Former CMS Acting Administrator Andy Slavitt accepts a position at private equity firm General Atlantic, where he will focus on healthcare investments in underserved populations.
An 85-year-old primary care provider in New Hampshire claims she is being forced to retire for refusing to implement an EHR, while the State Board of Medicine says she agreed to surrender her license “in light of an investigation into her record-keeping, prescribing practices, and medical decision-making.”
Microsoft President Brad Smith blames North Korean hackers for launching the WannaCry cyberattack that infected several NHS hospitals earlier this year. He says, “I think at this point that all observers in the know have concluded that WannaCry was caused by North Korea using cyber tools or weapons that were stolen from the National Security Agency in the United States.”
President Trump continues the dismantling of his predecessor’s programs without Congressional involvement by signing an executive order that would prohibit HHS from paying legally required (but also legally challenged) premium-lowering payments to insurers.
A CBO report from August predicted that such an order would increase premiums 20 percent immediately and increase the federal deficit by $194 billion over ten years, but would not significantly increase the number of people without insurance.
The immediate effect on the open enrollment period that starts in just over two weeks will vary by insurer and state. Some insurers built the expected action into their new premium prices, others advised insurers to assume the payments would be made in setting their prices, and the timing of the executive order makes it unlikely that insurers can get re-filed rates approved before enrollment begins, raising the possibility that they will pull out of the market.
Eighteen states have sued the White House over the executive order.
HHS Acting Secretary Eric Hargan and CMS Administrator Seema Verma release a statement supporting the order and criticizing the laws they swore to uphold, saying that “Obamacare is bad policy” and that cost-sharing reduction payments were authorized in an unlawful “unconstitutional executive action” (which is arguably true and the subject of the legal challenge).
Reader Comments
From Faith-Based Hill: “Re: Outcome Health. Overstating claims and fudging numbers will get you hundreds of millions in investment that you can use to buy time to hopefully turn things around. Too often the poor schmucks who try to build legitimate, ethical business get no such boost. The VC/PE world is ripe for such perverse incentives. A $5.5B valuation for putting TVs in doctors’ offices so Rx companies can prey on (cough, cough) I mean advertise to patients? How is this innovative? How is this going to actually benefit patients, lower costs, and (as their name ironically suggests) really improve outcomes? Sorry for ranting, but these Theranos-esque shysters make EHR vendors look like friggin’ Mother Teresa by comparison.” I’ll be interested to see how Outcome Health, as a privately held company, proceeds and how investors and customers react. Companies usually fire a few mid-level executive serving as scapegoats (giving them big go-away money and an ironclad NDA to prevent them from saying what really happened); apologize; and claim that the public penance marks a new chapter in the newly reinvented company’s inevitable destiny. The worst thing about Outcome’s business model of promoting drugs to patients at their vulnerable moments is that it works – doctors naively think they are immune from pharma propaganda and irrational patient pressure, but prescribing data proves otherwise. The most important “outcome” is boosting pharma’s bottom line. It’s distasteful to be reminded constantly that healthcare is like all other industries in being driven almost exclusively by profits, which was inevitable going back to the 1960s, when Medicare made the potential economic scale interesting to investors.
From Desperado: “Re: Cerner. Next CEO is … Zane Burke.” Unverified, but hardly shocking if true. CERN shares appeared (from my quick graph look) to have hit an all-time high after a nice run-up last, week, closing Friday at $73.57 as the company’s market cap approaches $25 billion. I’m happy that Burke at least earned an advanced degree (MBA) since so many healthcare executives rose through the sales ranks where graduate education is seen as a waste of time.
From ImageEnabler: “Re: Philips. Now requiring customers migrating away from their iSite PACS solution to use their third-party migration vendor of choice. Who owns the data again?” Unverified.
From Dr. Trump: “Re: ACA. Will Trump’s repeal of the health insurance subsidies and encouraging cheap individual health plans benefit Oscar Health, Joshua Kushner’s startup?” I expect so. The struggling Oscar was on the wrong side of Trump’s ACA wrath when he was elected since the company sold ACA plans, but it announced in April that it would start selling the kind of individual plans that will probably gain business from the executive order.
HIStalk Announcements and Requests
Incumbent HHS Secretary “None of the above” remains the favored candidate of poll respondents, although readers expressed tepid enthusiasm for having HUD Secretary Ben Carson swap chairs.
New poll to your right or here: what is the clinical and healthcare business impact of not having a national patient identifier?
This Week in Health IT History
One year ago:
Allscripts acquires CarePort.
AHIMA announces its plans to offer a health informatics certificate.
The Internet goes dark in many parts of the country when hackers hit DNS routing company Dyn.
Five years ago:
Wolters Kluwer announces that it will acquire Health Language.
NYC H+H’s board minutes explain why it chose Epic to replace QuadraMed CPR, a decision that led Allscripts to sue the health system for giving Epic the bid in what it claimed was improper procurement.
Google shares drop sharply when its financial printing firm releases the company’s SEC Form 8K in the middle of the day instead of after hours.
An IOM report finds that a health system co-managed by the DoD and VA s is spending an extra $700,000 per year for pharmacists to enter prescription data, required because their separate EHRs cannot create a sequential prescription number.
Ten years ago:
Medsphere settles its $50 million trade secrets and contract breach lawsuit brought against founding brothers Scott and Steve Shreeve.
Eclipsys announces plans to move its headquarters from Boca Raton, FL to Atlanta.
A Misys report concludes that doctors don’t use EMRs because they are expensive and hard to use.
Last Week’s Most Interesting News
A Wall Street Journal report says that waiting room digital advertising company Outcome Health misled investors about its advertising performance as fresh investment sent its valuation soaring to $5 billion.
President Trump signed an executive order that allows people to sidestep exchanges to buy less-expensive but less-comprehensive policies, a move that threatens to further destabilize ACA insurer risk pools.
Express Scripts announces plans to acquire EviCore Healthcare for $3.6 billion.
Webinars
October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.
October 25 (Wednesday) 1:00 ET. “Delivering the Healthcare Pricing Transparency that Consumers are Demanding.” Sponsored by: Health Catalyst. Presenter: Gene Thompson, director, Health City Cayman Islands. Health systems are unlike every other major consumer category in not providing upfront pricing information. Learn how one health system has developed predictable, transparent bundled pricing for most major specialties. Attendees will gain insight into the importance of their quality measures and their use of actual daily procedure costing rather than allocated costs. They will also learn about the strategic risk of other market participants competing with single bundled pricing. The organization’s director will expand how its years-long process is enabling healthcare delivery reform.
October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine; Gary Palgon, VP of healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Pine Rest Christian Mental Health Services (MI) chooses Epic.
People
Former CMS Acting Administrator Andy Slavitt joins growth equity firm General Atlantic as special advisor, focusing on healthcare investments in underserved populations. HIStalk readers are cited in General Atlantic’s announcement for voting Slavitt as their “Healthcare IT Industry Figure of the Year” for 2016.
Announcements and Implementations
Hospital operator Mercy’s IT organization and device maker Medtronic will work together to capture de-identified data from heart failure patients to analyze their response to cardiac resynchronization therapy. Medtronic, based in Ireland after a controversial 2015 move of its US headquarters to Dublin to dodge US taxes, sells an implantable device that offers that therapy.
Government and Politics
Two senators write to President Trump to inquire why he declared on August 10, 2017 that “the opioid crisis is an emergency and I’m saying officially right now it is an emergency” without following through on the legal rather than the rhetorical declaration that is required to take federal action.
Privacy and Security
A Microsoft executive says that the government of North Korea was responsible for using stolen NSA tools to create the WannaCry malware that hit hospitals hard earlier this year.
Other
A 28-year-old New York man and self-described “serial data tracker” says his two-year-old Apple Watch saved his life by alerting him that his heart rate had jumped, which turned out to be a symptom of a pulmonary embolism that was successfully treated.
An 85-year-old New Hampshire pediatrician says the state is shutting her practice down for not using an EHR and therefore not checking the state’s doctor-shopper database before prescribing, although she fails to note that she willfully signed an agreement to close the practice after an investigation into poor documentation and questionable decision-making. The Poland-trained doctor claims that New London Hospital, with which she is affiliated, is trying to steal her patients. She doesn’t believe in technology:
I cannot practice medicine because the system practices with electronics. The computer is giving the diagnosis and telling them what medicine to prescribe. They practice medicine, and I practice medical art. They manage the patient, and I treat the patient … It’s fine if you are with the system. If you are not, you are an enemy of the system.”
Patients in England report that their doctors are ridiculing and threatening patients who research their issues on the Internet before a visit.
CNN finds that drug companies are making hundreds of millions of dollars each year – much of it paid by Medicare – on Nuedexta, intended for treating a relatively rare condition that causes laughing and crying in multiple sclerosis patients, but being aggressively marketed by salespeople for dementia patients in nursing homes. Its manufacturer has also paid many millions to doctors in honoraria and consulting fees, with doctors who have received those payments being responsible for nearly half of the Medicare claims paid for the drug. Nuedexta, which costs over $9,000 per year, contains two ancient, dirt-cheap drugs – dextromethorphan (in over-the-counter cough syrups) and quinidine sulfate (a bark-derived heart drug that’s so old that nobody can remember when it was first used). The unfortunately not-rare condition it causes rather than cures is excessive pharma laughing all the way to the bank.
A visitor is stabbed to death in his son’s hospital room at Johns Hopkins Hospital (MD), with police investigating a domestic issue trying to determine whether it was murder or suicide.
In India, a bystander captures on video a hospital dumping its medical waste into a river.
Weird News Andy is singing “Sole Man” while failing to identify a good ICD-10 code after reading this story. A man in England goes into cardiac arrest after swallowing a six-inch Dover sole, saved by a first responder who was able to remove the fish after six tries. The man claimed that the fish spontaneously leaped from the water into his mouth, but a friend told the first responder that the intrepid angler was fooling around by putting the just-caught fish over his mouth, only to be rendered speechless when it wriggled down his throat.
