Recent Articles:

News 9/5/18

September 4, 2018 News No Comments

Top News

image

Atul Gawande, MD taps Jack Stoddard to be COO of the still unnamed joint healthcare venture of Amazon, Berkshire Hathaway, and JPMorgan. Stoddard was formerly general manager of digital health at Comcast, where he devoted some of his time to developing digital patient engagement and education tools for a (presumably defunct) program with Independence Blue Cross. Stoddard’s time in the healthcare trenches also includes stints at Comcast-backed Accolade and Optum.


Reader Comments

image

From Savoy Special: “Re: Medhost’s customer count. Down to 180 hospitals? That number cannot be correct since they still have their platform in most of the 119 CHS hospitals, plus a large number of LifePoint, Acadia, and Select hospitals. Plus they recently won a multi-entity deal at the end of last year. And then there is all of their EDIS business. The Curae bankruptcy was not unexpected. There was actually a lot of buzz about Medhost at Health:Further18.”


Webinars

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


Acquisitions, Funding, Business, and Stock

image

Global technology services company Persistent Systems acquires Herald Health for $5.2 million. Herald’s software helps surface relevant EHR data in real time across hospital departments. The Boston-based startup came out of Brigham and Women’s Hospital (MA), which, through its Partners HealthCare network, tapped Persistent last year to develop a SMART on FHIR digital platform for sharing best clinical practices.

image

Redox raises $3 million, bringing its total raised to $18 million since launching in 2014.

image

Medication risk management vendor Tabula Rasa Healthcare acquires EHR vendor Mediture and its third-party administrative services subsidiary EClusive for $22 million. Both cater to Program of All-inclusive Care for the Elderly markets. The businesses will be incorporated into Tabula Rasa’s new PACE-focused CareVention HealthCare technology and services division.

image

Following in Apple’s footsteps, Amazon momentarily hits the $1 trillion mark during day trading, focusing analyst’s eyes even more eagerly on its push into healthcare. The Internet retailer went public in 1997 at $18 a share, a figure that has skyrocketed to $2,050 and made founder and CEO Jeff Bezos the world’s richest man with a net worth of $167 billion.


People

image

Patrick McGill (Community Health Network) will join primary care management company Primaria Health as CEO in December.


Announcements and Implementations

image

Greenville Health System (SC) goes live on Agfa Healthcare’s enterprise imaging system.

The Brooklyn Hospital Center (NY) implements Epic at its ambulatory sites.


Other

image

Following on-campus protests and obvious malcontent amongst its staff, Providence Hospital management fires the majority of its Board of Directors via email after tensions mount around parent organization Ascension’s decision to stop offering acute care services at the hospital by the end of year as part of its transition to a “health village.” (It announced it would close its obstetrics and behavioral health departments last August.) A former board member claims a vote on the acute-care decision was snuck in at the end of a regular meeting, after several other members had already left. Ascension claims the shuttering will better enable Providence to focus on “care coordination, telehealth/virtual care, primary and urgent care, home care, community-based behavioral healthcare, senior care, and more.”

In Australia, Victoria’s Dept. of Health and Human Services begins migrating 12,000 users from Lotus Notes to Office 365. Lotus Notes was first implemented in 1998, making the number of applications that have been spawned around it too numerous to die a quick death.

image

Researchers develop an iPhone app capable of measuring blood pressure with the press of a finger. Readings were found to be similar to those from traditional blood pressure cuffs.

image

The Cincinnati business paper profiles Cincinnati Children’s Hospital surgeon Victor Garcia, MD and the predictive analytics software he has developed with Israeli researchers to stave off shock in ICU patients.


Sponsor Updates

  • AdvancedMD publishes a new e-guide, “In or Out-Source: Your Value-Based Care (VBC) Revenue Cycle Management.”
  • Aprima will exhibit at the Patient-Centered Medical Home Congress September 14-15 in San Diego.
  • Gartner recognizes Arcadia as a representative vendor across five categories in its latest report, “Healthcare Payer CIOs, Leverage Vendor Partners to Succeed at Clinical Data Integration.”
  • The University of Wisconsin-Madison profiles Bluetree Network founder Ted Gurman’s work with the Madison Entrepreneur Resource, Learning, and Innovation Network.
  • Datica will present and exhibit at HITRUST 2018 September 11-13 in Grapevine, TX.
  • The Chicago Tribune profiles Burwood Group Senior Director of Sales and Marketing (and Renaissance man) Greg Bueltmann.
  • CarePort Health will exhibit at ACMA New York September 8 in New York City.
  • Carevive Systems will exhibit at the 2018 ACS Cancer Programs Annual Conference September 5-7 in Chicago.
  • Collective Medical partners with the Hospital Council of Northern and Central California.
  • CoverMyMeds will present at the CBI Hub and SPP Model Optimization event September 12-13 in San Diego.
  • CTG will present at the Patient-Centered Medical Home Congress September 14-15 in San Diego.
  • Cumberland Consulting Group will sponsor the HealthCare Executive Group Annual Forum September 12-14 in Minneapolis.
  • The Connecticut Technology Council and Marcum LLP include Diameter Health on their list of the fastest-growing technology companies in Connecticut.
  • Yuma Regional Medical Center (AZ) expands its use of Vocera technology to include its entire enterprise.
  • Long-time Meditech customer DCH Health System (AL) will implement the company’s Expanse EHR across select hospitals and clinics.

Blog Posts


Contacts

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

125x125_2nd_Circle

Curbside Consult with Dr. Jayne 9/3/18

September 3, 2018 Dr. Jayne 5 Comments

image

I spent some time this week learning about the patient/family side of the changes that value-based care is bringing us. A close friend of mine had a hip replacement and got to experience the “new normal” in some dimensions of healthcare. He chose a surgeon at one of our local academic medical centers; since he is young (under 40) and otherwise healthy, he was offered the option of an outpatient procedure. As a physician who has been out of the primary care flow for a while, I wasn’t really aware that outpatient hip replacement was even an option. Of course, early ambulation is a good thing, but sending someone home the same day is relatively new.

It’s great to get people out of the hospital early – certainly not being in the hospital is a great protector against hospital-acquired infections. One can also think of the potential for higher-quality sleep at home, without having your vital signs checked or having IV pumps beeping at you. On the other hand, there may be children and pets at home, so quiet time is no guarantee. I’m sure one of the factors influencing a change to outpatient status for many procedures is the sheer cost of days in the hospital. As I learned more about my friend’s arrangements for his post-hospital care, one might begin to think twice about that cost equation. Certainly, there’s a smaller payment to the hospital, but there’s the reciprocal cost of having a spouse or family member take off work for a period of time because someone has to be home with the patient 24×7. Home health, home physical therapy, and other services may be substituted for the inpatient versions, and not having seen a bill for either of those services in a while, I’m not sure how much of a savings it truly is.

There’s also a psychological cost – for most of us used to western-style medicine, there may be comfort in knowing that if something “bad” happens, there are professionals close by. It’s easier to run laboratory tests if new symptoms or side effects develop; if the patient falls, there are trained staffers who know what to do and how to help. At home, there’s that shade of uncertainty about what might happen if things don’t go as planned, such as if the patient begins to run a fever or is having pain that isn’t controlled by the medications available at home. At an academic center there’s typically a “house officer” resident physician who can assess a patient if the nursing staff identifies a potential risk or worsening condition. At home, you have your telephone, and your own ability (or inability) to describe what is going on.

My friend is taking his recovery in stride, although figuratively rather than literally. He quickly figured out how to lash his portable, deep venous thrombosis compression pump to his walker so it didn’t strangle him when he was trying to make his way around the room, and shared his expanded knowledge of Netflix with the rest of us. Can’t Pay? We’ll Take It Away! is an interesting look at rather genteel British repo men and their work. I’m sure we’ll have some laughs when the surgery and home care bills start rolling in – we’ll see how long it takes to get everything paid and reconciled. Depending on how that goes, it might be the most frightening part of the entire procedure. Until then, he’ll have to be entertained by a parade of friends dropping by to sit with him so his family can leave the house, and endless card games playing Uno.

Labor Day Weekend is a fairly low readership environment, so I’ll keep this Curbside Consult brief. Whether you’re barbecuing, visiting with friends, packing away your white shoes, or using the long weekend to catch up, take a minute to remember what Labor Day is all about. It’s been a federal holiday in the US since 1894, and is also celebrated in Canada. Spend a few minutes thinking about the work people do and how much we all need each other to keep things going, especially the folks that are outside the C-suite. Be sure to thank the people in facilities engineering, sterile processing, dietary, custodial, and so many other departments that keep our healthcare world turning.

Email Dr. Jayne.

Morning Headlines 9/3/18

September 2, 2018 Headlines No Comments

Los Angeles billionaire’s hospital system declares bankruptcy

Verity Health (CA) files for Chapter 11 in an effort to survive the health IT missteps of Patrick Soon-Shiong, MD who acquired the health system in July 2017 with promises of achieving the Triple Aim using Allscripts technology, which he seemed to favor as a company investor.

