decisions

• Schoolcraft Memorial Hospital (MI) switched from Evident to iSolved HR and payroll software in June.
• Divine Savior Healthcare (WI) will replace Evident with Athenahealth in fall 2018.
• Crisp Regional Hospital (GA) will replace Meditech HR with Kronos in 2018.
• North Country Hospital & Health Center (VT) replaced Allscripts Paragon with Athenahealth in April 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

Chronic Care Management, Inc. hires two former executives of its defunct competitor CareSync, Gurpreet Singh (CIO) and Marc Gauthier (head of enterprise business development).

Announcements and Implementations

Publicly traded rural hospital operator LifePoint Health is considering selling itself to a private equity firm for up to $6 billion, with the report sending LifePoint’s shares up 40 percent. LifePoint Health also operates 15 hospitals in partnership with Duke University Health System under the Duke LifePoint Healthcare brand.

Privacy and Security

LabCorp is close to fully restoring its systems after they went offline in a July 13 ransomware attack. The company’s security team detected the Remote Desktop Protocol attack and stopped it within 50 minutes, but by then, the SamSam ransomware had impacted 7,000 Windows-based systems and 1,900 servers. SamSam took Allscripts down earlier this year, reportedly also using RDP as its vector.

Members of a private Facebook group for sexual assault survivors find themselves trolled by new users who threaten to post the intimate details they had shared under their real names. The group was apparently created by an anonymous administrator who either had duped the members or whose account was hacked. The report by “Wired” notes a Facebook flaw that allowed this to happen – groups can be created by “pages” that aren’t tied to an individual’s profile, the same way Russian propagandists used the platform before the 2016 elections to keep themselves anonymous. I was going to play around with some Facebook group stuff but decided instead to try Microsoft Teams now that the company is offering a free tier and no longer requires members to use Office 365.

Singapore says hackers stole the information of one-fourth of its population, 1.5 million people, in an attack involving its SingHealth clinics. The hackers specifically targeted the information of the prime minister in the cyberattack that lasted from June 27, 2018 until it was discovered on July 4. They breached a specific PC and then elevated its account privileges to access the database.

Other

Epic’s campus is free of cranes for the first time in two decades as the company’s frenetic construction projects wind down, having expanded the campus to handle employee headcount that tripled to 10,000. Epic says that it may another set of buildings next year.

The local paper reports that Banner Health’s $45 million, October 2017 conversion to Cerner at its acquired Tucson academic medicine locations caused medical errors and staff frustration, although hospital officials said delays in patient registration, lab ordering, and medication ordering and delivery didn’t harm patients. The paper just received heavily redacted records of an Arizona Department of Health Services investigation. Banner says it made 100 improvements to Cerner this year, naming specifically changes in pharmacy processing, oncology administrative activities, and patient records access. The paper notes these items uncovered from various state investigation documents and meetings:

• The Tucson locations had a smooth transition when they originally implemented Epic, but moving to Cerner “provided fraught for some patients and staff,” with significant problems due to poor implementation planning and training.
• This was Banner’s first implementation in an academic medical center (the former University of Arizona Health Network) and its Cerner system couldn’t distinguish between a medical resident and an attending doctor.
• A near-miss infant overdose happened because Cerner was set up to order per-kg weight-based doses, while Epic had been set up as per-gram ordering.
• Banner’s CFO admitted to state officials last month that it underestimated Cerner’s data center and bandwidth requirements.
• Banner’s CFO says both revenue and clinical productivity have yet to recover from the Epic-to-Cerner switch nine months ago. He replied to a Regents member who expressed concerns about Banner’s Tucson reputation, “You and me both.”
• The article notes that Phoenix-based Mayo Clinic Arizona will replace Cerner with Epic on October 6.
• In other Banner news from Tucson, the health system cancels its nurse Magnet status, where under University of Arizona Medical Center’s ownership in 2003, it became the first Magnet-designated hospital in Arizona. Banner will continue Magnet participation at its Phoenix campus.

AP Stylebook neatly summarizes how publications should use the results of political polls, offering rules that also apply to healthcare IT:

• The existence of a poll isn’t in itself newsworthy.
• The poll results should disclose who paid for it, and if the poll was commissioned by an organization that benefits from its results, it is not newsworthy.
• Polls should include a description of their methodology and a list of the questions asked.
• The polled group should be randomly selected to make sure that every member of that population has an equal chance of being selected. Online polls are valid only if participants are randomly recruited, while polls of website visitors, a company email list, or Twitter should be avoided.
• The poll should state its margin of sampling error.
• Reporting on results from a poll’s subgroup – such as people of a certain age or location – may be meaningless if the sample size is small.