Sponsor Updates
Harris Healthcare will exhibit at AHAAM’s Annual National Institute Conference October 18-22 in Nashville.
Vocera will exhibit at the ANIA DFW Clinical Informatics Academy October 18 in Grand Prairie, TX.
Black Book ranks ZeOmega number one for care management workflow applications, and includes it on its list of Top 50 Disruptive Health IT Companies.
Outcome Health, a Chicago-based healthcare startup, reportedly raised a $500 million funding round on a $5 billion valuation that was based on misleading performance metrics and falsified growth data. The company creates patient education videos intermixed with pharmaceutical ads to be played in doctor’s office waiting rooms.
President Trump signs an executive order that will create new, non-ACA regulated purchasing options for individuals shopping for health insurance plans. Advocates say sidestepping the ACA marketplaces will free payers to offer lower priced plans that do not comply with ACA protections, while critics say the move is aimed at gutting the ACA individual marketplaces of the younger, healthier demographic needed to sustain a market.
At its annual user conference, Cerner’s President Zane Burke announces that CommonWell services will remain free to Cerner clients for an additional three years, through 2020. The network now holds 60 million patient records.
A Harvard Business Review article by two Bain & Company’s healthcare partners argues that providers are not eager to embrace alternative payment models because they have been routinely excluded from the decision-making process.
A Wall Street Journal report says that Chicago-based waiting room digital advertising company Outcome Health overcharged drug company advertisers by intentionally claiming an inflated number of screens in use, manipulating third-party ad performance analyses, and creating phony ad campaign screen shots.
The company, formerly known as ContextMedia Health, has placed three employees on paid leave pending an investigation.
A former executive who confronted co-founder and CEO Rishi Shah about questionable business practices lasted only two weeks, joining the seven executives who have left the company so far this year.
Chicago Mayor Rahm Emanuel helped dedicate a 29-story building that was renamed Outcome Tower in late September, the same day the company finalized plans to lay off 76 of its 600 employees.
Drug companies had previously obtained refunds from the company after their reps noticed that claimed devices in medical practices weren’t actually there. Outcome has also been accused of altering prescribing data from QuintilesIMS to make its campaigns look more successful, which earned Outcome a scolding from IMS.
Outcome Health’s last fund-raise valued it at $5 billion, making co-founders Rishi Shah and Shradha Agarwal, aged 31 and 32, respectively, paper billionaires.
Reader Comments
From Kyle vs. Givenchy: “Re: Athenahealth. Per the KLAS report, 13 of 28 Athenahealth customers have delayed or cancelled go-lives, not the 20 claimed. Seven of eight reported pharmacy-related issues, while end users are less enthusiastic than executives.” Unverified. I don’t see KLAS reports since they quit sending them to me, so I’ll take your word for what it found.
From Jake Asp: “Re: telemedicine. I didn’t see this news item mentioned.” I rarely mention telemedicine news because it has nearly zero to do with health IT. Talking to a doctor over a video connection is no different than calling them up on the telephone and that’s not going to get health IT geeks excited. I’m puzzled by health IT sites fawn over virtual visit news or proposed telehealth regulatory changes, maybe because those topics are easy for inexperienced people to write about. I go off-topic only (sometimes wildly) when I read something that I think will interest my peers and even then it’s only a tiny blurb rather than a padded-out article.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Change Healthcare. The new, Nashville-based, 15,000-employee Change Healthcare — one of the largest independent technology companies in the US — includes most of the former McKesson Technology Solutions as well as the former Emdeon, which was renamed Change Healthcare when Emdeon acquired that company in September 2015. The company serves payers (Intelligent Healthcare Network for financial and administrative transaction processing); providers (eligibility, claims, productivity, imaging, clinical workflow, and value-based care); and consumers (True View Health Shopping Platform). The company just announced healthcare’s first enterprise blockchain solution. Thanks to Change Healthcare for supporting HIStalk.
Listening: new from the amazing Michigan-based hip-hop artist NF (born Nathan Feuerstein), whose hard-hitting yet non-explicit lyrics allow focusing on the anger and self-doubt he describes rather than the usual vapid, misogynistic swagger. The 26-year-old wrote about his mother’s drug overdose death in “How Could You Leave Us?”: “I don’t get it mom, don’t you want to watch your babies grow?; I guess that pills are more important, all you have to say is no; But you won’t do it, will you? You gon’ keep popping ’til those pills kill you; I know you gone but I can still feel you.” His long tour that starts in January includes a lot of stops in health IT centers like Nashville, Atlanta, Raleigh, Boston, Madison, and Kansas City. I’m also enjoying questionably named but inarguably talented Wales-based hard rockers Catfish and the Bottlemen.
This week on HIStalk Practice: Lightbeam Health Solutions will provide population health management solutions to American College of Osteopathic Family Physicians. In the Consultant’s Corner, Brad Boyd offers tips to help practice administrators proactively address physician burnout. Azalea Health merges with Prognosis Innovation Healthcare. Vermont physicians face criticism as medical marijuana clinics attempt to take off. ZDoggMD brings the house down at MGMA. Follow-up study shows PCP antibiotic overprescribing habits could benefit from “nudges.” Hope Orthopedics of Oregon kicks off patient-reported outcomes program. Formativ Health helps independent MDs in Pennsylvania transition to value-based care.
Webinars
October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.
October 25 (Wednesday) 1:00 ET. “Delivering the Healthcare Pricing Transparency that Consumers are Demanding.” Sponsored by: Health Catalyst. Presenter: Gene Thompson, director, Health City Cayman Islands. Health systems are unlike every other major consumer category in not providing upfront pricing information. Learn how one health system has developed predictable, transparent bundled pricing for most major specialties. Attendees will gain insight into the importance of their quality measures and their use of actual daily procedure costing rather than allocated costs. They will also learn about the strategic risk of other market participants competing with single bundled pricing. The organization’s director will expand how its years-long process is enabling healthcare delivery reform.
October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine; Gary Palgon, VP of healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Atlanta-based ambulatory EHR/PM vendor Azalea Health acquires community hospital EHR vendor Prognosis Innovation Healthcare, which was known as Prognosis Health Information Systems until it was renamed in 2014 by its new private equity owners. I interviewed Ramsey Evans, then CEO of Prognosis, way back in September 2010. He left the company in 2013 to return to Keais Records Retrieval as CFO and board chair – the Houston-based company offers electronic medical records retrieval for attorneys.
Consumer health benefits and wellness technology vendor Welltok acquires Tea Leaves Health, which offers consumer and physician relationship management systems. Ziff Davis, which bought 60-employee, Atlanta-based Tea Leaves for $30 million in 2015, sold it to Welltok for $83 million. Ziff Davis is owned by Internet company J2 Global, which also owns Everyday Health (MedPage Today, KevinMD.com and MayoClinic.org). ZD said in February 2017 that Tea Leaves might never make a profit.
The private equity owner of revenue cycle technology vendor Practice Insight sells the business to an unnamed buyer.
Wellness app vendor StayWell, a subsidiary of drug maker Merck, acquires MedHelp’s health engagement platform. Meanwhile, health shopping site operator Vitals buys MedHelp’s online health communities business.
Sales
North Carolina Hospital Association chooses PatientPing to offer statewide, real-time care coordination.
Announcements and Implementations
Cerner tells its user group attendees that it will continue to offer free CommonWell services through 2020.
Flirtey, which uses drones to deliver emergency medical supplies, will send automated external defibrillators in response to 911 cardiac arrest calls received by northern Nevada emergency medical provider REMSA.
Summit Healthcare chooses system integrator Speedum Technologies Health Solutions to resell its integration platform, scripting tool, and downtime reporting system.
EClinicalWorks will partner with clinical data registry and analytics vendor FIGmd to offer its EHR users connectivity to specialty registries.
Government and Politics
President Trump takes another step to kill the Affordable Care Act by signing an executive order that will make it easier for small businesses and perhaps even individuals to band together to buy health insurance across state lines (which is already legal but rarely done since it’s hard for insurers to create networks in new states and such sales require state-by-state approval). The order will also again allow the sale of short-term policies that don’t cover pre-existing conditions, which the ACA halted. Critics worry that cheap but low-quality plans will draw healthy people away from ACA plans, driving up premiums as sicker people are left without alternatives. Health systems will be watching the change in their patient bases closely. ACA expert Charles Gaba’s expert analysis is sobering and is a reminder that “slicing up the risk pool does absolutely nothing to lower the total cost of healthcare.” HHS will be responsible for setting definitions in drafting the legislation, which will likely take several months if the order survives the inevitable legal challenges.
Privacy and Security
A security researcher finds that the website of Equifax – fresh off its massive breach that exposed the information of 146 million people – was hacked this week, with visitors being tricked into installing an adware-pushing app posing as an update to Adobe Flash.
Other
Paul Purcell, administrator of STEP Pediatrics (TX), reports that Memorial Hermann some doctors are going back to paper after a nine-day performance problem caused by an EClinicalWorks upgrade.
An interesting review by Pew Charitable Trusts finds that a remarkable number of Americans use life-sustaining technologies in their homes and are thus vulnerable to storm-related power outages. HHS mined its Medicare claims database to create a map of people who had received government-provided medical equipment to help health officials locate them in an emergency.
In a PR move that always strikes me as a self-serving form of cost-shifting, at least one Las Vegas hospital and two ambulance services announce that they will not charge victims of the recent mass shooting for the services they received. Other patients whose circumstances were judged as less meaningful will have to cover the cost of the non-profit largesse, which would ring truer if the organizations just did it without crowing.
A Harvard Business Review article by two Bain & Company’s healthcare partners cites surveys suggesting that doctors understand that the cost of drugs and clinical care are too high, but that nobody’s inviting them to the table to figure out how to control costs, improve performance, or move to new reimbursement models.
