The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.
Leading with Fear – Not!
Researches say we are born with two fears — fear of falling and fear of loud noises. Every other fear is learned. Fear is developed and reinforced because of the consequences and punishments we experience.
Ironically, 85 percent of our fears are never realized. In fact, many are irrational, often based on emotion, not data. Real or imagined, the consequences of fear, especially in the workplace, are devastating.
Insecure leaders rule with fear. Even when effective, the use of fear to motivate employees is morally corrupt. Fear has no place at work. Confident leaders can achieve better results creating an engaged culture without fear. Who wants to work for a leader whose primary tactic is fear to motivate? Nobody.
Clearly, people still work for fear mongers. Leaders throughout history have leveraged fear. Despite the contemporary focus on management theory and professional development, leadership by fear continues.
Employees feel they may not have a choice but to capitulate to the fear mongers. Others have a victim mentality, feel incapable of escape, and assign the experience to fate. At the edge are those who believe they may deserve the punishment.
Naïve workers who know no difference may believe all leaders rule by fear. A smaller percentage know it is wrong, actively resist, and look for the first opportunity to escape. This reinforces the trend where the best employees tend to leave unhealthy environments while peers begrudgingly accept abuse and stay.
Leadership by fear is a management form of bullying. We spend too much time at work to be miserable and treated disrespectfully. There is a better way, and if you find yourself working for an abusive leader, you must stand up for yourself or leave. Pacifism only reinforces the behavior and nothing changes for you, nor for those who follow. Stay and fight if you have the skills, but move on if you have no support. Nobody deserves to be bullied.
I once observed an iron-fisted peer who ruled by fear. Insecure and simply unpleasant, he would routinely yell, curse, belittle, and threaten his team. I watched otherwise aspiring leaders shake to their core. His team trembled working for him. The more they passively accepted his leadership by fear, the deeper it became ingrained.
His power over them grew. His bullying became the new norm and eventually worked its way down to the depths of his division. Weak subordinates accepted and adopted this style and soon the stain and stench of fear permeated. Engagement plummeted as the culture shifted into the abyss. Next, performance fell. Fear, left unchecked, grows and takes no prisoners.
I felt sad. Heartbroken for the people who came to serve each day wanting to do good work, but were bullied. Torn to see aspiring leaders snuffed too early in their careers. Disappointed for customers who suffered deteriorating service. It became a slow death spiral. Lead with fear, and when performance suffers, add more fear.
By the time our parent organization took action, the damage was profound. The division was rebuilt over time, but the scars and pain from fear never disappear. Healing takes time and love.
Love is the antidote to fear. How can you change a fear-emboldened leader or a fear-based culture? Love does not imply that you overlook poor performers and sing Kumbaya all day holding hands sitting in a circle. No, love is a verb and is action-oriented. Love is discipline. Love is tough. While love is kind and respectful, it is never a crutch or excuse. Love does not accept mediocrity. Love propels performance. Love inspires.
I try to incorporate love into who I am as a person and as a leader. I remain a work in process, but it is easier to love then to hate. Love helps me develop compassion for those dealing with adversity. It increases my empathy towards others, which is why I’ve learned to listen to the heart as much as to words.
I am less judgmental and more tolerant. I am increasingly open to new ideas, diversity of styles and beliefs. I have embraced others very different from me and am better for it. Embracing love as a leader quickened my healing of wounds from past hurts. My heart aches for those who have not yet found love. Life is short; there is not time for fear to rule us.
It was awkward the first time I introduced love in the workplace. I was a young officer commanding my first platoon. My platoon sergeant was everything you would think of in a professional warrior. Battle-hardened, he chewed up Second Lieutenants like me for breakfast. But our platoon had challenges and we were not getting better by simply amping the fear in our squad leaders and soldiers.
First I and then SSG Hammer stopped yelling and otherwise intimidating our soldiers. While expectations and discipline never waivered, we demonstrated care and compassion to each of them. Word spread that upon an unexpected deployment, I mowed his young family’s lawn each week in his absence. It was small, but embodied the change in culture we sought. We changed, the platoon was transformed, and arguably it became one of the best engineering units in our battalion. Awkward at first, but love worked.
Love transformed me, my teams, my divisions, and my organizations. Love reached our customers and improved service. It created better opportunities for individuals to become whom they were created to be. It helped foster a culture of civility, setting a firm foundation for individual, team, and organizational success that exceeded expectations.
I learned of love from many sources and I continue to dig deep to find more. My mom loved me and believed in me before I believed in myself. My dad, who bared his soul in a TED Talk about his concentration camp escape while his family was left behind…and how he chose love over fear and till this day he has not once showed anger towards those responsible. Those family and friends who love me despite my failures. My life mentor led with love in a fear-based society and changed the world. Love wins.
Love chases away fear. The two can’t coexist. Where there is love, there is freedom. Where there is freedom, we are inspired to do our best. Lead with love and you’ll witness a transformation that may seem small on some level, but will be giant for those you serve.
Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.
The recent story about the rift over prescription drug prices between insurer Anthem and its pharmacy benefits manager Express Scripts should anger — and frankly, befuddle — any physician or electronic health record (EHR) vendor. Providers and IT vendors should be fed up with payers and patients getting ripped off by inflated drug prices, taking a disproportionate share of the healthcare dollar. They also ought to be puzzled about why, with all of our advances, we are still living in a marketplace where no one knows what drugs really cost.
It’s particularly absurd because technology exists that can put an end to the opacity, overpayment, and oligarchy that characterize prescription drug purchasing today. Providers deserve and EHR vendors can offer tools that deliver the prices for any drug at the five cheapest pharmacies nearby. Doctors can have this data at their fingertips, within a few seconds, at the point of care, integrated into their existing workflow. These technology solutions can also track prescriptions to make sure they are picked up and refilled on a regular basis to gain new insight into which patients are at risk for adverse events due to medication non-adherence.
For years, insurers and patients have just accepted that the price they are getting is the best price, or the only price. However, allegations like Anthem’s — that Express Scripts overcharged the insurer by $3 billion — should make everyone in the healthcare ecosystem skeptical about the fairness of drug prices. But truly lifting the veil on drug prices will take a concerted effort by many stakeholders in the provider and IT vendor communities to take on the PBM juggernaut.
Strangely enough, when PBMs gained widespread popularity in the 1980s, there was an understanding that they worked on behalf of payers to lower prices, both by securing discounts and by steering patients towards lower-cost drugs. The truth, however, is that PBM “discounts” have always included heavy padding in the form of ingredient spreads and per-prescription fees. In fact, while PBMs are typically paying manufacturers 96 percent off the Average Wholesale Price (AWP) —the “sticker price” for drugs —the prices they charge insurers and employers are between 70 percent and 85 percent off the AWP. PBMs are skimming 10-25 percent off each prescription.
Insurers and employers have had little recourse, both because they did not know the true price of prescription drugs and because they did not have a way to easily shop around between competing pharmacies to get the best price on every medication. Instead, complex, opaque package deals with PBMs mean the payer might be getting good deals on some drugs and getting raked over the coals on others.
Drug price transparency and shopping tools are essential for payers to rein in costs and keep both premiums and co-pays from spiking. The urgent need for this data has also intensified recently because an increasing share of prescription drug costs are borne by consumers themselves. Patients simply won’t take their drugs properly, or at all, if they are out of reach financially. Affordability is now the number one reason for non-adherence to medications, which leads to poor outcomes, including avoidable hospital readmissions. A lack of medication adherence is estimated to cause approximately 125,000 deaths, at least 10 percent of hospitalizations, and cost between $100 billion and $289 billion a year.
In the past, some patients have looked to Canadian or other foreign mail-order pharmacies to try to lower drug costs. But these transactions are usually outside the doctor-patient relationship and may cause more harm than good to the patient, either by exposing him or her to dangerous drug formulations or by causing rifts in care continuity.
Doctors and patients, together, must come to the best decision about the right drug for their condition and price must be a part of that equation. We need technology solutions that enable doctors to find the best price on any drug, at local pharmacies that are convenient to the patient. Tools exist to address these concerns. The key is to embed these tools into existing EHR systems. By doing so, we can avoid disrupting doctors’ workflow and can ensure that all e-prescribing information is captured in the patient record.
These solutions must achieve savings for both the payer and the consumer. First, the solution must provide the lowest possible retail price while consumers are still paying off their deductibles, and then provide the lowest negotiated payer price to the insurer or employer once they start picking up the tab. These solutions can also be used to circumvent common PBM strategies, such as excluding low-cost brand and generic drugs from formularies to artificially increase co-pays on these cheaper drugs, which costs insurers and self-insured consumers billions of dollars each year.
Typically, consumers don’t realize that the cash price is in many instances lower than their adjusted co-pay, with the excess going right into the pocket of the PBM. Drug price transparency and shopping solutions should crunch the numbers for the doctor and patient, letting them know when it’s better to pay the cash price and when it’s more cost-effective to pay the co-pay.
Health IT solutions are typically geared towards one healthcare user: hospitals, doctors, patients, insurers, or employers. But drug price transparency technology is one of those rare innovations that will benefit each of those audiences. Doctors and patients, together, will be able to make the best decisions about medication management, at the point of care, during the prescribing process. Hospitals will enjoy better population health management through better medication adherence. Insurers and employers will be able to wring more value from each healthcare dollar.
What we need now is a commitment from EHR vendors to adopt this type of technology. The bottom line is that we can’t succeed in bending the cost curve in healthcare if we don’t know what the costs are in the first place. That includes prescription drugs. We in the health IT industry have the insight and ingenuity to draw the curtain back on drug price secrecy and we have a real obligation to do so.
