I’ve been working with several challenging clients over the last several weeks. All of them have been playing various versions of the blame game: clinical blames IT, IT blames operations, operations blames clinical, some blame the consultant, most blame the government and payers, and everyone blames the vendor.
I think I’ve finally put my finger on the underlying problem: learned helplessness. Essentially, learned helplessness happens when a subject undergoes repeated painful stimuli and loses the ability to employ escape or avoidance behaviors. The subject feels they have lost control and ultimately stops trying.
In the case of healthcare IT, the repeated painful stimuli have taken the form of multiple rounds of governmental regulations, reduced physician payments, increasing numbers of risk-bearing arrangements, and shrinking organizational pocketbooks in response to greater uncertainty. The complexity of the environment in which healthcare organizations are asked to work makes it difficult to manage all the details unless one has full-time teams dedicated to doing so. Most smaller organizations simply can’t afford that kind of infrastructure, so they try to cobble together resources from local and state medical societies, professional organizations, and their IT vendors to try to make sense of all of it.
Many of these organizations are struggling to make sense of it themselves, depending on their size and level of funding. Based on my clients’ experiences, the amount of information put forth by EHR vendors ranges from comprehensive to zero. One vendor was even worse than zero, putting out information that was incorrect and therefore placed their clients at risk. Clients who use web-based platforms where the vendor upgrades them automatically have one set of issues, where they have to keep up with the vendor’s plans and be ready to roll out workflows over which they have little control. At the other end of the spectrum are clients who can choose when to upgrade and which features to enable, which can lead to analysis paralysis.
Provider organizations are understandably worried about the certification status of their vendors. A recent surfing of the Certified Health IT Product List shows a shrinking number of vendors who have completed the most current certification. Those organizations that need 2015 Edition software installed before January 1, 2018 are understandably nervous, especially those that are large or complex. These are the kinds of organizations that are finding their way into my client pool, trying to completely avoid the pain of an upgrade by outsourcing the entire thing.
I’m not sure what other consulting organizations do, but the first thing I explain to these potential clients is that it’s very difficult to entirely outsource an upgrade (or a go live, or many other IT processes). There will always be parts of the project plan that require ownership and involvement by the client for best results. These steps may include decision-making around new features; training schedules; whether or not demonstration of mastery will be required; and user acceptance testing.
Regarding the latter, I’ve found that no matter how good your test scripts might be, there are always undocumented (and often aberrant) workflows that no one will know to test that will cause you heartburn on go-live day. The best way to avoid issues is to have actual end users perform user acceptance testing, rather than analysts or contractors.
Clients also need to have active involvement if there are decisions to be made around customizations. Whether to retire or retain customizations depends on whether the vendor’s workflows are equivalent to the customization or will create issues. Although a third party can make an objective analysis of the pros and cons, we sometimes don’t have the understanding of organizational culture that is needed to make the ultimate decision. I’m not saying we can’t do the majority of the heavy lifting for our clients, but we’re not going to allow them to completely abdicate all responsibility.
Another critical piece of upgrades that often involves organizational culture is the training plan. Clients need to take ownership of whether providers and end users will be pulled out of clinic for training, whether they will be compensated for training, whether it will be mandatory, etc. Although we as consultants can execute on whatever is decided, we can’t force an organization to mandate training for providers and ensure they actually show up. Sure, we can beg, plead, cajole, and even put monetary incentives around getting a client to perform one way or another, but ultimately the client has to participate in the process.
I went through the discovery process with a potential client last week, who has some major barriers between them and an upgrade. They’ve had near total staff turnover during the last two years and are three versions behind on their vendor’s software. They can’t find any previous project plans, testing plans, test scripts, or training plans from previous upgrades. They want to hire someone to “just take care of it,” but are reluctant to pay for the time it would take to document their existing workflows, create a testing strategy, determine a training plan, etc.
They keep mentioning that they are a community health center with limited budget, but don’t seem to appreciate that third-party vendors can’t give away their services for free. It makes for a very challenging business relationship, and with this particular prospective client, I’m not sure we’re ever going to have a relationship.
I’ve also run into some passive-aggressive clients who expect EHR vendors to spoon feed them information on various governmental programs while taking no accountability themselves. Although vendors can be good sources of information, clients still have to create their own policies and procedures and operationalize them to ensure compliance with regulatory programs. Your vendor isn’t going to stand behind your staff and make them perform medication reconciliation. Ultimately, provider organizations have to ensure that their staff members do their jobs and meet expectations.
My team provides first-line support for a handful of small practices. Sometimes there are basic workflow questions, such as, “How do I document XYZ?” Other times they’re outside of scope of EHR support.
One of those came in this week from a provider. He wanted to know how to document in the EHR that he disagreed with the nurse practitioner’s assessment and plan, and how to reject it and send it back to her. My team escalated it to me since it had medico-legal ramifications, so I got on the phone with the provider. I asked how he would have documented it in the paper chart and his answer confirmed what I suspected: he wouldn’t have documented it in the paper chart — he would have had a conversation with the NP, asked her to adjust the treatment plan, and then documented his review after the patient had been notified, etc.
I asked him why he would now want to have that liability-rich conversation in the electronic record rather than verbally. It took a few beats but he finally got my point, that there are certain things that just need to be done outside the EHR. But in some ways, he had become unable to think it through on his own, instead relying on the EHR’s workflows to direct him what to do.
I’m not sure what the answer is in these situations, but it’s good for those of us in the trenches to be able to commiserate.
What examples of learned helplessness are you seeing? Email me.
Mr. Rob C. Thomas II Acting Assistant Secretary & Chief Information Officer US Department of Veterans Affairs
Dear Mr. Thomas:
The decision whether to bring state-of-the-art innovations to the VistA electronic health record (EHR) system or to replace it with a commercial EHR such as Cerner, Allscripts, or Epic will have far-reaching and long-term repercussions, not just for the VA, but for the entire country’s healthcare system.
Several years ago, when Farzad Mostashari was head of ONC, I attended a conference (see post) where he stated that when talking with clinicians across the country, the number one issue he heard was that their EHR was unusable, that "the system is driving me nuts." After his presentation, we had the opportunity to talk. I asked him, given the dominant market share (nearly monopolistic for hospital-based EHRs) that a handful of EHR vendors were in the process of acquiring, where would innovations in usability come from? His answer was that they would come from new “front ends” for existing systems.
In your deliberations, I would urge you to consider how innovative front end EHR user interfaces, based on the science of Information Visualization, could improve our country’s healthcare system. The field of Information Visualization systematically designs interactive software based on our knowledge of how our high-bandwidth, parallel-processing visual system best perceives, processes, and stores information. Stephen Few describes the process as translating “abstract information [e.g., EHR data] into visual representations [color, length, size, shape, etc.] that can be easily, efficiently, accurately, and meaningfully decoded.”
Sadly, while EHR technology has almost totally replaced paper charting over the past decade, not much has changed in EHR user interface design. For a number of reasons, the major EHR vendors have not made it a priority to develop better front ends based on principles of Information Visualization. The adverse consequences for physicians and other healthcare providers, for patients, and for our entire healthcare system are immeasurable. An Institute of Medicine Report found that current EHR implementations “provide little support for the cognitive tasks of clinicians . . .[and] do not take advantage of human-computer interaction principles, leading to poor designs that can increase the chance of error, add to rather than reduce workflow, and compound the frustrations of doing the required tasks.”
A well-known example of an EHR user interface design contributing to a medical error is the 2014 case of Mr. Thomas Eric Duncan at Texas Health Presbyterian Hospital, where there was a critical delay in the diagnosis and management of Ebola Virus. No doubt, this case is just the tip of a very large iceberg because most major EHRs use similar design paradigms (and because many medical errors are never reported or even recognized, and even when reported, are rarely available to the public). In the most comprehensive study to date of EHR-related errors, the most common type of error was due the user interface design: there was a poor fit between the information needs and tasks of the user and the way the information was displayed.
Furthermore, current EHR user interfaces add to physician workflow. A recent study found that nearly half of the physicians surveyed spent at least one extra hour beyond each scheduled half-day clinic completing EHR documentation. In addition, current EHR user interfaces frequently fail to provide cognitive support to the physician.
Innovative EHR user interfaces, based on principles of Information Visualization, are the last free lunch in our country’s healthcare. EHR usability issues are becoming increasingly recognized as a major barrier to achieving the Triple Aim of enhancing patient experience (including quality and satisfaction), improving the health of populations, and reducing per capita costs. Well-constructed EHR user interfaces have the potential to improve the quality and decrease the cost of healthcare while improving the day-to-day lives of physicians. In my opinion, a well-designed EHR user interface would easily increase physician productivity by more than 10 percent, probably by much more, while reducing physician stress and burnout.
On the design front, innovative EHR front end designs, based on principles of Information Visualization, are already being created by a number of research groups, including Jeff Belden’s team at the University of Missouri (Inspired EHRs). See also my design for presenting the patient’s medical record chronologically using a dynamic, interactive timeline.
In addition, technological advances in computer processing speed and programming language paradigms now support the development of a comprehensive, open source library of interactive, dynamic Information Visualization tools. In this regard, see the work of Georges Grinstein and colleagues at the Institute for Visualization and Perception Research at UMass Lowell.
The beauty of building new front ends on top of existing EHR data bases is that the underlying data structure remains the same. This makes the design much easier to implement than if the underlying data base structure and software code had to be rewritten. Fortunately, all of the EHR systems being considered by the VA, including VistA, have excellent and robust underlying data base structure and organization.
The question then becomes, which EHR system is most likely to embrace intuitive visually-based user interface designs and make these designs widely available? In my view, the clear winner is VistA, for the following reasons:
VistA, unlike the other for-profit vendors, is government owned. Its goal can be to improve the VA’s and the country’s healthcare system.
VistA became a world-class EHR through its now famous open source model of distributed development, incremental improvement, and rapid development cycles. Using this same model, visually-based cognitive tools for the EHR could be rapidly created, developed, tested, and implemented. Commercial EHRs do not use the same development model and their development cycles are typically much longer.