An interesting study finds that telling students to “find your passion” for a career is bad advice since most passions are grown from experience, not discovered. The danger of the “do what you love” argument is that it encourages people to give up too easily and move on to something else if they don’t receive immediate gratification.

This is where science and public health meet the reality of people who don’t value them or who think they are driven by conspiracies. The parents of 57,000 Texas public school students decline to have them vaccinated in the 2017-2018 school year for non-medical reasons. In a significant jump, some counties saw a 9 percent opt-out rate and nearly half of the parents of students at one Austin private school opted out of giving them vaccinations under the repeatedly scientifically disproven belief that vaccines cause autism and other diseases, with “vaccine choice” being viewed by some as resistance against overly intrusive government. Supporters of Texans for Vaccine Choice are mobilizing political activities, protesting with signs that say “The State Does Not Own My Children” and promoting “informed consent” in publishing anecdotal stories in which parents claim that the medical problems of their children were caused by vaccinations. Obviously their choice affects everyone as vaccines work for entire populations only when enough people receive them to create “herd immunity.”

A CNBC report notes that a roadblock to digital health company success is that apps always end up recommending that users see their doctors, which people don’t like doing and often can’t afford. That leaves apps as “a funnel or a stopgap rather than a revolution.” A cardiology fellow and digital health founder says, “All the things done well by digital health — they’re simple, fun, visual, with great user experience — are still missing from most clinical visits, so it remains pretty unpleasant to be a patient. To me, this gap gets closed by bringing the clinical experience up to the same standards as our digital health solutions.” That is pretty brilliant insight – imagine frictionlessly summoning a ride on Uber and then having a 2004 Pontiac Aztek show up an hour late with the meter already at $40 and the lost driver refusing to use the GPS.

Google, Facebook, Microsoft, and Twitter launch an open source Data Transfer Project that allows people to transfer their data from one online service to another (the technical overview is here). Healthcare wasn’t mentioned specifically, but it would be pretty cool if EHR vendors provided a similar capability in allowing patients who are seeing a new doctor to initiate their own transfer of data to the new doctor’s EHR, although questions would then arise about the lack of synchronization capability afterward.

Sponsor Updates

• Elsevier will offer its StatDX radiology diagnostic decision support tool through MModal’s Fluency for Imaging.
• Liaison Technologies partners with One Laptop Per Child.
• Pivot Point Consulting names Matthew Curtain director of business development.
• Sunquest will host its annual user group conference July 29-August 3 in Scottsdale, AZ.
• Vocera will exhibit at LeadingAge Florida July 29 in Kissimmee, FL.
• Mazars USA names Steven Herbst principal, health care consulting group.

Blog Posts

• Enhancing the Patient Experience with a Better Informed Consent Process (Access)
• Capitalize on Chaos: How to Zero in on Opportunity with Population Health (Medecision)
• Meditech introduces first fully FHIR-enabled CommonWell member (Meditech)
• The Future of EHR – Collaborate, Connect, Communicate. (Netsmart)
• Epic Revenue Integrity Assessment: Are You Capturing All of Your Charges? (Parallon Technology Solutions)
• Cloud TCO: The Soft Costs are the Hardest (CloudWave)
• How One VNA Uses mHealth to Boost Care Management and Coordination (PatientPing)
• Just How Rewarding is Your Patient Experience? (Patientco)
• Is Your Answering Service Disaster-Proof? (PerfectServe)
• Can Industry Outsiders Empower Patients Through Data? (Redox)
• Let’s Put the Value Back in Care (Sansoro Health)
• Hospital Revenue Cycle Teams Feel Financial Pain (The SSI Group)
• Patient safety is at stake: Will hospitals step up? (Voalte)
• 5 Reasons to Attend Ascend in 2018 (WebPT)
• 2018 Trends in Patient Engagement: Leveraging Technology to Engage Your Patient Community (WiserTogether)
• Highlights from #IEEEICHI2018 #ICHI2018: Using AI to synthesize information from the data chaos in healthcare (Wolters Kluwer)