HCA Healthcare to buy North Carolina’s Mission Health for $1.5 billion

HCA Healthcare buys Mission Health for $1.5 billion and pledges to invest $25 million in an innovation fund for the North Carolina-based system.

You’ll Never Guess Which Company is Reinventing Health Benefits

Comcast invests in companies like Accolade and Grand Rounds to help keep employee deductibles surprisingly low.

Monday Morning Update 9/3/18

September 2, 2018 News 1 Comment

Top News

image

As predicted, California-based Verity Health files for Chapter 11 bankruptcy in an effort to survive the health IT missteps of billionaire Patrick Soon-Shiong, MD who acquired the health system in July 2017 with promises of achieving the Triple Aim using Allscripts technology, which he seemed to favor as a company investor. Implementation efforts have been put on hold as the frustrations of local officials mount. “It has become crystal clear by the bankruptcy announcement that he virtually had no intention of keeping these hospitals open and to continue to serve the poor like the Daughters of Charity [the past owners] did,” says city official David Canepa. “The whole thing seems like one big lie.”


Reader Comments

image

From Vumcit: “Re: CIO departure at VUMC. Vanderbilt operating revenue down 68 percent after Epic implementation. CIO leaving. Unofficial hiring freeze in place.” It appears CIO Ken Letkeman will be heading to Houston Methodist after overseeing Nashville-based VUMC’s $200 million switch to Epic last November. The hospital’s latest financial statement says that while the drop in revenue was planned for, the implementation caused “muted” procedural volume, though future gains are expected.

From Savoy Special: “Re: Teladoc. Teladoc Rx ordering suffered widespread outage for over 36 hours between 8/29 and 8/31. After hours on the phone with Teladoc getting multiple stories, with the only consistent theme being ‘It’s not us, it’s them’ in a vague reference to a downstream integration or e-prescribing vendor platform doing an upgrade or emergency fix. Messages are flowing in a FIFO manner as of 9 a.m. ET on 8/31.” Unverified. Teladoc uses e-prescribing services from Surescripts.


HIStalk Announcements and Requests

image

Blockchain’s potential impact on healthcare seems to be minimal at best, which makes me wonder if an emperor-with-no-clothes mentality has swept investors (and other media outlets) off their feet. Clarence says, “The biggest impact is the cost of time and energy spent exploring this fruitless and wasteful expenditure.” Former CIO explains that, “It’s a database, a really slow database. What database has ever impacted cost or quality? When has a slower technology ever improved anything in healthcare?”

New survey to your right or here: Would you resort to sharing your medical bill with the media in hopes of getting it reduced?


Webinars

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


Acquisitions, Funding, Business, and Stock

image

Virtual care software vendor Zipnosis raises $3 million in a Series B round, bringing its total funding to $22 million.

image

The New York Times profiles Comcast and the surprisingly savvy investments it has made to keep healthcare costs down for its employees. (Most employees have a $250 deductible.) Through its Comcast Ventures investment arm, the much-maligned cable company has developed financial relationships with startups like Accolade, which helps employees navigate their health benefits; and Grand Rounds, which helps patients find second opinions. Comcast offers their services to its employees, plus virtual care from Doctor on Demand. It’s next admittedly self-serving play is to ensure the financial health of its employees through a startup it has created and funded call Brightside. Accolade co-founder Tom Spann made his debut as CEO of Brightside at the HLTH conference in Las Vegas.

HCA Healthcare buys Mission Health for $1.5 billion and pledges to invest $25 million in an innovation fund for the North Carolina-based system. Coincidentally, HCA is part owner of St. David’s Medical Center in Austin, TX, which slapped patient Drew Calver with a $109,000 bill for heart attack treatment, but then ultimately slashed it to $332 after receiving negative national media coverage it couldn’t “neutralize.”


People

image

Todd Hoisington (Huron Consulting) joins The Chartis Group as principal and partner.


Announcements and Implementations

image

Meritus Medical Center (MD) and physician practices go live on Epic.

image

In Australia, Chris O’Brien Lifehouse implements Meditech’s 6.x oncology and pharmacy software.


Sales

  • Mt. Washington Pediatric Hospital (MA) selects Meditech Expanse EHR implementation services from CloudWave.

Other

image

image

image

An interop enthusiast reflects on Epic CEO Judy Faulkner’s UGM comments on the benefits of “One Virtual System Worldwide.”

image

The integration of new devices for better communication tops the list of call center process-improvement goals, according to Spok’s inaugural survey of 400 providers involved with call-center strategy. Pagers are still going strong as a top communication method for staff, nearly tying with smartphones. Smart watches seem to be high on everyone’s wish list.


Sponsor Updates

  • Liaison Technologies releases a new video, “The State of Data Privacy and Security Compliance in Healthcare.”
  • LifeImage’s network now connects 1,500 hospitals and has facilitated the exchange of 7 billion image files.
  • MedData will exhibit at the Texas MGMA Fall Conference September 6-7 in Houston.
  • PatientPing releases a new success story video featuring Karen Yakabowskas of Saint Francis Healthcare Partners.
  • Surescripts recognizes nine EHR companies as finalists for the 2018 White Coat Award.
  • Vocera will exhibit at the 2018 Kansas Hospital Association Conference and Tradeshow September 6 in Topeka.
  • Philips Wellcentive publishes a new case study, “Eastside Health Network overcomes integration challenges.”
  • Meditech adds PDMP integration from DrFirst to its Expanse EHR.

Blog Posts


Contacts

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

125x125_2nd_Circle

Weekender 8/31/18

August 31, 2018 Weekender No Comments

weekender


Weekly News Recap

  • The first FDA-approved digital pill will soon be offered to Medicaid patients in certain markets suffering from schizophrenia and bipolar disorder.
  • At Epic UGM, CEO Judy Faulkner sheds more light on the company’s One Virtual System Worldwide initiative, which would give health systems across the globe the ability to share data across a single network.
  • Debt-ridden Verity Health System, acquired by Patrick Soon-Shiong last year, will file bankruptcy in the next few weeks thanks in part to poor health IT decision-making.
  • Harris Computer Systems acquires Iatric Systems, which it will run as an independent business unit.
  • 23andMe will turn off API access to its anonymized data sets, telling developers that they can access company-generated reports but not the underlying data.
  • Two key leaders of the VA’s Cerner implementation have turned in their resignations – Chief Medical Officer Ashwini Zenooz, MD and Chief Health Information Officer Genevieve Morris.

Best Reader Comments

The Politico story about Verity Health and Patrick Soon-Shiong is depressing to read, he drove a stake into the heart of that company. I looked back at my comment after the original sale and did a double take at the date, it only took him a year to bring it down. People need to stop agreeing to work with this guy, he’s a con man. (DrM)


Watercooler Talk Tidbits

dc1 dc2

Readers funded the DonorsChoose teacher grant request of Mrs. H from North Carolina, who asked for a laptop and case for her high school class. She reports, "The laptop you gave my students is helping them in numerous ways. For example, we used it when they were learning about permeability and porosity. They were able to research ideas about what they were observing and then post their results and comments on Google classroom to share with other students. We have also taken the laptop on a recent field trip to an aquarium to post comments and pictures about the student’s new discoveries and unique experiences. We made bottle rockets from recycled 2-liter bottles, then went outside and tested their bottle rockets. At that point, the students also created a live data sheet to record hang time, rocket mass, and general weather conditions. The data sheet was then shared online with the entire class. As a result, no paper or time was wasted and everyone could give positive feedback. Thank you for your generosity in helping my students to use technology in learning and doing real science!"

image

Indiana University Health updates its dress code, giving staff the option to display tattoos, sport non-natural hair dye, and even choose their own socks. (Tongue piercings are still verboten.) The hospital decided to make the changes in an effort to encourage employees to be themselves while still maintaining a professional image. “We knew that many of our caregivers had tattoos that they were hiding and that just didn’t feel genuine to us,” says Chief Nurse Executive Michelle Janney, RN. “Actually what we’re saying is use good judgment and we trust you.”  

image

Cerner co-founder Cliff Illig and members of the late Cerner co-founder Neal Patterson’s family attend a ribbon-cutting for Neal Patterson Stadium, Oklahoma State University’s renovated soccer venue. Patterson, an OSU graduate, donated $10 million to the stadium’s renovations before he passed away last year. Patterson and Illig seem to be big soccer fans, having bought the Sporting Kansas City football club in 2006.

image image

In Missouri, Burwood Group Senior Account Executive and cover band lead singer Stephanie Varone experiences a homecoming of sorts when she returns to Kauffman Stadium – home of the Kansas City Royals – to sing the national anthem. Varone first sang the anthem there 31 years ago, and has performed for similar crowds at Wrigley Field and Fenway Park.


