Morning Headlines 6/16/17

Apple is quietly working on turning your iPhone into the one-stop shop for all your medical info

Christina Farr reports that Apple wants to store health information on iPhone and work with EHR developers to allow users to export information to care providers as needed.

Coming to ONC – One Informaticist’s Journey

In his first blog post as National Coordinator for Health IT, Don Rucker, MD discusses the challenges facing the health IT industry, and his background as an informaticist.

Congress offers $65M as down payment on Vista replacement

The House Appropriations Committee approves a $65 million down payment toward the VA’s Cerner procurement, with the stipulation that it will integrate with both DoD and private EHR systems. The DoD’s Cerner implementation will cost $4.3 billion in total, and estimates suggest that the VA’s final cost could climb as high as $16 billion.

A.G. Schneiderman Announces Settlement With Healthcare Services Company That Illegally Deferred Notice Of Breach Of More Than 220,000 Patient Records

In New York, prescription eligibility check vendor CoPilot Provider Support Services agrees to pay $130,000 to settle a case with the state attorney general after waiting more than a year before notifying affected patients that a hacker had accessed its system and stolen 220,000 patient records.

News 6/16/17

Top News

Rumors related to Apple’s healthcare takeover abound, with CNBC reporting that the company is working behind the scenes to develop an Iphone-based repository of health data that users can share from at will. Lab results and allergy lists seem to be first on Apple’s pick list of data points to tackle. Tied in with that is the recommendation of a Citigroup analyst that Apple buy up Athenahealth in a move that would give it access to the EHR vendor’s 83 million patient records and its Epocrates physician end users and technology. Apple is certainly a force to be reckoned with when it comes the ubiquity of its mobile devices (though some have lately challenged that notion), but it seems the issue of interoperability with other competing platforms – as seen so often with healthcare – would raise its ugly head sooner rather than later. It would be fun to see how Apple fanboys would take to Jonathan Bush’s cult of personality.

Reader Comments

From First Fruits: “Re: App Orchard. Prices have gone up by $5,000 for the top two tiers effective May 25th from what I can tell. And they have taken away benefits, i.e. the number of included support hours, free app listings, and registrations to events. You don’t get any indication of available APIs until after you pay your annual fee. Does anyone consider this a pay-to-play interoperability?”

From Chip Hart: “Re: Larry Weed, MD. Larry passed away at the age of 93 earlier this month. Arguably the great-grandfather of EHRs, and certainly of the organized medical record. (He invented the SOAPM and POMR concepts.) His lectures are famous. I believe you’ve linked to them in the past. The stuff from the 70s is still relevant today. Here’s one.”

HIStalk Announcements and Requests

This week on HIStalk Practice: The FBI looks into Zoom’s falsified risk-adjustment payments. Community Health and Wellness Center of Greater Torrington leans on Stone Health Innovations for CCM expertise. Several cancer care practices select Flatiron Health software and support. Digital Noema Telehealth adds EazyScripts e-prescribing to virtual consult software. The Medical Society of the State of New York expands partnership with DrFirst. Spry Health raises $5.5 million. Dermatologist Stacia Poole, MD discusses the role health IT plays at a practice with older patients. Thanks for reading.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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

Acquisitions, Funding, Business, and Stock

Omada Health raises $50 million in a round led by Cigna, which will offer the company’s digital chronic disease management technology to its members.

Cleveland Clinic and Oscar Health will offer co-branded insurance plans to people in northeastern Ohio. The move is a first for both organizations, marking Oscar’s entry into the state and the health system’s first time offering an insurance product bearing its name.

Weirton Medical Center (WV) sues Cerner and its Siemens subsidiary for their failure to provide adequate support and service related to a $30 million contract extension for Soarian in 2013. A trial by jury has been requested. WMC’s end goal appears to be termination of its contract with Cerner, and Cerner’s free-of-charge assistance in switching the hospital to a new vendor.

PokitDok acquires the software and pharmacy assets of Oration, a prescription management and savings app developer. PokitDok plans to make Oration’s commercial pharmacy benefit data available through its DokChain network.