Analysis finds that dialysis operator DaVita makes more than half its profit from patients who receive charity help to pay their insurance premiums, with 13 percent of its patients receiving help from the American Kidney Fund to which DaVita makes tax-free donations. The company benefits because private insurance pays more than Medicare or Medicaid, with charity-funded insured patients contributing $540 million to the company’s annual profit.
The hospitals in Ontario’s largest network are reviewing five million electronic patient records after a patient-reported error leads them to discover a few incorrect records.
Count me in for a comprehensive $3,300 report on the “HER” market, as it’s referred to 25 times in the announcement without the sharp-eyed editors noticing their mistake. Adding to my interest is that the company’s address from which a wide variety of crappy reports emanate is — like the addresses of some of its 25 associated publishers — a house in a residential neighborhood. The report description is loaded with fractured English as a second language, but I’ll focus on “till,” best used as a synonym for “cash register” or as a verb referring to “plow” rather than a sloppy substitute for “until.”
Ross Martin, MD and his The American College of Medical Informatimusicology debuts his new song “DigituRN” at the Tri-State Health Informatics Summit this week. The term refers to transforming the nursing profession through informatics and digital innovation.
Weird News Andy likes that several animation studios worked with the Pediatric Brain Tumor Foundation for free to create short videos explaining procedures and conditions to children, a project they call Imaginary Friend Society.
Sponsor Updates
MedData and Experian Health will exhibit at the TAHFA & HFMA South Texas Fall Symposium October 15-17 in San Antonio.
Meditech will host the 2017 Physician and CIO Forum October 18-19 in Foxborough, MA.
Navicure will exhibit at the Raintree User Conference October 16-18 in San Antonio.
Health Catalyst is named as the 17th fastest-growing company in Utah, with sales growing 1,700 percent in five years.
National Decision Support Co. and Parallon Technology Solutions will exhibit at the Meditech 2017 Physician and CIO Forum October 18-19 in Foxborough, MA.
Netsmart will exhibit at the National Association for Home Care and Hospice Conference October 15 in Long Beach, CA.
Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Washington State AWHONN Conference October 15-17 in Lake Chelan, WA.
October 12, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 10/12/17
My travel schedule has been very busy with organizations that are taking advantage of the relative relaxation of requirements in some of the regulatory programs. They’re using the time to tackle workflow issues and work towards standardized best practices in preparation for the next round of regulatory hurdles. A fair number of my clients are non-profit organizations, but there are significant variations in their ability to fund these initiatives depending on how non-profit they are and how they run. We all know of non-profit organizations that have millions (if not billions) in the bank and those that run on a shoestring. At least half of my non-profit clients fall into the latter category, including community health organizations and other programs which are largely grant-funded.
Working with these organizations is a challenge and I was pulled into one of those situations last week. The practice is experiencing severe performance impairment in not only its EHR and practice management system, but in other applications. They brought their IT services in-house a couple of years ago to save money and have been trying to diagnose the issues without success.
I had recommended an IT vendor to do an assessment and it took several months to get them to agree to the cost. When he finally had the opportunity to look at the system, there are multiple potential root causes. The first is that their servers are well beyond their service life and everything is running on versions of software that are no longer supported. They haven’t taken maintenance releases or patches in more than a year on some of the applications and system resource use is off the charts. If their IT systems were a patient, I’d have to diagnose multi-system organ failure.
Now that we had data defining the problem, it was time to sit down and talk about a timeline for solutions. We discussed the fact that any attempts to enhance the EHR or the other applications would likely not have demonstrable results due to the overall performance issues. Not to mention that their situation leaves them vulnerable to total system failure, hackers, and more. Their cash-strapped state is why they gave up their white-glove IT support in the past and they’ve been holding things together with the proverbial bubble gum and duct tape since then. When you’re working with an organization that has prohibited overtime and reduced clinical shift coverage due to lack of funding, asking them to spend tens of thousands of dollars on servers and software is a non-starter. We discussed moving their system to a hosted environment to reduce some of the issues, but they don’t think they even have the cash flow to handle the monthly charges.
It’s difficult knowing that their users are experiencing the pain of using a system that often just doesn’t run properly, but that there isn’t a ready answer. Their patients are experiencing less-than-optimal care because the practice can’t implement some of the newer bells and whistles of the system because it will barely handle the basics. I spent several hours with the CEO and CFO, with the ultimate outcome being that they simply can’t afford upgrades and will have to just “make do.” They’re a safety net care provider, so it’s not like they can raise their fees or start offering lucrative cosmetic procedures to boost the bottom line. We’re now looking into additional grant programs and funding sources, but there isn’t going to be a quick fix if we can find one at all. I hate to see an organization like this flounder, but unless someone wins the lottery and throws some cash their way, they’re a bit stuck.
In addition to their IT woes, I was also asked to assist with some staffing issues. They’ve having trouble with physician retention and have had to start filling in with some locum tenens providers, which usually isn’t great for continuity or morale. To make matters worse, on one of the days I was there, the locum physician had the license plates stolen from her rental car. Apparently, the practice has provided special anti-theft screws to employees to secure their plates, but didn’t think about the locum. It made me think twice since I was in a rental car as well, although I didn’t think my plates from across the country would be as much of a temptation since they’re memorable and obvious, which might be a theft deterrent.
The practice is also struggling with hiring new staff, with some applicants being afraid to work at one of the organization’s locations. They don’t have the payroll to add security guards, and apparently there have been some incidents with angry drug-seekers threatening staff. This has introduced friction because the organization decided that requiring at least one male to be present on every shift was the solution and the men don’t want to work there, either. Although I can help with things like standardizing workflows to make the day flow better and people to be more efficient, I doubt the employee satisfaction that brings will do much to fix some of the deeper problems.
For people who work in other parts of the healthcare IT industry who might not always see this side of the equation, I offer it as food for thought. Whether you’re in development, marketing, public relations, finance, investing, etc. you may not always be exposed to the different situations that practices are living up to. It’s important to remember that ultimately the patients are the customers, and the teams that have to use our systems and solutions to care for them. A practice that is worried about keeping the lights on or worried about keeping its employees safe may not care very much whether your corporate logo is in one font or another or whether you’re using the most agile development methods. If they’re less than interested in what you’re trying to get them to buy, it may be because they’re farther down on the hierarchy of need than you can imagine.
This week, I’m working with a practice that is the polar opposite, one in an affluent suburb that is looking to maximize patient engagement and specialized offerings while delivering enough wow factor to lure patients from the competition. It makes me feel like I’ve gone through the looking glass into another world after last week.
Have any tips for helping practices on a shoestring budget? Email me.
Eric Hargan, a Chicago-based lawyer, Bush administration HHS staffer, and member of President Trump’s transition team, has been named acting HHS secretary.
ONC announces a FHIR-based development challenge, asking experts to deploy FHIR servers using best practice security standards. The challenge aims to “identify unknown security vulnerabilities in the way open source FHIR servers are implemented.”
The Guardian reports that a hacker has compromised a Deloitte server containing email data from 350 clients, including the NIH, the State Department, the Department of Energy, the Department of Homeland Security, and the Department of Defense.
Gary Fingerhut, the former executive director of Cleveland Clinic Innovations, pleads guilty to fraud charges stemming and will serve between three and five years in prison.
Express Scripts announces that it will acquire EviCore Healthcare, a company that preapproves scans and other costly medical tests for health plans, for $3.6 billion.
An HBR article argues that ” just as the cell phone, originally designed as a mobile communication device, has been adapted to an unimagined array of additional functions, the EMR is serving as a platform for innovation and creativity.”
In England, King George Hospital is reporting significant time savings and process improvements stemming from the implementation of System C’s Vitalpac, an iPad-based vital signs documentation system.
Pharmacy benefits manager Express Scripts will acquire care management vendor EviCore Healthcare for $3.6 billion.
Private equity firm General Atlantic formed EviCore in 2014 in merging its acquisitions CareCore (acquired in January 2014 for an undisclosed price) and MedSolutions (acquired in November 2014 for a reported $1 billion). The company renamed itself to EviCore in June 2015.
EviCore was rumored to be seeking a buyer in May 2017 in hoping for a valuation of more than $4 billion, but was simultaneously planning an IPO in case no acceptable offers were made.
EviCore Chairman and CEO John Arlotta has worked for General Atlantic and was previously president of Express Scripts competitor Caremark RX (now CVS Caremark).
HIStalk Announcements and Requests
Every October Lorre offers a deal for new HIStalk sponsors – sign up now and get the rest of 2017 free. Contact her if you want in before the usual pre-HIMSS rush that, shockingly, will be here before we know it.
I wanted to buy a baby monitor for some relatives who are new parents and ran across this IP-based camera that was so cool I had to get myself one afterward. The TenVis HD camera features two-way audio, rotation, night vision with 32-foot range, a micro SD card slot for recording, optional emailing of a snapshot or a telephone alert when it detects movement, and an app that allows viewing real-time video from anywhere. That’s a lot of technology in a $40 device. Setup was nearly instantaneous over WiFi, although I had to throttle back my router to 2.4 GHz for configuration and then switch it back to 5 GHz afterward because of some quirk. I don’t need to monitor babies, but it’s fun to check out what’s happening in the living room from anywhere in the house or anywhere in the world, while other Amazon reviewers love it for keeping an eye on elderly parents or driving their dogs crazy by talking to them from afar. My gift recipients report an added benefit that I hadn’t thought of – they’ve given the far-away grandparents access so they can take a wistful look at the little one whenever they want.
Webinars
October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.
October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine; Gary Palgon, VP of healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Pittsburgh-based AI vendor Petuum — which is developing products for several industries including an EHR-powered disease and treatment module — receives a $93 million investment, increasing its total to $108 million. Two of the three founders earned PhDs from Carnegie Mellon University in computer science and machine learning, respectively.