In Case You Missed It


Get Involved


125x125_2nd_Circle

Morning Headlines 8/31/18

August 30, 2018 Headlines No Comments

Otsuka Announces First Collaboration Agreement to Bring the ABILIFY MYCITE® System to the US Market

The first FDA-approved digital pill will soon be offered to Medicaid patients in certain markets suffering from schizophrenia and bipolar disorder.

Philips acquires Air Force technology for mobile patient monitoring

Philips Healthcare acquires patient monitoring technology from the US Air Force, with an eye towards further developing it for civilian telemedicine uses.

Centra launching new electronic health record system, anticipating increased wait times

Centra Health (VA) will go live on Cerner at each of its hospitals and 50 ambulatory and long-term care facilities September 1.

News 8/31/18

August 30, 2018 News 1 Comment

Top News

image

The first FDA-approved digital pill will soon be offered to Medicaid patients in certain markets suffering from schizophrenia and bipolar disorder. The Abilify MyCite regimen, which will come with a monthly price tag of $1,650, includes a sensor-embedded pill, wearable sensor, user app, and provider portal. Manufactured by Otsuka America Pharmaceutical, the pill is a digital version of the 16 year-old antipsychotic drug Abilify, which is now available as a generic for $700 a month.


Reader Comments

image

From CB: “Re: Curae and Medhost. Remember that Curae-Medhost deal earlier this year? Curae has filed for Chapter 11 after incurring ‘higher-than-expected costs for electronic health records.’ Rumor is Medhost is down from a high of 450 clients to less than 180.” Rural healthcare operating company Curae Health actually signed on with Medhost last September at two of its hospitals. Curae filed for bankruptcy earlier this week, citing an inability to pay vendors in a timely manner. Medhost insiders are welcome to comment on the unverified client count.


Webinars

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


Acquisitions, Funding, Business, and Stock

image

The US Patent & Trademark Office grants health data integration company Redox a patent for digitally translating messages between providers and vendors for smoother data exchange.

image

Workforce management and analytics software vendor API Healthcare will move from GE Healthcare’s campus in Wauwatosa, WI to its former headquarters in nearby Hartford. GE sold off API, along with its enterprise financial and ambulatory care management units, to Veritas Capital in July for $1 billion.

Malvern, PA-based FluidEdge Consulting receives a strategic investment from CitiusTech.

image

The USPTO issues Monarch Medical Technologies a patent related to providing patient-specific insulin dosing recommendations for its EndoTool Glucose Management System.

image

Philips Healthcare acquires patient monitoring technology from the US Air Force. The Battlefield Assisted Trauma Distributed Observation Kit was designed to help medics monitor casualties in the field via smartphone or tablet. Philips plans to further develop the technology, with an eye on telemedicine offerings for civilians.

image

Berkshire Hathaway CEO Warren Buffett tells Bloomberg that Atul Gawande, MD is hiring for unnamed positions within Berkshire’s joint healthcare venture with Amazon and JPMorgan Chase. Buffet added that the venture, of which Gawande has been CEO since early July, is in no hurry to upend healthcare. “We’d like to be in a hurry,” he added, “but we’re not going to try and do something faster than it can be done.”

image

Chicago-based Tempus raises $110 million in a Series E round that brings its total funding to $320 million and valuation to $2 billion. The oncology-focused precision medicine company was started in 2015 by Groupon co-founder Eric Lefkofsky, who plans to use the investment to expand its focus to cardiovascular disease and diabetes, and its reach to foreign markets.


People

image

Nashville General Hospital names Eric Stephens (Vanderbilt University Medical Center) chief analytics officer.

image

Jim Clifford (Philips Wellcentive) joins Rimidi as VP of strategic sales.


Sales

  • Woman’s Hospital (LA) selects Health Catalyst’s Data Operating System.
  • Oregon Health and Science University chooses Passport electronic forms from Access for surgical consents and safe opioid agreements.

Announcements and Implementations

image

UMass Memorial Medical Center (MA) implements real-time patient messaging software from HealthLoop to better support total joint surgery patients.

image

Definitive Healthcare announces GA of commercial medical claims data on 210 million de-identified patients.

image

In the UK, Great Ormond Street Hospital deploys Elsevier’s Arezzo clinical pathways software in its endocrinology and metabolic unit.

image

First announced in April 2016, Centra Health (VA) will go live on Cerner at each of its hospitals and 50 ambulatory and long-term care facilities September 1. Four hundred Cerner trainers will be on site to help with the culmination of what has been dubbed “Project Unison.”


Government and Politics

image

VA Secretary Robert Wilkie tells American Legion national convention attendees that customer service will be a top priority within the agency, as will transitioning to Cerner and working with the DoD to help patients navigate from active-duty to veteran status. He stressed that no veteran should have to endure what his father, Army Lt. Col. Robert Leon Wilkie Sr., went through when he carried 800 pages of medical records to VA appointments.


Other

Epic’s annual user group meeting brings an influx of end users and staff to company headquarters in Verona, WI. Locals bemoaned the crowds (made worse by the University of Wisconsin at Madison’s move-in week and exceptional rains), while conference-goers griped about the lack of an agreed-upon hashtag. CEO Judy Faulkner made her typical opening remarks, with even the local press picking up on her vision for a global health data sharing network. A few images from the event:

image

image

image

image

image

Weird News Andy says this California couple’s first kiss was definitely one to remember: Max Montgomery suffered a heart attack and collapsed on the beach during his first date with anesthesiologist Andrea Traynor, MD who quickly administered CPR. EMTs revived Montgomery in the ambulance and admitted him to the hospital for bypass surgery. The couple – and Montgomery’s heart – are still going strong 10 months later.


Sponsor Updates

  • EClinicalWorks will exhibit at CASA 2018 September 5-6 in Huntington Beach, CA.
  • The Healthcare Business Intelligence 2018 report from KLAS Research gives HBI Solutions an overall score of 91.3 for advanced analytics.
  • Iatric Systems will exhibit at HCCA Regional September 7 in Boston.

Blog Posts


Contacts

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

125x125_2nd_Circle

EPtalk by Dr. Jayne 8/30/18

August 30, 2018 Dr. Jayne No Comments

image

Thousands of health system leaders have descended on Epic’s headquarters this week for its annual Users Group Meeting. I’m even more curious about the upcoming, first-annual, Un-Users Group Meeting, slated for September and specifically inviting groups that don’t use Epic. The meeting is designed to review options for connecting with Epic-using facilities and for attendees to understand patient-driven mechanisms of data sharing. The Epic-using hospitals in my area have zero interest in connecting with anyone who isn’t part of their respective systems, so I’m not sure that hearing from the vendor would be that helpful. If you’re in an area where everyone plays nice, registration is $100 and the meeting is only one day, so you might be able to fit it into your schedule.

Speaking of vendor user group meetings, I’ve attended quite a few in my time and beyond the educational and networking components there is typically a bit of fun. As we’re in the swing of the user group season, let’s all take a moment to review an analysis of alcohol consumption and health risk recently published in The Lancet. Although mainstream media has picked this up as a warning that there is no amount of alcohol that is safe to consume, the facts of the analysis need to be considered. Researchers looked at data on alcohol use and the risk of alcohol-related conditions from people in almost 200 countries and used it to create a global risk profile for alcohol. The authors kindly note that they adjusted for tourism and “unreported” consumption, which is an interesting concept to consider.

Not surprisingly, alcohol-related harm was less where no alcohol was consumed, and the risk increased with a rising number of daily drinks from 0 to 15. Because the study used previous data rather than being a new clinical trial, researchers weren’t able to control for other health risks such as smoking or low socioeconomic status. The New York Times brings some sanity to the data in its review of the study. Author Aaron Carroll notes: “Consider that 15 desserts a day would be bad for you. I am sure that I could create a chart showing increasing risk for many diseases from 0 to 15 desserts. This could lead to assertions that “there’s no safe amount of dessert.” But it doesn’t mean you should never, ever eat dessert.” As someone who indulged in a spirit-bolstering piece of gooey butter cake this afternoon, I fully agree. Much appreciation to my Midwest client who introduced me to the delicacy.

image

HIMSS19 registration is open, and they’ve upped the early bird price by $35 to a base of $825 for HIMSS members. Fees are extra for the Health 2.0 VentureConnect offering and various pre-sessions, receptions, and the SeaWorld event. I registered early so I could check one more thing off my ever-growing “to do” list, and was happy that I had booked my hotel weeks prior because my hotel of choice is already sold out.