Announcements and Implementations

JD McCarty Center for Children with Developmental Disabilities (OK) implements Evident’s Thrive EHR. The center enlisted the consulting services of TruBridge to assist with the roll out. Evident and TruBridge are both subsidiaries of CPSI.

Technology

Physician’s Computer Company adds FDB’s MedsTracker e-prescribing tool to its EHR for pediatricians.

MModal’s CAPD tools now support Epic’s NoteReader CDI module.

Salesforce adds new communications features to its Health Cloud CRM, enabling caregivers outside of the doctor’s office to communicate via mobile device, and to share care plans across different organizations.

Sales

Community Medical Centers (CA) will implement LogicStream Health’s Clinical Process Improvement solutions.

Neighbors Emergency Center selects Presidiohealth’s FSEC Foundation software, which combines T-System’s EDIS with Presidio’s PM technology.

People

Clinical Computer Systems, developer of the Obix Perinatal Data System, promotes Cindy Bell to VP of customer services.

Cambia Grove founder and executive director Nicole Bell will join Amazon Web Services as principal business development manager, serving as a healthcare industry liaison.

Erin Jospe, MD (PatientKeeper) joins Kyruus as CMO.

Citing closer proximity to family, Vancouver Island Health Authority President Brendan Carr, MD plans to step down to take over as president and CEO of the William Osler Health System in Ontario. His five-year tenure at Island Health has included oversight of the rocky rollout of the IHealth EHR, which still has physicians up in arms over its risk to patient safety. “I’ve learned immensely from that experience,” he explains, “sometimes painfully so. It’s been a challenging thing, and I think it’s something that will absolutely allow this organization to do great things in the future.”

Privacy and Security

Microsoft releases a bevy of security updates to protect users from WannaCry-like attacks. In addition to automatic updates, the company is making the updates available for manual download and installation for unsupported software versions including Windows XP and Windows Server 2003.

Sensato Cybersecurity Solutions will focus on the attacker’s perspective during its Hacking Healthcare Workshop, set to take place September 13-14 in Asbury Park, NJ.

Government and Politics

A GAO report finds that pharmacists at the VA have trouble accessing patient data via its pharmacy system, and often run into trouble when transferring or refilling prescriptions from non-VA facilities. Recommendations include updating the system and taking a deeper look at barriers to interoperability.

Innovation and Research

Colorado’s UCHealth launches the virtual Applied Decision Science Lab through its CARE Innovation Center to collaborate with entrepreneurs on healthcare technology. Researchers are particularly interested in using AI and machine learning to enhance EHR workflows and clinical decision support.

Other

Bloomberg reports that nearly half of the $2 billion raised on popular crowdfunding platforms like GoFundMe are being used to pay medical expenses. Facebook has gotten in on the action, adding a health category to a new feature that lets users set up fundraisers for personal causes.

A US District judge sentences Wilbert Veasey, Jr. to pay over $23 million to CMS and serve 17 years in prison for his part in what authorities call the biggest home health fraud in the history of Medicare and Medicaid. Veasey, along with four conspirators, convinced already vulnerable Medicare patients to sign up for unnecessary home health services, after which they then filed for reimbursements for via a number of shell companies. The racket ultimately ran up $374 million in fraudulent claims.

The Michigan Attorney General charges HHS Director Nick Lyon and Chief Medical Executive Eden Wells in the latest round of criminal charges related to the Flint water crisis in 2014 and 2015 that resulted in 12 deaths and dozens more sickened by contaminated drinking water. Lyon’s actions were particularly reprehensible. According to court documents, he “willfully disregarded the deadly nature of the Legionnaires’ disease outbreak, later saying he ‘can’t save everyone,’ and ‘everyone has to die of something.’”