Contacts

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

Weekender 7/20/18

Weekly News Recap

• A survey finds that both consumers and physicians recognize the benefits of virtual care, but few consumers have experienced it and few doctors offer it
• Tenet Healthcare considers selling its Conifer Health Solutions business for up to $2 billion
• LabCorp shuts down its nationwide computer network when it detects that a hacker has penetrated it and is trying to access patient records
• Draft CMS rule changes would make major changes to physician billing, the Quality Payments Program, EHR design in supporting simpler billing requirements, and telehealth coverage
• The VA creates a committee to oversee its Cerner implement that will be led by ONC Principal Deputy National Coordinator Genevieve Morris

Best Reader Comments

No one is commenting on the CMS announcement, I suppose because no believes they are serious, or capable of executing any part of this grand plan. (DZAMD)

As a former CFO at a university medical center, a ROI of $190m that requires a $180m investment is a no-brainer — that is the people moving ahead with it have no brains! Any project as large and complex as this has at least a 90 percent probability of being 20 percent (or more) over budget. Nor did I see a contingency allowance in the budget which would allow for any mistakes. Given that, I would need to see at least a 50 percent ROI before moving ahead. Good luck UW, you’ll need it. (HISJunkie)

The communication director for BJC needs a communication director for her own messaging. You START the public statement about how bad you feel for the people whose lives you just turned upside down. You don’t bury that sentiment after two lengthy paragraphs about “market forces.” This should be a PR no-brainer in today’s hyper-sensitive environment for businesses who face these tough decisions. (AreUKiddingMe?)

“If I were a CareSync investor.” Apparently CareSync got millions from a local county development fund. That makes the county taxpayers the investors. Good luck to them recouping any money. (Blocked by Gurus)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. B, whose classroom is in “one of the most dangerous cities in America” in New Jersey, as she describes it. She asked for puzzles, books, and STEM supplies for her after-school program in which students remain on campus until 6:00 p.m. She reports, “My students were so excited when our After School Fun box arrived! Thank you again for your continued support to our school and specifically my classroom. My students come from a city that will not define their future and it is because of donors like you that make them see the possibility this world has for them!”

Telehealth vendor Dictum Health’s Virtual Exam Room and VER-Medic are featured in Discovery Channel’s new show “Sharkwrecked,” where paramedics used it to monitor the health of participants at the show’s shooting location in the Bahamas. Producers blew up a boat in the ocean, then left two men floating with sharks for two days to see what happens in simulating a real-life (yet rather far-fetched) situation. Just in case anything in Shark Week sounds like actual science, the network eliminated all doubt by featuring budget-friendly, D-list celebrities like Ronda Rousey and the massive Shaquille O’Neal, whose fear-overcoming shark dive might well trigger tsunami warnings.

Something I learned about the Chrome browser today after months of pondering instead of simply Googling: yellow lines stacked in the scroll bar show where the most recent search term appears on the page. Remove the search term from the search box and they go away, but otherwise you can scroll to one of the lines and then you’ll see your search term highlighted in yellow in the page text.

A woman is charged with breaking into Westmoreland Hospital (PA) on two occasions to steal soda, once by guessing the ICU door’s access code to enter its conference room, from which she left with a backpack full of drinks. The woman says she regrets her arrest since it might impact her ability to return to her paralegal studies, explaining, “I was thirsty, and it was really late at night, and there are no convenience stores really in my neighborhood. I just thought I’d get some soda. I didn’t think it was this big deal.”

British Airways responds to a customer’s tweeted complaint by asking him to provide his personal information “to comply with GDPR,” which the dimwitted customer (among others) does by tweeting it right back at the company and to the world. A security expert baffled at why the company would try to solve problems on Twitter instead of asking the customer to call in. He also notes that British Airways allows customers to check in online only if they disable their browser’s ad blockers, after which it sends their information to many third parties.

In England, a 63-year-old NHS doctor who is upset about his pension investment losses sends messages to his financial advisor threatening to kill himself, then uses a “hire-an-assassin” site on the dark web to order the advisor killed. The National Crime Agency detected his activity while investigating the Chechen Mob’s site, finding that the doctor had chosen the first of four predefined options: kill the man, beat him, set his car on fire, or set his house on fire. The doctor entered the advisor’s address but didn’t pay the $5,000 fee, leading him to plead not guilty of attempting to solicit murder.

Catholic Health Initiatives collaborates with AHA and Mass General to develop a set of IICD-10 codes that allow providers to document sex and labor exploitation.