I completed my registration while waiting on a conference line for a client who is chronically late. As a consultant, my meter starts running at the scheduled meeting start time, and the client is on the hook for any wasted time. Of course, if a client has an extenuating circumstance I will typically make an exception, but not for a client who does it all the time and has been reminded often about the time she is wasting. While I was productive, the other people waiting on the call engaged in some fairly un-professional, pre-call banter, despite being able to clearly see that an outside person was connected to the Web conference via both audio and video. I’m cool with chit-chat about weather, sports, weekend plans, kids, and what’s for lunch, but complaining about your boss probably isn’t the best thing to do on an open conference line. Especially when your boss hired the consultant who is chuckling to herself while on mute.

image

A friend clued me in to Paladina Health, which delivers integrated care in a medical home model. Like other offerings, its goal is increasing value while reducing healthcare spending. However, it leads with a high-touch primary care setting –  think concierge medicine as an employee benefit. There’s plenty of technology going on with population health management, risk stratification, and outreach, but the primary physician is empowered to truly build a relationship with the patient, with appointment slots ranging upwards of 30 minutes. Physicians are paid a salary and receive bonuses based on outcomes, patient satisfaction, and cost management. Patients can be seen without paying a co-pay, with the intent of encouraging them to seek care when they need it and not having cost be a barrier. I’m not sure exactly what the physician compensation piece looks like, but it was enough to convince my colleague to leave her part-time, family-friendly position and take on being available to patients 24×7. I’ll add Paladina Health to my watch list and see how they do over the next year or so.

image

For those of you in healthcare IT who don’t have to deal with the revenue cycle piece, think kindly if you encounter stressed-out colleagues who do. There are so many steps needed with appeals, resubmissions, and more, it’s enough to make someone lose their mind at times. CMS is one of the biggest offenders, although I’m currently working with a client who has several payers that are taking more than 52 weeks to pay, leaving the practice holding the bag. HHS filed a brief this week estimating that it will be able to clear the Medicare claim appeals backlog by Fiscal 2022 – but unfortunately, that’s a year longer than stipulated by a US District Court. The issue goes back to a 2014 lawsuit by the American Hospital Association against HHS, claiming that the Recovery Audit Contractor (RAC) program’s slow appeals process violates the Medicare Act’s 90-day appeals requirement. HHS has long claimed that administrative judges are overwhelmed and it doesn’t have the budget to hire more. There are over 600,000 appeals pending, and it’s expected that the number will be over 950,000 by the end of Fiscal 2021. To solve the problem, HHS plans to use over $180 million in additional funding to hire enough judges and staffers to more than double the number of appeals it can process annually. I’d love to see some provider-side data on what those appeals and delays cost those who are providing care. I’m betting there could be some serious savings if healthcare organizations didn’t have to hire staff to chase their payments.

What’s the longest delay in payment you’ve seen? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/30/18

August 29, 2018 Headlines No Comments

Mississippi hospitals and owner seek bankruptcy, to be sold

Hospital and physician practice operator Curae Health (TN) files for Chapter 11, citing higher-than-expected EHR costs and an inability to pay its vendors (likely including Medhost) in a timely manner as contributing factors.

Groupon Cofounder’s Health Startup Hits $2 Billion Valuation With Latest Funding Round

Oncology-focused data analytics company Tempus raises $110 million, bringing its total raised to over $320 million.

Epic Systems CEO Judy Faulkner shares vision of single global network for patient data

Epic CEO Judy Faulkner sheds more light on the company’s One Virtual System Worldwide initiative, which would give health systems across the globe the ability to share data across a single network.

Morning Headlines 8/29/18

August 28, 2018 Headlines No Comments

Harris Healthcare Group Acquires Iatric® Systems, Inc.

Harris Computer Systems acquires Iatric Systems, which it will run as an independent business unit.

Did Patrick Soon-Shiong’s high-tech gamble help bring 6 hospitals to the brink?

Debt-ridden Verity Health System, acquired by Patrick Soon-Shiong last year, will file bankruptcy in the next few weeks thanks in part to poor health IT decision-making.

Bridge Connector Raises $5.5M To Connect CRMs And Health Care Data

Palm Beach Gardens, FL-based Bridge Connector, which integrates customer relationship management systems with EHR and other hospital systems, raises $5.5 million in a Series A funding round.

St. Luke’s opens ‘virtual hospital’ in Boise

St. Luke’s Boise Medical Center (ID) opens a 60-station, 350-employee virtual hospital that will offer clinic consultation, hospital consultation, and home monitoring.

News 8/29/18

August 28, 2018 News 4 Comments

Top News

image

Harris Computer Systems acquires Iatric Systems, which it will run as an independent business unit.

Iatric President/CEO Frank Fortner will join Harris as EVP of Iatric Systems.

Iatric’s website says it has 200 employees. The company is headquartered in Wakefield, MA. It has won awards for patient privacy monitoring, specimen collection barcoding, interoperability, and EHR optimization.

Harris’s health IT business includes Amazing Charts, GEMMS, Harris Healthcare Clinical Solutions, Harris Coordinated Care Solutions, IMDSoft, MediSolution, Morcare, Picis, PulseCheck, and QuadraMed.


HIStalk Announcements and Requests

Listening: the amazing if unlikely 2011 pairing of Amy Winehouse and Nas, leading me to belatedly appreciate her troubled genius. The eclectic streaming station roped in my scanning with the little-heard 1967 tune “Monterey” by Eric Burdon and the Animals and moved on to a weird mix of great music, including that of Amy, who died of alcohol poisoning in 2011 as her initiation into the 27 Club of musician deaths.


Webinars

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


Acquisitions, Funding, Business, and Stock

image

Politico reports that debt-ridden Verity Health System, acquired by Patrick Soon-Shiong last year, will file bankruptcy in the next few weeks. The article notes that Soon-Shiong forced the system to implement Allscripts Sunrise when he held a financial stake in that vendor, costing the health system an estimated $20 to $100 million even though it preferred Epic. Losses have forced the health system to cut back on IT infrastructure services and charity care. The health system lost $119 million in the year ending in June 2018 versus an expected break-even budget even as Soon-Shiong’s management company was paid $20 million.

image

Palm Beach Gardens, FL-based Bridge Connector, which integrates customer relationship management systems with EHR and other hospital systems, raises $5.5 million in a Series A funding round that follows a $4.5 million investment in its June 2018 seed funding round.


Sales

  • Steward Health Care chooses Wolters Kluwer for point-of-care knowledge tools, infection surveillance, and evidence-based clinical decision support.
  • Mohawk Valley Health System (NY) chooses Epic to replace its five non-Epic EHRs.
  • Partners HealthCare will offer urgent care video visits through its health plan, working with Teladoc Health.

People

SNAGHTML26f64d

Pivot Point Consulting hires Janice Wurz (Impact Advisors) as VP of advisory services.

image

CTG co-founder G. David Baer died August 21. He was 82.


Announcements and Implementations

image

A new KLAS report covering the European EHR market finds the top vendors to be Epic, Cerner, and Allscripts in that order, with Epic growing market share in Netherlands and Scandinavia despite customer feelings that its approach is US-centric and Cerner seeing its growth mostly in the UK but with inconsistent delivery. Meditech and Allscripts are noted as performing very well for their users despite a small customer base. The top three vendors in terms of 2012-2017 market wins are InterSystems (by far), Agfa, and Epic.

image

The Pew Charitable Trusts, MedStar Health’s human factors group, the AMA, and external reviewers publish “Ways to Improve Electronic Health Record Safety,” a call for voluntary improvement of usability testing, integration of usability and safety reviews into product life cycles, and creating safety-focused test case scenarios.

image

Adventist Health System – which is changing its name to AdventHealth – buys the 10-year naming rights to the practice facilities and administrative offices of the Tampa Bay Buccaneers NFL football team, saying the move will allow it to “identify and tackle important health issues in the Greater Tampa Bay Area” (the pun may or may have not been intentional).

image

St. Luke’s Boise Medical Center (IA) opens a 60-station, 350-employee virtual hospital (St. Luke’s Virtual Care Center) that will offer clinic consultation, hospital consultation, and home monitoring.

OSEHRA will create an international version of the VA’s VistA EHR, with participation from South Korea, China,  and Jordan.