VistA is the only EHR in contention which is open source. Any innovative user interface designs developed in VistA would be freely available to commercial EHR vendors and third-party developers and would thereby benefit our entire healthcare system.
A major federal health IT goal is for EHRs to “be person-centered,” permitting patients to aggregate, organize, and control their own medical records, regardless of the sources. Innovative user interface designs developed in VistA could, with modification, serve as the basis for an intuitive, open source patient-centered medical record.
If the VA’s goal in selecting an EHR, both for the VA and for the country as a whole, is to improve health outcomes, reduce costs and errors, and improve physician satisfaction, then VistA is the clear choice. Any other choice will set our country’s healthcare system back decades.
Rick Weinhaus, MD practiced clinical ophthalmology in the Boston Area until 2016. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.
US Surgeon General Vivek Murthy, MD, MBA resigns as the Trump administration announces its intentions to replace the ACA-supporting, Obama-appointed physician.
Serving as interim is Deputy Surgeon General Rear Admiral Sylvia Trent-Adams, BSN, RN, MSN, PhD.
Trent-Adams is the first non-physician to hold the role (either as interim or permanent) since veterinarian Robert Whitney served as acting Surgeon General for a few months in 1993. Whitney was at that time the first non-physician to hold the role since its creation in 1871.
Reader Comments
From Obi-Wan 2.0: “Re: HIMSS buying Health 2.0’s conferences. What’s your take?” I’m not sure I have a relevant opinion since, as an enterprise health system IT guy, I just can’t get interested in startups that often feature unoriginal or irrational ideas, spotty execution, questionable leadership, and naiveté about how to sell into health systems if indeed that’s their target market at all. That’s not to say that interesting companies never make it to the next level, only that I don’t waste time following the gaggle until they beat the long odds and actually do it (otherwise, it’s like scouting tee ball games to find future MLB stars). It’s a great exit for the Health 2.0 folks, who matched up with the only potential buyer who had the money and unbridled ambition to buy their conferences since HIMSS has to spend its profit on something relevant to its non-profit mission. In that respect, it’s a poetic ending since most of the companies in their universe dream similarly of finding a willing, deep-pockets buyer (for many of those techno-toddlers, it’s a race to cash out before the wheels come off). Matthew Holt and Indu Subaiya presumably get deservedly rich, while their ragtag band of pink socks-wearing, self-proclaimed disruptors who cling together seeking relevance among far bigger players are left to wonder whether they will find a comfortable home within Diamond Member-fawning HIMSS, the odds of which are not favorable. I’m not clear on what happens with the remaining parts of Health 2.0, or in fact what those parts actually are.
From Conga Dipper: “Re: Medhost. I doubt its website visitors are fluent in translating nursing benefits from Lorem Ipsum filler text.” Maybe it’s a sales message for prospects in Latin America.
From TxHIT45: “Re: MedStar. Interesting idea mixing ride-sharing and healthcare in this way.” Inexpert HIT fanboy site writers often misstate a hospital’s “partnership” with Uber for patient rides home as though it were hot technology news (failing to see that it’s no different than giving patients a cab company’s telephone number), but this is a bit more interesting. A Texas ambulance service’s nurses are triaging 911 calls and sending low-acuity callers a Lyft ride instead. It costs $450 to roll an ambulance, while that same amount covered all of the 38 Lyft rides it substituted in February. At least that’s a small step in trying to manage costs incurred by people who visit the ED for non-emergent conditions for a variety of reasons, some of them rational only because our healthcare “system” is anything but.
From Oregonian: “Re: Mid-Columbia Medical Center’s layoffs due to losses. The additional $3 million in unpaid debt appears to be due to legacy AR write downs as a result of the audit, which has nothing to do with what rev cycle product is being installed.”
From Reluctant Epic User: “Re: the MUMPS programming language. Made it to the top of Hacker News a few weeks ago with a lot of talk about Epic and Meditech. The 176 comments make common complaints that we’re mostly already aware of, but some of the defenders raise interesting points as well.” Some of the points made:
All variables are global and are named with a maximum of six capital letters.
Meditech writes all of its own languages, databases, operating systems, and tools.
Meditech’s new programming hires, most of whom aren’t computer science majors, go through a 6-12 month training program that allows them to succeed at Meditech, but they are stuck there because experience in a company’s proprietary language isn’t worth much elsewhere (a similar situation holds true for Epic developers, another commenter says).
“I find Epic to be more horrifying than Meditech because Epic has somehow managed to convince many healthcare workers that it is a ‘modern’ product worthy of praise despite all evidence to the contrary. People talk about SmartPhrases like it’s some miracle instead of a damn snippets manager (and a bad one at that). The fact that they’re moving away from VB6 to a web-based front-end in 2017 should be reason enough to assume that whatever they come out with is going to be excruciating.”
“The MUMPS codebase I worked on in the 80s was so fragile that deleting a single global string could cause the whole system to break down in ways that required a restore from backups. Don’t ask me how I know that.”
“A MUMPS program tends to be an unreadable mess to anybody who hasn’t touched it in the last 30 seconds.”
“I’m very, very happy to not be using this language any more. After my first year on the job, I read some JavaScript code and I nearly wept at how comparatively beautiful it was.”
“The tech stack was a real resume killer. I still get contacted by recruiters desperate for MUMPS developers and they make me feel like someone trapped inside a house besieged by zombies. I get really quiet and hope they don’t break any windows.”
“Companies like Epic are why healthcare costs in the US are huge and growing. Epic never refactors anything that still works well enough to hold together with some expensive human labor. It is a technology company that runs on well-trained people instead of well-designed code and processes.”
“I found Epic MUMPS to be remarkably readable. Lots and lots of documentation, quite consistent coding standards, and although I would have preferred to write SQL queries rather than MUMPS routines, I didn’t find it that abhorrent.”
From Big Data Hard Times: “Re: Atigeo. The analytics software firm seems to have been hit by hard times, listing 95 employees in April 2016 and now listing only 49. That seems to be the wrong direction for a company that received $18.5 million in VC investment in late 2015. I’m looking to including them as part of the vendor pool our hospital is looking at, but won’t if they are headed for the big data crunch in the sky.” Unverified. The company was founded in 2005, has received funding only through a Series B round, and lists no customers or recent sales on its site. The company’s “About” page grandly describes it as, “Atigeo is a compassionate technology company for a wiser planet,” which makes me think that maybe too much of that Series B money went toward hokey marketing. The company’s excessive tweeting dried up to nothing in October 2016, suggesting that something happened then (I like to think that the corporate tweeter was the “wiser planet” hack and the company wised up to their prior lack of supervision).
HIStalk Announcements and Requests
About half of poll respondents have volunteered to give up their seats on flights. Me being one, which worked great the two times my offer was accepted (most recently, I got a $400 voucher for giving up a seat to take a flight just three hours later). One reader recommended going for cash, not a voucher, and trying to wangle a first-class upgrade. Nick longs for the good old days when airlines sometimes offered a voucher good for a ticket to any domestic destination served by the airline. Everyone seems to agree that if you can get a seat on another flight that leaves shortly, or if you can choose a nearby airport and drive to your destination, it’s a pretty good deal.
New poll to your right or here: what will be the VA’s biggest challenge if it decides to implement Cerner or Epic?
Grammar peeve: the innumerable folks who write sentences such as, “The building houses 10 different companies,” apparently believing readers require the redundant clarification of “different” to comprehend that it’s not 10 of the same company.
Vocational dissonance: the puzzlement that results from trying to reconcile the lofty accomplishments and skills claimed by someone on their inflated, largely fictional LinkedIn profile with first-person knowledge that suggests far more modest capabilities.
We funded the DonorsChoose grant request of Mrs. O in Texas, who asked for programmable robots and electronics kits for her library maker space. She reports, “The technology that was donated is really helping my students become independent problem solvers. My students are learning to work with one another and most importantly communicate effectively with one another in order to learn how the new technologies work. Students come to the library in the mornings for about 50 minutes of maker space time and I give them the opportunity to use all the different technology. I provide a risk-free learning environment and give them this time to engage in creative play, but they don’t realize that they are really learning because they are having so much fun! Surprisingly, more girls than boys are attending the maker space technology days. I am really impressed that the girls are really drawn to creating things with the Little Bits.”
Listening: new from Chris Cornell, who in addition to his solo career is also lead singer and songwriter for both Soundgarden and Audioslave. He has an amazing voice and his compositions are strong.
This Week in Health IT History
One year ago:
Federal prosecutors launch a criminal investigation to determine whether Theranos misled investors about the state of its technology and operations.
UnitedHealth Group pulls its plans from ACA exchanges, citing $1 billion in losses.
CMS announces that it will hold off on publishing quality ratings for hospitals for several weeks amid questions from healthcare providers and Congress over its methodology.
Five-hospital health system Centra (VA) contracts with Cerner to replace EHRs in use at each of its hospitals and 50 ambulatory and long-term care facilities.
New York insurer EmblemHealth lays off 250 IT and operations employees after contracting with Cognizant to modernize its IT systems.
Five years ago:
Cerner CEO Neal Patterson makes the cover ofForbes in a piece called Obamacare Billionaires.
Mediware closes its $2.2 million acquisition of Cyto Management System, an oncology management system.
Thomson Reuters announces it will sell its healthcare unit to Veritas Capital for $1.25 billion in cash.
Liverpool Heart and Chest Hospital chooses Allscripts Sunrise, the company’s first sale to a UK trust.
Weekly Anonymous Question
I asked respondents to describe the most patient-endangering IT issue they’ve seen personally, with these responses:
Medication reconciliation that isn’t a priority, done well, or enforced.
The usability of patient identity functions being so bad in a new EHR that the front desk just defaulted to making a new patient record and let HIM sort it out. Who then … didn’t. We found it later in trying to do analytics in support of an ACO.
The way that our major commercial EMR vendor handles medications. When you make an adjustment in the med dose without issuing a new script, there is absolutely no way to show that as part of the formal medication history.