I’m not sure if this is an Amazon success or failure, but the company’s website was so busy in the first few minutes of  this week’s Prime Day that its servers bogged down, forcing IT staff to deploy a stripped-down home page and to shut off international access. The company’s auto-scaling feature apparently also failed, requiring manual server spin-up and the need for “looking at scavenging hardware.” Prime Video was slowed, Alexa experienced outages, and warehouse employees weren’t able to prepare orders. Experts say that Amazon may have a bug in its auto-scaling service, but they nevertheless marvel that all of the Amazon sites remained up despite unprecedented volume. The company’s Sable computational and storage system processed 64 million requests per second under last year’s less-busy Prime Day.

The 63-year-old chief of cardiothoracic surgery at Jersey City Medical Center (NJ) is commissioned as a US Navy Reserve commander after receiving an age waiver for his in-demand skill. Tyrone Krause, MD, who was sworn in by his Navy ensign daughter, said, “Why don’t I just relax and sit in my back yard and drink some beer? But that’s not my style. I’ve always been on the move. And hopefully I’ll always be on the move.”

In Case You Missed It

• News 7/20/18
• EPtalk by Dr. Jayne 7/19/18
• HIStalk Interviews Mudit Garg, CEO, Qventus
• News 7/18/18
• Curbside Consult with Dr. Jayne 7/16/18
• HIStalk Interviews Eric McDonald, CEO, DocuTap
• Monday Morning Update 7/16/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
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• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 7/20/18

What can health systems do to encourage physicians to embrace virtual care?

A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t had a virtual visit and only 14 percent of doctors offer them.

CEO Gawande’s first task: a road trip to hear firsthand about workers’ health challenges

Atul Gawande, MD — head of the still-unnamed healthcare joint venture among Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies.

Survey: Progress on Patient Safety Slowed by Ineffective Technology, Healthcare Professionals Say

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors.

News 7/20/18

Top News

A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t experienced a virtual visit and only 14 percent of doctors offer them.

The most commonly implemented virtual care technologies are email / patient portal consultations, physician-to-physician consultations, and virtual visits. Adoption was in the single digits for remote care management and coaching, remote patient monitoring at home or in other facilities, and integration of wearables.

The factors listed above do not include the big ones that doctors can’t control — reimbursement and licensing. You can bet that they would be quick to offer those services if adequately paid to do so or if per-visit fees were eliminated under value-based care payments and an in-person visit actually cost the practice money.

Reader Comments

From DisCerner: “Re: Banner Health. CIO Ryan Smith has tendered his resignation and a posting is up for SVP/CIO on Banner’s site.” The job is posted here, although Ryan is still listed as CIO on the company’s executive page. His career was with Intermountain until he joined Banner in October 2013. He was paid $900K in the most recent year. The tax filings also indicate that Cerner was Banner’s third-highest paid independent contractor at $47 million. 

From Email Privilege: “Re: HIPAA. I was emailed a receipt after paying online that included my name, account number, date of birth, and telephone number. Should they not just have the account number and amount paid because of HIPAA?” All of those fields, as well as your email address itself, are elements of PHI. However, your use of the provider’s portal probably could be taken to indicate your consent for communicating by email (I bet that was listed in its terms of service). It’s also not illegal to send PHI by email – HHS’s only requirement is that the provider “apply reasonable safeguards,” of which encryption would be one even though the rule doesn’t specifically require it as far as I know.

From Avuncular Robert: “Re: McKesson’s outpatient pharmacy point-of-sale system. It’s been down for over 24 hours and their service desk is blaming Amazon Web Services. It is a huge headache – we’ve had to go back to the old cash box process.” I reached out to McKesson, which provided this response:

We are aware of the situation that affected a subset of our customers and impacted their operations for the past 24 hours. Though point-of-sale services were impacted, the dispensing of medication was not affected. We have resolved the issue and have informed customers of next steps. As always, we appreciate our customers’ support and thank them for their patience and cooperation.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor EPSi. The Allscripts-owned, Chesterfield, MO-based company is the industry leader in health system integrated financial decision support, budgeting, and planning. More than 900 US hospitals — including nine of the top 10-rated hospitals, 128 IDNs, and 40 global academic facilities — rely on EPSi for data-driven insight into managing costs and improving their long-range financial performance, as well as addressing requirements created by value-based care, bundled payments, accountable care, and continuum of care. The company’s just-launched, cloud-based RealCost financial decision support and analytics system allows health systems to quickly gain deeper cost insights and empower informed decision-making. Check out case studies from Texas Children’s Hospital, University of Kentucky Healthcare, and UMC Health System. Thanks to EPSi for supporting HIStalk.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Acquisitions, Funding, Business, and Stock

Stat reports that Atul Gawande, MD — head of the still-unnamed healthcare joint venture of Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies. Those conversations will likely fuel the nonprofit’s business plan, which could include a digital primary care solution, according to Mount Sinai Health System Chief Population Health Officer Niyum Gandhi. “I wouldn’t put it past them to … test it on all their employees first before they go broadly to market. I mean, if anybody could do it, it would be them. But they’re going to have to do things that are at national scale, which there just aren’t quick wins on.”