Other

image

Another struggling, rural hospital gets in trouble for allowing itself to be used in a questionable lab billing scheme. Blue Cross Blue Shield of North Carolina sues LifeBrite Hospital of Stokes and removes the hospital from its network after its volume of submitted lab tests rises from 267 per month to 67,000, most of them for urine toxicology screening for out-of-state patients who had no hospital connection. BCBSNC paid $11 million for what it says are fraudulent, inflated-price tests before it stopped payments, claiming that the hospital was purchased strictly to take advantage of its in-network contracts. LifeBrite bought the bankrupt 99-bed hospital last year – then named Pioneer Community Hospital of Stokes — for $400,000 and BCBSNC says it has billed $76 million since. The Georgia company has just one other hospital, but runs national reference lab LiteBrite Laboratories.

image

Central Maine Healthcare’s recently hired CEO Jeff Brickman says he moved too quickly in trying to turn around the health system’s finances, causing doctors and employees to push back over its Cerner implementation. Their no-confidence vote failed, however, as the board reiterated its support for him.

image

We’re going to need a lot more reporters: an HCA hospital tells a heart patient that his insurance will cover his four-night, out-of-network heart attack stay, then bills him for $109,000 and turns it over to collections when the high school teacher can’t pay. State-mandated protection against balance billing didn’t apply in his case since his employer is self-insured. Experts say Aetna had already paid the hospital at least 2-4 times reasonable charges. NPR’s coverage of the story suddenly resulted in the for-profit hospital offering a “financial assistance discount” that reduced the teacher’s bill to $782, a 99.3 percent “bury this story now” cost savings that it will surely make back from patients whose stories earn less press.

image

Meanwhile, former ED physician Matthew Wetschler – who was left with a $500K bill after his insurer Oscar refused to pay out-of-network San Francisco General Hospital for emergency treatment after he broke his spine – says UCSF has turned over 41 separate accounts under his name to debt collectors. This is a good lesson – given their inability to hold prices down by negotiating with market-dominant health systems, about the only tools insurers have left are to (a) deny coverage; (b) increase the portion patients pay; and (c) most damaging of all, to create such narrow networks that bills for emergency care or services received while away from home are almost certain to be denied, with the patient getting stuck with the balance at full list (imaginary) price.


Sponsor Updates

  • Bluetree will exhibit at the CHIME Partner Education Summit September 5-7 in Chicago.
  • Bernoulli Health showcases the latest features of its Bernoulli One platform, including integration of patient ECG rhythm reports into Epic’s EHR, at Epic UGM this week in Verona.
  • CompuGroup Medical will exhibit at PainWeek September 4-8 in Las Vegas.
  • Spok will participate in several health events through fall.
  • Dimensional Insight emerges as a top cross-industry vendor in the latest KLAS Healthcare Business Intelligence Report.
  • DocuTap will host its annual user conference October 3-5 in Denver.

Blog Posts


Contacts

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

125x125_2nd_Circle

Morning Headlines 8/28/18

August 27, 2018 Headlines No Comments

Verscend Technologies, Inc., Completes Acquisition of Cotiviti Holdings, Inc.

Verscend Technologies wraps up its $4.9 billion acquisition of healthcare payments vendor Cotiviti, with Verscend President and CEO Emad Rizk, MD maintaining his role over both businesses.

After planting its flag with remote staff, tech company CDW wants to bring its office culture to Nashville

Hardware, software, and IT services company CDW opens a new office in Nashville to better cater to its healthcare customers.

Humana To Establish Center For Digital Health And Analytics In Boston

Humana opens Studio H in Boston to focus on developing digital health products and analytics for internal use, plus senior-focused healthcare solutions.

Curbside Consult with Dr. Jayne 8/27/18

August 27, 2018 Dr. Jayne No Comments

I’ve been helping a good-sized provider organization through a practice transformation project recently and it’s been a major challenge. They initially hired me to help them spin up a transformation team, which would be tasked with running various projects across the organization. Some of the change that needed to happen was financial or revenue cycle, but there were also a number of clinical projects that had been repeatedly placed on the back burner due to lack of focus or resources.

The goal was to help them identify which internal resources might be a good fit for the team and to educate those resources on not only the overall process of change management and practice transformation, but to ensure that they had a super-user level of knowledge of the EHR, practice management system, and ancillary applications. This would allow them to have the deep knowledge required to lead people through change, even in small groups where there might not be a subject matter expert readily available. They were to serve as kind of a SWAT team for transformation – go to a practice or site, lead the efforts, make suggestions, get it all documented, and supervise the rollout of the changes.

I was also tasked with helping the organization hire external resources to fill any gaps that we couldn’t fill internally. We knew that some members of the transformation team would only spend part of their time on the team – they may stay as half-time in their regular role and spend half of the time on transformation. My client felt strongly that for the transformation team to have a high degree of credibility, they needed to be in the trenches at least part of the time. I wasn’t opposed to the concept as long as we could make the scheduling and workload allocation work. The clinical employees selected for the team were particularly excited about being able to do the transformation work without having to give up the clinical experiences that they enjoy.

Where the super-user development and change leadership education went well, the hiring of external resources quickly turned into a disaster. My client subscribes to some HR functions through its parent hospital system and the hiring process is one of them. The first roadblock we ran into was getting the job descriptions created and approved.

Despite the provider organization being 100 percent on board with what I had created (drawing on samples from other major provider organizations), the hospital HR team didn’t understand what we were trying to do and insisted on trying to create the new positions around an IT-centric model that didn’t make sense for the provider organization. They wanted to classify the new transformation resources as project managers, which although it makes sense on some levels, doesn’t totally match what we expected them to do. In that IT-centric model, having the PMP certification may have been important, but not necessarily for our project. What was more important to us was having a proven track record of leading organizations through complex change, and especially experience in healthcare.

After a couple of months, we finally had the jobs posted and then were at the mercy of the hospital’s talent recruitment team to screen and vet potential candidates. I’m not sure whether it was market forces or what was going on, but nearly all of the first 10 applicants they presented to me came from the automotive industry. Their resumes were heavy on project management and not a single one had ever participated in a clinical project. That led to many phone calls between the provider organization’s leadership, the talent team, and myself trying to again explain what we were looking for.

Apparently our job postings had been handed off to a new recruiter who didn’t receive all the notes from the original HR team, and the new guy thought we wanted project managers and that’s what he was serving up. Following that clarification, we received a steady stream of candidates that were either medical assistants or office managers, but who didn’t have any background in change management. It took a little over two months to actually receive a screened applicant who seemed capable of doing practice transformation. In the mean time, I was contemplating regular appointments with Miss Clairol to cover the grey hair that I was sure this scenario would cause me.

By then, I was handed off to a third recruiter, who explained what was going on. The hospital had outsourced that particular part of HR and the recruiters were actually contractors from a third party that also provided services for a multitude of non-healthcare organizations. After some additional level-setting, we had a decent pool of applicants and were off to the races for some video interviews.

I was excited about using the video platform to do an initial interview. Particularly for activities that are technology-heavy and people-focused, understanding how they interact with their device is a good test. Our first video interview was a disaster. The candidate was logged into the Webex session twice and was trying to use both a phone session and a computer microphone / speakers session at the same time. There was a horrible echo and everything I said was played back to me as it resonated around the applicant’s desk, which was right in front of a large sunny window so that the applicant was backlit and you couldn’t even see his facial expressions.

We spent 10 minutes of the interview trying to get him to hang up one session, or at least disconnect the audio, which he finally figured out. Still, he was left with two sessions. He must have been using a laptop for the camera, but looking at us on another device, because then we always got a shot of his right-side profile as he looked away from us. At that point, I knew it wasn’t going to be a good fit because if you can’t figure out how to talk directly to your interviewer, I’m not going to want to spend a ton of time with you.

It also became apparent that he was probably doing the interview from his current place of employment, as someone walked in and just started talking to him about his work without knowing that he was busy. That’s not a good sign, either. I began to wonder whether he was doing the interview using company property or what was going on, which makes you think that a candidate is likely to pull those kind of shenanigans on you if you’re foolish enough to hire them.

By the end of the call, the HR rep was as frustrated as I was. In our debrief, it seemed that he was even more motivated to try to find the right kind of candidate for us so we can get going on these projects. I’m getting rather impatient because my client wants to power ahead with transformation efforts even though they’re short-staffed relative to what they want to do and we haven’t finished building the methodologies and training the resources that we do have. It’s hard to convince the C-suite that sometimes you have to hurry up only to wait, and that sometimes you need to go slow at the beginning so that you can go quickly in the future.

I’m doing a lot of “managing up” on this engagement and helping them understand that their impatience is what got them to the place where they needed to bring in outside assistance and to get them to trust the process and trust the team. I’ve got another stack of candidates ready for interviews once we get the scheduling sorted, so let’s hope this week is a better one.

What’s your favorite interview question? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Mike Linnert, CEO, SymphonyRM

August 27, 2018 Interviews No Comments

Mike Linnert is founder and CEO of SymphonyRM of Palo Alto, CA.

image

Tell me about yourself and the company.

The team and I have been doing customer relationship management solutions for large consumer service brands for 15 to 20 years. We’ve had the privilege to work with some of the biggest brands in the country, such as American Express, AT&T, Wells Fargo, and Verizon. We’re taking the learnings from those industries — how they take data, how they distill data down to action, how they use it to proactively engage their customers — and bringing that insight into healthcare. There’s a real opportunity for it.

How does healthcare compare to other industries in its use of customer relationship management systems?

We’re 10 to 15 years behind. You can see it in a few key ways. Healthcare is just starting to think about how to proactively reach out to our customers. Traditionally, the business model was that we waited for them to need us and call us, then we focused on providing good access. The paradigm is shifting. It’s both a competitive imperative and a business imperative, but it’s also a health imperative to drive healthier, happier customers. Health systems are beginning to aggressively reach out.