At a previous hospital, we had a EHR from a vendor whose name starts with Mc. It was mixing up sigs on medications, literally assigning them to the wrong patient and med in the database. Issue was quickly discovered and software was declared unfit for use and was yanked.
On an old system no longer in use, there was not any logic not to prevent a new line in the middle of a medication dose. It happened leaving ‘0.’ on the line above and 10 beginning the next line. It was not until a patient was injured and a very competent nurse was devastated during root cause analysis that this issue came to light. At the time there was a comment about the "stupid nurse," which made my blood boil.
Wrong med given due to system having order on wrong patient.
Lab labels generating on the wrong patients.
Oh, my God, this one still causes me panic. Zero-day architectural decision in erx by people with no concern for safety or even basic understanding of the practice of medicine caused the wrong prescription to be created, depending on how a medication was ordered. The mistake was invisible to physicians in the UX, due to yet *another* terrible design decision. Two patients received scripts that would have killed them, one was caught by the doctor who thankfully double-checked the printed rx, the other by the pharmacist.
Lack of a singular and accurate person identifier across all systems.
Letting unqualified people do patient merges.
Malfunctioning IV pump used (on me), supposedly to deliver much-needed pain medication after emergency orthopedic surgery.
Upper EMR managers: "If it saves the physician one click, nobody cares about the downstream effects to <insert department>.” Do the customization.
CPOE architecture that required only selection of a single generic name as the drug product despite the directions (it’s too hard for physicians to select a specific product or dosage form). The product would be automatically selected by the CPOE system. The first item alphabetically would always be selected, so for instance, all fentanyl orders would be sent as Fentanyl 100 mcg/hr patch whether instructions were 50 mcg IV q1h prn, patch, PCA.
Allowing entry of orders prior to allergy entry.
Suppressing all physician alerts. Everyone ELSE needs to deal with allergies, duplicates, and order requirements.
Endless customization and lack of standardization. It might seem like a great idea to have a zillion versions of the same thing and have unseen programming operating in the background, but it is not.
Implementation of an inpatient EHR that included a pharmacy and MAR application, where the MAR had incorrect doses listed.
This week’s question: If you are a former or current individual HIMSS member who either considered quitting or actually did so, what led to your decision?
Last Week’s Most Interesting News
Alphabet’s life sciences business Verily launches its Project Baseline initiative, a four-year project to create a database that will be used to look for early warning indicators for a variety of illnesses.
AMA introduces a web-based EHR training tool developed by Regenstrief Institute that uses the de-identified records of 11,000 patients with built-in medical histories going back as far as 40 years.
Theranos settles its ongoing legal battles with CMS over unsafe practices at its Newark and California labs and settles its legal battles with the Arizona Attorney General, agreeing to issue a full refund to all 175,000 Arizona residents who received Theranos blood tests.
The Phoenix VA Medical Center announces plans to partner with CVS to expand coverage locations, including local MinuteClinics.
HHS Secretary Tom Price, MD announces the availability of $485 million in state grants for combatting the opioid epidemic.
Webinars
April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.
April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
A hedge fund that is suing Theranos deposes 22 former company employees or directors who told it:
Theranos formed a shell corporation to buy commercial lab equipment from companies like Siemens, then modified the machines to run its proprietary finger-stick blood samples.
The company ran fake investor demonstrations of what it claimed was its innovative technology that was actually equipment sold by other companies.
The company’s financial projections for investors that called for $1 billion of annual profit in 2015 were vastly different from similar estimates provided to the IRS just two months later, which estimated $100 million in 2015 annual profit.
Sales
Stephens County Hospital (GA) will deploy Wellsoft’s EDIS including clinical documentation, CPOE, patient tracking, results reporting, and charge capture.
People
Voalte founder Trey Lauderdale returns to the CEO role. Former CEO Adam McMullin has left the company after a year “to pursue other opportunities.”
Announcements and Implementations
Video visit provider PlushCare launches Lemur, the telehealth EHR used by its 50 doctors. The announcement (and the fact that the company felt compelled to make one) suggests that PlushCare is commercializing its EHR, but I think it’s actually just pointless PR puffery in describing its internal-only product.
TransUnion Healthcare adds a prior authorization solution to its patient access offerings and enhances its existing eligibility product.
In Saudi Arabia, King Faisal Specialist Hospital and Research Center goes live on GetWellNetwork’s in-room interactive patient services.
RadmediX launches its urgent care digital radiology solutions.
Privacy and Security
Computer systems of Erie County Medical Center (NY) remain down following an April 9 ransomware attack.
A patient seeks class action status for her lawsuit against virtual visit vendor MDLive, which claims that the company’s app sends an average of 60 screenshots per visit to an Israel-based app performance testing company.
A proposed class action lawsuit claims that Bose’s wireless headphone app collects the music listening habits of users and that the company then then sells that information to other companies.
Government and Politics
Some AMIA members participated in Saturday’s March for Science in Washington, DC and other locations, which depending on your point of view was created to: (a) protest the Trump administration’s policies; (b) highlight scientific acccomplishment; or (c) influence the government keep taxpayer dollars flowing into the pockets of scientists via federal research grants.
Innovation and Research
Atlanta NPR reviews blockchain in healthcare, with the CEO of one personal health record startup unconvincingly explaining why she’s trying to duplicate the health record storage practices of Estonia, 95 percent of which involves blockchain. A blockchain-related vendor disagrees in saying that blockchain isn’t good at storing large amounts of data, instead suggesting that its healthcare use focus on storing digital signatures of patient records to maintain an access log of who has viewed them.
Apple hires Steven Keating, the MIT mechanical engineering PhD who is best known for creating a 3-D printed image of his own since-excised brain tumor (he’s still on chemo). He described in a conference presentation last week that he learned from his experience in collecting 75 gigabytes of his own health information (his “medical selfie”) that it’s hard for patients to obtain their own data:
My doctors are incredible for sharing my data and encouraging me to learn more from it. However, the process raised some questions for me, as I received my data on 30 CDs, without easy tools to understand, learn, or share, and there was no genetic data included. Why CDs? Why limited access for patients to their own data? Can we have a simple, standardized share button at the hospital? Where is the Google Maps, Facebook, or Dropbox for health? It needs to be simple, understandable, and easy, as small barriers add up quickly. Imagine having your whole medical record that you could not only share with doctors and scientists but also with friends and family, too. Patients could get second opinions very easily, and doctors can follow what leaders in the field are doing.
Other
The dean of Stanford’s medical school says that “innovation is at the algorithmic level,” predicting that significant medical and health advancements will be driven primarily by the ability to interpret huge datasets.
Kaiser Permanente Chairman and CEO Bernard Tyson tells the Nashville Health Care Council that the future isn’t in “heads in the beds,” but rather in virtual visits. He asked the 300-plus attendees how many of them can do as he can in pulling up their medical record on their phones, which resulted in fewer than a dozen raised hands. Tyson also says KP is mimicking the Starbucks concept of community and coffee in creating buildings that provide walking paths, healthy foods, and areas where people can study and share health information.
A Reaction survey finds that nearly half of McKesson customers didn’t know that the company was spinning off its IT business with Change Healthcare, although both customers and non-customers were neutral about the potential effects and nearly no respondents say they’re more likely to buy products from the new company.
Bizarre: men are signing up for telemedicine visits using false IDs just to flash their video-connected doctors. Sherpaa says people have sent its doctors more than 30 unrequested penis photos, while American Well explains that as with face-to-face medical visits, the solution is to ban problematic patients and to verify all IDs by credit card. A guy must really be desperate to showcase his package to unwitting viewers if he’s willing to pay telemedicine fees to do so. Armed with this newfound knowledge, I’m sensing a business opportunity in creating an app that matches pervs to people willing to look at their private parts for cash (my working name is Glory Telehole).
A doctor in England faces suspension for looking up a patient’s personal details in her medical record; using her information to contact her to suggest having sex with him to help restore sensation in her genitals that had been reduced by multiple sclerosis; and then discouraging her from researching her condition in assuring her, “Trust me, I’m a doctor.” The married urologist’s version of the story is that the woman asked him for sex.
Vince and Elise review physician practice EHR vendors. I would, however, be cautious about assuming that each vendor’s client base can be inferred by the number of MU user attestations, especially given vendors like Epic that have relatively few (but also relatively large) health system customers that have lots of doctors as employees and affiliates.
Sponsor Updates
TierPoint completes its most recent round of HIPAA, PCI-DSS, GLBA, and SOC 2 Type II annual compliance audits.
ZeOmega introduces the Jiva Consultant Certification Program.
Employees of Clinical Computer Systems, Inc. raise $10,500 for the March of Dimes annual fundraising walk.
Visage Imaging will exhibit at ConHIT April 25-27 in Berlin.
First Databank Senior Director of Clinical Knowledge Charles Lee, MD will present the company’s recently acquired Meducation solution at Health Datapalooza this week.
ZeOmega will exhibit at Health Integrated Empower April 26-28 in St. Petersburg, FL.
ZirMed publishes a new infographic, “Riding the Sea of Change.”
Spok posts a case study of Hospital for Special Surgery’s use of Care Connect for medical, gas, and fire alarm alerting.
Cybersecurity company Tanium puts its own client’s network at risk by using an installation of its software at El Camino Hospital (CA) to do product demonstrations for two years without permission, revealing server and computer names, employee information, and real-time security vulnerabilities during the demonstrations.
National Coordinator for Health IT Don Rucker, MD publishes a paper suggesting that analyzing telecommunication activity within healthcare settings may help developers target clinical workflows in need of redesign.
The Advisory Board Company EVP Jon Kontor, MD offers a primer on how to optimize EHRs to be able to better manage clinical and financial risks within value-based payment models.
Alphabet’s life sciences business, Verily, launches its Project Baseline initiative, a project aimed at creating a database that will be used to look for early warning indicators for a variety of illnesses. The project will sequence the genomes of 10,000 volunteers, and then use an activity tracker to monitor a participant’s sleep, activity, heart rate, and other health metrics over the next four years.