The Bipartisan Policy Committee publishes a report on health IT and patient safety, calling for “a coordinated effort—supported by public and private sector funding—to set health IT safety priorities, drawing upon existing reporting and analysis efforts,” in addition to disseminating best practices and continued development of safety standards.
An OIG investigation of suicide prevention programs in VHA facilities finds that while veterans account for 18 percent of all deaths from suicide within the US, many VHA facilities still fail to conduct mandatory community outreach activities designed to bolster suicide hotline call volumes.
The Bipartisan Policy Center calls for creating a public-private effort to set health IT safety priorities and to disseminate best practices.
The report recommends:
General patient safety efforts should incorporate the safety of health IT throughout its life cycle.
Health IT safety should be addressed via a non-punitive learning system similar to medical error reporting.
Voluntary and mandatory reporting systems should collect de-identified data about health IT safety issues that can drive creation of evidence-based practices and tools.
The report does not specifically address ONC’s proposed EHR safety center.
Reader Comments
From Vaporware?: “Re: Cerner. How long do they get a free pass on selling interoperability without delivering? Beth Israel Deaconess Care Organization lists just six EHRS of the 40 its providers use – Cerner not among the six – that are willing and able to contribute information to its population health analytics system. Do the live MHS Genesis pilot sites have connectivity to outside EHRs?” I’ll invite readers with the firsthand experience with either project that I don’t have to comment anonymously.
From Chaste Kiss: “Re: this HIMSS-owned publication’s story. I’m embarrassed that I actually clicked the tweet to read more.” No wonder – you were cheated when a publication runs a story titled “Is a takeover of Athenahealth inevitable?” that doesn’t actually answer the question it poses (nor could it). It simply rewords a lazy Bloomberg opinion column in which those original authors speculated –without using any sources or providing evidence of analytical thought — that maybe Cerner, IBM, UnitedHealthGroup, Aetna, or Epic might be interested in buying Athenahealth (the fact that Epic was named means the authors are clueless). The embarrassingly lazy source article wasn’t improved one iota by having the HIT publication improperly legitimize it by rephrasing its undisciplined conclusions. In both cases, the writers seemed desperate to fill their allotted space with whatever fizzy “news” they could make up with a minimum of expended effort.
From Greg: “Re: sepsis monitoring. The new Meditech 6.1 Surveillance product has a rules-based approach that looks at real-time EMR clinical data in the EMR. There the clinician can be notified and take appropriate action in an efficient and sometimes life-saving manner. These actions can include orders, medications, labs, documentation, problems, interventions, etc. I have personally not seen another EMR that is as far advanced with regards to surveillance.”
From SgtPerkins: “Re: John Brownstein’s tweet about Epic’s App Orchard developer terms. It is no longer available. $50 says he got a C&D from Epic to remove it. Even their awful legalese is intellectual property to them.” Unverified. My screenshot of his tweet from the Boston Children’s chief innovation officer is here. My experience is that such takedown requests often come from an individual’s employer rather than the subject of their comments, especially when the employer is a partner of the company mentioned (as I well know, having been threatened in my early, less-anonymous HIStalk days with being fired by my hospital employer for writing about one of our vendors even though it wasn’t inside information). Also, Epic’s App Orchard legal wording wasn’t really a secret anyway since it’s publicly available and, as other readers have noted, is similar to that of the Apple Store.
HIStalk Announcements and Requests
Readers funded the DonorsChoose grant request of Mrs. D in Arkansas, who asked for writing journals and math activity kits and games for her elementary school class. She reports, “These materials have allowed students to learn using a hands on approach. We love all of our games and our writing journals! Students are so proud to have their own journal to write in each day. You have made all the difference! Thanks again.”
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Post-acute care software vendor Optima Healthcare Solutions acquires Hospicesoft, which offers hospice software.
Sales
Five Ontario hospitals add PatientKeeper CPOE and medication reconciliation to their existing system and will expand their use of the company’s physician documentation solution, providing an overlay to Meditech Magic and other systems.
St. Joseph Health (CA) will expand its use of Clearsense analytics in implementing Inception for archiving, access, and visualization of its legacy Meditech data.
Harbin Clinic (GA) chooses analytics from PrecisionBI, a division of Meridian Medical Management.
People
A Philadelphia innovation organization recognizes Children’s Hospital of Philadelphia AVP/Chief Health Informatics Officer Bimal Desai, MD, MBI as its healthcare innovator of the year. He co-founded CHOP spinoff Haystack Informatics, which offers security technology that detects EHR snooping by learning normal staff behavior and calling out exceptions.
Rush Health (IL) launches Rush Health Connect, which aggregates information from its Epic and Allscripts EHRS using InterSystems HealthShare to give clinicians patient information and real-time alerts and notifications.
Change Healthcare joins the Hyperledger open source blockchain project.
The Fresno paper covers the use by Community Medical Centers of RightPatient iris recognition at patient registration, which the article explains isn’t an infrared scan, but rather just a photo of the patient’s eye. It also notes that palm vein ID systems are an alternative. RightPatient can also analyze a patient’s general headshot to identify them going forward.
DrFirst will integrate prescription pricing information from GoodRx into its e-prescribing platform.
Government and Politics
A VA OIG suicide prevention report finds that around 20 percent of inspected VA facilities don’t perform the mandated five outreach events per month, haven’t developed suicide prevention safety plans that are documented in the EHR, and don’t flag high-risk patients in the EHR. More alarmingly, OIG found that while 84 percent of non-clinical hospital hires completed their mandatory suicide prevention training within 90 days, nearly half of newly hired clinicians did not do so.
The director of Denmark’s version of the FDA expresses concern that US tech companies like Google and Apple are rolling out medically-related fitness tools and devices that “have no requirements to demonstrate efficacy and safety, but we are forced into the direction of taking them seriously.” The finance minister warns that while patients are notified by email any time their Denmark-based interoperable electronic medical records are viewed, private services and apps offer no such protection, explaining, “We need to make our citizens aware that there is no free lunch with these big companies. People should make some more demands when they give their data away. These companies want to know what you want before you know it yourselves. We need to look into regulation. These private companies will have this patient data for eternity. Can we be sure they’ll always do good things with it?”
A report by HHS’s Office of the Assistant Secretary for Planning and Evaluation blames the Affordable Care Act for the 105 percent jump in premiums from 2013 to 2017 in the 39 states participating in Healthcare.gov, as the average monthly premium increased from $224 to $476. The report, however, didn’t look at the increase in non-exchange sold individual plans and admits in its “Limitations” section that much of the premium increase is probably due to older, sicker people signing up in 2017 vs. 2013. The analysis also fails to note that pre-ACA policies (Healthcare.gov went live in 2013) were often full of coverage loopholes, exclusions, lack of coverage for pre-existing conditions, and lack of insurer experience with an uncertain risk pool.
HIMSS complains about President Trump’s proposed federal budget that calls for major funding cuts for ONC, CDC, CMS, and NIH along with zero money for AHRQ, which would likely be rolled into NIH. The proposal also calls for cutting Medicaid by $800 billion over 10 years.
Other
A Spok survey of 100 hospital CIOs finds that 40 percent of hospitals don’t discipline staff members who violate mobile policies, 30 percent say a significant portion of hospital data is shared insecurely, and more than half of doctors and nurses are unhappy with the communications methods available outside their EHR. Forty-one percent of hospitals don’t offer secure texting and those that do are equally split between providing it via the personal devices of employees vs. hospital-issued technology. Nearly one-third of clinical staff can’t receive clinical alerts or mobile messages from colleagues. CIOs say their hospitals are still using pagers because they are appropriate for some groups, are reliable, and are cheap and easily supported. More than half of the respondents say their biggest challenge in protecting hospital data is a lack of money and people.
A ProPublica investigative piece observes that the still-increasing US maternal death rate is the highest in the developed world and 60 percent of those fatalities are preventable, profiling NICU nurse Lauren Bloomstein, who died of preeclampsia shortly after giving birth in which hospital medical errors apparently contributed. Factors include women giving birth later in life when their medical histories are complex, the nearly half of US pregnancies that are unplanned, the complications of C-sections, and the fragmented health/insurance system that makes it hard to get prenatal care (likely to get worse with any cutbacks to Medicaid, which pays for nearly half of US births). The article notes that perhaps the healthcare system is focused so much on saving the lives of babies – which it has done well – that it isn’t paying enough attention to the health of the mother. A standardized approach to quickly reacting to possible preeclampsia reduced UK maternal deaths to just two in three years, while up to 70 US mothers die of it annually even as US hospitals push back on implementing evidence-based processes.
All you need to know about US health insurance is contained in this one story. An Army veteran whose wife requires pregnancy-related injections not covered by their medical insurance finds that they make $70 too much per month to quality for Medicaid, so they move from North Carolina to Alabama for a job that offers better insurance. He pays COBRA to cover the one-month lapse before their new insurance kicks in. The baby came in early, the NC insurance wouldn’t pay since Alabama is out of network, and the couple gets a bill for a two-week NICU stay for $178,000, of which neither insurance would pay a penny. They can’t get loans and he will lose his defense-related job if they file bankruptcy. They raised a few thousand dollars in a GoFundMe campaign and are hoping to work out a hospital payment plan for the balance that will probably last the rest of their lives.
Instead of the help desk tech term PEBCAK (problem exists between chair and keyboard), this was PEBCASW (steering wheel). In China, a car show model who is demonstrating Nissans’s emergency braking system by standing in front of the moving car is run over (with only minor injuries despite being thrown 10 feet) after the demo driver – who was not familiar with the system – pushes its button twice, turning it on and then off again.
Sponsor Updates
Docent Health assembles bags and lunches for Boston-based charity Bridge Over Troubled Waters.