Sales
Aetna selects Stanson Health to automate its clinical prior authorization process by integrating with provider EHRs to collect both discrete and free-text information.
Southwestern Health Resources (TX) chooses Phynd’s provider management system that will integrate with its Epic and credentialing systems, managing 50,000 providers in 31 hospitals.
People
Chris Mathia (Hyland) joins Innara Health as EVP of sales.
Announcements and Implementations
Clinical Architecture releases version 2.0 of its Symedical enterprise terminology management platform.
EClinicalWorks announces that its EHR now supports the OpenNotes initiative in allowing clinicians to share visit notes with patients via its patient portal.
Nokia will cease development of its $45,000, 360-degree Ozo virtual reality camera for filmmakers, saying that the VR market is developing more slowly than the company expected. Nokia will focus on digital health, enabled by its June 2016 acquisition of France-based consumer medical gadget vendor Withings for $191 million.
HIMSS Analytics launches a mobile version of its Logic database, giving health IT salespeople access to information about provider organizations and their technology-related activities.
Switzerland-based Ascom releases Digistat Vitals, which allows bedside EHR entry of vital signs and clinical scores in eliminating double entry and paper transcription.
PatientKeeper announces a hosted version of its physician charge capture solution.
Government and Politics
A study finds that the FDA‘s requirement that direct-to-consumer drug advertisements list side effects paradoxically increases sales of potentially dangerous drugs. The “argument dilution effect” leads consumers to assume that the mandatory long list of possible side effects – some of them included because of frequency of occurrence rather than severity – misleads them into thinking a drug isn’t likely to harm them.
A former Missouri nursing home company CEO is sentenced to 41 months in prison and ordered to pay $667,000 in restitution for using Medicaid payments to pay for strippers, casinos, and country clubs as residents of his facilities were given clear broth as meals and did not receive their meds because the company failed to pay its pharmacy provider.
Privacy and Security
Security researchers find an unsecured Amazon Web Services S3 file containing the medical information of 150,000 people, apparently patients of anticoagulant monitoring company Patient Home Monitoring Corporation.
In a related item, another security firm finds four unsecured, Accenture-owned AWS S3 buckets holding customer decryption keys, passwords, and certificates. Ironically, the exposed information includes software for Accenture Cloud Platform, the company’s enterprise cloud offering.
Technology
A Wall Street Journal review of scientific studies confirms my suspicion that smartphones make their users stupider. Not only do phones distract people from real-world tasks (the average phone user whips theirs out 80 times per day), keeping a phone “nearby and in sight” diminishes the ability to learn, reason, and solve problems even as users suffer from “delusions of intelligence” in confusing what they actually know vs. what they can look up on their phones. The article notes,
It isn’t just our reasoning that takes a hit when phones are around. Social skills and relationships seem to suffer as well. Because smartphones serve as constant reminders of all the friends we could be chatting with electronically, they pull at our minds when we’re talking with people in person, leaving our conversations shallower and less satisfying … The evidence that our phones can get inside our heads so forcefully is unsettling. It suggests that our thoughts and feelings, far from being sequestered in our skulls, can be skewed by external forces we’re not even aware of … A quarter-century ago, when we first started going online, we took it on faith that the web would make us smarter: More information would breed sharper thinking. We now know it isn’t that simple. The way a media device is designed and used exerts at least as much influence over our minds as does the information that the device unlocks.
In England, the local paper covers the use by King George Hospital of Vitalpac, an iPad-based vital signs documentation system from System C Healthcare that has reduced hourly rounding time by 75 percent. McKesson bought England-based System C for $140 million in 2011, then sold it to private equity form Symphony Technology Group in 2014 as McKesson began its health IT exit.
Other
Two Northern California hospitals – Santa Rosa Memorial and Queen of the Valley Medical Center — evacuate patients after Wine Country wildfires spread to 100,000 acres, burning down 1,500 buildings and killing a least 11 people. If there’s such a thing as wine futures, now would be a great time to load up.
A. James Bender, MD, medical director for clinical informatics at Virginia Mason (WA) and his Virginia Mason Center for Health Care Solutions co-author write in Harvard Business Review that the EHR is increasing innovation, with these examples:
Alerting clinicians about possible omissions in care based on evidence.
Adding transparency to patient and family engagement with ICU electronic patient scoreboards to prevent blood clots.
Providing intelligence, such as auto-ordering of labs when specific drugs are ordered.
Blocking orders for high-cost imaging studies that are not supported by evidence.
The local paper reports that three-hospital Maui Health System (HI) has experienced a few technology problems in the first 100 days of turning over operation of the to Kaiser Permanente. Community-based doctors say they don’t automatically receive faxed information about the hospital visits of their patients like they used to, causing billing delays.
The Salt Lake City, UT police chief fires the detective who handcuffed an ED nurse who refused to allow him to draw a blood sample from a patient without obtaining a warrant as hospital policy requires.
The work of Richard Thaler, who just won the economics Nobel prize, has healthcare implications. His specialty is behavioral economics, which studies why people act irrationally when it comes to money, why they fail to stick with their plans, and how they choose whether to act selfishly or selflessly. He says people segregate money in mental accounts and it’s easier for them to spend someone else’s money. He also urges organizations and government to nudge people to help them make good decisions, which would make his observations on the US healthcare system interesting. He said previously that employer healthcare insurance sites are too complicated, such as displaying deductibles as a full-year sum while pricing premiums by the paycheck. One of his significant contributions involved 2006 federal retirement savings plan changes that encouraged employers to make participation opt-out rather than opt-in, which doubled participation, although he’s disappointed that companies encourage under-contribution by setting the default contribution at the minimum amount instead of escalating it over time.
A woman in Japan posts Instagram-worthy photos of the hospital meals she was served following the birth of her child, making it obvious that they do things differently there.
Sponsor Updates
Colquitt Regional Medical Center (GA) describes the benefits it has seen from its summer 2016 go-live on Meditech 6.1.
Fortified Health Security President Dan Dodson will present “Out of the Dark: Seeing and Securing Network-Connected Medical Devices” at the Raleigh Health IT Summit on October 20.
Aprima will exhibit at the American Academy of Home Care Medicine Annual Meeting October 13-14 in Rosemont, IL.
Besler Consulting will present at the SC HFMA Fall Institute October 12 in Greenville.
Black Book publishes the results of its annual outsourced coding and HIM market client experience surveys.
CoverMyMeds partners with Pelotonia to raise over $100,000 for cancer research.
CTG will exhibit at the Northwest Arkansas Technology Summit October 17 in Rogers.
October 9, 2017HeadlinesComments Off on Morning Headlines 10/10/17
CNBC’s Christine Farr reports that Amazon is in the final stages of planning its move into the healthcare space, and is considering selling prescription drugs as an entry point. The tech giant is expected to make a decision on its next steps by Thanksgiving.
California Governor Edmund Brown Jr. announces the formation of the Governor’s Advisory Committee on Precision Medicine. The committee will advise the governor on the use of data-driven tools and analysis to help the State improve health and health care.
The Wall Street Journal reports that President Trump will sign an executive order this week rolling back health insurance regulations governing ACA’s individual marketplaces.
Federal prosecutors are investigating Lenox Hill Hospital’s (NY) Chairman of Urology and Chief of Robotic Surgery at for simultaneously running operating rooms on hundreds of occasions, a practice patients did not know about.
October 9, 2017Dr. JayneComments Off on Curbside Consult with Dr. Jayne 10/9/17
I spent another weekend seeing patients, the by-product of a practice that is expanding physically faster than it can expand its staffing. In an environment where various organizations are grappling for market share, there’s good business justification to grow quickly, but it can create pressure on the people, processes, and technology needed to support the growth.
I mentioned last week that we had a mini-release from our EHR vendor that added some clunks to the documentation workflow. The clunks are still there, with no end in sight as far as streamlining around them. They were added to facilitate document upload to a health information exchange, but we’re not connected to one. Based on some of the patients who arrived at my location, I could really have used the HIE.
The day started pretty slow, allowing me to catch up on some journal reading and continuing education. I read an interesting article on physician burnout from the state medical society in one of the states where I’m licensed but don’t practice. In addition to physician burnout, it talked about how physicians receive healthcare in general, which is to say poorly at times. There are many physicians who feel like seeking care is a burden, either to their schedules (having to cancel office days or move patients for a sick visit) or to their colleagues, who have enough on their plates.
This leads to physicians often treating themselves, which is generally a bad idea. It’s hard to be objective about your own symptoms and examining yourself isn’t the most productive diagnostic activity. Nevertheless, it happens, with studies estimating the prevalence of self-treatment from 52 to 90 percent. Physical illness can impact how we render care, as can psychological problems like burnout. The article mentions that in the particular state, licensure applications require physicians to self-report any conditions that limit or impair judgment or affects the ability to practice medicine in a safe and competent manner.
I’d argue that burnout can affect the ability to practice medicine in a competent manner – loss of empathy, loss of patience, tunnel-vision, and more – but physicians aren’t likely to self-report because that triggers the need for a sheaf of documentation and an investigation from the licensing board. The article goes on to mention a 2009 study that found that 69 percent of state medical licensing applications ask questions that would be considered “likely impermissible” or “impermissible” based on the Americans with Disability Act and relevant case law. Other countries have fewer barriers to physician care, with Norway leading the pack with a group of physicians trained by the Norwegian Medical Association to specifically care for other physicians.
It was in the context of having read this article and been thinking about physician stress and burnout that I cared for a couple of challenging patients. The first had some drug-seeking behavior that was validated by a query to my state’s Prescription Drug Monitoring Program. It’s not integrated with my EHR, but rather is a separate website, but I was happy to do those extra clicks to confirm what I suspected. Score one for technology assisting the physician, although the technology doesn’t make the conversation with the patient any easier, especially when you’re denying them the care they’re seeking. Fortunately, this was a patient who accepted her situation rather than one who became angry when I refused to prescribe oxycodone, because as an urgent care, we’re not well equipped to handle angry or potentially violent patients.