Tenet Healthcare considers selling its Conifer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion. Tenet hired Goldman Sachs last December to help it divest Conifer as part of a $250 million cost-reduction initiative that it aims to wrap up by year’s end.

Vyera Pharmaceuticals, known as Turing Pharmaceuticals under the infamous leadership of now-incarcerated pharma bro Martin Shkreli, reports Q1 losses of over $1 million thanks to declining sales of Daraprim, the drug Shkreli infamously raised the price of by over 5,000 percent when he acquired it in 2015. Vyera is considering changing its name to Phoenixus, no doubt in an effort to shed its former association with Shkreli and revitalize slumping sales.

Announcements and Implementations

NYU Langone Health (NY) implements Omnicell’s automated medication management software and dispensing cabinets at its new inpatient hospital.

Northwestern Memorial Healthcare (IL) selects HealthSource release-of-information technology from Ciox.

AdvancedMD releases a redesigned version of its AdvancedInsight financial reporting suite for private medical practices.

People

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.

Sales

• Methodist Hospital (KY) selects cloud-based backup and recovery software and services from CloudWave.

Other

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors. A lack of adequate staffing and budget is a close second.

Sponsor Updates

• Formativ Health is recognized as the Gold Winner in the startup categories of both the CEO World Awards and the Globee Awards
• RxBenefit Clarity, a prescribing decision support solution developed by CoverMyMeds and RelayHealth Pharmacy Solutions, will be adopted by a dozen health systems that use Epic, Allscripts, and other EHRs.
• EClinicalWorks Director of Interoperability Strategy and Business Development Tushar Malhotra joins the CommonWell Health Alliance Board of Directors.
• FormFast and Kyruus will exhibit at the AHA Leadership Summit July 26-28 in San Diego.
• The Jacksonville Business Journal recognizes The HCI Group as one of the city’s fastest growing companies for the sixth year in a row.
• Optimum Healthcare IT publishes an infographic ttitled “3 Keys to Change Success.”
• Impact Advisors promotes April Smith to principal.
• InterSystems will exhibit at the Defense HIT Symposium July 24-26 in Orlando.
• CoverMyMeds announces that its RxBenefit Clarity prescribing decision support tool, developed with RelayHealth Pharmacy Solutions, will soon be used by 250,000 providers via new integrations with a dozen EHRs and Epic health systems.

Blog Posts

• A ‘reverse’ chatbot helps med students hone their diagnostic skills (Elsevier Clinical Solutions)
• Revenue Integrity: A Unifying Force Overcoming Compliance Challenges (Hayes Management Consulting)
• Healthcare IT Leaders Series: Tanya Townsend (Part One) (The HCI Group)
• Huntzinger Earns High KLAS Rankings in the HIT Assessment & Strategic Planning 2018 Report (Huntzinger Management Group)
• Transition to Change Readiness (Optimum Healthcare IT)
• Simplify Troubleshooting your IT Healthcare Virtual Architecture with Goliath Technologies (Goliath Technologies)
• Did You Know? 6 Ways to Make Physicians’ Lives Easier (Spok)
• Top Go-Live Blogs You May Have Missed (Leidos Health)
• You’ve Detailed Your Last Wishes, and Only Your Care Navigator Knows Them (PMD)
• QPP Proposed Rule for 2019: An Overview (Impact Advisors)
• Applying content services to complete your EHR (Hyland)
• Find Hidden Patterns with Role-Based Behavioral Analysis (Iatric Systems)
• Palm vein biometrics solution ensures positive patient identification and reduces duplicate medical records at University of Utah Health (Imprivata)
• Speaking Up: Healthcare Marketing in the Age of Voice Search (Influence Health)
• Making the Care Connections That Matter Most in Rhode Island (InterSystems)

Contacts

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

EPtalk by Dr. Jayne 7/19/18

Every fall, providers across the country are required to update their ICD-10 codes in order to be compliant for services performed on or after October 1. A quick review of this year’s changes offers some insight about healthcare and culture in the US.