Sponsor Updates

• Meditech releases a new podcast, “Home Care & Population Health.”
• Liaison Technologies will host an IT Leaders Forum on data strategy June 21 in London.
• Meditech will host the 2017 Revenue Cycle Summit June 20-21 in Foxborough, MA.
• Navicure will exhibit at the Florida MGMA 2017 Annual Conference June 21-22 in Orlando.
• Experian Health publishes a new case study featuring Yale New Haven Health.
• Health Catalyst adds Duncan Gallagher (Allina Health) to its Board of Directors.
• The Medical Society of the State of New York will offer its members complimentary access to DrFirst’s e-prescribing and medication management app.
• InterSystems customers Northwell Health and Mount Sinai Health System connect their private HIEs to the New York-based Healthix public HIE.
• ROI Healthcare Solutions will present at Inforum 2017 July 10-12 in New York City.

Blog Posts

• Is “Cloud Slice” the Next “VM” for Hands-on Learning? (Learn on Demand Systems)
• Planning for Collaboration: CMS Emergency Preparedness (LiveProcess)
• Easy as Pie: Most Effective Training Techniques for Learning New Technology (Navicure)
• Interoperability: It’s Time to Get in the Game (Netsmart)
• You Can Book Flights Online – Why Not Medical Appointments (Experian Health)
• Patient Payments and Patient Experience: A Chicken & Egg Scenario (Patientco)
• Brexit Follow-up (Reaction Data)
• Managing the surprisingly troublesome impact of real-time healthcare on decision-making (PerfectServe)
• Testing, it’s not just for IT anymore (Optimum Healthcare IT)
• Healthcare IT’s Relatively Brief and Exciting History (Spok)
• 6 essential tips for adding on Epic’s home care applications (Nordic)
• Interoperability Bubble (ClinicalArchitecture)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Readers Write: Top 10 Takeaways From the EClinicalWorks Settlement

Top 10 Takeaways From the EClinicalWorks Settlement
By Colette Matzzie

1. The federal False Claims Act provides an effective way to hold EHR vendors accountable for failing to meet Meaningful Use standards.

Many customers had complained to EClinicalWorks about major problems with its software, but little changed. It took a knowledgeable healthcare IT implementation specialist and the might of the US government to get the software problems fixed. They used a powerful whistleblower law known as the False Claims Act, which encourages whistleblowers to fight fraud by filing “qui tam” lawsuits, to force ECW to take action. Anyone who “causes” false claims to be submitted to the government is liable under the False Claims Act. Customers of ECW relied on representations that ECW’s EHR technology was properly certified and therefore, unknowingly submitted tens of thousands of claims for government incentive payments that falsely attested MU requirements had been met.

2. The federal Anti-Kickback Statute forbids EHR vendors from paying or rewarding users to promote or refer others as customers.

Many healthcare providers, pharmaceutical companies, and medical device manufacturers have been penalized for violating the Anti-Kickback Statute, but the ECW case is the first time it has been applied in the EHR industry. The government cited payments totaling almost $300,000 through ECW’s “referral program,” “site visit program,” and “reference program,” in addition to unknown amounts for consulting and speaker fees paid to influential users, as evidence of alleged violations of the Anti-Kickback Statute. The law prohibits providing money, gifts, or other remuneration intended to get referrals for services or items paid for by federal healthcare dollars except under very limited circumstances.

3. The accuracy of representations made to certifying bodies will be a factor when the DoJ reviews the liability of an EHR vendor under the False Claims Act.

Certification by a government Authorized Testing and Certification Body has been a prerequisite to successful sales because buyers can obtain federal incentive payments only for certified EHR technology. The government cited EClinicalWork’s decision to modify its software to “hard code” the drug codes needed for testing without meeting the certification criteria as evidence that ECW had “falsely obtained” its certification. This gave rise to its liability under the False Claims Act. Accurate and truthful information will remain a requirement for certification, despite the debate over whether the certifications adequately ensure software reliability and patient safety.

4. The Office of Inspector General crafted an innovative Corporate Integrity Agreement requiring ECW to fix deficiencies, notify its customers, provide customers with free upgrades, and permit customers to transfer clinical data without penalty.