You see pockets of it starting to happen, in particular, with organizations that are looking at population health and starting to take some risk. They’re moving from “we have a lot of data” to “we have lists that we need to call or execute against.” We’re seeing it more aggressively by organizations that have taken more risk, or those that have the luxury of being able to be forward thinking. But they’re in the early stages. They haven’t thought about how to use technology to drive it, haven’t identified the business metrics that indicate that they’re doing well, and haven’t institutionalized the process.

Health systems historically didn’t want to make it obvious in a customer-facing way they were running a business. Is it a change for them to be behave like a for-profit business in going after new patients, upselling services, and measuring doctor loyalty?

I would say it’s less about thinking about being a profitable business and more about improving delivery to customers. Other customer service industries have found a way to take the business they have, distill it down to a few key metrics, and then take action based on those metrics. Can we distill all our data down to value, delight, loyalty, and next best action for every single customer we have?

The most important of those is the next best action. A health system should be able to answer the question of, if I had the privilege of talking today to any one of the million people that I have in my patient / customer database, what would be the most important thing I could say to them? That involves looking across the health system. We execute in different silos — the population health team, the primary care team, case managers, care coordinators, revenue cycle, and on and on. I need to grab all the data from all those different groups and distill it down to action. What do we want to do?

Then I need to the able to prioritize those actions by combining what it takes to keep my patients healthy and loyal, the capacity I have available to serve them, and the metrics that drive my business. The metrics I use to drive my business don’t have to involve profitability. Some look at growth. Some look at profitability, because no money, no mission, and I need to run the health system. But if my goal is delight, I’m measuring how happy my customers are with me. That’s an important metric and it impacts my next best actions as I allocate them.

People miss the concept of stirring capacity and business metrics into patient need. When I’m looking for the right patients to reach out to proactively, I don’t want to call a patient and extol the virtues of an annual wellness visit if their doctor doesn’t have any capacity to do annual wellness visits for the next three months. If I’m going be proactively reaching out, I need to prioritize who I can serve the best right now. That’s a fundamentally different way of metric-driven thinking.

How much overlap exists between pure analytics systems versus your system of using analytics to drive consumer engagement?

We think of ourselves as an algorithm-driven CRM company. It has two parts. Part one is getting all the data that we can, factoring in the corporate priorities or imperatives and the available capacity. Running algorithms that map the combination of those three variables into next best actions for everybody. That’s part one, the analytics.

Part two is how to engage customers around those next best actions. Engaging them is where a traditional CRM takes over, but they’re not well married to that next best action data analytics piece within healthcare. Once we inject those next best actions, we can start looking across the different silos of the business and saying, for this list of patients, the population health team is the most important next best action. The population health team might determine that their metrics are driven by the imperative around driving down per-member, per-month costs, which is really a proxy for making sure we’re seeing the right numbers at the right venues and the right times.

I’ll give you a tangible example. Some of our clients are coming to the conclusion that the next best actions that can help them bend the cost curve and drive patient delight are weekly or monthly phone calls. Maybe we take our high-cost, high-need patients and put them on a schedule. We’re not calling to say “you have a care gap” or “we have some coding gaps we’d like to get closed with you.” We’re calling to say, “Hey, how are you doing? We noticed that you’re consuming a lot of care. How can we help you better map into the services we have that are maybe more appropriate for you, making sure we’re seeing you in the right venue?”

We find that those weekly and monthly calls aren’t necessarily just health focused around how the patient is feeling, their pain, or their medications. They evolve to be things like, “How did you do last week? You were going to do a 5K, how did it go? How’s your family doing?” It’s in the context of those weekly calls that we discover the things that we can be doing to help. Referrals to job placement, referrals to food banks, getting a patient to see a primary care doc for an emergent issue before it turns into an ER visit.

This sounds like new ground for hospitals in having non-billable patient conversations. Do you coach them on what they should be doing?

We work together with our clients. Our business model is fewer, bigger clients. We talk to every one of our clients every day. As we learn things with different clients and we see things work, we’re constantly sharing.

But the driving force usually has to start within the medical group or the executive team. There has to be a metric or an imperative that gets reduced down to next best actions. Calling people with a potentially high need is not enough. You need a true metric that says, the way we’re going to measure success around this effort — and I’m grabbing a random one — is that we’re going measure per-member, per-month cost and customer delight. If we do that, then we can show that based on those metrics, we can identify the actions that drive those metrics. We can reduce our next best actions to a dashboard that we can manage against. It’s not spinning up an effort, but rather trying to drive a metric, and in service of that, here are the things that we’re going do.

Frankly, things go pretty fast. If you don’t see the metric moving the way you want within a month or two, then something’s wrong. If we’re doing a good job of tracking both activity and accomplishment, we can say that the metric is not moving because we didn’t get in touch with the patients we said we wanted to. Or, we got in touch with them, but our schedules are such we weren’t able to get them in for the appointments we wanted them to have. Or, we got them scheduled, but some of them no-showed the appointment.

If you’re tracking that, you can decide what to do differently. You should be able to be reduce whatever issue you’re tackling to next best action and what to do differently for each customer.

Are those health system and medical practice efforts segregated by whether a given patient is covered by a risk agreement versus being billed under fee-for service?

Some of those things get considered some of the time. We’re looking for the opportunities to create value for our customers. What do they need from us? You make a really good point that when people come to us, it’s easy. We just do the things that they ask for or the things that we believe they need. When we switch that and say we’re going to go to them and we’re in the proactive outreach business, we have a problem. If we have a million people in our customer database, we couldn’t call all of them today even if we wanted to. If somehow we could call all of them today, we don’t have appointments or services available for all of them today. Now we’re in the business of trying to figure out the most important people to call.

You’re correct that part of the decision involves corporate priorities. If we have a priority around our ACO and one of our priorities for our ACO patients is driving down per-member, per-month cost, then we look at those people who might have the the biggest impact and what things we can do for them, then call them first. Those things can range from consuming care in the right place to leveraging social determinants of health. If we know financial security is a challenge for you right now and that drives your health, then let’s make sure that we’re talking to you about referral to job training or job placement and engage around some of those things through the proper channels.

What best practices have you seen for health systems improving their relationships with physicians?

You have to be really clear if you’re going to have physician outreach. What’s the purpose? What is the definition of success? We see a lot of physician outreach teams meeting with providers and talking about referral patterns, but it’s not clear how you measure them. An executive team could say to the provider outreach team, we want you to make sure our providers are reducing leakage. That’s probably the most common one we see.

But some of our more sophisticated customers are also saying, we want to educate our providers about what’s going on in the system and where we think we’re moving forward. Or, we want to educate our providers about our solutions to help them drive their quality metrics. Or, we want them to understand that we have marketing programs they can take advantage of. That’s one aspect.

The other aspect is that if we do next best actions the right way, we’re having a pretty big impact on provider satisfaction. Systems that have moved into population health are using their population health system to surface lists for the primary care office, such as those people who need retinal exams or breast cancer screening. The lists help offices hit their quality scores, but they create another administrative burden for the office. Now the office has to figure out which lists move which metrics, which metric they are furthest behind on, and how they can find time to do outbound calling. That’s a challenge for them.

The right way to do that — and the way any other industry would do it — is to say, let’s look at those lists as yet another feed into our candidates for next best actions. Then go to the office and say, we have one list. We’ve run the algorithms for you. We’ve prioritized the most important people for you to reach out to.

If we’ve done that right, we can even offer to take that outreach effort out of the office. And if I’m really looking forward, instead of having you remain accountable for your quality scores, let us the central health system be accountable for reaching out, driving the right patients to you, getting them on your schedule and into your office, and letting you know the most important things to do with them while they’re there. That puts you in the business of engaging the patients, doing the things you see as most important. Just make sure to check our list of why this particular patient is in your office or why we reached out to them to come see you.

Do you have any final thoughts?

Healthcare is evolving really fast. If you look forward five or 10 years, most health systems are under-serving their customers today. They are under-investing in their customers and in proactive outreach. If they can generate these lists of next best actions, use the data and lists they have, inject their business imperatives and capacity availability, and map next best actions for every single patient, then they can engage in proactive outreach in a way that drives patient health, drives patient delight, and hopefully reduces provider burnout. It also drives financial performance.

That really is a big change because it requires rethinking about metrics and where they are going. We’ve taken in over five billion lines of data in pursuit of coming up with these next best action plans for every single patient in our universe.

The imperative we see is that if you don’t do it, somebody else will. There are a lot of people coming into healthcare today who are trying to compete with health systems. Their number one observation is that most patients are not tightly tied to those systems, so they have an opportunity to insert themselves between the health system and the patient and grab that customer relationship. If health systems can start mapping the next best actions and engage in proactive outreach, they can drive the relationship they want to have.