The American Association of Critical Care Nurses chooses Kathy Douglas, RN, MHA, chief clinical officer of Abililty Network’s ShiftHound, for its Pioneering Spirit award.
CSI Healthcare IT provides at-the-elbow support for MaineHealth’s Epic go-live.
Besler Consulting releases a new podcast, “Lessons learned from the introduction of a physician incentive compensation plan.”
Spok executives will speak at several industry events.
Direct Consulting Associates will exhibit at the SIIM Annual Meeting June 1-3 in Pittsburgh.
The American College of Radiology – a National Decision Support Co. partner – wins the ABIM Foundation Creating Value Challenge for its Radiology-Teaches initiative.
I ran across an article about the impact on multi-tasking and memory. We’ve known for a while that the idea of multi-tasking is a myth. What really happens when we try to do multiple things at once is rapid switching of attention, which sometimes doesn’t work very well.
In my experience, trying to tackle two tasks simultaneously only works when one of them is significantly less critical and the majority of attention is paid to the more critical task. This is how we can get away with browsing Facebook while on conference calls, or reading the newspaper while eating breakfast.
When people try to do equally critical tasks at the same time, that’s when things start falling apart. I’ve had a couple of instances where people tell me they’re on two conference calls at the same time, and based on their participation on my side, it’s clear that they’re probably not paying adequate attention to either.
The article specifically looks at the impact of multi-tasking on memory. Research has showed that when people don’t fully attend to an event, they’re less likely to be able to create a strong memory of the event. One of the people interviewed in the article, Anthony Wagner, is a neuroscience researcher. He intentionally avoids having a smart phone, and has found that without it, he’s not lured into surfing the Internet or being constantly connected. As a result, he’s more focused on the activities around him. According to research coming out of the Stanford University Memory Lab, this means he’s more likely to remember the activities he’s watching.
There’s something to be said about just saying no to technology, although most people would be reluctant to give up their smart phones. Unfortunately, it then becomes a matter of discipline, where you have to consciously leave your phone in your pocket or bag rather than give in to the need for constant connection. That seems to be getting harder and harder for many people. I’ve had several uncomfortable conversations recently with employees who cannot pull their noses out of their phones long enough to pay attention to even a brief conversation. Fortunately, these people are not my personal employees because they wouldn’t last long.
Still, I’ve been increasingly asked to help teach people how to work in the new world of technology. People sometimes assume that because younger employees have grown up with technology, that somehow they know the best practices. I’ve found this challenging as workers struggle with prioritization of work, distraction, and follow through. Some of them are not aware of seemingly straightforward work habits, such as how to assess and prioritize an overflowing inbox when time is limited, or how to carve time out of the day to look at that inbox when you’re assigned to train end users or support a go-live.
The research shows that abilities such as attention and recall can be trained. It’s human nature for our minds to wander, but some of us definitely go walkabout more than others. One study mentioned in the article looked at brain function in heavy multi-taskers vs. that in light multi-taskers. The heavier multi-tasking group did worse on certain tests, and brain activity showed they were having to work harder to focus on the task at hand. It’s not clear whether this is a chicken or egg phenomenon – whether this was caused by multi-tasking or whether people with more fluid attention were more likely to multi-task.
Other research has looked at whether using technology causes our cognitive skills to atrophy. One study mentioned looked at those who used Google Maps for navigation vs. using landmarks. Those who used landmarks built better mental maps than those relying on digital assistance. Another looked at people taking pictures of museum pieces vs. those who simply looked at them. Those with cameras had worse recalls of the details. Anyone who has ever been to a school program, assembly, concert, or recital in the last decade has to wonder about the people who are experiencing the entirety of their children’s lives through the screen of an iPhone. Are they really seeing what is going on or are they more focused on getting the perfect video? Regardless, I long to attend events without people holding phones and tablets in the air, blocking everyone’s view.
The article also mentions a 2011 paper titled “Google Effects on Memory: Cognitive Consequences of Having Information at Our Fingertips.” It showed that people are more prone to think of how to find information than to be able to remember it. As someone who deals with tremendous volumes of complex information, the ability to look things up instantaneously is a great asset. On the other hand, if it’s making us somehow less able to retain and recall information, it might not be so great.
One researcher talks about being selective regarding the use of technology. For tasks that are going to be done multiple times, it’s better to learn the information. For one-and-done type work, it might be OK to leverage technology. A non-tech example would be for those of us from the days of the dinosaurs, where we had to memorize our multiplication tables and regurgitate them on 60-second “timed tests” rather than calculating out the numbers each time. No one wants to have to use a calculator to figure out 7×6.
You can easily identify people who haven’t figured out how to successfully leverage technology. They’re the ones who repeatedly ask you questions that fall into the “let me Google that for you” category. They’ve been habituated to need external resources to figure out even small things. Frankly, I’d be glad for some of these folks to use technology as their primary resource rather than waste their employers’ consulting dollars asking me for basic information because it’s easier to ask someone else than to leverage your company’s Intranet, personnel manuals, and policies and procedures.
These are the kinds of basics I’m having to work on at some of my client sites. I recently taught a class on the successful integration of instant messenger into the clinical office to improve patient care rather than detract from it. People don’t inherently know when they should use IM, when they should use email, or when they should simply talk to one another. They need to understand the right use of each modality and then solidify it with documented processes for patient care. Unless you address it head-on, it will continue to cause chaos. I never thought I’d be teaching these kinds of skills, let alone teaching them to physician peers. It’s part of the evolution of technology and healthcare, though, and if a practice is savvy enough to ask for help, I’m certainly glad to provide it.
What’s the most egregious example of multitasking you’ve ever seen? Email me.
May 22, 2017Digital HealthComments Off on Telemedicine Benchmark Survey Points to Increasing ROI and Improved Outcomes
Digital health updates are written by LoneArranger, an anonymous industry insider.
A recent survey conducted by Reach Health on the status of telemedicine initiatives at healthcare organizations identified that these programs are evolving from specialty offerings to mainstream services.
Survey participants represented a broad mix of healthcare organizations. More than half of the 436 respondents were from teaching hospitals or systems, with just over a quarter from non-teaching hospitals or systems and slightly over 10 percent from physician practices. Around a third (31 percent) of the organizations have revenues of $1 billion or greater, 21 percent have revenues between $50 million and $1 billion, with just under half (48 percent) at the low end of the scale with under $50M in revenues.
Patient-oriented objectives including improving patient outcomes, improving patient convenience, and increasing patient engagement and satisfaction were the most common objectives for telemedicine programs. Reducing the cost of care also ranked consistently high across objectives.
The overall priority of the telemedicine program at an organization, as ranked among other provider priorities, had a strong correlation with success. Telemedicine programs with a dedicated program coordinator or manager are also 20 percent more likely to be highly successful.
Reimbursement, both government and private, continues to create the most significant obstacles to success, accounting for the top four unaddressed challenges to telemedicine. Challenges related to EMR systems also create significant obstacles to success, accounting for three of the next four unaddressed challenges. Interoperability and integration issues continue to pose significant challenges.
Telemedicine platform features were rated by respondents based on their value to an organization. Three of the top six platform features were related to telemedicine data, including clinical documentation, ability to send documentation to/from the EMR, and ability to analyze consult data. All of these features were rated as critical or valuable by nearly 80 percent of respondents.
Over half of participants indicated their telemedicine platform was primarily purchased or licensed from a vendor. In general, larger organizations are more likely than smaller organizations to build systems internally. However, the survey results indicated that the mix of build vs.buy is highly consistent across the spectrum of organizational sizes.
Two-thirds of the survey participants indicated their telemedicine solution is a standalone system, and not integrated with their EMR system. Only 10 percent indicated their EMR system serves as their telemedicine system. This is beginning to change as vendors improve integration capabilities, but not rapidly.
Over the past three years that the survey has been conducted, there is a clear transition toward enterprise level programs instead of departmental initiatives. A key driver is improving ROI with several primary motivators, including improving patient satisfaction, keeping patients within the health system, securing reimbursement, enhancing the reputation of the organization, and increasing provider and staff productivity.
Activity has increased across the board and for all settings. However, active E-visit programs grew by 40 percent in 2017 and general practice initiatives also showed strong growth. Maturity levels of programs vary. Service lines requiring access to specialists, especially those in increasingly short supply, are maturing more rapidly than the more generalized service lines. Over 70 percent of the survey participants operate telemedicine programs within the boundaries of a single state.
Comments Off on Telemedicine Benchmark Survey Points to Increasing ROI and Improved Outcomes
A local paper covers the Erie County Medical Center’s (NY) recent ransomware attack, in which hackers likely executed a brute force attack to identify the password needed to access the hospital’s system, after which they manually encrypted system files and then demanded a $44,000 ransom.
Medical University Hospital (SC) will stop paying its providers based on the profitability of their department and start using an RVU-based system, a change that has is unpopular within the local physician community.
May 21, 2017NewsComments Off on Monday Morning Update 5/22/17
Top News
A Buffalo News report describes the ransomware infection of Erie County Medical Center (NY), from which the hospital has still not fully recovered six weeks later. The hospital declined to pay the $44,000 demanded because it had backups, users could look up patient information from the HealthLink HIE, and administrators worried that the hackers might not restore its files even if the hospital paid up.
The hospital thinks hackers used a brute force password attack to gain control of a hospital Web server a week before the attack, then manually logged on looking for files to encrypt. Clinical systems weren’t restored until a month later.
A hospital-provided screenshot of the ransomware message suggests that the malware is Samas, in which hackers use a variety of tools (including login-stealing malware) to gain credentials and install programs that use Active Directory to propagate the malware to all attached devices.