As part of the settlement, ECW signed an expansive, state-of-the-art Corporate Integrity Agreement that the OIG put together to ensure that providers and patients are protected going forward. ECW is required to take significant remedial steps, which included sending out a series of notifications and advisories to customers that advise them of patient safety risks with its software, giving customers an opportunity to obtain updated (and presumably remediated) software free of charge; and offering the opportunity to transfer clinical data to another vendor free of onerous penalties or other restrictions. Software vendors should consider the agreement a guide to understand the risks they will face if their software does not meet federal requirements or if other misconduct occurs.

5. The government deems data portability and audit log requirements to be essential to proper EHR functioning.

EHR systems are required by the government to be able to export clinical information on patients electronically, including by batch exports, and reliably and accurately record user actions in an audit log. In its complaint-in-intervention, the government faulted ECW for allegedly misrepresenting these capabilities, and made clear that these omissions from the software were not acceptable.

6. EHR vendors need to respond in a timely and effective manner to customer reports of software defects, usability problems, or other issues that may present a risk to patient safety or that may violate federal law.

The Corporate Integrity Agreement requires ECW to notify OIG of certain reportable events that involve patient safety, certification, or a matter that a reasonable person would consider to be a violation of law. The government wants all EHR vendors to report significant problems or violations of law, especially when patient health or safety may be at issue.

7. EHR vendors should have persons and procedures in place to ensure compliance with federal law, just as healthcare companies do.

ECW’s Corporate Integrity Agreement requires the company to establish a compliance program with a compliance officer and a written code of conduct, similar to what many healthcare companies have. That’s something all EHR vendors should consider doing, as it’s wise to offer employees clear avenues to report concerns internally. Most employees prefer to address concerns internally before blowing the whistle by filing a qui tam lawsuit – unless the company has shown it is not responsive to legitimate concerns or will retaliate against employees who speak up.

8. The government will hold managers personally responsible for activities of the EHR vendor company.

The ECW settlement holds both the company and its three founders (the CEO, CMO, and COO) liable for payment. The settlements reinforce the DoJ’s commitment to individual accountability for corporate decisions in a very tangible way.

9. EHR vendors must ensure that all contracts and agreements with its customers do not restrict disclosures of information about the performance of the software or reporting of patient safety concerns (the “anti-gag” rule).

ECW’s Corporate Integrity Agreement requires that contracts between the company and its customers do not restrict customers from disclosing concerns about the performance of its software. This includes concerns related to patient safety, public health, and product quality. Other vendors should consider adopting similar “anti-gag” practices.

10. Whistleblower rewards may be paid for information that leads to successful resolution of a federal qui tam action against an EHR vendor.

The ECW case shows the government welcomes whistleblowers who have information about significant problems with EHR software. Under the False Claims Act, the government will pay whistleblowers a reward of 15 to 25 percent of the proceeds recovered by the government as damages and civil penalties, if the government joins the “qui tam” case filed by the whistleblower. The government awarded the ECW whistleblower $30 million.

Colette Matzzie is a whistleblower attorney and partner at Phillips & Cohen LLP, which represented the whistleblower in the EClinicalWorks case.

EPtalk by Dr. Jayne 6/15/17

Congratulations to the University of Arizona College of Medicine – Phoenix for receiving full accreditation from the Liaison Committee on Medical Education. The school was created more than 10 years ago to help address Arizona’s physician shortage and was originally a branch campus of the UA College of Medicine – Tucson. Now, UA joins the ranks of only a few universities with multiple accredited medical schools. Starting up a new medical school is a daunting process, whether it’s a branch of an existing school or not. I had the pleasure of speaking recently with one of the faculty members at the Dell Medical School at The University of Texas at Austin who shared some of their trials and tribulations. Becoming fully accredited is quite an accomplishment.

While EHR vendors are working on their certification testing, many are expanding the incorporation of user testing. NCQA is also getting into the act with a website usability and navigation study. I appreciate the fact that they’re trying to make the website easier to use, but I wish they’d make their recognition programs less cumbersome and more affordable for primary care practices. I’ve been contacted by multiple clients who are struggling with the transition from their 2014 program to the updated 2017 program. One of my staffers is attending the course in Washington, DC this week, and at nearly $900 for one day it’s certainly not cheap. Tack on some hotel and travel, and it’s a lot for a small practice to spend for training.