That happy technology-enabled bubble burst a few patients later, however, when I was confronted with a medically complex patient with difficult social circumstances. She had issues following a transplant for over a year, largely related to changes in her insurance and inability to get new coverage. Transplant patients need coordinated care that has many inputs, including the surgical team, organ-specific team, pharmacists, social workers, and more. Being disconnected from your team and having to rely on episodic care can result in organ rejection and serious complications. She had bounced around due to the insurance issues and then was further impacted by a recent hurricane, which displaced her to another state.
At least in her previous city, urgent care or walk-in clinic providers might be willing and able to call the transplant team for advice, regardless of the insurance coverage situation. However, providers in another state aren’t going to necessarily have that willingness to try to make that connection, especially if they’re in a stressed healthcare system. The patient realized that and had been trying to connect with a transplant group in her new state, but began to have signs of organ failure before establishing that connection.
Due to some family issues, she traveled to yet another part of the country, and several weeks and a 30-pound weight loss later, she wound up in my urgent care an hour after we closed, halfway across the country from either of her previous residences, feeling terrible and looking very ill. As soon as I heard the basics of the story from my triage nurse, I was wishing that clicky HIE popup was actually connected to something. I can log in separately to a regional HIE, but it’s a fairly immature repository that rarely contains anything useful for my local patients, so I wasn’t hopeful about finding anything on this interstate traveler. Regional HIEs often have web access for people like me, but I doubt they’d be too keen on a request from out of state, and even if they were, it’s not like that request is going to get validated and turned around at 11:00 on a Sunday evening.
After seeing the patient and dividing her concerns into short-term and longer-term categories, I started to work on a plan. One concern for transplant patients is the sensitivity of their medication regimens and their relatively immune-compromised status. In general, you can’t rely on the “bread and butter” medications we use every day because they can have serious consequences. I maximized my use of drug interaction checking but was still unsure about my plan, and had to turn to a quick literature search to see if I could get the answer. The search was fairly silent about what I was considering in my plan of care, and without documentation of safety, I couldn’t use it.
As a community physician, I don’t have any transplant colleagues I can just call up and ask questions. The hospital I’m most closely affiliated with doesn’t have transplant services, so that was a dead end as well. Since this was after closing time, we were paying overtime to our staff, and as an hourly employed non-partner physician, I couldn’t authorize more overtime to have them start to call around to the local academic centers and hope we could track down a transplant fellow on call as it approached midnight.
I was left with providing simple and supportive advice to the patient for her short-term problem, with the hopes that she could reach her original transplant team in the morning and that they would be able to offer definitive advice despite the lapse since her last visit with them. I can’t begin to describe the feelings of helplessness that these situations evoke for caregivers. We are wired to help people and our training supports that. But when we’re placed in situations like this, it’s hard to not internalize that sense of failure or the feeling that you should have been able to do more. Especially when there are multiple and ongoing situations like this, they contribute to physician burnout and further stress our healthcare system.
In thinking back through it with my CMIO hat, would a true national HIE have helped? Maybe a little. If I could have looked through past records and seen how her previous physicians handled similar symptoms, that might have given me a clue. If I could have accessed past medication lists (older than the year I could get from our Pharmacy Benefit Manager link) that might have helped. Direct messaging to providers wouldn’t have helped given the time of day or the acuteness of the situation, but at least I would have felt more like I was doing something. Direct messaging might have been tricky though, because she didn’t know the individual names of her physicians, but rather listed the transplant program as her primary care provider.
Health information technology has so much promise, but most of us are working with only bits and pieces of it and it’s not in an integrated fashion. The care we’re giving isn’t worse than it was in the paper world, but how we feel about it has changed. We feel like we should be able to do more with the technology or that we could have done better if we were fully connected along with the rest of a patient’s caregivers. There’s a certain psychic load to knowing what could be and comparing it to where we are.
I don’t know what the answers are, but hope that the people who are making healthcare policy and deciding how and if we are going to fund different healthcare initiatives think about situations like this. It’s not only how it impacts the patient, but also how it impacts the caregivers and their ability to stay resilient. In my area, losing a physician from active practice can result in between $200K and $300K in replacement and ramp-up costs, not to mention the lost patient accessibility during the transition time.
We’ve got to find a better way to ensure the available technology makes it to caregivers across the country, not just those in academic medical centers or large cities. We have to figure out how to help those who are in backwards states that don’t adequately fund PDMP or HIE efforts. We have to figure out how to get past hospitals and health systems that are actively engaging in information blocking and refuse to share patient information with the greater clinical community.
Do you see a solution in your crystal ball? Email me.
Interoperability and Standards Will Be Areas of Focus Through Year End By Michael Burger
Michael Burger is practice lead, EHRs and EDI, for Point-of-Care Partners of Coral Springs, FL.
While there are many uncertainties in healthcare, interoperability and standards will undoubtedly be areas of focus through the end of 2017. To that end, the government and industry will continue to refine existing standards and address interoperability challenges. This involves activities by the Office of the National Coordinator (ONC) and ongoing efforts by standards development organizations (SDOs) and electronic health record (EHR) vendors.
Despite potential severe budget cuts, ONC says it is committed to interoperability and standards as main areas of emphasis. For example, ONC is putting the finishing touches on its Proposed Interoperability Standards Measurement Framework, the final document for which will be issued this fall. It also is accepting comments through November 20 for the Interoperability Standards Advisory, which is a stakeholder-informed catalog of the standards and implementation specifications that can be used to meet interoperability needs in healthcare. The newly created Health Information Technology Advisory Committee will also be influential with regard to standards and interoperability. Its recommendations to ONC doubtless will be translated into rulemaking and policy.
The next few months also should see continued progress by SDOs in refining standards for interoperability with a focus on practical use cases by EHR vendors.
One example is FHIR (Fast Health Interoperability Resources), which is one of the newest standards from Health Level 7 (HL7). Vendors are beginning to embrace the most recent iteration of the standard for various clinical use cases and FHIR is being used to extract relevant clinical data from EHRs.
Also, the National Council for Prescription Drug Programs (NCPDP) is refining the SCRIPT standard to facilitate the transition to electronic prescribing of specialty medications. Today, specialty prescribing is largely a manual process that isn’t easily adapted to existing electronic prescribing workflows. An NCPDP task group is looking at ways in which new data elements could be added to the SCRIPT standard to handle enrollment for specialty medications, which accompanies the prior authorization that is required for nearly all such medications. The goal is to enable enrollment and electronic prior authorization (ePA) for specialty medications. Changes to the standard will enhance the ePA functionality, which EHR vendors have already built for non-specialty medications.
There are still obstacles that must be overcome to move health IT interoperability down the field. Three come to mind:
Lack of a national patient identifier. One of the biggest interoperability challenges is the lack of a national patient identifier. While industry solutions are being developed, they are one-offs that are not totally standards based. True interoperability cannot be achieved unless this problem is solved.
Changes in business models. There is much talk around data-blocking by EHRs, but this is not so much a technology challenge as a business one. The competitive nature of healthcare delivery is primarily what prohibits the exchange of clinical information, as competitors don’t want to make it easy for patients to seek care outside of their networks. When there is demand among customers to connect systems, software vendors respond by building and selling connectivity solutions. The most successful of these solutions rely on standards that have been created and vetted through SDOs.
Variations in standards implementation. Other interoperability challenges are created by variations in how standards are used in application program interfaces (APIs) with EHRs. Sometimes these APIs rely on technology that is not standardized, thus adding to the complexity and inconsistency in how data are exchanged among EHR platforms. The goal of using standards to achieve interoperability can only be met when standards are interpreted, implemented, and used consistently.
These are but some of the opportunities and challenges we see in the waning months of 2017 when it comes to standards and interoperability. These issues are not going away anytime soon and will continue to occupy stakeholders’ attention in 2018.
October 9, 2017Readers WriteComments Off on Readers Write: The Untapped Data That Can Improve Lives and Lower National Healthcare Spending
The Untapped Data That Can Improve Lives and Lower National Healthcare Spending By Kurt Waltenbaugh
Kurt Waltenbaugh is founder and CEO of Carrot Health of Minneapolis, MN.
Ask 10 mechanics which costs more — preventive or corrective maintenance — and each will likely give the same answer. It’s cheaper to change a car’s oil regularly than to repair a seized engine. The same principle holds true for healthcare.
In 2015, US healthcare spending reached $3.2 trillion. More than half of that went toward hospital care and physician / clinical services, which increased by 5.6 percent and 6.3 percent, respectively, according to the Centers for Medicare and Medicaid Services (CMS). The surge in payouts for these services was due to “non-price factors,” specifically an increase in “use and intensity of services.”
This makes sense given that the coverage expansion under the Affordable Care Act (ACA) gave more Americans access to healthcare than ever before. But at a time when the public and healthcare professionals have centered their focus on reducing insurance premiums and the cost of care, there is one question missing from the debate. Could the need for some of these services have been prevented?
The answer lies in a well of big data that has, until recently, been untapped by the healthcare industry.
In the health insurance market, there exists a disconnect between medical costs and an individual’s health quality. Behavioral and socioeconomic factors determine roughly 60 percent of their overall health, yet 88 percent of the country’s healthcare spending goes towards medical services, which impacts merely 10 percent of a person’s healthiness.
A study entitled “Health and social services expenditures: associations with health outcomes” compared spending by 11 nations on medical care against social care and the impacts on health outcomes. The findings showed that not only was the US the only country to spend more on healthcare than social services as a percentage of GDP, but that a higher ratio of spending on social services was also associated with better outcomes in infant mortality and life expectancy.