MedStar Health fell victim to Samas in March 2016 days after both Microsoft and the FBI issued public warnings of its threat. The malware requires online access to just one vulnerable server, often one that’s running unpatched Red Hat JBOSS middleware.
Reader Comments
From Identity Thief: “Re: CHIME’s patient ID challenge. Is anyone questioning its usefulness? The $1 million winner has to provide their solution to the market free of royalties, which means they can’t use any underlying technology that isn’t free. Also, the challenge is based on authentication rather than identity assurance. From NIST, ‘authentication’ implies confirmation of the patient’s presence using authentication factors, while ‘assurance’ means verifying that the person presenting those factors is in fact who they say they are. The solutions of the finalist appear to focus on using tokens (most likely biometric) to authenticate themselves. But before a token can be used, there is a need to identify the patient via inspection of their documents, verifying via a third party , or conducting KBA activities. The FY17 Omnibus legislation requires a strategy that is more than just the pervasive use of an authenticator. It requires a way to roll out a program nationally for all patients and to link a known patient to all of their records from any location in which they have received services. We should question whether a winning authentication solution truly solves the patient identity problem. In my opinion, it does not.” I agree that someone would need to physically verify a person’s identity in issuing their authentication token, but then there’s the question of how a different provider would connect to that information collected elsewhere (perhaps it would be self-contained, like a fingerprint profile stored on a smart card.) As you said, positive identification doesn’t necessarily imply data sharing, but that doesn’t seem to be part of the conversation despite the NIST definition. I would be happy with a solution that would (a) prevent identity fraud; and (b) give hospitals a single ID that would eliminate patient merges and that would link all of a patient’s information even just within that one organization’s systems.
From Arm Twister: “Re: Athenahealth. They say they have 35 MU attestations using their complete inpatient solution, but CMS shows only 17 inpatient attestations. Also, is it really Athena that’s being used to attest? HIMSS Analytics shows that most of Athena’s 25 sites are still running RazorInsights for registration, scheduling, and patient billing, so wouldn’t they also be running at least parts of the Razor clinical package, too?”
From Bushie: “Re: Athenahealth. Is it undervalued as the activist investor says?” Value is whatever the buyer thinks it is, but certainly the company has struggled to meet longstanding high-flying expectations as investors begin to question its slowed growth, management changes, forays into marginally related business lines that are defended by deeply entrenched competitors (inpatient), slowing post-HITECH EHR sales, and erratic investor guidance and resulting performance. I would also question, as I have from the day the company announced its IPO, if there’s too much of a Jonathan Bush cult of personality among fanboy equities analysts and whether Athenahealth is really a tech high-flyer vs. a boring business process outsourcer that just sends scanned paper to teams in India for manual entry. The stock price jumped after last week’s announcement that Elliott Management had acquired a 9.2 percent stake (and Wall Street firms predictably applied their impressive 20-20 hindsight to immediately upgrade their share price targets), but that’s probably more of a kneejerk reaction to the assumption that change is inevitable. Carving up the business into parts that are more valuable than the whole doesn’t seem likely and I don’t see opportunities to gain unmet synergy. I suspect the biggest fear out there is that JB will be pushed out and Athenahealth will be left as just another mature, sometimes struggling, not all that interesting industry player whose arc flattened out short of expectations. Quite a few EHR companies looked smart when the government was paying for EHRs in its $40 billion cash for clunkers program, but nearly all of them are scrambling frantically to pivot into population health, analytics, or revenue cycle to prop up their businesses that weren’t prepared for the inevitable scale-back required once the HITECH fired had been extinguished and doctors realized that the EHRs they hated pre-HITECH weren’t any more likable just because someone else (you and I) paid for them. I’ll turn to readers – is ATHN undervalued, what changes should it make, and what companies might like to buy some or all of it?
From Carry On: “Re: HIMSS. What are they paying Steve Lieber these days?” The newest IRS Form 990 I can find is for the fiscal year ending 6/30/15, when he made $1.1 million, a number that’s sure to swell dramatically this year as his retirement benefits are paid out. HIMSS paid more than $400K that year to Carla Smith, Norris Orms, John Hoyt, Jeremy Bonfini, and Alisa Ray. I would enjoy dissecting the HIMSS 2015 990 form if anyone has it – it’s apparently not online anywhere like the older ones.
From Lengua Taco: “Re: VIPs. I was surprised to read that hospitals treat VIPs differently.” You must never have worked in one. My first eye-opening experience was when, as a recent graduate turned hospital department head (unimpressively – it was a crappy, for-profit rural hospital) the awful second banana executive nearly lost his mind upon hearing that the mother of our big-money ophthalmologist was being admitted. He cleared all the rooms around hers, mobilized the dietary people to make special meals well beyond their culinary capabilities, and bossed around the nurses and techs to make sure they tiptoed about deferentially and didn’t screw up clinically (which as any hospital person knows actually makes mistakes more likely in replacing well-honed routines with new exceptions). In hospitals, everyone is treated the same in the ED, but once they are admitted and are found to have connections, money, or power, they are elevated from economy class to first (which, like the best table at McDonald’s, still isn’t that great). Wealthy, demanding local businesspeople and politicians don’t share semi-private rooms with the unwashed rest of us, nor do celebrities or Middle Eastern oil sheiks who might get their own entire floor. I doubt their clinical outcomes are any better, though, just their accommodations, a free pass to break hospital rules, and the endless middle management fawning over their magnificence.
HIStalk Announcements and Requests
Nearly 40 percent of poll respondents say the most important factor in reducing US healthcare costs is to move to a single-payer system that eliminates middlemen, with the next top choices being to control prices and increase emphasis on prevention. Frank provided a thoughtful response in saying that consumerism has worked well with cosmetic surgical procedures, won’t work as well with routine outpatient care and non-emergent elective procedures, and won’t work at all with care in emergencies, with the aged, and involving terminal illness, at least without societal upheaval. He adds that, unfortunately, most of the cost is involved in those areas where consumerism isn’t effective. He also warns that medical technology is advancing in providing expensive treatments for more Baby Boomer conditions. Cosmos says the best use of federal money is for public goods that have not not been addressed by the free market, such as disease prevention, promoting access to care and insurance, and rewarding physicians who do the right thing. Cash payer says treatment costs should be standardized to allow consumers to shop effectively.
New poll to your right or here: does your business card or email signature list a certification or fellowship credential? That issue comes up sometimes in HIStalk, where people complain that I don’t list their FHIMSS, FACHE, CHCIO, etc. My policy is that I list only academic degrees above the US bachelor’s level, with one exception — the non-US MBBS, which technically is a bachelor’s degree but is equivalent to the US MD. I also don’t list licensure, but it gets fuzzy where someone’s practice requires only a bachelor’s degree, such as a nurse, where I wouldn’t ordinarily list either the BS or the RN but there’s otherwise no good way to indicate that the person is a nurse. Sometimes I omit even graduate “degrees” that LinkedIn shows came from unaccredited (and sometimes hilariously phony) schools or that were honorary rather than earned, thus upsetting the folks who are anxious to flaunt a pointless credential in hopes nobody will notice the source.
Readers funded the DonorsChoose grant request of Mrs. A in California, who asked for a projector, document camera, USB camera, and laser printer for her middle school’s library, where she teaches math to 150 students. She reports, “The document camera and projector have improved the quality of my instruction. We will often show different strategies with different colors so that students understand that there is more than one way to solve a math problem. Lately, students have been going up and presenting their work under the doc cam, while other students ask them questions about their work. I also use the document camera and projector heavily for instruction. One particular student who has warmed to the doc cam and projector is Ramses. He loves presenting his work, and he was the first student to do so under the document camera in my 6th grade class. After he presented, students gave him ‘glows’ and ‘grows feedback about his presentation. Now other students present based on his model presentation and students are able to practice presenting their work proudly in front of their peers.”
This Week in Health IT History
One year ago:
Kansas Heart Hospital (KS) pays a hacker after a ransomware attack, but still doesn’t regain access to its systems.
Fired Practice Fusion founder and CEO Ryan Howard launches iBeat, which will offer a heart monitor and emergency notification watch.
Apple CEO Tim Cook says the company is focused on health and its entry point will be Apple Watch, which will have new sensors added.
HP announces plans to spin off its enterprise services business in a merger with CSC.
Paul Tang, MD joins IBM Watson Health as VP/chief health transformation officer.
Five years ago:
Cerner CEO Neal Patterson predicts that the company will hit $10 billion in annual revenue by 2020 and says he will probably retire before then.
Victoria, Australia ends its HealthSMART hospital software project that involves Cerner, CSC, and InterSystems after running over budget to $557 million.
HealthCor launches a proxy fight against Allscripts following the resignation of three Eclipsys-connected directors the previous month.
The VA announces plans to spend up to $5 billion to enhance VistA via the private sector and open source community.
US CTO Todd Park announces the Presidential Innovation Fellows Program.
The UK NHS announces plans to shut down its HealthSpace personal health record.
Weekly Anonymous Reader Question
I made last week’s question too specific, I think, given the small number of responses to the question of the most customer-unfriendly contract term or condition seen. I’ll just list those few responses here:
Charging maintenance fees for applications that just kicked off an implementation, as well as charging implementation and hosting fees! The ultimate double-dip rip-off.
Arrogant PeopleSoft VP refused to include any language protecting the customer should they be acquired, after all, “they are PeopleSoft”. Two years later, Oracle had them.
Non-compete clauses that inhibit people from their employment choices.
Having one vendor try to set the terms for who else I can engage with to optimize pieces of my organization. I have software I like to buy. And I have professionals I prefer to do business with for process improvements. When the software company tries to restrict my ability to engage with the professionals I trust, I view that as very unfriendly toward me.