Fortune recently released its list of the 500 companies that generated the most revenue in the last year. Multiple healthcare systems made the list, including HCA Holdings, Community Health Systems, Tenet Healthcare, DaVita, Universal Health Services, LifePoint Health, Kindred Healthcare, and Genesis Healthcare. Health insurers made it on the list as well, with UnitedHealth Group ranking at number six. Other payers making the cut include Anthem, Aetna, Humana, Centene, Cigna, Molina Healthcare, and WellCare Health Plans.

A friend sent me this piece about “Perfect Non-Clinical Income Ideas for Doctors.” I had to laugh at some of the suggestions, especially considering the time pressure that many physicians face. I don’t imagine that many physicians would be up for multilevel marketing, peddling insurance, or renting out their cars. Not to mention, the author fails to appreciate the concept of “passive” income. The only side businesses I see my colleagues involved in are in the property ownership realm, and none of them are personally managing their properties.

My practice opened two new locations in the last 30 days, so I’m working more clinical shifts than I usually do. Unfortunately, that increased schedule came right when my vendor is experiencing an ongoing problem with API errors. The impact is worst when we’re trying to use the e-prescribing functionality or when staff is trying to search for the patient’s preferred pharmacy, which means it impacts pretty much every patient when it happens. Although I appreciate the communication, receiving an email every two hours that essentially says “yes it’s still going on, and no we don’t know how to fix it yet” becomes annoying. Even while I scowled at my inbox, however, I did get a kick out of a marketing email that popped in from our friends at EClinicalWorks. Apparently they’re offering an ill-timed promotion called “Make the Switch” that includes free data migration to the system. I wonder how many takers they’re getting.

A reader sent me this piece about workplace wellness programs. It references some interesting statistics that I wasn’t aware of, such as the fact that 50 percent of companies that have more than 200 workers either offer or require employees to complete biometric screenings. Of those companies, more than half offer financial incentives to employees to participate. Others mandate the screenings for employees who elect company-provided health insurance plans. I’m sure wellness programs will continue to expand, as employers try anything they can to try to control rising healthcare costs.

I’ve written about my concerns around wellness programs before, namely that programs often aren’t compliant with screening recommendations. They may require employees to participate in screenings, such as blood glucose and cholesterol, that are not recommended for their age group and that may lead to distress and interventions that ultimately do more harm than good. Another tidbit I wasn’t aware of is the fact that modifications to regulations around employee wellness programs were nestled into the Affordable Care Act, allowing employers to shift 30-50 percent of employee-only healthcare premiums onto employees who fail wellness tests. I haven’t had to participate in biometric screening since I left Big Hospital, although when you compare the hassle, invasion of privacy, and dubious science against the premiums paid by small businesses, it doesn’t seem so bad.

I’m always on the lookout for stories of adventures in healthcare, and today I had one of my own. I was calling to make an appointment for a procedure with a provider who has multiple offices. Even though I haven’t been seen there in a couple of years, they were willing to schedule the procedure without a consultation first, which seemed unusual given the opportunity to not only collect an updated history and physical but to also generate some extra charges in a procedure-based specialty. The scheduler then paused and said, “Let me write all this down” and I assumed that she was going to take my request to a surgery scheduler, who would get back to me for the actual scheduling. She “wrote” for over a minute, and apparently used the information as a reference while she looked at the computerized scheduling system. As a process improvement person, I can’t imagine how that works given an average office’s phone volume. I can’t wait to see it in person in a couple of weeks. Needless to say, I won’t be surprised if they call me back and ask to schedule a consultation first, but you never know.

Email Dr. Jayne.

Morning Headlines 6/15/17

American Health Care Tragedies Are Taking Over Crowdfunding

Bloomberg reports that half of the $2 billion raised on popular crowdfunding platforms like GoFundMe are being used to pay medical expenses.