New codes were added for elevated lipoprotein(a), postpartum depression, and newborns affected by maternal use of opioids and other substances. Other codes help document forced labor and sexual exploitation. The one I found most disheartening was Z28.83, Immunization not carried out due to unavailability of vaccine. It’s unfortunate that practices that want to administer vaccinations can’t do so for a variety of reasons – manufacturing shortages, cost of supplies, cost of appropriate storage, and more. Vaccines are one of the most clinically-proven and cost-effective services we can provide, and access should be universal.

I appreciate the book recommendations that readers have been posting in response to my recent Curbside Consult. Bill Gates has also been recommending books over the last eight years, and they’ve been compiled into a list by Quartz.  Many of them address public health issues, including:

• “Dirt and Disease: Polio before FDR” (Naomi Rogers)
• “House on Fire: The Fight to Eradicate Smallpox” (William H. Foege)
• “Infections and Inequalities: The Modern Plagues” (Paul Farmer)
• “The Fever: How Malaria Has Ruled Humankind for 500,000 Years” (Sonia Shah)
• “Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver” (Arthur Allen)
• “The Checklist Manifesto: How to Get Things Right” (Atul Gawande)

As a confirmed Atul Gawande fan-girl, I’ve read the last one, but will add the others to my list for when I need something substantial to counter my summer reading diet of chick-lit.

I have to admit that I was pulled in by the headline “Pay Bump for PCPs Fails to Drive Medicaid Participation.” Looking at data for 2013 and 2014, when payments increased under the Affordable Care Act, researchers didn’t see an increase in the number of physicians willing to accept Medicaid patients or the number of Medicaid patients seen by the cohort of 20,000 physicians. It should be noted that the boost only took the payments to the Medicare amount, not all the way to the amount paid by commercial insurance carriers. If Medicaid payments were increased to that amount, I think you’d see a boost, but not a tremendous one.

Medicaid patients are some of the most challenging to treat due to concomitant social and resource issues. Providers and their practices spend a large amount of time trying to coordinate care, identify subspecialists who are willing to consult on Medicaid patients, and trying to figure out how to improve outcomes and quality of life while dealing with issues such as unemployment, lack of transportation, low health literacy, poverty, overutilization of emergency services, and more. Providing those additional services costs money, which is one reason (besides low payments) that providers limit their care of Medicaid patients.

The article goes on to mention a possible solution with advanced payment models, including risk-adjusted capitated payments with bonuses for outcomes and cost-control. This would only work if you also provided the other necessary economic and social supports that complex patients need in order to successfully navigate our healthcare system.

In other news, LA Care Health Plan is throwing $31 million at efforts to recruit primary care physicians in a move to reduce physician shortages at safety net clinics that see its 2 million members. LA Care Health Plan is publicly operated and understands that physicians are more likely to choose employment with larger organizations such as health systems rather than opt for the smaller salaries often paid by clinics and health centers. They’re targeting younger physicians through grant programs, medical school scholarships, and loan repayment programs and are intentionally not recruiting physicians already serving in the county or working with underserved populations. Additional moves include salary subsidies, signing bonuses, and payment of relocation costs. The latter two are fairly standard for physicians in a highly sought-after specialty, so it’s a bit surprising that they’re just adding them now.

Focusing on loan repayment doesn’t incentivize some older physicians, who have had theirs paid off for some time. I know quite a few seasoned family physicians who would be willing to move to a more meaningful care environment if the compensation was right. However, when loan repayment comes from grant and other funds, potential employers are not able to compensate with a higher salary for physicians without loans, and the recruiting falls apart. Employers are eager to trumpet “total compensation” except for when employees do the analysis. I have several colleagues who don’t take health benefits from their employer, which is a substantial savings for the organization, but were unsuccessful in negotiating higher salaries to offset the change in the total package. Finding the right physicians will reduce turnover and save them money in the long run, so I wish LA Care Health Plan the best of luck.

As we swing into another hurricane season, the Food and Drug Administration has formed a Drug Shortages Task Force to address shortages of medically necessary drugs. Our practice is still contending with supply chain issues impacting IV fluids, which manufacturers continue to attribute to Hurricane Maria’s assault on Puerto Rico. We’re also short on local anesthetics, injectable anti-nausea medication, and several injectable antibiotics. It’s nerve-wracking to have to use a drug that you’re not familiar with that is the only available substitute for something you need. I hope they can find some long-term solutions quickly.