Activist investor Elliott Management takes a 9.2 percent stake in Athenahealth.
Two highly-touted, well-funded, for-profit primary care clinic chains fail.
GQ exposes the efforts of fired Trump campaign manage Corey Lewandowski to sell access to the President, with Flow Health hiring the company hoping to reverse the VA’s termination of its data analysis contract.
Global impact of the WannaCry ransomware is muted when a security researcher finds and activates its kill switch.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Decisions
Johnson Memorial Hospital (IN) will switch from Meditech to Cerner in August 2017.
Marshall Medical Center (CA) will replace McKesson with Epic in November 2017.
St Michaels Medical Center (NJ) went live with Epic this year.
These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.
People
Melissa Bell (MedAssets) joins Inovalon as SVP of client success.
Jim Feen is promoted to SVP/CIO at Southcoast Health (MA).
Announcements and Implementations
Messaging and patient engagement technology vendor Talksoft integrates its appointment reminder app with Uber, allowing patients to click an app button to call a car to take them to their appointment.
Teladoc will expand telemedicine services in Texas following the end of its six-year legal battle with the state over the now-eliminated requirement that patient-physician relationships begin with a face-to-face visit.
Other
Doctors at MUSC’s Medical University Hospital (SC) are reportedly “livid” that the hospital will start paying them based on the number of patients they see (RVUs) instead of based on the profits of their department. The CEO says that doctors who aren’t clinically productive “are going to have a tough time. Everyone has to be accountable to this clinical productivity.,” He adds that the current system is unfair to trauma surgeons who treat uninsured patients but benefits gastrointestinal surgeons who treat mostly Medicare patients. A patient safety advocate whose son died from a MUSC medical error says, “Paying doctors by RVUs is a terrible system and absolutely antithetical to patient safety, never mind workplace satisfaction. The doctors are right to be worried. I think this is a real comment on the priorities of the current MUSC leadership.”
Erie County Medical Center (NY) confirms rumors that the cyberattack that brought its entire network, including email, EHR, and billing systems, was indeed a ransomware attack. Hospital executives declined to pay the ransom and have instead been working to restore services from backups.
DataBreaches.net is served a threatening cease-and-desist letter from Bronx-Lebanon Hospital Center lawyers after reporting that the hospital was exposing patient information due to an improperly configured server.
Activist hedge fund operator Elliott Management takes a 9.2 percent position in Athenahealth, sending ATHN shares soaring 22 percent Thursday.
The fund issued its standard language that refers to “operational and strategic opportunities” (often involving selling the company) and expresses its interest in engaging with Athenahealth’s board.
Elliott has pressured other healthcare-related companies to increase shareholder value, most recently The Advisory Board Company and Cognizant.
Reader Comments
From Justin Box: “Re: Mary Washington’s video ‘Right Hand Man.’ We’ve reposted it on YouTube.” Justin, who is SVP/CIO of Mary Washington Healthcare (VA), said the hospital initially pulled the unlisted video from YouTube after I mentioned it Tuesday since it was intended to be for an internal audience only, but has since decided to repost the original, unedited version, which is spectacular. The hospital’s marketing people did an amazing job putting it together and the hospital employees who appear in it were fantastic. This would win my HISsies Best Picture award if I had one. Here’s an even more impressive factoid from Justin – President and CEO Mike McDermott, MD, MBA came up with the Hamilton theme idea, wrote the lyrics, and took on the starring role. I’ve watched it at least 10 times so far today. In one of those IMDB-type “goofs,” listen for the Epic product name that is mispronounced.
From Aftab: “Re: Aspen Valley Health (CO). A failed Epic implementation caused a loss of millions of dollars and the RIF of dozens of long-term employees. The 20-something IT director brought in an inexperienced team with no healthcare background and farmed out the technical IT jobs to an Indian outsourcing company. There was open revolt from the hospital staff, coupled with the CEO and CIO leaving.” Unverified. The 25-bed hospital signed up for Epic at a cost of $5.4 million in October 2015, affiliating with UCHealth. I reviewed the online video minutes of the hospital’s recent board meetings to look for updates — in the March 2017 session, the board talked about choosing a new EHR from among Cerner, EClinicalWorks, and current vendor Meditech, focusing on a system that is “affordable and accessible to any practice.” The board also wants its own MPI that isn’t shared with another hospital and its own EHR build. The board also noted that Cerner and EClinicalWorks are cloud-based, while Meditech would require 50 hospital servers, but they want to make sure cloud-based systems are ready for prime time. They’ve issued an RFI and hope to be live by 2020.
From Publius: “Re: Health Gorilla. Have you heard of them? They’re seemingly a Web-based EMR that supports electronic lab ordering. Is it used by smaller private practices?” I’ve mentioned the company a few times, labeling them as a “medical record aggregator” and secure network that allows sharing records and placing electronic lab orders. Practice price ranges from free to $60 per month. The Silicon Valley-based company – formerly known as Informedika — has raised $4.4 million, none of it recently, and hasn’t issued a press release since October 2015.
From SugerHound: “Re: Apple Watch and glucose monitoring. The rumors are more substantial than are being reported. Chrissy Farr has a great report on CNBC that cites multiple sources.” The article says Apple’s team of biomedical engineers has been developing non-invasive blood glucose sensors for several years in a project originally envisioned by Steve Jobs. They are reportedly conducting feasibility trials and figuring out how to earn FDA approval, which probably won’t come easily or quickly.
HIStalk Announcements and Requests
Readers funded the DonorsChoose grant request of Ms. S in California, who asked for non-fiction books for her third graders, with an emphasis on the environment. She reports, “My students and I have become passionate about plants! Not just any plants, but native plants in particular. The chaparral biome which surrounds our school and community is thriving with plant and animal life. Using the books that you so generously donated, my students learned about the environment, and they started a close study of their backyard ecosystem: the chaparral. Caring for the plants and becoming experts of many of the living things in our ecosystem, my students are now serving as stewards for the environment. Without your generous donation, our project would not have been able to take off.”
My “Listening” selection from three weeks ago was the new solo release of Soundgarden and Audioslave front man Chris Cornell. He died by suicide Wednesday night after a Detroit performance of the reunited Soundgarden. His last song on stage was a cover of Led Zeppelin’s “In My Time of Dying.”
This week on HIStalk Practice: One Medical opens first practice in Seattle. Vivid Vision raises $2.2 million for VR-enabled vision disorder treatment technology. US HealthWorks develops telemedicine app. MD EMR Systems, Bridge Patient Portal work on Centricity integration. CMS allocates $30 million for medical societies interested in helping to develop MACRA measures, adds four regions to CPC+ program. Premise Health will roll out Epic over the next two years.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
A Singapore-based private equity firm buys a majority position in supply chain technology vendor Global Healthcare Exchange from PE firm Thoma Bravo, which bought the business in February 2014 and will remain a minority owner.
Seattle-based primary care clinic Qliance Medical Management, which had raised $33 million from investors that included Amazon’s Jeff Bezos, shuts down. The two principal officers bought the company in March 2016 from its investors.
Clinical process improvement technology vendor LogicStream Health closes a $6 million Series B funding round.
Credentialing and compliance software vendor Symplr acquires Vistar Technologies, which offers a provider data management system.
Conversa, which offers doctor-patient conversation programs, raises $8 million in a Series A funding round led by the venture arm of Northwell Health (NY), which will also use the company’s systems.
UnitedHealthcare subsidiary Harken Health, launched in 2015 to offer health insurance combined with low co-pay visits in its Atlanta and Chicago health clinics, will shut down after extensive losses.
Amazon is considering entering the pharmacy market, according to reports, which could involve either selling drugs online (which it already does in Japan) or extending its in-house pharmacy benefits management program.
McKesson is basically out of the health IT business (or will be soon), but if anyone still cares, the company announces Q4 results: revenue up 5 percent, EPS $16.76 vs. $1.88, although that includes a pre-tax net gain of $3.9 billion related to the creation of Change Healthcare. MCK shares rose 6 percent in early after-hours trading Thursday, having beaten earnings expectations but falling short on revenue.
Sales
National non-profit behavioral health provider Compass Health Network chooses Netsmart’s EHR in a 10-year agreement.
The VA awards Document Storage Systems (DSS) a $19.6 million contract to implement its ForSite2020 patient self-scheduling system that integrates with VistA. DSS acquired the product in December 2016 with its $2 million purchase of Streamline Health’s Looking Glass patient scheduling and surgery management software, which Streamline had previously bought in its February 2014 acquisition of Unibased Systems Architecture.
Prime Healthcare will implement real-time sepsis surveillance systems from Hiteks Solutions, integrated with Meditech and Epic.
People
Robert Califf, MD — who served less than a year as FDA commissioner before the administration change — returns to Duke Health as vice chancellor for health data science and will also split time in a leadership role at Alphabet’s Verily Life Sciences, where he will work with turning health-related data into practical applications. Verily, formerly known as Google Life Sciences, has worked on continuous glucose monitors, smart contact lens, retinal imaging, and surgical robotics.
Announcements and Implementations
Visage Imaging releases its Visage 7 Open Archive solution of its enterprise imaging platform to customers in North America.
Athenahealth announces a Meaningful Use Stage 3 guarantee for its hospital customers. The company also opens San Francisco-based MDP Labs, an innovation program that offers workspace, mentorship, and exposure to potential investors, partners, and customers.
Healthgrades enhances its online scheduling system to allow health systems to display their nearby alternative providers when a given one is booked up.
Siemens Healthineers will integrate test results from its HbA1C and urinalysis diagnostic equipment with practice-based EHRs via technology from Scotland-based Relaymed, owned by Goodmark Medical of Longwood, FL.