Reader Comments
From Not Surprised: “Re: HIMSS buys Health 2.0. HIMSS continues to gobble up industry trade shows, this time opting for one that it hopes will ‘make it possible for HIMSS to have a greater influence on the cutting edge of health IT.’ While I’ve never been to a Health 2.0 event, I always got the impression that it was a far more energetic, grassroots affair than the typically straitlaced HIMSS events. Healthcare IT is already filled to the brim with boring suit-and-tie shindigs that, instead of moving the industry forward, serve only to line the pockets of organizers. I can only hope that this deal won’t result in Health 2.0 losing its edge.” HIMSS has indeed acquired the Health 2.0 conferences, which now span five continents. Health 2.0 CEO Indu Subayia, MD will join HIMSS as an EVP, while co-chairman Matthew Holt will move into a consultant role.
HIStalk Announcements and Requests
This week on HIStalk Practice: Providence Medical Group plans roll out of Chiron Health telemedicine services. GAO report outlines challenges, benefits to Medicare telemedicine programs. CMS proposes MU reporting changes, exceptions, and exemptions. Evans offers ambulatory providers emergency preparedness protocols. Michigan goes live with new PDMP. Practice EHR, Sequel Systems announce e-prescribing capabilities. Grand Rounds opens its first East Coast office. MDLive faces class-action lawsuit for alleged patient privacy violations. Thanks for reading!
Webinars
April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.
April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Cardinal Health will acquire Medtronic’s Patient Care, Deep Vein Thrombosis and Nutritional Insufficiency businesses for $6.1 billion in cash.
Siemens Healthineers will acquire Medicalis for an undisclosed sum. Siemens plans to fold the San Francisco-based company’s clinical decision support, imaging workflow, and referral management technologies into population health management line.
Care Innovations will relocate and expand its R&D center in a $1.7 million project that will create 24 jobs in Louisville, KY. The Roseville, CA-based home health and remote monitoring company – a joint venture between Intel and GE – opened its first office in the area 18 months ago.
People
James “Butch” Baxter (Santa Rosa Consulting) joins Nashville-based secure messaging vendor Medarchon as CEO. Founder Baxter Webb will take on the role of chief strategy officer.
Announcements and Implementations
LifeBridge Health (MD) moves forward with an enterprise-wide roll out of Cognizant’s Onvida communications software.
NTT Data Services will offer Praxify’s Mira voice-enabled charting technology.
Technology
Experian Health works with MyHealthDirect to add patient self-scheduling to its line of self-service payment tools.
Surescripts develops an accuracy monitoring tool for e-prescribing to help providers and pharmacists reduce callbacks and faxes, and better understand utilization patterns.
Healthgrades rolls out CareChats to help providers and patients stay in touch between appointments. The automated text- and email-based communications software integrates with the company’s CRM.
ImageMoverMD creates a Web-based solution to import medical images into a user’s EHR.
Sales
Arkansas Surgical Hospital selects PeerWell’s PreHab mobile app to help patients prepare for and recover from joint replacements.
Hill Hospital of Sumter County (AL) will add CPSI subsidiary Evident’s Thrive EHR to its existing Evident financial management tech.
Privacy and Security
Tanium finds itself in hot water after the Wall Street Journal reports that the cybersecurity company tapped into live hospital networks without permission during product demos between 2012 and 2015. Desktop and server management details were exposed, with some even showing up in videos. While patient data was not compromised, providers like former Tanium customer El Camino Hospital (CA) are not taking the intrusion lightly. “We are dismayed to learn that desktop and server management information was shared,” a hospital spokesperson told the WSJ. “We are thoroughly investigating this matter and take our responsibility to maintain the integrity of our systems very seriously.”
Government and Politics
At a meeting earlier this week with White House officials, health insurance lobbyists and executives seeking assurances that subsidies would continue to be paid for low-income consumers buying individual marketplace plans – a step seen as critical to stabilizing the individual markets – were given no assurances and were instead told to take the matter up with Congress.
Innovation and Research
Nearly a month after Elon Musk announces his intent to develop an implantable brain-computer interface, Facebook unveils its plans to develop a similar interface that lets you type with your thoughts. The ultimate goal, according to Facebook researcher Regina Dugan, is to develop an interface that enables a person to to type even faster than they could with their hands, at close to 100 words per minute.
Other
AMA introduces a web-based EHR training tool developed by Regenstrief Institute that uses records from 11,000 de-identified Eskenazi Health (IN) patients with built-in medical histories going back as far as 40 years. The EHR training platform includes functionality based on Meaningful Use Stage 2 certification criteria so that the workflows will be similar to what residents will see in a hospital setting. I interviewed Regenstrief Institute CEO and Indiana University School of Medicine Professor Peter Embi, MD last month.
Sponsor Updates
Intelligent Medical Objects will exhibit at the European Federation for Medical Informatics meeting April 24-26 in Manchester, England.
LogicWorks will exhibit at the Alert Logic Cloud Security Summit April 26 in New York City.
MedData will exhibit at the HFMA Hawaii annual conference April 20-21 in Honolulu.
Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Florida Perinatal Quality Collaborative meeting April 27-28 in Tampa.
PatientKeeper will exhibit at the MUSE Community Peer Group-Canada East Coast April 27 in Nova Scotia.
Optimum Healthcare IT publishes a new infographic, “The Importance of Data Security.”
PokitDok cofounder and CTO Ted Tanner will present at Business and the Blockchain April 24-25 at Rice University in Houston.
Sphere3 Consulting moves into new office space in St. Joseph, MO.
Surescripts will exhibit at Health Datapalooza April 27-28 in Washington, DC.
PMD makes the San Francisco Business Times 2017 Best Places to Work list.
The Leapfrog Group released the most recent iteration of its Hospital Safety Scores, grading over 2,600 hospitals from A to F. Transparency is a good thing, but I was surprised to see how some of my local hospitals (including a world renowned tertiary care center) fared. In going through the detail, it looks like there were several areas where they declined to report, but another is confusing. They scored low on “specially trained doctors care for ICU patients,” which is funny because they have one of the leading critical care fellowship programs and all patients are cared for by intensivists. The average patient isn’t going to be knowledgeable enough to dissect the rankings. Several smaller hospitals in town received A rankings but I still wouldn’t go there for a cardiac procedure or other specialized surgeries.
CMS announces upcoming webinars regarding the Achievable Benchmark of Care (ABC) and five-star rating programs. The data will appear on the Physician Compare website, so clinicians should become familiar with what their patients are seeing. I have need of a new specialist, looked up the physician I am considering, and didn’t find any information that helped support (or contradict) my choice. The webinars will be hosted:
I’ve been receiving encrypted summary-of-care records from one of my local hospitals, for patients who used to be mine when I was in traditional family medicine practice. The most recent one was over 145 pages long and contained every single laboratory test performed on the patient, including bedside blood glucose testing performed four times daily. Somehow I’m still listed as the primary care physician of record for this patient, which is surprising because he lives in a group home and has to have orders reauthorized every six months, so he must be seeing someone in the community who should have received this document instead of me. A call to the hospital wasn’t helpful, and I’m planning to call the group home to try to straighten it out myself. I assume that if this data was directly imported to my EHR it would make sense, but as a 145-page PDF it’s pretty overwhelming. The best part of it was the discharge diagnosis: “Recent Acute Hospitalization.”
I recently had lunch with some of my physician colleagues and the recent approval of direct-to-consumer genetic testing was a hot topic. Since I just went through genetic counseling and testing, I decided to investigate the 23andMe process. It’s easy to order the testing package – no more challenging than ordering something on Amazon. However, I got to the “enter your payment information” screen without any mention of some of the critical things that patients should consider before they have genetic testing: Do they have adequate disability and life insurance in place, should something be found? Is there a concern regarding long-term-care insurance? Are there concerns about a specific disease process or does the patient want a “shotgun” approach? I’m not sure the average person is going to think about these things and I would have liked to have seen them at least mentioned before consumers plunk down $199 for a testing kit. I opted to proceed conservatively with my recent testing and only test for a single mutation, which ended up being present. I was able to use the results to justify why I need early screening. I wonder if insurance carriers will accept data from 23and Me to justify early intervention. The panel that they offer to consumers looks a little scattered. I’d be interested to hear from anyone who has had testing with them.
I’ve been working through some continuing education and maintenance of certification (MOC) activities over the last week and have come to the conclusion that sitting for my family medicine board exam next year is going to be more of a challenge than I thought. The MOC activities are making me crazy with their “which is the most appropriate intervention” questions when all of the choices present are appropriate interventions. The definition of appropriate can be nebulous. Which is the most appropriate from a cost/utilization perspective? From a patient satisfaction perspective? From a patient acceptance and compliance perspective? Does the patient have insurance? Are they working three jobs? Determining the appropriate intervention for a given patient takes many more factors into account than statistical minutiae. Is the difference between 28 percent and 33 percent statistically significant enough to merit spending time on analyzing what the right answer is supposed to be?
It’s also particularly challenging for those of us that no longer practice what our board certifying organization considers to be full spectrum family medicine. Although I delivered over 150 babies, the last one was more than 15 years ago, but I’ll still have to field OB questions. Even if I wanted to give up my clinical certification and keep my informatics certification, I can’t do that since informatics requires primary certification from another board. Losing board certification is the kiss of death for insurance credentialing, so if I want to play the game and keep seeing patients, or keep being a board certified clinical informaticist, I’ll need to comply.
Wisconsin has designated this week as Healthcare Decisions Week and encourages people to complete an advance directive to document their wishes for end-of-life decision making. It’s unfortunately not enough just to have the document, but people need to talk to their loved ones about their wishes and why they have made particular decisions. We had one of these conversations at a recent family gathering and it was instructive, with revelations about what people did or did not want as far as medical treatment and funeral arrangements. As a physician, I’ve seen many arguments about care, and having both the conversation and the documentation is the best way to make sure your wishes are honored. It’s also not just for older people – there are plenty of things that go wrong with routine happenings like childbirth or small elective surgeries, so everyone should be prepared.