This one almost snuck under my radar, but the FDA has given its first approval to a drug for smallpox treatment. Smallpox has been considered eradicated since 1980, and I hope it stays that way. There aren’t any human clinical trials due to the lack of disease, but it has proven effective in animals. It has also been shown to have no severe side effects during human safety tests. The drug has been in development since 2001 and approval went to Siga Technologies, which developed it under a federal contract. Smallpox is a nasty disease, killing a third of those infected. Although research stockpiles remain in Russia as well as at the Centers for Disease Control and Prevention in Atlanta, there is concern that gene hackers could create strains for release. For those of us without the telltale vaccination scars on our arms, it’s a terrifying thought.

What disease do you fear the most? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/19/18

UnitedHealth Is Among Suitors Circling Tenet’s Conifer Business

Tenet Healthcare considers selling its Confer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion.

HHS Secretary Azar Announces Senior Advisor for Fourth Departmental Priority

Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.

Israel grants $33 million to GE, Medtronic, Change Healthcare to boost R&D

Israel’s Innovation Authority will award $33 million over six years to Change Healthcare, GE Healthcare, and Medtronic as part of a program to attract digital health companies to the country.

HIStalk Interviews Mudit Garg, CEO, Qventus

Mudit Garg, MSEE, MBA is co-founder and CEO of Qventus of Mountain View, CA.

Tell me about yourself and the company.

Qventus is an AI platform. We work with hospitals and health systems to help them manage their day-to-day operations. I’m one of the founders and CEO of the company. My background for the last 10-11 years has been in healthcare operations, specifically in lean process improvement. I’m proud of that. I started a few technology companies and spent time at McKinsey & Company’s healthcare practice. I’m an engineer by background.

How can data and dashboards be made useful to frontline people as they are making operational decisions?

That was one of the biggest prompts to start the company. The first time I walked into a hospital, I was struck by two things. One, how the managers and caregivers did whatever it took to provide care. Second, maybe because they cared so much and because the system was dependent on them doing these heroic acts day after day, the system itself never developed. My perhaps biased view in the beginning was that data could help folks be more prepared and to require fewer of these heroic acts.

We are comfortable in the conference room thinking all we want about dashboards and information, but in the moment when people are busy, nobody has any time to do something about it. Nobody logs into a dashboard. Nobody has time to read through a graph or a report and understand it. That was the earliest insight into the way of using data that we learned from.

We started talking a lot about what was needed in 2013. We said, what makes it so hard in healthcare operations? Typically the answer came back as, half my patients are unscheduled, we don’t know how long they will stay in the hospital, and the resources they will need is unknown. Predicting would be great.

It’s an often-used buzzword, but we started using machine learning tools back in 2013. My co-founder and I both had a background in it. We started predicting.

But we learned that predictions by themselves are sometimes counterproductive. While an average manager doesn’t have time to stare at a dashboard, they also don’t have time to interpret a prediction. A nurse we worked with at that time said, I don’t have time to figure out 30 percent chance do this, 40 percent chance do that. If my GPS said it’s a 30 percent chance to take a left, 40 percent chance take a right, I would toss it out the window. I have more load than I do while I’m driving. Just make it simple.

The goal of the product is not to expose more data, but to take those things that a really good manager would do. A really good manager in an emergency department anticipates. They say, things are getting really bad, I had better have my lab manager start doing X or start prioritizing these things. I had better tell the house supervisor to prioritize some beds. By doing those things two, three, or four hours in advance, they can get ahead of the situation. But that only happens when they have a calm environment where they have the time and capacity to look ahead and solve those problems.

Our product’s goal is to take away that mental load — the data processing, the evaluation of options — and to offer a suggestion in the moment as a message, discussion, or into the workflow in some way.

Hospitals usually have some internal expert they call in when they have a problem, but are lost when that person isn’t available. It would seem that once a hospital has formalized the decision-making process, it would be easier to then enhance it.

Absolutely. An excellent manager has to look at data and make sense of it. That depends on that manager’s time. What judgment they apply depends on that manager’s experience. All those things create inconsistencies.

But in that ED example I gave, the system would be saying, it’s Monday after Thanksgiving. The patients in the waiting room are much sicker. Dr. Smith is working and he tends to he tends to order more labs, but our lab is really slow right now. Based on all of this, we will run out of capacity in the next three hours.

Then the hospital can connect those subject matter experts. Gather the lab manager, house supervisor, and charge nurse and say, “Here is something that we see. We suggest you do this.” Let them have a workforce huddle on that discussion topic and do something about it well before the problem becomes bad.