CHIME announces the finalists in its patient ID technology challenge that will move to the prototype testing round:
Michael Braithwaite (multiple biometrics)
Bon Sy (behavior information, biometrics)
HarmonIQ Health Systems (blockchain, FHIR, encryption)
RightPatient (photos, biometrics, other data)
Government and Politics
The Justice Department files a civil fraud lawsuit against UnitedHealth Group, claiming that the insurer was overpaid at least $1 billion in Medicare Advantage payments after intentionally submitting inaccurate risk adjustment data. UHG says it tried to comply with CMS’s “unclear policies” and adds that the Justice Department either misunderstands or ignores how Medicare Advantage works.
Insurance company executives and state insurance regulators say the ACA insurance marketplaces aren’t collapsing under their own weight, but rather because of the Trump administration’s erratic management, vocal lack of support, and ongoing threats to stop payments, according to an LA Times article. In a remarkably partisan response for a federal department employee, 28-year-old Alleigh Marre — quoted as an HHS spokesperson but self-identified on her LinkedIn profile as a “Republican Communicator,” — said, “Obamacare has failed. For this reason, Republicans are reforming healthcare so it delivers access to quality, affordable coverage to the American people.” The article also notes that CMS Administrator Seema Verma told insurance company executives that the White House would continue allowing the payment of cost-sharing reductions (premium subsidies, required by law to be paid unless a court rules otherwise) if insurance companies would in turn support the Republican ACA repeal bill, a puzzling offer (even for a near-shakedown political demand) since repeal would do away with the subsidies.
Privacy and Security
Bronx-Lebanon Hospital Center (NY) and its contractor iHealth send threatening cease-and-desist letters to the author of DataBreaches.net after she let the hospital know that their patient information was exposed due to an improperly configured server, for which the hospital originally thanked her. They claim that the discovery of their apparent screw-up constitutes “hacking,” which happens often when companies are embarrassed and attempt to shoot the messenger.
Erie County Medical Center (NY) finally confirms that the April 9 cyberattack from which it is still recovering six weeks later was indeed ransomware, which had been widely speculated. The hospital declined to pay and was forced to move back to paper as its systems were slowly brought back online from backups. They don’t believe it was the WannaCry malware.
Technology
Google is applying machine learning to millions of de-identified patient records from major teaching hospitals to see if it can predict an individual’s medical events.
Google’s major announcements from its developer conference:
Google Lens, an app that can identify objects from a smartphone’s camera.
New Daydream virtual reality headsets.
Photo facial recognition that will suggest sharing images with people pictured in them and AI-powered removal of unwanted objects in photos.
A visual positioning system that will identify a precise location based on nearby objects, such as finding items on a store shelf.
The addition of calling and proactive information presentation to Google Home and the porting of Assistant to the iPhone.
In India, Aetna rolls out the first phase of its global launch of it subscription-based vHealth by Aetna, which offers unlimited PCP visits by video or telephone, diagnostic tests at home, home prescription delivery, and referrals. Patients can rate their doctor experience afterward.
FiercePharma profiles Israel-based MedAware, which uses aggregated prescription data and a patient’s own medical records to predict what drugs are likely to be ordered, improving patient safety in providing what it calls a “spell checker” for prescriptions. The CEO has astutely noted that all of that information is also attractive to drug companies that are interested in targeting their physician prospects, giving it an unexpected yet lucrative market.
Other
Boston Children’s Chief Innovation Officer John Brownstein weighs in on the language in Epic’s App Orchard agreement, which basically says that Epic can use any of the submitter’s information to develop a competing product and that Epic permanently owns any documentation that the applicant submits. In other words, it’s exactly opposite of the highly restrictive language contained in Epic’s customer contracts.
In an interesting twist on medical tourism, a nearly completed medical center in Jamaica plans to lure not only medical tourists to fly there for procedures at discounts of up to 40 percent, but also to recruit American doctors to perform the work while taking a Caribbean vacation. Critics point out that it’s been tried before, failing because doctors are too busy to interrupt their vacations and are not likely covered by their malpractice insurance when doing work outside the country.
Bizarre: Michigan suspends a DO’s license after a patient complained that her liposuction surgery was performed in an unfinished pole barn, during which the doctor poured her removed fat down a sink drain.
Sponsor Updates
Medicity and Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Texas Regional HIMSS Conference May 25 in San Antonio.
Wavelink is named as the first Spok distributor in Australia.
Medecision presents its annual innovation awards at its Liberation 2017 conference in Austin, TX.
Definitive Healthcare is recognized by Boston Business Journal for its growth and work environment.
FormFast and Imprivata will exhibit at the 2017 Spring Hospital & Healthcare IT Conference May 22-24 in Atlanta.
May 18, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 5/18/17
The National Patient Safety Foundation is holding its annual Patient Safety Congress this week in Orlando. This is the first meeting since NPSF merged with the Institute for Healthcare Improvement at the beginning of this month. I’m a big fan of both organizations, not only because patient safety is such a big deal, but because they both offer accessible and cost-effective training for practices and organizations trying to improve their safety culture.
Awards programs recognized NYC Health + Hospitals/Bellevue for their primary care diabetes program and recognized Christiana Care Health System for a care coordination program aimed at reducing readmissions. For all of us who complain about EHRs, we need to remember how hard it was to pursue these types of initiatives with paper charts. If you missed it, next year’s Congress will be held in Boston from May 23-25.
Although telehealth continues to be promoted as a way to increase access to patient care and reduce costs, it isn’t being widely adopted in the primary care trenches. Researchers from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care queried family physicians to understand their use of telehealth and what barriers exist that prevent expansion. The results were published in the Journal of the American Board of Family Medicine and indicate that although many of us are interested in providing these services, few of us are actually doing it. The survey is somewhat limited by its 2014 data; it would be interesting to see whether adoption has been driven forward given changes in technology and payment policies. At the time, however, only 15percent of respondents had used telehealth services during the year, with many using it only a handful of times throughout the year.
The most common uses of telehealth services included diagnosis/treatment (55 percent), chronic disease management (26 percent), follow up (21 percent), second opinions (20 percent), and emergency care (16 percent). I always shudder when I hear about virtual care of emergency problems, but many of the “emergency care” situations aren’t truly emergent in reality, so perhaps this number isn’t as shocking as I originally found it. Those using telehealth were more likely to be rural, have an EHR, and be in a smaller practice that was less likely to be privately owned. Respondents cited lack of reimbursement and lack of training as obstacles to use – both among those who used and did not use services. The authors recommend that residency training be expanded to include telehealth services and that payers should expand coverage.
Personally, I don’t see the latter happening. As we shift towards value-based care, it’s more likely that physicians will explore telehealth as a relatively low-cost care option, at least compared to office visits. As physicians receive bundled payments and operate under payment systems that are tantamount to capitation, they’re going to look for alternatives to bringing people in.
What remains to be seen is how well telehealth vendors will be able to integrate their solutions into mainstream EHRs and how clunky the arrangements are. I’m working with a third-party care management vendor with one of my clients and the technology itself is a major barrier to use. They actually partner with the primary care office to provide telehealth chronic care management services, which the primary care practice bills for under the Medicare Chronic Care Management codes. The vendor has nurses and care managers who review patient-generated data such as daily weights, blood pressures, blood glucometer logs, and more.
The vendor’s employees meet with patients and document care plans and progress, then send the information back to the EHR. In principle it sounds great, but in practice it’s a tangled mess.
First, the vendor offers a standalone patient portal and wants the patient to submit all their data and conversations that way. This directly competes with the practice’s patient portal and creates confusion for the patient on what kinds of questions should be sent to the office and what should be sent to the care management portal. Although the practice sends data to the vendor discretely, what is pushed back to the office to document the virtual visits and care plans comes back as an image. That means it lives in a separate place in the patient chart from all the other data that physicians are reviewing when they see the patient.
Apparently the root cause of this disconnect is the fact that the third party wanted to quickly partner with multiple EHR vendors to sell its chronic care management services, but the EHR vendors were too busy building certification requirements into their products to be able to build the kind of integration that needs to happen. Unfortunately, my client (the practice) didn’t pick up on this during the slick sales demo, and now is stuck with this hybrid approach, at least until their contractual obligations end.
They’ve stopped enrolling new patients in the service in the meantime and are struggling to stand up their own care management team, which is how I came into the picture. Their EHR has great care management content but just couldn’t handle the billing piece, so we’re working through that gap. They will fully separate from the third party in a few months and I’m confident they’ll be able to ramp up their own program. The practice may not have the same slick videoconferencing capabilities that the third party had, but they can practice telehealth the old fashioned way — via phone. This approach can still help with access issues and cost issues as well as reduction of readmissions. We’ll see how it goes.
As a side note, I’m waiting for the EHR vendors I work with to get through all their regulatory certifications and mandatory releases so they can get back to the business of enhancing usability and coding features that their users actually want. Of course, I’m not delusional enough to think that there won’t be some other burdensome pack of regulations coming right after, but there might be a window of opportunity to do some good work before it hits.
Compass Health Network (MO), a national non-profit behavioral health network, signs a 10-year agreement to implement Netsmart’s behavioral health EHR and an interoperability platform that will allow it to exchange data with local practices and hospitals.
A widely-cited BGR article reports that the next Apple Watch will include non-invasive glucose monitoring technology, a rumor that it attributes to a single, anonymous source.
The Robert Wood Johnson Foundation announces that BiAffect is the winner of its Mood Challenge, a contest soliciting ResearchKit-based studies of mood and its impact on health and wellbeing.