AMA introduces a web-based EHR training tool developed by Regenstrief Institute that uses records from 11,000 de-identified patients with built-in medical histories going back as far as 40 years. The EHR training platform includes functionality based on Meaningful Use Stage 2 certification criteria so that the workflows will be similar to what residents will see in a hospital setting.
Alphabet’s life sciences business Verily launches its Project Baseline initiative, a 4-year project aimed at creating a database that will be used to look for early warning indicators for a variety of illnesses. The project will sequence the genomes of 10,000 volunteers and then use an activity tracker to monitor participant’s sleep, activity, heart rate, and other health metrics over the next four years.
A study published in Nature finds that sharing exercise activity over social networks does have a positive influence on the exercise habits of friends.
At a Tuesday meeting with White House officials, health insurance lobbyists and executives seeking assurances that subsidies would continue to be paid for low-income consumers buying individual marketplace plans, a step seen as critical to stabilizing the individual markets, were given no assurances and were instead told to take the matter up with Congress.
Theranos settles its ongoing legal battles with CMS over unsafe practices at its Newark and California labs, agreeing that it will not own or operate a clinical laboratory for the next two years in exchange for reduced monetary penalties.
Theranos also settles its legal battles with Arizona Attorney General, agreeing to issue a full refund to all 175,000 Arizona residents who received Theranos blood tests.
Cardinal Health announces that it will acquire Medtronic’s Patient Care, Deep Vein Thrombosis and Nutritional Insufficiency businesses for $6.1 billion in cash.
Tail tucked between its legs, Theranos agrees to exit from the lab-testing business for two years as part of deal with CMS that will reduce its fine to $30,000 and reinstate its operating certificates. What’s left of the company’s employees are supposedly “looking forward” to helping Theranos work with regulators to commercialize its miniature lab-testing device.
Theranos also settles its legal battles with the Arizona Attorney General, agreeing to issue $4.65 million in refunds to all 175,000 Arizona residents who received Theranos blood tests over the last four years.
Webinars
April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.
April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Announcements and Implementations
Livongo Health will add Glytec’s EGlycemic Management System to its line of digital diabetes management tools.
Lancashire Teaching Hospitals NHS Foundation Trust in the UK adds integrated medication management to its implementation of Harris Healthcare’s QCPR EHR. Like all NHS facilities, Lancashire Teaching Hospitals hopes to go paperless by 2020.
Prime Healthcare ACO (CA) implements population health analytics and benchmarking from Persivia to assist its 70 practices with 2016 reporting requirements.
Grays Harbor Community Hospital (WA) will continue its use of CipherHealth’s post-discharge patient engagement technology and protocols after a four-month pilot that saw patient satisfaction increase and hospital readmissions decrease.
Acquisitions, Funding, Business, and Stock
HCA reports Q1 results: Revenue climbed to $10.6 billion compared to $10.2 billion in Q1 of 2016. However, net income dropped from $694 million to $659 million over the same time period; EPS $1.74 vs. $1.69. Revenue and net income missed analyst estimates, sending share prices down yesterday 3.6 percent.
UnitedHealth reports an increase in revenue and profits after exiting from the ACA exchanges. It expects a $3 billion increase in revenue over 2016, and a net income of $2.17 billion. The company predicts EPS will increase to between $9.65 and $9.85, compared to last year’s $9.30 to $9.60.
Mid-Columbia Medical Center (OR) attributes last week’s round of layoffs – its first in 20 years – to budgetary pressures related to its transition to Epic, as well as fewer patient visits during harsh winter months and uncertainty around Medicaid and Medicare reimbursements.
People
Kevin Hill (Leidos) joins Orchestrate Healthcare as area VP Southeast.
BJC HealthCare (MO) hires Jerry Fox, Jr. (Rockwell Automation) as SVP and CIO.
Sales
Wake Forest Baptist Medical Center signs a seven-year contract with Atlanta-based NThrive for outpatient RCM services.
Government and Politics
The VA awards Leidos company Systems Made Simple a potentially $29 million contract for IT development and support of its Repositories Program, which helps facilitate the sharing of health data between the VA, DoD, and other agencies. Leidos acquired Systems Made Simple as part of its $4.6 billion acquisition of Lockheed Martin’s IS and global services business last year.
A Black Book report evaluating Epic, Cerner, Allscripts, Meditech, and Athenahealth says Cerner is the best EHR vendor to replace VistA within the VA. The market research firm based its findings on customer satisfaction and how well each vendor’s offerings line up with the VA’s requirements. Allscripts and Epic round out the top three choices. The DoD, as you may recall, has opted to replace its AHLTA system with Cerner’s EHR. Fairchild Air Force Base went live in February; a full roll out is expected within the next four years.
The Air Force rebrands its MiCare patient communications portal to TOL Patient Portal Secure Messaging – the same name used by Army and Navy facilities.
The Phoenix VA Health Care System partners with CVS Health to increase access to care for veterans. Phoenix VA nurses can now refer patients to local MinuteClinics as part of the Veterans Choice Program. CVS entered into a similar arrangement with the Palo Alto VA HCS last year.
Privacy and Security
Erie County Medical Center continues to recover from a virus that shut down its IT systems April 9 – a process that has involved returning to paper charts; scrubbing 6,000 hard drives; and enlisting the help of IT specialists from neighboring Kaleida Health and Catholic Health, its EHR vendor, Meditech, GreyCastle Security, and Microsoft. The hospital has yet to confirm it was the victim of a ransomware attack.
Virginia Mason Memorial (WA) notifies 419 ER patients that their medical records had been improperly accessed over a three-month period last year by 21 employees. “We believe this to be a case of snooping, or individuals who were bored,” says Chief Compliance and Privacy Officer Trent Belliston. “[There is] no evidence that the information’s being used in an improper way.”
Other
The HHS Idea Lab previews Health Datapalooza, which will take place April 26-28 in Washington, DC, and include the launch of challenges related to patient matching and health behavior data.
Sponsor Updates
Besler Consulting releases a new podcast, “Episode Payment Model final rule explained.”
KLAS includes Casenet’s TruCare platform in “Best in KLAS for Care Management Solutions” for 2017.
Cumberland Consulting Group will sponsor and present at the Model N Rainmaker Conference April 24-26 in Miami.
ECG Management Consultants will present at The Governance Institute – Leadership Conference April 23 in Scottsdale, AZ.
Elsevier Clinical Solutions makes available a HIMSS presentation featuring BIDMC CIO John Halamka’s thoughts on the future of health IT.
EClinicalWorks will exhibit at the MPCA Spring Symposium April 19-20 in Helena, MT.
HCS will exhibit at the NALTH Spring Clinical Education & Annual Meeting April 20-21 in San Antonio.
Huntzinger Management Group’s Tanya Freeman joins the AEHIA Board of Directors.
Conduent’s pharmacy benefit management module, Conduent Flexible Rx System, receives federal certification in the state of Montana.
A Black Book report evaluating Epic, Cerner, Allscripts, Meditech, and Athenahealth says Cerner is the best EHR vendor to replace VistA within the Department of Veterans Affairs.
HCA reports Q1 results: revenue climbed to $10.6 billion compared to $10.2 billion in Q1 of 2016, however net income dropped from $694 million to $659 million over the same time period, EPS $1.74 vs. $1.69. Revenue and net income missed analyst estimates, sending share prices down 3.6 percent Monday.
A JAMIA study on dashboard-based support tools aimed at reducing 30-day all-cause readmissions for heart failure finds that readmission rates were pushed downward from a 14 percent baseline to 10.1percent after the implementation of dashboards.
Several of my friends in medicine, engineering, and other high-tech fields participate in decidedly “traditional” craft projects in their leisure time. I’ve got a handful of friends who make soap, and many others who knit, crochet, quilt, sew, cross stitch, needlepoint or do woodworking, stained glass, or paper crafts. I see a fair amount of people at professional conferences who are knitting or crocheting during sessions. I have a lot of respect for them, because those are two skills I can’t master. My grandmother tells me I used to be a proficient knitter as a child, and even made a set of golf club covers, but based on recent attempts to master knitting I can’t imagine how the club covers came to be, despite the fact that one or two of them are still in my garage.
Except for the yarn-related projects, several of my friends use technology to augment their abilities. When you spend a good chunk of your life pursuing a professional career, there’s not a lot of time to build leisure/hobby skills. Many of us spent our teens trying to get into competitive colleges, then our college years trying to get into graduate programs, etc. If we’re physicians, we may have a three to seven year “black hole” called residency in our lives from which no free time escaped. Now that we have leisure time, we want to be able to make cool-looking projects without waiting years to hone our crafts.
Over the past year, I’ve gotten deeper into a hobby that requires a bit of computer assistance, and it’s been a great stress reliever as well as a lot of fun. I’ve met some great people, several of whom are former healthcare types who have gone into the hobby as a business in part to get away from the stress of healthcare. There are also some former teachers, who are happy to take relative youngsters under their wings and point us in the right direction. Being in a competitive “day job” world where collaboration isn’t always valued, it’s been great to have people I can call or text when I get stuck or need a few tips. Thank goodness for the night owls, who are up crafting past midnight just like I am.
Over the past month or two, though, I’ve seen several parallels to healthcare IT. The equipment I purchased to do my hobby work is from a manufacturer that dominates the market. They value their customers and understand that the work that they do is a big part of what has built their reputation as a vendor. They’re a company that started from small-town roots and grew by word of mouth and then regionally, and now have customers all over the world. They also know they have people hooked, and that the cost to change to another vendor would be significant, not only from the equipment standpoint but due to downtime, lost knowledge, etc.
Every couple of years, they issue a major software release. I came into the market in 2016 on what was then the latest and greatest software, which honestly I have very few complaints about. More than 90 percent of the time when I’ve run into trouble, it’s been due to user error or some other problem between the keyboard and the chair. Still, I am looking forward to the new software and the potential that it might bring, especially as a relative newbie to the hobby. In releasing the new package, the vendor took a couple of departures from its previous practices but that from my IT viewpoint are pretty common place. They released a list of hardware specifications required for the new software. They also distributed a beta version to the client base, along with a list of features and enhancements, and a list of known issues. They gave clear direction that formal training would not occur until general release, and set up a process for reporting defects.