I would love people to think about us as the next best action guys. Being able to reduce all the data to actions, not just presenting more data, is the critical thing that will happen in healthcare. It has proven successful in every other consumer service industry.

Morning Headlines 8/27/18

August 26, 2018 Headlines No Comments

Genevieve Morris resigns from VA-focused CHIO role

Genevieve Morris, a key leader of the VA’s Cerner implementation, turns in her resignation less than two months into the job.

23andMe will no longer let app developers read your DNA data

Home genetic test vendor 23andMe will turn off API access to its anonymized data sets, telling developers that they can access company-generated reports but not the underlying data.

Epic Systems Corp. to draw huge crowd for its annual Users Group Meeting, starting Monday

Epic expects to host 8,000 users and 9,000 of its own employees at UGM this week.

This firm already microchips employees. Could your ailing relative be next?

Three Square Market is developing medical microchips with GPS tracking and voice activation aimed at dementia and Alzheimer’s patients.

Hospital’s coordination center brings patients more efficient care

Staff at Yale New Haven Hospital’s Capacity Coordination Center credit Epic dashboards with helping ambulances avoid overcrowding area hospitals during a K2 overdose crisis that saw 114 calls come in over a two-day period.

Monday Morning Update 8/27/18

August 26, 2018 News 1 Comment

Top News

image image

Two key leaders of the VA’s Cerner implementation have turned in their resignations – Chief Medical Officer Ashwini Zenooz, MD and Chief Health Information Officer Genevieve Morris.

They had held those jobs for just 15 months and barely more than one month, respectively.

image

Morris posted her resignation letter on Twitter.

Morris had tweeted a few days earlier that her song of the day was Tom Petty’s “I Won’t Back Down.”


Reader Comments

From Shalom: “Re: news articles. I just wanted to say thanks for the curation.” You’re welcome, but I push back at the term “curation” for several reasons: (a) it’s insufferably trendy; (b) it marginalizes the reporting of breaking news, rendering opinion, and developing reader interaction that goes beyond linking to someone else’s stories; and (c) quite a few questionably educated and experienced folks have taken on the “curator” title, which like “thought leader,” is a self-bestowed honorific that often deflects attention from a striking lack of actual accomplishment. I’m careful who I trust to filter news and render opinion.


HIStalk Announcements and Requests

image

Most poll respondents aren’t expecting much to result from Silicon Valley tech giants announcing their support for healthcare interoperability. Furydelabongo concludes, “As long as we consider interoperability to be a technology problem, it will never be solved. For the same reason, I doubt I’ll ever be able to move seamlessly between a Honda, Ford, and BMW and have a similar data experience. Everyone has their own secret sauce that gives them a market advantage. Why would they do anything to compromise that?”

New poll to your right or here: How much impact will blockchain technology have on healthcare cost and quality? My implicit message is that until it can directly influence those factors, then don’t waste time salivating over it.

image

Welcome to new HIStalk Gold Sponsor Prepared Health. The Chicago-based company’s EnTouch Network makes it easier for patients to stay healthy at home by connecting them with providers, caregivers, and payers. Health systems use the platform to stay connected to referral sources, involve the patient’s caregivers in their care, receive real-time alerts of changes in risk or care setting, and monitor for fraud and abuse via GPS-powered visit verification. Its EnTouch Analytics identifies and manages evidence-based interventions. Centegra’s director of care coordination explains, “We were struggling to reduce excessive use of medical staff and better match patients with the right level of care when they left the hospital. We needed a tool to track our patients and their progress from the moment we got involved with them. The phone calls and faxes between various providers and manually writing down notes were not working.” Co-founders Ashish Shah and David Coyle spent years in key roles with Medicity. Thanks to Prepared Health for supporting HIStalk.


Webinars

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


People

image

Urgent care documentation technology vendor Edaris Health promotes Meg Aranow to CEO.


Government and Politics

image

New York City police arrest former CDC Director Thomas Frieden, MD, MPH on charges that he grabbed the buttocks of an unnamed female acquaintance of 20 years who was leaving a dinner party in his home.


Privacy and Security

The adoptive parents of a two-year-old who died of drowning sue McAlester Regional Health Center (OK), claiming that some of its cafeteria workers accessed his records and one of them contacted the boy’s birth mother. The lawsuit says that a food service employee whose EHR credentials allowed looking up patient information for meal delivery had been told to post their login credentials on a sticky note on a computer, which gave other workers access. The couple’s attorney admits that he can’t sue for a HIPAA violation, but he can claim that the hospital was negligent in not meeting HIPAA requirements.


Other

image

The New York Times looks at dementia-fighting strategies in the Netherlands that include a bus ride simulator; a mini-vacation room built to mimic a beach with sounds and heated sand; video projection; a re-creation of a bar complete with singing and real alcohol; robotic pets; and rooms featuring rotary phones, typewriters, and other decor with which many residents grew up. Residents enjoy memories and shared experiences that reduce the need for medications and restraints. 

image

Financial Times says big pharma is willing to embrace clinically validated software that serves as a key component in managing or curing a particular condition. It notes MoovCare, an algorithm-powered web portal offer by Israel-based Sivan Innovation that studies suggest can extend life expectancy for lung cancer patients by early detection of relapses and complications. Novartis is working with Pear Therapeutics, which offers a software-only treatment for substance abuse that will be launched in the US in the next six months. 

image

Tobacco companies are using sophisticated hashtag campaigns in reaching out to social medial influencers – who are sometimes paid or invited to attend promotional events — to portray smoking and vaping as hip while getting around laws that prohibit tobacco advertising. One company specifically told the influencers to use only cigarette pack photos in which the required health warning is obscured.

image

England’s new health secretary Matt Hancock vows in a Facebook post to implement national interoperability standards after he observes staff at Chelsea and Westminster Hospital reverting to pen and paper.

image

Home genetic test vendor 23andMe will turn off API access to its anonymized data sets, telling developers that they can access company-generated reports but not the underlying data. 23andMe had previously planned to launch an app store, but was worried about vetting third-party developers. The company turned off access to an anonymous developer in 2015 who used it to create a “race wall” so that sites could block users of specific gender, ancestry, or genetic characteristic.

image

Stanford’s John Ioannidis, MD, DSc urges reform in nutritional epidemiology research, noting that newspapers and websites pick up wildly misleading studies that conclude that eating or not eating a particular food changes health status or longevity. He basically says that everybody eats, so you can always find some questionable correlation between diet and health that usually means nothing and distracts consumers from the amply documented risks of smoking, lack of exercise, air pollution, and climate change. 

image

The Dallas business paper profiles Children’s Health SVP/CIO Pam Arora.

The decision by the late Senator John McCain to stop his cancer treatment provides a reminder of how to avoid being insensitive or incorrect in those situations:

  • Don’t refer to someone as “battling cancer” or as a “cancer victim” – they simply have cancer
  • Declining chemotherapy, radiation treatment, or surgery doesn’t mean the person is “giving up” in choosing quality of life over aggressive treatment
  • Palliative care is a medical care option, so someone who chooses it has not “ended their medical care”
  • The military metaphor that comments on the person’s toughness, bravery, or willingness to “fight” doesn’t necessarily help them “beat cancer” or suggest that those who failed to do so were lacking those qualities
  • The term “survivor” isn’t always meaningful because the person will always wonder if the cancer will come back and isn’t necessarily leading the same life they led before

image

Epic expects to host 8,000 users and 9,000 of its own employees at UGM this week. Sunday offered dinner around the campfire with an emphasis on Wisconsin foods (I’m thinking cheese curds, wursts, and beer, but that’s from my own limited experience). Verona got pounded by rain this weekend and it will be hot and humid with highs in the mid-80s through Tuesday, but the sun and cooler temperatures return Wednesday with highs barely breaking 70. Attendee updates and reports are welcome.

image

I ran across Citizens’ Council for Health Freedom when Googling something unrelated, noting that its nurse CEO just published (via a vanity press) “Big Brother in the Exam Room: The Dangerous Truth about Electronic Health Records.” A tweet congratulates her for “hitting #1 on an Amazon best seller list,” although (a) that was in just the “Medical History & Records” category; (b) it has since fallen to #12 in that category; and (c) the book’s overall sales rank suggests that it is selling maybe 5-10 copies per day. Its website seems to harbor a lot of anger about healthcare in general:

  • It asks people to sign a form declaring that they will not enroll “the national Obamacare Exchange system,” although the point why anyone would do that (versus just not signing up) isn’t clear.
  • It says the Affordable Care Act is a “massive national tracking system” and that its implementation means “Our life, our liberty, and our future as a free nation hangs in the balance. Will the government get control of our healthcare, and with it the power to decide whether we live or die? ”
  • It urges people to refuse to sign a provider’s Notice of Privacy Practices, although it makes no argument as to what value that provides beyond being annoying to staff.
  • It posted a petition demanding that people be allowed to get Social Security benefits without signing up for Medicare since they are then “involuntarily enrolled in Affordable Care Act Accountable Care Organizations.”
  • It declares PCORI to be a “federal rationing plan.”
  • It says doctors “push” flu vaccine to hit government targets even though the “best quality of care may be to recommend against the vaccine”
  • It decries provider score cards based on adherence to evidence-based medicine to be “government cookbook medicine.”