Who would typically serve as the internal champion of that kind of real-time monitoring?

The executive sponsor often ends up being someone like a chief operating officer or a chief nursing officer. But the internal champion often comes from the lean groups in the hospital. They are the ones who have seen the day-to-day problems, are trying to improve them, are trying to build a system around them, and are connected enough to the day-to-day problems. They can be good champions. Oftentimes department heads will see these challenges, such as the medical or nursing director of the ED.

Those are the internal champions who want this to become a part of the system. The executive sponsors typically are the chief operating officer or the chief nursing officer, who are day-to-day focused on these problems and who jump in to help when things don’t go well.

What is the physical and operational manifestation of how your product gets used in a average hospital?

The ideal end state of the product is that there is no physical manifestation. The ideal end state is that it is invisible, like a really good assistant or someone who is helping you have the insight. It just disappears into the background and brings in the right information at the right time. That’s why it is like virtual air traffic control.

The product has three parts. The most important one brings the insight into the moment. It tells you, this patient in room 434 is likely to get admitted. We don’t have an admit order. We probably won’t have one for the next three hours, but let’s start preparing the bed. Or, this patient is likely to leave without being seen, or that we’re going to have a bad situation with this patient. It’s processing these insights in the background and delivering them in the moment — on a Vocera device, on a secure messaging device, or whatever the right mechanism might be.

Our system provides situational awareness, a sort of mission control. It can be in the break rooms or the huddle rooms, where people can have meaningful information displayed to help them understand the situation. Some of these nudges can be shown at that same place.

The last part is being able to understand the data to see where changes need to be made. An average department will get insight in the moment when they need to do something.

As hospitals centralize and and have larger deployments, there is an interesting role to play for a centralized place. In General Stanley A. McChrystal’s book “Team of Teams,” he talks about how the traditional image of command-and-control came to fail. The military started it, but in the most recent war, we struggled with that approach. They had to rebuild it and dismantle the command-and-control approach. He talks about the importance of spreading shared consciousness throughout the frontline people who are experiencing the situation and who have the most knowledge in the moment.

Our job is to spread the context, consciousness, and best knowledge to the people in the moment who are about to make that decision. While there’s a role to play for the central manifestation in escalation and awareness, the ideal situation is one where the information and the shared consciousness is going to the front lines. That’s how our product works.

Your site allows looking up any hospital’s efficiency index as calculated from publicly available information. What metrics might improve in using your system?

Our product is in 60 or 65 hospitals. Patient flow is a big use case — in the ED, inpatient, and OR. Length of stay, as you can imagine, is a really important metric, because it’s one of the most important measures of affordability and survivability for an organization to be profitable on Medicare patients. Length of stay is a big one on the inpatient side.

Length of stay is important in the ED, but so is patient satisfaction. The number of patients who are leaving without being seen is important.

On the operating room side, they look at efficiency — how much time it takes to turn a room, how many of the rooms are being used, whether supplies are being used appropriately, and how well patients are being informed throughout.

Then we have use cases for pharmacy and outpatient clinic access. In pharmacy, how to manage the drug spend. In outpatient access, how can the health system, with the resources it has, provide patients with quick access to care?

These metrics are beneficial regardless of the payment mechanism or the healthcare system’s economic model. As an example, one hospital freed up about a million minutes of patient wait time in their ED when they deployed the system. That helps them provide care to more patients in the community with the same resources. That lowers the cost, helps the hospital, and helps the patients. Regardless of the economic model, it helps both the health system and the patient.

Where do you see the company’s future being?

I grew up in India. We have in the US healthcare system the best clinicians, some of the best equipment, some of the best therapies. What’s holding back the potential of our system is oftentimes is the ability to execute on the processes day-to-day consistently and reliably, without placing an excessive burden on the people who provide it. If we can do that, if we can create a mechanism where it doesn’t take the heroic effort to provide that consistency and reliability, we can do that across every aspect of delivery of care. Whether it’s your experience in the unit, how well informed you are, your billing, or your staffing. Whether its in the emergency centers, in urgent cares, or in outpatient clinics.

My hope is that we can provide the infrastructure to allow for consistent, reliable execution of the clinical practices we know. Managing the logistics around delivery of care so that the human connection, and the calm that we can provide to people while delivering the care, is feasible. That’s my hope. I’m hopeful that we’ll be able to play a meaningful role in bringing that about.