As in informaticist, I followed this process closely, particularly with regard to how the end users would adapt to this. Most of the end users are in their 50s or 60s, and many began the hobby in a non-automated fashion, transitioning to automated methods when they became available. In so many ways it parallels what we see in healthcare IT. I wanted to understand how they would react to change and what similarities or differences there would be from clinical end users. I belong to a couple of independent online support groups, as well the vendor-sponsored blogosphere, so I could see the dialogue in multiple venues.
It’s been surprising how similar the user psychology is to what we see when we’re talking about an upgrade or update to an EHR system. The user community is going through the cycle of grief, lamenting the process even though they’re being allowed to stay exactly where they are, if they want, without penalty. The vendor is committed to supporting every user on every version across the globe, which is largely unheard-of in the world of certified healthcare IT. And yet, people are yelling that the sky is falling, despite the fact that they don’t even have to change at all. I’ve worked with users who have been on the same old software since 1998 and they produce beautiful work that I couldn’t even dream of creating with brand new equipment. They’re efficient, productive, and creative yet are balking at the mere idea of an upgrade that they might have to or want to consider.
The biggest issue is the hardware requirements – the vendor is requiring that users move to a vendor-supplied PC to drive their hardware, which probably 80 percent of the customer base is already on. For those who don’t want to upgrade, they can stay right where they are and be supported, or they can buy the latest and greatest. There has been a great deal of angst among people who don’t understand the difference between Windows XP, Vista, 7, 8, and 10, and also some outright resistance to knowledgeable individuals who try to explain the difference and the various benefits of upgrading. At times, when I read the conversation threads, I feel like I’m right back in healthcare IT.
I’m not a huge fan of installing beta software, especially for a hobby at which I’m just becoming proficient. I decided to wait for the general release, until I had the opportunity to attend a class fairly close to home. One of the certified vendor trainers was going to be an hour and a half away, so I decided to go despite wanting to have my first look be a GR version. The class was an all-day affair, and again, I looked at the parallels to healthcare IT. At Big Hospital, providers balked when we asked them to be out of office for a half day to learn about a pending upgrade, even though it was going to change their workflow and they’d benefit from formal training. Many tried not to go and the decision ended up haunting them. Instead, I was surrounded by people who chose to close their businesses for a day to learn the latest and greatest, or to at least see what it had to offer them. Despite the turmoil on some of the online communities, in person people were very reasonable and willing to learn. How different would some of our EHR upgrades be if we had people willing to put in enough time to learn about software changes?
In addition to learning about the upcoming changes, one of the greatest benefits of going to training was meeting new people and creating new networking opportunities so that I can be better at what I’m trying to do. The same benefits could come from EHR training, if we could get people to acknowledge that just because it has to do with the EHR it’s not inherently undesirable. I met some serious super users who were happy to share their knowledge with a new user, and also learned some tips and tricks that I can do immediately without waiting for the upgrade. I was also gratified to learn that I must not be the only person making a mistake I make commonly, because the vendor has tweaked the software to reduce the impact of that particular workflow issue. Like many EHR vendors, they’ve also done a fair amount of usability work (some very formal, according to our instructor). Where people were surprised by the seeming blandness of the user interface, the instructor explained why they did it the way they did, and how other features were added to address users with low vision or other functional limitations.
If I wasn’t experiencing some serious déjà vu then, I really was when she mentioned that it wasn’t just an update of the workflows, that they had completely gotten off their old code base and had rewritten the program on a new platform. Then we launched into a discussion about making sure you are on the right version of the .NET framework, and I knew I had truly fallen down the rabbit hole. I did walk away from the experience with some new ideas about how to train and how to reduce anxiety for end users, which will translate nicely from the craft space to the healthcare IT space. I met several professional educators who experience similar challenges as I do, that I can stay in touch with ongoing. I got some great ideas about different ways to use my equipment, and some workarounds that I had never thought of for sticky situations.
All in all, it was a good opportunity to see that what we deal with in healthcare IT isn’t as unique as we think it is. Sure, there are some nuances, but there is a lot we can learn from other industries, processes, and people. What’s your favorite craft project? Email me.
In New Jersey, a program is being launched to move the documentation of end-of-life care decisions off of paper and onto a state-wide database that will integrate with EHR systems in use across the state’s hospitals.
The Wall Street Journal profiles RWJBarnabas (NJ) CISO Hussein Syed and his approach to maintaining the network security across his organization’s 12 hospitals, 250 clinics, and 75,000 devices.
The Advisory Board outlines the implication medical marijuana legalization is having on care delivery, and the potential role health IT will have in educating providers on the appropriate strains, dosages, and methods of ingestion.
The New York Times reviews 5-year results from a program in New York State aimed at improving early detection of sepsis in hospitals. The program has resulted in a 21 percent decline in mortality among adults, but showed no decline in pediatric mortality.
April 16, 2017NewsComments Off on Monday Morning Update 4/17/17
Top News
The FDA issues a warning letter to St. Jude Medical – acquired by Abbott Laboratories in January – for failing to respond to cybersecurity vulnerabilities that could allow a hacker to control implanted devices remotely and for failing to address battery issues that have been linked with two deaths. The warning comes three months after the FDA issued a similar notice warning St. Jude of the vulnerabilities. Further inaction could result in disciplinary actions that include “seizure, injunction, and civil monetary penalties.”
Reader Comments
From Athenahealth Spokesperson: “Re: ‘Will Athena be able to deliver, on time, for hospitals MU3?’ Athenahealth offers cloud-based revenue cycle and financial management, EHR, patient communication, and care coordination services for community hospitals. All of these services are on one platform, AthenaNet, which enables a single patient chart and a seamless Athena “look-and-feel” across the health system – inpatient, ED, outpatient, clinic, and ancillaries. The RazorInsights platform has been completely sun-setted. As of December 2016, we have over 90 contracted hospital clients, of which 35 are live on all or a portion of our AthenaOne for Hospitals & Health Systems service. These organizations are already seeing tangible results. For example, our clients saw an average of 106.5 percent of patient collections as a percentage of baseline during 2016. Stage 3 Meaningful Use is optional in 2017 and mandatory in 2018. Currently, AthenaClinicals for Hospitals & Health Systems is a 2014 Certified EHR Technology (CHERT), which allows our clients to pursue Stage 2 Meaningful Use this year. We plan on achieving 2015 CHERT status, which is required for Stage 3, in the second half of 2017. Thanks to our cloud-based platform, we can deploy the Stage 3 update to our entire client base overnight. All of our Meaningful Use services – a certified platform, real-time performance insight, performance coaching, and attestation – are included in our percentage of collections pricing. Our clients don’t have to pay hefty upgrade fees or endure cumbersome upgrade rollouts. Our results prove that our model works: 95.7 percent of our hospital clients successfully attested for Stage 2 Meaningful Use in 2015. We expect similar results for 2016, which will become available in the coming weeks.”
HIStalk Announcements and Requests
Just over a third of poll respondents teeter on the edge of full-blown enthusiasm for using at-home genetic testing kits to better understand their hereditary health risks. An almost even number of people are as eager to order their spit kit as are to likely not. No matter how you slice and dice the results, they are likely music to 23andMe’s ears – not to mention known competitors and those contemplating moving into it. MPW says, “I utilized their service a few years ago when some members in my family were testing positive for the same genetic abnormality, and have had no regrets. One thing to remember if you’re looking into this is that discovering a propensity for a trait does not mean it is an eventuality. For example, I’m listed as likely lactose intolerant. However, my Wisconsin roots and love for almost all things dairy says otherwise.” MineoPie explains that, “I voted ‘highly likely’ as my practical side sees the opportunity to plan appropriately whether that be treatment, an increase in health, life or long-term care insurance, or general peace of mind. There is also the potential to share these risks with my children for their own well-being. While I vacillate between this view and the one where I stick my fingers in my ears while yelling ‘la la la I can’t hear you,’ I ultimately see more benefit in having the data. Then I read the response from ‘no name’. I certainly share the concern that any negative results will not be proprietary leading to increased insurance costs and general shunning. I’m reminded of the Monty Python & The Holy Grail scene (‘I’m not dead yet, I think I’ll go for a walk’). Perhaps I’m more on the fence that I realized.” Barbara, on the other hand, thinks that “the public availability of this information will be used as a detriment in the future, i.e. insurance rates will go up, misinformation will be provided by targeting populations through Google/Facebook adds, etc. Not to mention the lack of professional interpretation resulting in self diagnosis, which could result in personal hysteria. This has already been evidenced with the advertising of medications and patients demanding of their physicians they be given this new, wonderful medication that may not be suitable for their situation. This should be done professionally where confidentiality is supported by both federal and state laws. No Name takes an even dimmer view: “I wish I trusted my government and insurers more, but don’t. I am now retired, but if I were still working, I don’t think I’d trust any employer to not use this info to possibly discriminate against employees who might prove to be high risk. Yep, that’s just the way it is.”
New poll to your right or here: Have you ever volunteered to be bumped from a flight? Share your circumstances – and the cash value you finally jumped at – by leaving a comment after voting.
This Week in Health IT History
One year ago:
CMS launches the Comprehensive Primary Care Plus model, a value-based payment program that will give PCPs more financial flexibility when caring for the chronically ill.
Epic wins $940 million in its trade secret lawsuit against Indian IT firm Tata Consultancies.
VA CIO LaVerne Council says she will unveil plans for a “new digital health platform” to replace VistA.
Intermountain Healthcare will partner with the University of Utah and several other organizations to create a joint security center focused on thwarting cybersecurity attacks.
Federal regulators propose banning Elizabeth Holmes from the blood-testing business for two years after Theranos fails to correct serious problems discovered at its California lab.
Five years ago:
The DoD Inspector General finds that drug abuse among Marines in the Wounded Warrior Battalion at Camp Lejeune, NC is hard to detect because of EHR shortcomings.