Access to this socioeconomic and behavioral data gives payer organizations a clearer picture of a member’s health risks. For example, detailed knowledge about where a person lives — such as neighborhood crime rate, average household income, and availability of healthy food — provides more predictive information than higher-level information on the coverage region, data that delivers far more accurate insights into quality of life. Environmental factors like “walkability” can help determine how easy it is to exercise, while air quality can indicate a person’s risk for lead exposure. For individuals living in a low-income, high-risk area, education and local job opportunities can determine their probability for upward mobility and, by extension, how likely they are to improve the socioeconomic factors impacting their health.
On the surface, proponents of data privacy might argue that these companies would push to use this information to raise premiums for those whose socioeconomic and/or behavioral patterns make them more susceptible to life-altering medical conditions. A deeper examination, however, reveals an opportunity for payers to cover more individuals with less-costly interventions without losing any competitive ground. By connecting these individuals with services that help address social and behavioral determinants of health, payer organizations help them improve their lives while also reducing the potential need for higher-cost care interventions, such as emergency room visits or hospitalization.
In fact, this approach has the potential to change the way insurance operates throughout the country. Rather than balancing enrollment with enough low-risk members into a health plan to cover the care costs for high-risk members, a strategy centered on preventive care through social and behavioral interventions means payers become more invested in their members’ total quality of life, thereby creating a healthier population.
Comments Off on Readers Write: The Untapped Data That Can Improve Lives and Lower National Healthcare Spending
eClinicalWorks reports $130 million in Q3 revenue and the addition of 3,750 new providers. It claims to now be “the second most widely used EHR in the country.”
In England, West Suffolk NHS Foundation Trust stops using Cerner-generated patient discharge letters after a software bug leads to incorrect medication reconciliation information making its way into the letters.
PatientKeeper announces reconciliation tools to help hospitals find unclaimed inpatient professional fee charges. The company estimates that hospitals typically fail to charge for 10 to 15 percent of their inpatient professional fee charges.
EClinicalWorks says at its annual user conference in Grapevine, TX that it had Q3 revenue of $130 million. The company notes that its EHR is the second-most widely used in the US.
ECW’s migration statistics for 2017 to date show that the EHRs it most often replaces are those of Greenway (by far), Allscripts, and Athenahealth.
EClinicalWorks also announces December 2017 availability of an interoperability development platform that allows developers to connect to ECW’s API-enabled EHR.
Also announced: a voice-powered Virtual Assistant called Eva, Healow Virtual Room for telemedicine, and v11 of the company’s core product.
HIStalk Announcements and Requests
Two-thirds of poll respondents think customers that are featured in a vendor’s product sale announcement should be required to indicate whether they hold a financial interest in that vendor. The “required” part of that assertion is the problem, of course, since the obvious remaining issue is, “Required by whom?” Still, the idea that a provider’s purchase of a product wasn’t made using purely objective criteria is troubling to some since the announcement may influence others, especially in health IT-land where “I’ll have what he’s having” purchasing behavior is not uncommon.
New poll to your right or here: who among the rumored candidates would you like to see appointed HHS secretary? I can’t say I’m enthused about any of them except at least they aren’t Tom Price.
Welcome to new HIStalk Gold Sponsor CenTrak. The Newtown, PA-based company’s real-time location system has been installed in 850 healthcare facilities, with its Clinical Grade-Visibility providing certainty-based location accuracy; rapid location and condition updates; easy installation without requiring patient rooms to be closed; and an open location platform that can be integrated with EHRs, nurse call, and other systems. Its app is available for both iOS and Android devices. CenTrak is KLAS’s 2017 Category Leader for Real-Time Location Systems, receiving the highest performance score among ranked RTLS vendors. The company offers a free Enterprise Location Services Handbook and an RTLS RFP template. Thanks to CenTrak for supporting HIStalk.
I found this video describing how CenTrak is used at Our Lady of Lourdes Regional Medical Center (LA).
Thanks to the following companies that have recently supported HIStalk. Click a logo for more information.
Listening: the amazing alt-acoustic Jamestown Story, which I’ve mentioned before since it’s a project of independent singer-songwriter Dane Schmidt, whose dad Mark is a consultant with Navin, Haffty & Associates. Mark reports that his other son Jordan is one of the top songwriters in country music and has three songs on the charts right now. I’m also listening to former Porcupine Tree singer and guitarist Steven Wilson, justifiably recommended by a reader who also suggests Wilson’s older work with the tragically underappreciated Porcupine Tree as a “modern Pink Floyd.” I’m tracking Porcupine Tree while I’m writing HIStalk today and it is stunningly perfect, even in live recordings. Video from Wilson’s live 2013 performance gives me prog chills, to the point that I just now bought tickets for his US tour that starts in April, where I’ll be silently thanking the reader who showed great insight in recommending Wilson’s music.
This Week in Health IT History
One year ago:
Theranos announces that it will close all of its clinical labs and lay off half of its employees in pivoting from running labs to commercializing its MiniLab testing system.
Xerox, preparing to split itself into two publicly traded companies, chooses Conduent as the name of the business process services segment.
HHS publishes the final MACRA rule.
Five years ago:
Allscripts offers MyWay EHR customers a free upgrade to Professional as it begins the product’s retirement.
Allscripts files a protest against New York City’s hospital system for choosing Epic.
The developer of Nashville Medical Mart shuts down the project for lack of leasing interest.
Ten years ago:
Misys Healthcare re-forms under new private equity owner Vista Equity Partners and returns to its old name of Sunquest Information Systems, with Richard Atkin as president and CEO.
Microsoft’s healthcare head predicts that the company’s HealthVault personal health record and Azyxxi data aggregation platform will generate a billion dollars in annual revenue.
Word leaks out that Epic is developing its own PHR called Lucy.
Sage fires its North American executives as the company’s US performance continues to lag.
Last Week’s Most Interesting News
France-based IT consulting firm Atos acquires three US EHR-focused consulting companies.
The US Supreme Court hears arguments on the legality of Epic’s requirement that employees agree to arbitration rather than lawsuits to settle employment issues.
Several names are floated as possible replacements for fired HHS Secretary Tom Price.
A Wisconsin court reduces the $940 million awarded to Epic in its intellectual project lawsuit against Tata Consultancy to $420 million.
Canada’s Alberta Health chooses Epic.
Webinars
October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.
October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine; Gary Palgon, VP of healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Medecision acquires 58 client contracts of AxisPoint Health’s retired CCMS and Vital software platforms, making it the largest independent provider of care management applications in the country. AxisPoint Health has retained its services business.
A fascinating profile of the richest man in Florida — an immigrant from Hungary who made his many billions from the electronic stock brokerage he created — contains his deceptively simple business strategy: “My strategy has always been to try to focus in on a product or service where you can create a dollar of value for 20 cents and sell it for 40 cents. The only way to do that is to use technology that has not been used before in producing that product or service. If I can create that dollar, then I’m already ahead 20 cents of earnings, and I’m going to keep way way way ahead.” Thomas Peterffy said when he introduced hand-held computers to Wall Street trading floors in the 1980s, “I think the way a CEO runs his company is a reflection of his background. Business is a collection of processes, and my job is to automate those processes so that they can be done with the greatest amount of efficiency.” Some other quotes that may be applicable to healthcare IT:
“Some traders still think that a computer could not trade as well as they can.”
“I always preferred computer programmers because I knew how to talk to them. I never knew how to talk to salesmen because I never believed them.”
“I moved to a commodity trading firm and my job was to figure out how to price options. That was a very, very interesting job because in those days people were trading options by the seat of their pants because nobody understood the mathematics. And after a very long period of ruminating and running simulations on my computer, I eventually came up with a model that is very similar to what today is known as the Black-Scholes formula. Given the fact that I was the only one at the time who had that formula, I saved my money. I bought a seat at the American Stock Exchange and I became a market maker.”
“Given that the market is very complex and our strategy is to give our customers an advantage over the customers of other brokers, we cannot do that with just a simple system, so unfortunately the system has to be complex. The only way we can do that is to provide a facility just like your Apple iPhone. People who only use it to make phone calls and send texts don’t know about all the other things that it can do … As to onboarding, that’s been a hassle forever … The regulators tell us that we have to know our customer rules. We have to know many things about our customers to make sure that they will not do certain trades, because even though we don’t give any recommendations, we are liable. We have to make sure that they do not do trades that they are not fit for. I don’t really know how to judge that.”
Decisions
Palmetto Health (SC) will switch from McKesson Star to Cerner revenue cycle management in October 2018.
Cape Fear Valley Health System (NC) will replace Cerner revenue cycle management with that of an undecided company.
These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
People
Health Catalyst promotes Patrick Nelli to CFO. He replaces Dan Strong who, unlike his replacement, has experience taking companies public.
Announcements and Implementations
PatientKeeper announces Charge-Note Reconciliation, which automates the reconciliation of clinical notes and inpatient charges to find the 15-20 percent of typically unsubmitted professional charges. It’s available immediately in the company’s charge capture solution.
Other
NPR covers the three-fourths of Puerto Rico hospitals that are still running on emergency power and no air conditioning. An Arecibo hospital’s cardiac unit registered 112 degrees, requiring patients to be moved by HHS’s Disaster Medical Assistance Team to air-conditioned tents.
Eric Topol, MD posted this about patients owning their data.
A terminal cancer patient expresses frustration with feel-good healthcare marketing that spreads false hope of miraculous recoveries with endless pink ribbons and catchwords like “thrive” and “smile out,” with the implication that people like herself who are dying maybe just aren’t being positive enough. Experts say that hospitals market themselves against their competitors by tugging at emotions, while drug companies are prohibited by FDA from running “this is where miracles happen” type messages that aren’t backed by rigorous studies or outcomes results.
Arizona funeral homes are left unable to bury their customers due to problems with the state’s new death certificate processing system that went live October 2. Bodies can’t be buried or cremated until doctors have acknowledged the cause of death and many doctors didn’t sign up for the new system, requiring some funeral homes to go back to paper.
In England, West Suffolk Hospital stops using discharge letters after doctors complain that they contain errors in medication doses, a problem the hospital blames on a Cerner software bug. One doctor says a patient collapsed after following the incorrect dose listed in the letter.