New York’s state Assembly passes The New York Health Act, a single-payer health insurance healthcare bill that would provide universal coverage statewide. The bill has passed the Assembly three times in the past, but has yet to clear the Senate, where the current version will now be sent.
I will turn 50 this year. A few days after my birthday in May, my daughter will graduate from Yale, the second of my two children to earn that distinction. In October, I will graduate from Columbia University’s Executive Master of Public Health program.
I guess you could say it’s a watershed year for me, one of the biggest of my life so far. We all have them. And once the celebrations are over, I imagine we’re all faced with the same question. What’s next?
Here is what I learned as I looked for answers to that question.
It’s never too late for a new beginning
Some of us might feel inclined to stop and take a breather at 50, especially once the kids are out of school. We may think we have reached a high point that we’ll never exceed in our time on earth. As for me, I’m viewing it as a new beginning.
It’s a simple construct. Fifty is half of my life. Sure, it’s a milestone, but it doesn’t scare me. I’ll admit I am tickled to be at a point in my life where I have no dependents. My son and daughter are well on their way to taking their places in the workforce and the world. While I have strong relationships with my children and see them often, there is a level of excitement, a feeling of freedom now that they are adults.
I don’t want to waste that feeling of freedom. I want to channel it in constructive ways and put it to good use.
The opportunity to focus is a gift
There is an even greater excitement in the fact that I recently began a new phase of my career, a phase that I have envisioned for a very long time. I am no longer simply an IT guy, but a healthcare professional, a CIO for a very exciting organization in NYC brimming with possibilities.
When I was a kid growing up in Turkey, I dreamed of becoming a medical doctor, so this move into healthcare feels as if I have come full circle. Our dreams get tweaked as we get older, but I like the way this one has turned out. Though not an exact match, I am still able to use my skills and experience to effect change in the healthcare sector, and probably on a much larger scale.
The transition wouldn’t mean half as much if I weren’t confident that I did everything I could to prepare myself for its challenges. That’s one of the benefits of maturity. They say good things come to those who wait, but I also believe that good things come to those who are prepared. Now I have the time, the skills, and the experience to give my new healthcare position the total focus it demands. This opportunity is a gift and I am eager to embrace it with all the dedication and energy I have.
Maturity and passion are not mutually exclusive
I’ve attended HIMSS healthcare IT conferences in previous years, but at this year’s event, something was different. Instead of observing from the sidelines, I was involved. I was invited to participate in sessions. I was a contributor. I felt respected and connected and I was able to help others make connections, too. One of these connections resulted in CHIME welcoming a new foundation member.
This ability to find the things two professionals might have in common and make a connection happen for their mutual benefit is probably the thing I am best at. While others are inspirational leaders, effective organizers,or impeccable planners, I’m a connector.
In my work with colleagues and partners, I can find win-win solutions, shape commitments between parties, challenge others to exercise their own good judgment, and solidify their trust in one another. That is very exciting to me. I heard it time and again at the HIMSS conference this year: people notice my passion. It is gratifying to be able to say that at this point in my career.
Here’s to 50
There’s a saying now that 50 is the new 30. I’m not so sure I agree. Physically, I don’t feel that much different from the way I felt at 30. But in terms of what I have learned about my industry and about myself over the past two decades, I’ll take 50 over 30 any day.
Comments Off on Readers Write: Celebrate the Milestones, But Keep Your Eye on the Road Ahead
The IT concept that you hear most about today is blockchain systems design and technology. If you have not, you will very soon. It’s a concept that relies heavily on core Internet communication tools and shared information.
When you mention blockchain, some people automatically think of bitcoin, but bitcoin is just one application of the block chain concepts and tools — it is not blockchain proper. HIStalk posted a good synopsis of blockchain last year .
Blockchain in its simplest form is a virtual ledger. A ledger that is available to all on an instantaneous basis via the Internet.
Let’s look at an example. Say I borrow $100 from my office buddy Joe. If it’s just the two of us involved and no one else cares, then he notes on his paper ledger an asset of $100, with an offsetting entry of his cash decreasing by $100. On my ledger, I note an increase in my cash balance of $100 and a liability to Joe of $100. If an auditor were to check our ledgers, they would see all four entries and all things would be kosher, or in accounting terminology, in balance.
Now assume everyone in our office cares and we all have electronic ledgers and all our ledgers communicate with one another via the Internet, thereby creating one big virtual ledger. Every time one ledger changes, they all change instantaneously. Everyone in our office would see I owe Joe $100. As I make payments on the loan (or fail to), all ledgers would reflect the subsequent activity.
Blockchain software maintains a universal virtual ledger by maintaining constant communication among all participants. All updates and transactions — whether add, change, or delete — are stored forever. Hence the full provenance of any activity is easily viewable. The number of participants is not limited and could be in the billions, limited only by agreed-to privacy and security constraints.
The implications of blockchain technology are enormous. For example; since the blockchain is always in balance (no single entity entries allowed), goodbye auditors, bookkeepers, accountants, financial intermediaries, clearinghouses, many regulators, and so on.
Some industry pundits are predicting that blockchain will transform healthcare and make the interoperability mountain into a mole hill. A deeper understanding of the healthcare landscape with its many non-technical issues makes me a skeptic.
On the business side of healthcare, the impact should be pretty much the same as in commercial business. You can expect a big impact on finance and supply chain management. Operations such as scheduling and resource management will see significant impacts. Many will happen within the next decade. Legacy systems will have a tough time adapting, more so than their adaptation to the Internet, but slowly they will adjust.
On the clinical / medical side, I predict a much longer runway before we see any real impact. There are two reasons. First, blockchain is highly dependent on definition and structure. Terminology must be consistent and procedures must be standardized. Generally Accepted Accounting Standards (GAAP) have been in place for centuries, and as they have changed over the decades, multiple oversight groups have hashed out agreed-to changes. On the supply side, UPC codes have been around for almost 50 years and go down to almost the molecular level.
Not so in medicine. A practitioner’s understanding and use of terminology and protocols is highly dependent upon where they went to medical school and who they trained under. Studies have shown that even today, after the federal government has paid out over $30 billion in EHR incentives, still over 70 percent of a patient’s medical record is entered into the EHR as free text.
The second reason is that blockchain cannot work without absolute accurate identification about the transaction initiator and the information target. Identifying the initiator is easy. The target is the person / patient and that’s another matter. Still today after decades and trillions of dollars spent on healthcare IT we do not have a unique person / patient identifier.
As I have noted in my past writings on HIStalk and other blogs, this is not a technology problem, but a political one. If blockchain is to be the savior of healthcare interoperability, as the technocrats suggest, then it’s Congress that will have to forge the most critical first link in the chain.
My prediction is that systems developers will continue to jury rig solutions around this missing link. Providers would do well to remember that a chain is only as strong as its weakest link.
GQ profiles Corey Lewandowski, a one time Trump campaign adviser that launched his own lobby firm after the election, offering access to Trump and influence across government agencies. Health IT vendor Flow Health hired the lobby firm to reverse a decision by the VA to cancel its contract, which it illegally agreed to pay $250,000 for if the decision was reversed.
Missouri’s effort to pass prescription drug monitoring program legislation died Friday afternoon after the Senate added a provision mandating use by providers, a clause the Missouri State Medical Association opposed. The bill then lost support and failed to pass by 6pm Friday, when the 2017 legislative session ended.
The National Data Guardian at the UK’s Department of Health states in a leaked memo that Google DeepMind’s use of real NHS medical records to test an app designed to diagnose kidney disease was legally "inappropriate.”
A bipartisan group of Senators introduce the Fair Drug Pricing Act, a bill that would require that pharmaceutical companies submit a report to HHS before increasing the price of a drug by 10 percent in one year, or by 25 percent over three years.
GQ publishes an article critical of fired Donald Trump campaign manager Corey Lewandowski, who tried to parlay his connections to the President after his June 2016 dismissal into a lucrative lobbying business that includes a health IT connection.
Among the clients Lewandoski recruited was Flow Health (the former GroupMD), which hired Lewandowski’s firm in December 2016 to pressure the VA to reconsider its termination of Flow Health’s contract for AI-powered patient care systems.
GQ reports that Lewandowski’s partner (who managed Ben Carson’s presidential campaign) told Flow Health CEO Alex Meshkin that the lobbying firm could reverse the VA’s decision because he and Lewandowski were personally vetting Trump’s picks for VA secretary. He also promised that the firm would allow Flow Health’s CEO to submit a list of his preferred choices for role of VA CIO, overseer of the Flow Health decision.
The article says that Flow Health proposed an apparently illegal payment schedule of a flat payment of $250,000 if the VA reversed its decision by February 17 and $100,000 if it took an extra week, later amended to reword the payments as severance fees. None of that mattered, as it turned out, because Trump chose as VA secretary David Shulkin, who had co-written the letter that dismissed Flow Health in the first place.
GQ says Lewandowski then proposed that Flow Health do an end-run around the VA by either appealing to Trump directly or by using Lewandowski’s appearance on the Sean Hannity talk show to trash Shulkin in hopes of getting him fired.
Lewandowski quit the firm – for which he was serving as an unregistered lobbyist — two weeks ago after widespread questions about his efforts to sell access to the President, which he calls “fake news” and for which he blames his former partner. Flow Health’s VA contract remains terminated.
Googling “Alex Meshkin” turns up a fascinating Bloomberg story from 2005 about the then-24-year-old’s questionable background as he formed a Nascar racing team that quickly failed.