3M acquires CodeRyte.
HHS proposes a one-year delay for ICD-10 compliance, pushing the deadline to October 1, 2014.
Verizon announces a relationship with NantWorks to create the Cancer Knowledge Action Network.
Weekly Anonymous Question
Last week, I asked readers what passion they’d pursue given enough free time and money:
Play music … all acoustic band.
Dog rescue and fostering 24/7. I would get property and have a place to foster many dogs; and would collect codified data regarding the adopters/adoptees to be able to identify traits of good dog/person pairings.
Ride coast to coast on a motorcycle.
Create a business-school partnership to encourage additional learning opportunities for math and critical thinking; incorporate local in-person and online virtual mentoring.
Travel the world, meeting people from all different walks of life, and seeing the beautiful landscapes of our planet. I also would love to do something to help those in need, so maybe a nonprofit that combines my dream to travel and also takes disadvantaged children on these adventures. Having fun with them and seeing their reactions to experiences like that would bring me such joy!
Build community gardens in areas where fresh produce is hard come by.
I would do more volunteer work. And make quilts – a lot of quilts.
Instead of having one in five kids in the US go to sleep hungry at night, I would work to drive that number to zero.
Roadside BBQ stand. It’s done when it’s done and it’s gone when it’s gone.
When I grow up, I want to be a photographer. I would love to travel the world snapping pictures of whatever comes my way.
Traveling to the best restaurants around the world and return to food blogging. I had to quit my blog last year (after a six-year run) due to cost and limited time.
Finish that novel, get it out there. Write another one.
Art. Art. Art. Nothing but painting, drawing, sculpting, weaving … and gardening. All things visually creative that require getting my hands dirty!
I’d follow my favorite bands around the world.
Music. That’s been the dream ever since I started playing guitar at age 12. I knew it had a chance since I can play almost every rock/blues song that I hear just by ear, but a) I never found the right band and b) my desire to secure a career somewhere besides McDonald’s led me to attend college and get a "real job" as opposed to rolling the dice and heading from the North Country out to LA a la Neil Young. That doesn’t seem to work out as well in the 21st century as it did in the mid 60’s. I still do some local gigs on occasion and play everyday; it will always be my number-one passion.
Photography – Weird News Andy
Attending as many music festivals as I could across the US and when I feel that is fairly complete, move on to Europe, Australia, etc.
Coaching people on living a more balanced life to have time with friends and family, and to look after emotional, physical, and spiritual needs.
Building and promoting a not-for-profit, nationwide health IT co-op.
Rock and roll guitar. What else could there be?
Space travel.
Hosting international yoga and wellness focused retreats.
Right now, a free weekend to relax and read a non-technical book and some time to travel and see some new places sounds pretty good, albeit mundane. The list of top 50 restaurants in the world just came out and a checking out a new one every week would be fun.
Cruising around the world.
I’d help patients learn how to be informed advocates for their own healthcare and the health of their family and friends.
Coding! Python, SQL, JScript and everything in between. Nothing like coding to keep your mind sharp and busy. And I do have the time and money to do it, so I do it and love every moment of it. Strongly recommended.
This week’s question: What’s the most patient-endangering IT issue you’ve personally seen?
Last Week’s Most Interesting News
NextGen will acquire Entrada in a deal worth $34 million.
The White House finalizes its rules aimed at stabilizing the individual marketplaces.
Erie County Medical Center (NY) returns to paper after a virus brings down its network.
United Airlines suffers financial loss and extreme PR backlash after dragging a physician, later hospitalized, off a flight.
India-based provider appointment-scheduling vendor Practo lays off 10 percent of its workforce.
Webinars
April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
EncounterCare Solutions wraps up the sale of its telemedicine and chronic care management operations to IGambit, which plans to market the services under the HealthDatix brand.
Salt Lake City-based Collective Medical Technologies announces plans to hire nearly 600 people over the next eight years. The company specializes in real-time care management tech for EDs.
People
Natoshia Erickson (Washington Health Benefit Exchange) joins Royal Jay as senior manager of solution delivery.
Announcements and Implementations
Trinity Health (MI) expands its home health telemedicine program, powered by technology from Vivify Health, to six additional states.
Miami Children’s Health System will work with telemedicine hardware and software vendor Tyto Care to expand its MCH Anywhere virtual consult services.
Decisions
Indiana Regional Medical Center (PA) will switch from MEDITECH to Cerner On May 1.
Sierra Vista Hospital (NM) will switch from Evident (a CPSI company) to Athenahealth on July 1.
Van Wert County Hospital (OH) Human Resources will go live with Infor this year.
Cameron Memorial Community Hospital (IN) Human Resources will go live with Oracle in 2017.
These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.
Other
New Jersey Hospital Association President and CEO Betsy Ryan and NJ Dept. of Health Commissioner Cathleen Bennett attempt to drum up interest in the forthcoming statewide roll out of the electronic Practitioner Orders for Life-Sustaining Treatment program. The initiative will convert the state’s paper-based, end-of-life planning documents for patients to a digital format, and give physicians access to the documents via a Web-based portal.
Here’s Part 4 of the top 10 HIS vendors report from Vince and Elise.
Sponsor Updates
T-System will exhibit at EDPMA 2017 Solutions Summit April 25-28 in San Diego.
TierPoint will host a grand unveiling of its newest Chicago data center April 27.
TransUnion publishes, “Revenue Cycle POS and High-Risk Patient Toolkit.”
ZeOmega publishes a case study highlighting how a large health system implemented Jiva HIE to connect 36 disparate EHR systems.
ZirMed publishes a new ebook, “3 Ways to Take Control of Your Contacts.”
ClinicalArchitecture makes donations to Boy Scouts of America, Casa de los Ninos, and Compassion International on behalf of HIMSS17 contest winners.
The White House finalizes its rules aimed at stabilizing the individual marketplaces, introducing insurer-friendly provisions that limit when consumers can gain coverage outside of open enrollment periods, while shifting authority to states to determine whether health plans have adequate provider networks, and allowing insurers to refuse to cover persons who haven’t paid their premiums.
The FDA issues a warning letter to St. Jude Medical of failing to respond to cybersecurity vulnerabilities that could allow a hacker to control implanted devices remotely and for failing to address battery issues that have been linked with two deaths.
After winning its patent case in the EU patent courts, UC Berkeley appeals its recent CRISPR patent loss to Broad Institute of MIT and Harvard here in the US.
Quality Systems subsidiary NextGen Healthcare will acquire mobile physician documentation and communication technology vendor Entrada in a deal worth $34 million. NextGen President and CEO Rusty Frantz says the company will focus on expanding Entrada’s capabilities.
Reader Comments
From Bob Oakley: “Re: Allscripts dbMotion. I no longer have a horse in this race, but feel compelled to write as I weathered the introduction of CareInMotion – including being miscategorized by KLAS. Setting expectations – this will hit about three or four of your bad branding hot buttons. You indicated that it was part of the Care Management population health platform, when it should have been identified as the CareInMotion population health platform. The confusion is not surprising, as CareInMotion (egregious capitalization not withstanding) is trying to corral several disparate applications under one brand, while working to create the common backbone necessary for it to be the platform it’s purported to be. Contributing to that is that the word Care prepends several legacy applications under the brand, including Care Management (the legacy ECIN utilization management, discharge planning, and referral management application). It is definitely confusing. I wish it weren’t, but its use is only a little over a year old and the dbMotion Azure announcement is heartening that the platform is being realized.”
From HIT User: “Re: Athenahealth. Athena seems to be making a lot of traction in the acute care space. This seems to mostly be to the attractiveness of their percentage of collections model for smaller hospitals that cannot afford most EHR price tags. What offering are they really providing to hospitals? Is it fully vetted or half-baked with RazorInsights hodgepodged with their ambulatory system? I see they are just now certifying this for Stage 2 per the CHPL site. Will they be ready by Stage 3 with all of the customers they are trying to reign in? I heard of one site – Cottage – that was delayed over a year from original anticipated go live (into the middle of 2018) for an install. Will Athena be able to deliver, on time, for hospitals MU3?”
Webinars
April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
HIStalk Announcements and Requests
This week on HIStalk Practice: CMS awards United Way of Greater Cleveland a $4.51 million grant to help it create an Accountable Health Communities Model. Thirteen people from three clinics are busted for their roles in a $24 million multi-clinic pill mill and fraudulent billing conspiracy. Physicians seem to favor faxes and phones over e-prescribing tech. Researchers determine community physicians are less likely to order unnecessary tests than their hospital-based counterparts. Dean Dorton acquires Metro Medical Solutions. Craft Behavioral Health Practice Manager Cara Farooque shares the challenges her practice faces in vetting technology for security and privacy controls. CareSync goes after customers for back payments. OCR gives Metro Community Provider Network a $400,000 slap on the wrist. ChenMed’s Jessica Chen, MD and Denise Hatzidakis offer insight into building and using IT for value-based primary care for seniors. Sign up for physician practice news here.
Acquisitions, Funding, Business, and Stock
Caradigm announces that it will reduce its workforce as part of a reorganization that it hopes will streamline operations. “GE Healthcare is committed to supporting the Caradigm team as they continue to evolve, positioning themselves to develop digital solutions for better outcomes in population health,” says Charles Koontz, chief digital officer, GE Healthcare. The company went through similar motions last fall, reorganizing product teams and its Services organization.
Sansoro Health raises $5.2 million in a Series A funding round led by Bain Capital Ventures. The Minneapolis-based company, which has raised $6.4 million so far, has developed a data integration tool for digital health apps and EHRs. It won the Venture+ Forum startup contest at HIMSS16.
Austin, TX-based healthcare cloud vendor ClearData raises $12 million, bringing its total funding to $55 million since launching in 2011.
Announcements and Implementations
Freeman Health System (MO) implements Access e-form and electronic signature software.
Kroger pharmacies connect to the Michigan Automated Prescription System with help from Appriss Health, which is helping the state develop and launch a new prescription drug monitoring system. Kroger expects to start sharing PDMP data between Michigan, Indiana, and Ohio within the next several weeks.