Congratulations to the 10 people (out of 252) who scored a perfect 100 percent in Dean Sittig’s informatics terminology quiz. The mean score was 68 percent, with the most-missed terms being “structural alignment” and “syncytium.” Biomedical informatics professor Dean just published “Clinical Informatics Literacy: 5,000 Concepts That Every Informatician Should Know.”
Bizarre in mass hysteria, sad current events sort of way, especially if you thought you were the only one sick of the fall “pumpkin everywhere” craze. A Baltimore high school is evacuated, dozens of students are triaged by Hazmat teams, and five students and adults are hospitalized for breathing problems after reports of a strange smell. Firefighters discovered the cause in a classroom – someone had plugged in a pumpkin spice air freshener.
In England, a hospital’s power goes off during electrical system testing, leaving the delivery suite in darkness just as midwives are cutting the new mom’s umbilical cord. Her mother whips out her smartphone and turns on its light to allow the delivery to be completed. The new mom reports, “There was just no dignity because I had people pointing their phones at me. It was so surreal. I was thinking, what is my mum doing? Is she filming this?”
LogicStream Health will host a reception during the Cerner Health Conference October 10 from 5:30-7:30 at Cleaver & Cork in Kansas City, MO.
Meditech releases a video on its Sepsis Management Toolkit featuring Capital Region Medical Center Clinical Analyst Marlene Stiefermann, RN.
Navicure will exhibit at the US Women’s Health Alliance October 12-14 in San Antonio.
Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the National Association of Neonatal Nurses October 11-13 in Providence, RI.
France-based Atos acquires three US health IT consulting firms: Pursuit Healthcare Advisors, Conduent’s Healthcare Provider Consulting business, and Conduent’s Breakaway Group business.
Willis-Knighton Health System (LA) Chief Cardiologist Michael G. Futrell, MD resigns following a failed vote of no confidence in the hospital’s 52-years-long CEO James Elrod. The board voted to keep the embattled CEO in place, despite criticism that he has shown “resistance to changing with the times and refusal to upgrade the hospital system’s information systems.”
France-based IT consulting firm Atos acquires three US healthcare consulting firms that focus on EHRs: Pursuit Healthcare Advisors, Conduent’s Healthcare Provider Consulting, and Conduent’s Breakaway Group.
The acquisition gives Atos 400 new consultants. The company expects its healthcare revenue to increase to $1.2 billion.
Atos acquired Anthelio Healthcare Solutions a year ago for $275 million in cash.
Reader Comments
From Kyle Armbrester: “Re: Givenchy’s rumor report from Tuesday. The statement that ‘about 20 hospitals are cancelling scheduled go-lives’ is false. It’s unfortunate that a few, CPSI in particular, persist in seeding and spreading misinformation about Athenahealth and our in-market momentum and success. Some facts: Earlier this year, KLAS reported that only three vendors achieved net gains in the hospital space—Cerner, Epic, and Athenahealth. Our clients are realizing improved financial and clinical results; four out of five of executives who we work with are seeing real positive impact on bottom lines (KLAS). We have plenty who would love to do a Q&A for HIStalk. We are building true partnerships across the community hospital space which are directly attributed to addressing the needs of an underserved segment. We offer low up-front costs, no maintenance fees, and aligned incentives. It’s our cloud-based, results-oriented platform model that gives us our edge and sets us apart from traditional software players that now seem to be kicking-up some in-market desperate and unsavory behavior. Givenchy, would love to talk further.” Kyle is chief product officer at Athenahealth. Givenchy also named three specific (but still unverified) hospitals that have returned to CPSI, not including Jackson Medical Center (AL), which a CPSI-issued press release says went back to Evident Thrive after its collections dropped 75 percent after a few months running Athenahealth. I’m happy to talk to folks from hospitals that have either gone live on Athenahealth in the past 6-12 months or that have returned to CPSI after trying Athenahealth, which is about as fair and direct as I can make it.
From Cheap Seater: “Re: cavorting on the UGM stage. What about so-called journalists who make the mistake of letting vendors court them at user meetings and conferences?” I think that happens only rarely since most of those folks don’t have a lot of influence to be worth courting, but I do picture most industry writers as introverted, inexperienced with frontline healthcare or IT, and easily swayed by token vendor executive attention, so I agree that their reporting might be suspect at times. It’s like reading an online review from Yelp or elsewhere – be wary of starry-eyed accounts that don’t contain at least one negative observation. I like staying anonymous because that removes even the possibility of vendors trying to apply schmooze in return for positive commentary. It’s like fake news – the problem isn’t that it exists, it’s that Facebook users aren’t smart enough to recognize it or are so anxious to validate their beliefs that they suspend whatever objectivity they once had.
From Lazy Crazy AZ Days of Summer: “Re: Banner Health. Went big bang in replacing Epic at the former University of Arizona Health Network on October 1. A colleague says ED lab turnaround is six hours and they had to divert patients.” I reached out to Banner, whose PR contact said the hospital was briefly on diversion for some ED patients, but remained open for trauma and walk-ins. They are now off diversion.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor CarePort. The Boston-based company – acquired by Allscripts a year ago – offers a care coordination platform that bridges acute and post-acute EHRs, providing visibility into the care that patients receive across post-acute settings so that all providers and payers can efficiently and effectively coordinate patient care. Starting at discharge, CarePort Guide enables patients to choose the best next level of care based post-acute quality scores, services, and geography. Post-discharge, CarePort Connect helps the care team to track patients as they move through the continuum by pulling real-time data from acute and post-acute EHRs. Finally, CarePort Insight aggregates data across providers to deliver the insights needed to manage a high-performing post-acute network. A spokesperson from customer Cleveland Clinic says, “We are giving patients all the information they need to make an informed decision that best suits their needs and preferences.” Co-founder and CEO Lissy Hu – who earned her MD and MBA degrees from Harvard – previously worked on a Medicare demonstration project involving transitions in care for complex patients. Thanks to CarePort for supporting HIStalk.
Listening: a new live album from The Magpie Salute, which carries some Black Crowes DNA in offering straight-ahead rock. They’ll play in Madison next week and Kansas City the week after.
Music I won’t listen to: young female singers who start every vocal phrase with a dramatically loud intake of breath even though it’s obvious they’re using vocal improvement software that could have removed even trendy extraneous bodily noises. You would not enjoy hearing most of those musically enhanced warblers on “MTV Unplugged,” which is probably why that program went away.
I know little about guns (even though I have a satisfyingly hefty .357 Magnum revolver that I used to love shooting at the range) and was curious about the inexpensive and entirely legal “bump stock” used by the Las Vegas shooter to turn a semi-automatic rifle into a poor man’s machine gun, turning up this video that illustrates a product that is either ingenious or terrifying depending on which end of it you expect to be on. I was amused only by the portion showing the product’s schematic in which the gun is throbbing in a phallic-like manner in time with heavy metal music that suggests a stereotypically swaggering target audience (notwithstanding this unfortunately accented female customer). The device is likely to be banned quickly because it’s made by a small family business (it shut down all competitors via copycat lawsuits) rather than a big gun manufacturer. The company owner should go out rich, though, since sales have gone off the charts since the massacre.
This week on HIStalk Practice: California IPAs merge as they expand Epic utilization. DuPage Medical Group fills physician pipeline with new resident incentive program. WebPT acquires Strive Labs. CareCloud launches patient intake, payment system. Practices outpacehospitals on healthcare pricing transparency. Former US Surgeon General Vivek Murthy, MD highlights loneliness epidemic. EHR investment makes up good chunk of Q3 digital health funding. MGMA President and CEO Halee Fischer-Wright, MD previews upcoming annual conference, addresses role companies outside of healthcare will play in EHR development. HIStalk’s Must-See Exhibitors Guide for MGMA 2017 goes live.
Webinars
October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.
October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.
October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.
November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine; Gary Palgon, VP of healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
ECG artificial intelligence analysis vendor Cardiologs raises $6.4 million in a Series A round, increasing its total to $10 million. The company’s ECG analysis platform earned FDA clearance in July 2017. Cardiologists upload a digital ECG from a Holter monitor, smart watch, or personal monitoring device and the system reviews the often-long recordings to alert the doctor if it finds one of 10 types of cardiac events, most of them related to atrial fibrillation.
Sales
The board of Hiawatha Hospital Association (KS) approves the replacement of Allscripts/McKesson Paragon with Athenahealth.
Seven Hills Foundation (MA) chooses Netsmart as the care coordination and population health management provider for the Massachusetts Care Coordination Network.
People
James Murray, MS (CVS/Minute Clinic) joins Culbert Healthcare Solutions as CIO.
Announcements and Implementations
IVantage Health Analytics, part of The Chartis Group, launches Performance Manager, which allows health systems to benchmark performance, identify opportunities for improvement, manage initiatives, and share best practices in a peer-to-peer community.
Government and Politics
Stat reports that IBM is using its lobbying clout to shield its Watson system from medical scrutiny. A former IBM executive (Janet Marchibroda) helped draft legislation that removed some kinds of health software from the FDA’s oversight; IBM hosted an event to introduce Watson to high-powered members of Congress; and the company has deployed lobbyists to argue that Watson should be exempt from medical device law. It’s an interesting piece, but it seems obvious that IBM Watson Health, like most other clinical decision support or medical knowledge systems, does not fall under FDA regulation because it is not a closed-loop system since the clinician is free to accept or reject the advice it offers. The real scrutiny should come from Watson’s customers and I’ve seen little positive commentary in that regard.
An Oracle executive applauds the federal government’s move to the cloud, its data security efforts, and IT service consolidation in a letter to the White House’s American Technology Council and Jared Kushner, but makes these observations:
The federal government should emulate the best practices of Fortune 50 customers rather than Silicon Valley vendors that often fail even though they know how to deploy products at scale.