Reader Comments
From Athenahealth Spokesperson: “Re: Diego’s questions about Athenahealth’s inpatient customer MU attestations. All 35 hospitals referenced are using Athenahealth’s complete inpatient solution, including EHR, revenue cycle and financial management, care coordination, and patient engagement services. This past year, Athenahealth submitted Meaningful Use attestations on behalf of all of our hospital clients live on AthenaClinicals for Hospitals & Health Systems as of the end of 2016.”
From Cerner Observer: “Re: Mon Health, Morgantown, WV. Hearing that its Cerner go-live has been pushed back to 2019 and they’re exploring other options.” Unverified. I couldn’t find a contact there to ask for verification. I was, however, a bit annoyed to observe that the locals are so challenged to pronounce the name of the county in which they live (Monongalia) that the health system that lives in the shadow of Epic-using WVU Medicine felt the need to officially dumb down its name to “Mon Health,” giving me visions of those rainbow-colored (and uncomfortably stereotypical) Rastafarian dreadlock hats you see for sale on vacation in the Caribbean that say “Hey, Mon, we be jammin!”
From Second Responder: “Re: anniversary date. Isn’t HIStalk’s anniversary coming up soon? I remember it’s late spring.” I started writing HIStalk in June 2003, although I don’t recall the exact date.
From Judith R. Lin-Miranda: “Re: video. It’s now a common practice for new Epic customers to introduce themselves. Mary Washington Health Care just set the standard by which all others will be judged.”The elaborate video is indeed well done, including taking some digs at Siemens/Cerner Soarian that was “cobbled together” as they were “working with a third of what Soarian promised.” The video even lobs some shots at Epic’s high cost. President and CEO Mike McDermott, MD, MBA did an amazing job in the lead role. It’s better than anything ZDoggMD has done. I would give it my “Best Picture” award if I had one.
From Gory Details: “Re: press release. Here’s ours, which you probably won’t mention since we aren’t an HIStalk sponsor.” Not true. I mention every press release that I think is newsworthy to my C-level audience, which typically includes all sales and go-lives that: (a) involve a vendor, client, and event that are all significant; (b) would interest readers who don’t follow the company; and (c) contain a link to a timely press release that is well enough written that I can quickly figure out what it’s trying to say. Otherwise, readers outside the company usually aren’t interested in fluff pieces about partnerships, self-proclaimed market momentum, and minor personnel and funding events and I’ll nearly always skip those. I’ve learned over the years that every company executive thinks all of their announcements are anxiously awaited, which is nearly always not the case. Do something newsworthy and you’ll see it on this page.
HIStalk Announcements and Requests
HIStalk readers funded the DonorsChoose grant request of Ms. W, who asked for tablets and headphones for her California kindergarten class to extend their environmental studies. She reports, “The Fire tablets have been such a great learning resource for my students. They love using them to watch ‘Meet the Environmental Defenders.’ They love singing along to the song. You can hear them chanting quietly, ‘Reduce, reuse, recycle!’ They do this over and over again. Next thing you know, that tune is stuck in my head all day long!”
I’ve noticed a recent sneaky practice of call centers (both inbound and outbound) that place you on hold, but play pre-recorded keyboard clicking sounds so you think a human is on the line.
A reader offers a third punk band whose singer has a PhD (in addition to those I named, Bad Religion and The Offspring): The Descendents, which has been a major influence to untold bands that aren’t even punk for its 40 years of existence. Milo Aukerman left the band to complete his PhD in biology at UCSD and conducted post-doctoral research in biochemistry at UW-Madison. His nerdy caricature is the band’s mascot, rolled out in 1982 for the album “Milo Goes to College” that noted his temporary departure. Beyond all that academic talk, there’s a new hard-rocking album from Seether that’s worth a listen.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
I asked John Gomez to put together a WannaCry malware webinar with only hours of lead time because his presentations are always outstanding and informative. This one he did Tuesday afternoon is no exception. I was attentive for the whole thing, which isn’t usual for me since I have a short attention span. Thanks to John for agreeing to help get information out quickly.
Acquisitions, Funding, Business, and Stock
Wisconsin startup IDAvatars, which develops healthcare avatars powered by IBM Watson, opens a funding round in hopes of raising $2 million.
Sales
Premise Health will implement Epic in its 500 work site health and wellness centers. It apparently replaces Greenway Health.
University of Miami Health System (FL) chooses Kyruus Provider Match and KyruusOne to connect patients with providers based on their clinical needs and preferences.
The Commonwealth of Virginia and Bayview Physicians Group will integrate Appriss Health’s prescription drug monitoring program analytics software into provider EHR workflow.
People
Mark Costanza (Nordic) joins Spok as SVP of professional services.
Announcements and Implementations
Memorial Hermann Memorial City Medical Center (TX) goes live with a digital wayfinding app powered by Connexient’s MediNav.
National Decision Support Company adds appropriate use criteria for pediatric imaging to its ACR Select product.
CPSI’s TruBridge subsidiary announces its business intelligence dashboard at the company’s user conference.
Government and Politics
Social media outcry pressures Miss USA to walk back her comments from the Q&A portion of the competition in which she stated that healthcare is a privilege rather than a right, unconvincingly explaining that what she really meant is that she is “privileged” to have healthcare, but regardless, it’s a “right” for all.
Missouri’s lost its chance to stop being the only state that doesn’t have a doctor-shopper prescription database as legislation to authorize it failed Friday after the Senate added a mandatory prescriber participation clause, which was opposed by the state medical association.
Privacy and Security
HHS says in a ransomware update call that several medical devices have been infected with the WannaCry virus, but otherwise the US healthcare system seems mostly unaffected for now. Several hospitals around the world reported that they were attacked. Northwell Health (NY) initiated its incident command system Friday morning and patched 200 computers that were behind on Microsoft security updates.
In England, a leaked February letter from National Data Guardian Dame Fiona Caldicott to Royal Free Hospital’s medical director says the hospital should not have turned over the detailed records of 1.6 million patients to Google DeepMind for testing of its Streams application, saying it was not appropriate to send Google the information without patient permission since it was not related to their care.
Rutland Regional Medical Center (VT) becomes the latest in a long string of hospitals that have exposed patient information by sending a bulk email to patients using CC: instead of BCC:.
Marcus Hutchins — the 22-year-old security researcher who interrupted his vacation to stop the global spread of the WannaCry virus by discovering and activating its kill switch before it hit US hospitals – is awarded a $10,000 hacker’s bounty that he will donate to charities. He works from a spare bedroom in his house in England for US-based Kryptos Logic.
Other
Wired runs a lengthy piece describing the last creation of Steve Jobs, Apple’s $5 billion, 2.8 million square foot mother ship campus.
A graphic, moving blog post by ED physician Kristen Ott, MD explains that medical professionals use profane language outside of public spaces because they have to deal with the aftereffects of unspeakable atrocities that can’t really be described politely.
This should ring the cash registers of pharma lobbyists: three members of Congress introduce the Fair Drug Pricing Act, which would require drug companies to provide detailed cost and price records to HHS before increasing an expensive drug’s price more than 10 percent in one year or 25 percent over three years.
Australia-based surgeon Eric Levi, MBBS muses on the suicide of a Brisbane gastroenterologist, which triggered him to think about what factors lead him to his own “dark seasons” as a doctor:
Loss of control with extensive hospital call time and new physician-directed policies written by people who don’t see patients.
The impersonality of computer-assigned work, pressure to beat the timer that says tonsillectomies should take no more than 14 minutes of surgeon time, overbooked clinics, and never-ending telephone calls, all of which leave no time to reflect about life with colleagues or to spend time with friends and family. Doctors who ask for emotional support can be placed on restriction or labeled as underperforming.
Relentless administrative pressure that takes away meaningful patient engagement as medical practice transforms from a “meaningful pursuit” to a “tiresome industry” that has been “codified, sterilized, protocolized, industrialized, and regimented.”
Sponsor Updates
Point-of-Care Partners publishes a white paper titled “EPrescribing Information to Improve Medication Adherence.”
Arcadia Healthcare Solutions will speak at the HFMA Region 1 annual conference May 23 in Uncasville, CT.
CapsuleTech will exhibit at the National Teaching Institute & Critical Care Exposition May 21-25 in Houston.
Besler Consulting will exhibit at the HFMA Region 1 annual conference May 23 in Uncasville, CT.
CoverMyMeds will exhibit at the QS/1 Customer Conference May 17-19 in Atlanta.
Besler Consulting releases a new podcast, “Evaluating post-discharge cost and quality.”
CTG announces expanded portfolio management and help desk services in its Application Advantage program.
Cumberland Consulting Group will sponsor the ASO Opportunities Value Visit May 17-19 in Chicago.
Impact Advisors VP Lydon Neumann is named one of Consulting Magazine’s Top 25 Consultants of 2017.
The local business paper profiles Diameter Health and its ties to Connecticut Innovations.
White House officials refute claims that the NSA deserves any blame for the WannaCry cyberattack after Microsoft President and chief legal officer Brad Smith publish a blog post publically criticizing the agency for losing control of a stockpile of unknown security vulnerabilities, saying “An equivalent scenario with conventional weapons would be the US military having some of its Tomahawk missiles stolen.”
FDA administrator Scott Gottlieb, MD issues a memo to his staff addressing his view of the agency’s role under his leadership. He discusses the importance of continuing to drive down US smoking rates, the emergency of gene therapies, the need to reduce drug prices, and the implementation of the 21st Century Cures Act.
As a small Ebola outbreak takes hold in the Democratic Republic of Congo, Merck confirms that it has stockpiled 300,000 doses of an experimental Ebola vaccine designed by scientists at Canada’s National Microbiology Laboratory that has shown “high efficacy in clinical trials and could play a vital role in protecting the most vulnerable”
"HHS OIG rates HHS’s information security program as “not effective” in its annual review, the same rating it gave HHS…