People
Verscend Technologies hires Chris Coloian (Welltok) as SVP of revenue and growth, and Michael Kapp (WellPoint) as SVP of government services.
Former State of Minnesota CIO Scott Peterson joins Avalere as VP of data architecture.
Technology
AMD Global Telemedicine updates its Agnes Interactive software to offer improved EHR integration.
Iron Bridge develops a portal to help providers query and submit data to public health registries.
Intermedix adds Web and mobile form configuration and management capabilities to its EMS patient-tracking software.
Sales
McPherson Hospital (KS) will implement EHR and RCM software and services from CPSI subsidiaries Evident and TruBridge.
Innovation and Research
Final Frontier Medical Devices wins a $2.6 million Qualcomm Tricorder XPrize for its efforts to develop a diagnostic device for multiple ailments akin to the one used in Star Trek. Runner-up Dynamical Biomarkers Group will take home $1 million for its attempt at developing a lightweight tool that can diagnose 13 ailments and measure five vital signs at the same time. XPrize organizers will use what’s left of the original $10 million purse to help both teams develop their devices. The Roddenberry Foundation, organized by Star Trek creator Gene Roddenberry’s son, has pledged an additional $1.6 million to the effort.
Government and Politics
The VA launches a website aimed at helping bring transparency to access and quality across its facilities. Patients can look up same-day availability, average appointment wait times, satisfaction scores based on those times, and hospital and outpatient compare data.
CMS issues a final insurance market stabilization rule. The 139-page rule, set to take effect next year, will, among other things, cut the enrollment period in half, allow lower minimum coverage requirements, and put health plan physician networks in the hands of the states rather than the federal government. CMS Administrator Seema Verma admits that, “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”
Meanwhile, in an effort to draw Democrats to the healthcare policy negotiation table, President Trump threatens to withhold payments to insurers meant to cover discounts for low-income consumers, explaining, “I don’t want people to get hurt. What I think should happen—and will happen—is the Democrats will start calling me and negotiating.”
The VistA replacement saga continues as the VA issues a request for information on a commercial, SaaS-based replacement that would enable – eventually – easy updating across the entire system. Vendors have until April 26 to submit their proposals for streamlining the 130 variations of the system and migrating them to the cloud.
The Vancouver Island Health Authority decides against suspending the CPOE feature of its IHealth EHR as originally announced in February. Government officials claim the $174 million Cerner system, which has earned a fair amount of media coverage based on end-user concerns with patient safety risks and documentation quality, is too intertwined with other systems and workflows to be taken offline, even temporarily. This may be a decision that pushes some nurses over the edge: A British Columbia Nurses Union survey found that 32 percent of RNs had seriously considered leaving or retiring because of the software.
Privacy and Security
Erie County Medical Center (NY) returns to paper after a virus brings down its network early Sunday morning. A hospital spokesman refused to comment on speculation that the virus was actually a ransomware attack, and if it had been contacted by hackers or asked for payments to restore access. ECMC hopes to have patient data available today and its IT systems fully restored by Saturday.
Other
The Leapfrog Group launches a calculator designed to illuminate the impact medical errors have on an employer’s covered population. The calculator estimates the number of avoidable deaths among covered lives, how much employers spend annually due to medical errors within general acute care hospitals, and how much of their total health care spend goes to these medical mistakes.
A local media outlet publishes a nicely written profile of Epic founder Judy Faulkner. Some HIStalk readers may not know that Faulkner’s mother Del, who graduated high school at the age of 15, received a Nobel Peace Prize in 1985 for her work as director of the Oregon Physicians for Social Responsibility – an affiliate of International Physicians for the Prevention of Nuclear War. Those who have been in the industry since the company’s early days will appreciate the accompanying photos.
Sponsor Updates
Everest Group recognizes Conduent Health in two reports, “Healthcare Payer BPO – Service Provider Landscape with PEAK Matrix Assessment 2016” and “Contact Center Outsourcing Marketing for Healthcare Industry – Service Provider Landscape with PEAK Matrix Assessment 2017.”
Netsmart will exhibit at the VNAA National Leadership Conference April 19 in San Diego.
NVoq will exhibit at the TORCH Annual Conference & Tradeshow April 18-20 in Dallas.
Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at Symposia Medicus April 18-20 in Las Vegas.
Experian Health will exhibit at HFMA Hawaii April 20-21 in Honolulu.
The SSI Group will exhibit at the Alabama HIMSS chapter Spring Conference April 19 in Huntsville.
Sunquest Information Systems publishes a new white paper, “Build or Buy: Optimizing Informatics for Genetic Testing.”
The FutureTech Podcast features Sytrue’s Kyle Silvestro.
Solutionreach becomes a preferred partner of Crystal PM for optometrists.
April 13, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 4/13/17
I unfortunately had to spend some non-quality time this week at the Microsoft Store. The pen for my Surface Pro tablet has been acting up over the last month and all troubleshooting maneuvers have failed. Since I’ve been on the road a lot, I’ve spent more time than I care to admit perusing various support articles, blogs, and commentaries on how to get it back up and running. Although the button was working, the business-end was not, and then the tip started to actually disintegrate. I had to wait until I was in a city that actually has a Microsoft store, and until I had free time during normal store hours to address it.
The staff at the store was eager to greet me, but then when they found out I was (gasp!) an individual consumer and not a corporate or enterprise customer, it started going downhill. The fact that I bought my device at Costco rather than directly from Microsoft was clearly an issue for them, and they made a big deal about not being able to locate the purchase in their system and having to use another system to find me (which they did, in about 20 seconds, so I’m not sure why we needed the drama). They then informed me that I was out of warranty on the pen. Apparently it’s not hard to be out of warranty when the warranty is only 90 days, which is pretty short in my opinion.
The rep did all the troubleshooting I had already done, then replaced the tip, which didn’t make a difference. He then proceeded to tell me he’d have to make me a tech appointment, but didn’t explain what that meant or what the timeframe might be. I was treated like a child when I asked, as if I should know intrinsically what a “Microsoft store tech appointment” expectation might be. As a consultant, I’m sensitive to my hourly rate and how much time and money I’m burning with exercises like this. Knowing the pen was about $50 and that I had been down for weeks and getting to the store when it was open was an ordeal, I asked if I could just buy a new pen and be done with it. He acted like that was the strangest thing he ever heard, then disappeared “to see if there is anything else we can do.”
I appreciate the fact that he was trying to save me money and resolve my issue, but it felt like an odd piece of “service recovery” after the initial stumbles over being an individual consumer and having purchased from a reseller. Ultimately they agreed to warranty the pen and swap it out, which took an additional 15 minutes of paperwork and back and forth. Counting the drive, the trek through the mall, and the troubleshooting, then getting home and back to work, I spent an hour and a half getting a new pen. Adding in the hours of troubleshooting that I did before even going to the store, you can bet that if this one malfunctions in the least I’m going straight to an online order for a new one.
I mentioned a couple of weeks ago that I was working with a clinical informaticist that was learning the ropes of actually managing a team – dealing with expense reports, vacation approvals, and the other managerial functions that we don’t learn much about in medical school. This week we waded into the minefield that is the annual performance evaluation. I’m a firm believer in the concept that the annual performance review should never be a surprise. It’s important for managers to incorporate the concepts they’ve been discussing with the employee for the last year, and to make overall comments on progress (or lack thereof) but nothing should be a revelation. When there is a transition in managers or a change in job role, this is particularly tricky because one needs to incorporate any available feedback from the previous manager or role.
The good thing is that the time frame for the review process is usually clear, and shouldn’t be a last-minute exercise. Of course there are exceptions to that, such as when my previous employer decided to move everyone from “review on your anniversary date” to “review the entire company all at the same time, STAT,” which was a horrendous exercise I never want to repeat. But in this case, my managerial trainee had well over a month to track down information from previous managers, peruse previous reviews, assess completion of employee goals, etc. We had been talking about the process for a couple of weeks, and he seemed like he was with the program, so I was surprised when I met with him in person and he looked like a cornered animal. He said he had no idea what to do with some of the feedback he received from employees.
The company asks employees to write a one-page summary of their growth and accomplishments over the last year, highlighting successes and what they have learned from challenges. It’s the employee’s opportunity to offer specific details that can bolster a high-scoring review or give a new manager more flavor for what the employee has been working on and how they see themselves. However, it has the potential to be a mine field, because “one page free text” can apparently mean different things to different people. He has more than 20 people on his team, and let’s just say the variability of the personal narratives was striking. The most effective employees provided bulleted lists or well-organized statements, often with supporting quotes from other employees or customers. Those were easy to get through. The ones he wasn’t sure on handling were frankly ones that I wasn’t sure on handling either.
I’ve done a lot of performance reviews, going back to my time as Chief Resident. I can definitely say I’ve never encountered an employee or supervisee who decided to use the annual review as an opportunity to roast the company or provide openly hostile comments about management in writing. Until now, that is. The employees were clearly informed that their statements would be part of their records as part of the annual review process and would be seen by second-level approvers, yet still elected go down this path. Needless to say, after seeing their statements, their objective rankings on “insight” and “professionalism” just went down the tubes. Additionally, if there was a score for Tasseography, they’d score low on that as well. When you openly throw your manager under the bus, and fail to appreciate that your manager has a significant amount of executive support, you’re not doing yourself any favors.
These are the things that as a consultant make you say “hmmmm,” and also ensure the ability to propose ongoing engagements and assistance for your clients. We definitely need some coaching/education for these two employees, as well as creation of performance improvement plans. It’s also the opportunity to assist with the hiring process should they not be able to right themselves. In the short term, I’m going to continue supporting my new manager, and help him build the skills to get through this, manage these folks objectively, and not give in to his emotions. It’s also an opportunity to reflect on giving direction for future reviews. The idea that a review should not be a surprise goes both ways when employee comments are involved.
What’s your wildest performance review story? Email me.
Seema Verma - that’s quite a spin of “facts” good luck.