The government should focus on procurement and program management, not IT development, a lesson long since learned by large companies. It says that the most important CIO skills are choosing commercial products, implementing them efficiently, and maintaining those systems to prevent cyberattack.
The federal government should focus on open data instead of open source software development in recognizing that nothing requires the federal government to give citizens systems it builds or buys for free.
The most important driver of cost and complexity is customization, with code written by 18F, USDS, and other agencies creating a support tail that drives unbudgeted costs.
The government should modernize its processes across agencies since government-specific processes drive IT cost overruns.
The government is using technology preferences and vendor-favoring standards instead of competition, which “places the government at substantial risk of failing to acquire the best, most secure and cost effective technology, even if those de facto standards are proposed by well-meaning government employee who ‘came from the private sector.’”
Privacy and Security
Brilliant satire – as usual – from The Onion. Substitute “hospital employee” for “mom.”
Innovation and Research
The NIH issues a $2.3 million grant to the chief epidemiologist at Maryland’s VA system to study why physicians overuse lab tests in believing they are more useful than evidence suggests.
Technology
Major League Baseball – which prohibits the use of Internet-capable devices in the dugout during games because of concerns about stealing or relaying signs — launches an investigation as to why a Diamondbacks coach was captured in a photo taken during a Wednesday wild-card game wearing a smart watch.
Other
Western Australia’s coroner blames Fiona Stanley Hospital’s lack of follow-up for the death of a 41-year-old patient who died of septic shock on March 2015 after being ordered a contraindicated drug. The patient had inflammatory bowel disease and was prescribed mercaptopurine after clinicians failed to notice a red-flag lab result on his electronic chart. The coroner noted that the hospital now watches patients who are ordered the drug more closely and has developed new requirements for reporting abnormal results, but also recommends that the hospital install better patient tracking systems and send lab results to the physicians overseeing treatment.
The chief cardiologist of Willis-Knighton Hospital System (LA) resigns as part of a no-confidence vote in the hospital’s CEO, who has run the hospital for a record 52 years. Critics say he has been too slow in making changes and refuses to upgrade the hospital’s computer systems. The system wasn’t mentioned, but Googling suggests that the hospital has run Meditech and Siemens/Cerner Soarian in the past.
A Utah neurology clinic that was previously sued for unpaid wages and investor fraud leaves patients without access to their MRI results when it shuts down without notice. The owner blames the clinic’s closure on an electrical surge that damaged its computers, but says he sent its electronic records to Salt Lake Regional Medical Center (UT), which was able to recover those of a patient quoted in the newspaper article.
A jury finds that a hospital’s collection agency isn’t meeting legal notification requirements when it sends a collection letter via a secure PDF email link since, unlike reliable postal mail, there’s no strong likelihood hat the intended recipient will read the letter. The collection company’s own software proved that the intended recipient did not open the letter. The judge summarized, “She was required to open an email and then click through over the Internet to an unknown web browser inviting her to then open a ‘Secure Package’ … modern consumer practices are not conducted this way. Although a consumer may regularly open e-mails from persons and companies she knows and to which she has given her email address for communications (like a recognized email from the utility company or the bank one does business with), there is no evidence that Ms. Lavallee should have recognized as safe an email from Med-1 Solutions.”
This is fascinating: one of 12 companies that were awarded medical marijuana growing permits by Pennsylvania’s Department of Health in June is offering the never-used permit and its 47,000 square foot cultivation facility for sale at $20 million. The company, run by a former candidate for governor, wants to obtain an even more lucrative clinical research (CR) license that would allow it to investigate the medical benefits of marijuana in partnering with a teaching hospital, which would also let it open another growing facility and to operate six storefront dispensaries. Six of the eight Pennsylvania CR permit holders have already signed research agreements with medical schools — Penn, Drexel, Thomas Jefferson, Temple, UPMC, and Lake Erie College of Osteopathic Medicine. The company’s chief medical officer is the recently retired president of MedStar’s medical group.
Sponsor Updates
Influence Health announces its 2017 EHealth Excellence Award winners.
The Chartis Group publishes a white paper titled “Solving the IT Investment Paradox.”
Black Book names Nuance as the leading vendor for end-to-end healthcare coding, clinical documentation improvement, transcription, and speech recognition technology.
McLaren Flint (MI) implements an RTLS-smart pump interface between Versus and B. Braun, allowing clinicians to see on a real-time floor plan where pumps are located and whether they are actively infusing to improve re-distribution.
A Health 2.0 conference demo shows how FDB’s Meducation solution, previously available only to providers, can now be viewed and shared by a patient-controlled app.
EClinicalWorks will exhibit at the Louisiana Primary Care Continuing Education Conference October 10-12 in Lake Charles.
This week is National Health IT week, with events being held across the country. The “points of engagement” for this year’s events include: supporting healthcare transformation; expanding access to high-quality care; increasing economic opportunity; and making communities healthier. I’m particularly fond of the point regarding healthcare transformation, as so much of my work revolves around helping healthcare organizations make sense of the changing delivery environment and payment models. Many organizations are transforming for the right reasons, such as patient and community health, and those efforts make me feel energized and that I’m doing valuable work.
However, I still see far too many organizations that are on the “stick” end of transformation, only changing because they feel they are being forced to. Many of these groups are fighting themselves as they move through the change, with the C-suite saying change is here while allowing some of their more vocal (and often more profitable) physicians and subspecialties to basically opt out. I watched one group mandate that primary care physicians enter all data through discrete template fields, while allowing their orthopedic surgeons to dictate because they were afraid the surgeons would leave the group. This kind of behavior doesn’t do much to engender collegiality or build professional rapport. The most successful groups I work with are transforming because they believe in their ability to deliver care more efficiently and effectively, but trying to spread that enthusiasm continues to be a challenge.
It feels like there is considerably less buzz around Health IT Week than there was even just a few years ago, let alone what it was like in the heyday of excitement around Meaningful Use. Even Google seemed a bit lackadaisical, with my “national health IT week 2017” search bringing up an article about the 2016 events as the fourth item in the search. Let’s face it, healthcare IT isn’t as sexy as it once was and there aren’t as many so-called rock stars out there doing the moving and shaking, but it’s something in which every single one of us is a stakeholder. Having gone through yet another round of medical adventures this week, I’m grateful to have care with physicians that continue to use technology to its fullest and who enable me to be a more educated and engaged patient.
Despite the relative lack of buzz, healthcare IT continues to be of interest to young physicians and those still in training who have decided that clinical medicine may not be right for them. Maybe it’s the rigors of the schedule, the stress of feeling responsible for so many outcomes, or lack of resilience to deal with the chaos that can be modern medical practice that are raising interest. I’ve been mentoring a young resident who is considering whether he should pursue a clinical informatics fellowship or give practice a try. It’s hard to watch a once-idealistic trainee talk about his level of burnout before he’s even made it out of training. Primary care salaries continue to lag behind other subspecialties and doing something other than going straight into the trenches has a certain appeal. He’d like to stay in our metropolitan area for family reasons, so I’m encouraging him to try some moonlighting shifts in the urgent care setting to see if that’s a better fit.
One of the reasons he’s so burned out is that his residency program hasn’t truly embraced the model of team-based care. The faculty physicians are still in the mold of doing things how they were trained, which means a lot of work rolls downhill to the trainees. They have to do all their own patient callbacks and aren’t allowed to leverage staff to manage routine patient requests or to do care management activities – everything must be done by the resident physicians. I don’t dispute that this gives them a lot of knowledge about managing patients, but it doesn’t teach them how to work effectively with other members of the care team or how to lead the care team. The residents don’t get assistance with chart prep or morning huddles, leaving them to try to address gaps in care as part of the routine office visit. Worst of all, when patient-facing work is delayed by other clinical rotation activities, the patients aren’t getting good care. I’m trying to help him arrange some elective work in a setting where he can see clinical transformation in play, along with a rotation with a clinical informaticist in the academic setting. He needs to see first-hand that healthcare IT isn’t all that glamorous either, and depending on where you wind up, you may not escape patient care.
I’m still waiting to see if all this talk about the shift to value-based care will increase primary care salaries, but I’m not holding my breath. I do have a number in mind for which I would hang up my frequent flyer card and go back to primary care, but it would also require some addressing of the details of physician autonomy and practice structure. The wait for a new patient appointment with a primary care physician in my community is upwards of two months if you have commercial insurance, three months for Medicare, and four to six months for Medicaid. When people complain about the potential for rationing in healthcare, they don’t understand that in all practicality, it’s already here. These issues are daunting to new physicians (and old alike) and aren’t doing much to increase enthusiasm among physicians in crisis.
I’m always on the lookout for new vendors and found one this week in the form of CampDoc. The product is positioned as an electronic health record system for camps and they’ve been doing some epidemiologic research looking at the camp population. In addition to injuries, heat-related illness, insect bites, and allergic reactions, camp physicians also have to contend with head lice, infectious diseases, and disaster preparedness. They’ve partnered with the University of Michigan to broaden their research, which has been presented at the American Academy of Pediatrics, the Society of Academic Emergency Medicine, and other groups. Upcoming studies will focus on head injuries and concussions during summer camp activities. Interested parties can visit their website or reach out to CampDoc for more information.
For all you IT road warriors out there, join me in saluting Southwest on their retirement of the Boeing 737-300 series planes. The last of the fleet without Wi-Fi or exit windows that open like a DeLorean vs. having to be thrown out, they officially ended service September 30. I was pleased to see that several will be turned into firefighting tankers and others are in the process of being brokered. I’ve spent many hours in its confines, usually on time. I’m looking forward to its replacement, the 737 MAX 8 ,which has enough range for destinations in South America and the South Pacific. If SWA ever heads to OGG or HNL, I’ll be cashing in my points faster than you can say humuhumunukunukuapua’a.
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Would have liked to have seen more about Expanse here. Would like to see more about it on this site…