If you like the book I mentioned above, you’ll surely want to study this article in the ultra-conservative Washington Times titled “How AI is pushing US healthcare down a USSR path.” It concludes that behind the “bureaucratic bull-crappery” of the announced support for interoperability by tech giants is this:

Out go the individual’s expectation of medical records’ privacies; in comes the prioritization of the healthcare as a collective, not individual, good. The medical breakthroughs may be significant. But the flip side is that suddenly, it’s not you and the doctor in that office. It’s you and the doctor and a nationally approved streamlined course of care, based on Big Data collection, Big Business information-sharing, and AI-fueled decisions. And when you’re done? Count on your outcomes — the success or failure of your medical treatment — being fed as fuel to the machine learning beast.

 image

Weird News Andy has an unnatural love for fecal transplant stories and titles this one “Bottom’s Up.” Scientists create a “baby poo smoothie” probiotic supplement. Punster WNA says this idea has reached a new low and hopes that this, too shall pass.


Sponsor Updates

clip_image001

  • Summit Healthcare staff volunteer at The Greater Boston Food Bank in support of company-wide philanthropic initiatives.
  • Loyale Healthcare provides insight on rising healthcare costs and impacts on patient satisfaction.
  • MDLive will exhibit at the Connected Health Summit August 28-30 in San Diego.
  • Meditech 2018 Revenue Cycle Summits boost customer communication.
  • National Decision Support Co., Pivot Point Consulting, Surescripts, and Visage Imaging will exhibit at Epic UGM August 27-30 in Verona, WI.
  • WebPT publishes “The 2018 Rehab Therapy Salary Report.”
  • Philips Wellcentive releases a new video, “Bridging the VBC Care Gaps Survey.”
  • Chief Executive profiles ZappRx CEO Zoe Barry.

Blog Posts


Contacts

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

125x125_2nd_Circle

Weekender 8/24/18

August 24, 2018 Weekender No Comments

weekender


Weekly News Recap

  • Medicaid Transformation Project signs up 17 leading health systems to develop solutions to improve the healthcare and social needs of the 75 million Americans who are on Medicaid
  • Employer-focused primary care clinic operator Paladina Health gets a $165 million investment
  • A New Yorker article describes the hostile shareholder attack launched last year on Athenahealth by activist investor Paul Singer’s Elliott Management and the company’s history of using shady tactics to pressure CEOs to cave
  • CNBC reports that primary care group One Medical is discussing a possible $200 million fund raise
  • The VA gives its providers the ability to automatically view the immunization and medication histories of those patients who are also Walgreens pharmacy customers
  • Anthem settles its huge 2015 data breach for $115 million

Best Reader Comments

New generations can learn from pioneers’ and predecessors’ successes and failures, not make same mistakes on new technology. A patient automated post-discharge call system is a part of larger business (financial, clinical, CRM) and technology ecosystems. Technology is key component of effective “solution,” but no more than culture, goals/metrics,org structure, supportive processes / technologies, and right staff (level, role, skills). Payments models are complex and in flux; Medicare and Medicaid future uncertain, human factors play a huge role in these processes. ROI is challenging. (Ann Farrell)

The IT vendors game the system, and with these scores submitted by profit-driven IT vendors, CMS seems to come up with comparative ratings. I’m hoping some sensible person can establish a true and accurate performance evaluation system. I wonder if all this has contained the rate of Medicare spending? (Mipsvendor)


Watercooler Talk Tidbits

image image

Readers funded the teacher grant request of Ms. F in Florida, who asked for action cameras and storage for her STEM charter school third grade class. She reports, “Thank you for donating to my students’ project. This project was one that they specifically asked me to write. They love taking pictures and videos and even more so they love watching or looking at pictures or videos of themselves and their friends. They were so excited when I told them this project was funded, and even more excited to start using the cameras. It has become a reward in the class to be the class photographer for the day. With this I have started to teach them how to upload their pictures, edit them and publish them. This project is one that will continue to be fun for my students and will be extremely useful for class projects, class field trips, and memories of our time together in class. Thank you for your support!”

A GAO report finds that while the perceived high cost of health insurance turned some consumers away from buying policies on Healthcare.gov, HHS also intentionally reduced the 2018 coverage numbers by slashing advertising by 90 percent, cutting navigator funding by 42 percent, and shortening the enrollment period.

image

This week sees a second huge investment in primary care practices – Paladina Health (DaVita’s former employer clinic business that was sold this year for $100 million) raises $165 million for expansion and acquisition. One Medical has raised $350 million and Iora Health has taken in $100 million in investment. The Bloomberg article notes that UnitedHealth Group’s Optum now has at least 30,000 doctors on its payroll, while companies like Walmart and GM are contracting directly with health systems to provide employee health services. 

A New York Times article observes that while FDA requires drug manufacturers to prove that their products are safe and effective, that doesn’t answer the question of how their safety and effectiveness compares to that of similar drugs, which would help prescribers choose more wisely.

Another New York Times article says NYU’s elimination of medical school tuition for all students is noble but misguided, suggesting that the med school should follow the lead of NYU’s own law school in waiving tuition only for those students who commit to lower-paying public service jobs or who practice in underserved areas.

image

A Tincture article decries the healthcare expense of erecting billion-dollar hospital buildings such as those of Stanford, Boston Children’s, and the Denver VA hospital. A snip:

It is true that hospitals (excuse me, “health systems”) are diversifying — building/buying satellite locations, freestanding emergency rooms, urgent care centers, and physician practices — but those big buildings remain the locus, and their sunk costs weigh on hospitals’ finances …  What I want to see are images of services being delivered where I am, focused around me, aimed at my convenience — not at the convenience of the people delivering my care … Don’t donate money for hospital expansion / renovation plans. Don’t buy bonds for them, either. Don’t sit passively on hospital boards that push for them or expensive new equipment. Instead, we should be questioning: how can a “hospital” most impact our communities’ health? What kinds of investments in our communities’ health can they be making? How we do push healthcare and health down as close to where and how people live as possible?

image

The Boston endocrinologist whose questionable claims that vitamin D deficiency is “pandemic” spawned creation a billion-dollar lab and supplement industry has been paid by companies that sell those products. Just about every other researcher has concluded that Americans get plenty of vitamin D and wouldn’t benefit from supplements or tanning beds.

A contract firm’s security guard is arrested at St. Francis Hospital (TN) after being caught having sex with the corpse of a patient whose body was being prepared for organ harvesting.

image

TV news always tries to leave you laughing with a vapid, irrelevant story, so here’s one that’s hilarious yet relevant. A Deloitte survey of C-level executives finds that 74 percent of those in healthcare say their understanding of blockchain technology is “excellent” to “expert.” These are no doubt the same executives who can’t perform even basic laptop tasks unaided, who pay secretaries to print out their emails so they can read them on paper, and who sympathize with hospital departments who send an employee off to Best Buy with a procurement card to buy PC and networking equipment because the IT process isn’t immediately gratifying. Only 39 percent of executives in all industries think blockchain is overhyped and 43 percent say blockchain is among their top five strategic priorities. This is the greatest gift a blockchain snake oil salesperson could ask for – clueless yet overconfident executives anxious to get on a questionable innovation bandwagon despite a complete lack of a business case.


In Case You Missed It


Get Involved


125x125_2nd_Circle

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • Anonymous: Thanks for sharing the article on hospital architecture! On a recent walkthrough of a brand new multimillion dollar ...
  • David Dieterich: Thank you Mr. H for reminding readers of what Memorial Day is about. - A Gold Star family member....
  • Will Weider: Wait, I thought Walgreens was going to put all of the traditional medical groups out of business?...
  • Right Said Fred: Fred's right on the money here. I vividly recall one of Epic's TLMMs (Team Lead Management Meeting - a meeting where...
  • Elizabeth H. H. Holmes: My personal opinion is that burnout is most directly influenced by the relationship you have with your direct manager, a...
  • HISJunkie: Is Epic still growing, not if you read between the lines. Last year they said they hired 400 new employees. Now they say...
  • Vaporware?: Mr. H, you can add this little propaganda gem to your file of Top 10 Euphemisms (emphasis mine). You have one of those f...
  • Fred: Epic's response to burnout is precious. Yes, everyone is happy and challenged, excluding of course the thousands who hav...
  • Brian Too: Any complex software that you spend a lot of time in, you'd better learn it well. Most people do that but if you invest...
  • AC: I don't believe they give you raw click numbers yet (only PEP/NEAT score), although I think Feb 2019 release is bringing...

Sponsor Quick Links