Ron Peterson retiring as Johns Hopkins Health System president after 44 years

Johns Hopkins Health System President Ron Peterson announces that he will retire at the end of this year. Peterson arrived at the health system in 1973, starting as an administrative assistant.

5 people, including Michigan health chief, charged in Flint

Nick Lyon, the former director of Michigan’s Health and Human Services department, is charged with involuntary manslaughter along with five other officials as a result of the 2014 Flint water crisis.

Your Doctor’s Office Is Vulnerable to Hackers, but Congress Could Change That

MIT Technology Review weighs in on legislative changes that could improve cybersecurity for smaller health care facilities.

Morning Headlines 6/14/17

Kieran Murphy Appointed CEO of GE Healthcare, Succeeding John Flannery

Kieran Murphy is named president and CEO of GE Healthcare, succeeding John Flannery who has been promoted to CEO and chairman elect of GE.

MEDITECH Signs 16 More Hospitals in Q1 2017

Meditech signs five new health systems, with 16 combined hospitals, to its 6.1 Web EHR in Q1.

Drones carrying defibrillators could aid heart emergencies

Researchers launched drones carrying defibrillators from a fire department to see if drones could deliver a faster response time than an ambulance, and found that drones arrived at the scene of 18 cardiac arrests within about 5 minutes of launch, almost 17 minutes faster on average than ambulances.

New Mexico Physician Chosen as AMA President-elect

At the Annual Meeting of the American Medical Association, Barbara McAneny, MD, an oncologist from Albuquerque, NM, is elected as the next president of AMA.

News 6/14/17

Top News

An audit reveals that CMS may have paid out nearly $729 million in improper Meaningful Use incentives between 2011 and 2014. OIG auditors based their estimate on the review of 100 payments – 14 of which were made for incorrect reporting periods, or were based on incomplete verification documentation, and totaled just over $290,000. Auditors also found that CMS should not have paid out $2.3 million to providers who switched between Medicare and Medicaid incentive programs during that timeframe. OIG recommends that CMS recoup the money and undertake a more thorough review of all payments made.

Reader Comments

From OITNB: “Re: Athenahealth/Medhost deal. I think you may have it wrong or that Medhost may have multiple suitors. Allscripts CEO Paul Black was at the Medhost office on the executive floor a few weeks back.”

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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

Announcements and Implementations

Torrance Memorial Medical Center (CA) rolls out Mobile Heartbeat’s smartphone-based clinical communications system to its 2,700 team members.

Acquisitions, Funding, Business, and Stock

Genetic testing company Invitae acquires Ommdom, developer of the CancerGene Connect risk assessment and family history analysis tool.

Cognizant plans to acquire TMG Health, a subsidiary of insurer Health Care Service Corp., later this year. TMG, which caters to government-sponsored health plans, will continue to provide IT and business process services to HCSC business units. Cognizant’s largest publicized acquisition was TriZetto in 2014 for $2.3 billion in cash.

People

Erin Trimble (Athenahealth) joins Redox as VP of business development.

GE promotes healthcare lead John Flannery to CEO and chairman elect. GE Healthcare Life Sciences CEO Kieran Murphy will take over Flannery’s role. Murphy will likely devote much of his time to strengthening GE Healthcare’s technology with the relocation of hundreds of tech workers to its office in Boston, as well as with a planned $500 million software spend over the next several years.

Patientco hires Alan Nalle (Accenture Strategy) as chief strategy officer.

The American Medical Association names New Mexico Oncology Hematology Consultants CEO Barbara McAneny, MD president-elect at its annual meeting. She will succeed newly sworn-in Mercy Clinic VP David Barbe, MD.

Tycene Fritcher (Solutionreach) joins health system-focused telemedicine company Avizia as CMO.

Sales

Greater Baltimore Medical Center (MD) selects Phynd’s Enterprise Provider Data Management solution tool to help it manage the data of 15,000 credentialed and referring providers.

Meditech signs up 16 hospitals in the first quarter of 2017.

Technology

Caradigm releases a trio of population health tools to help Medicare ACOs understand clinical and financial risk and utilization patterns, and to identify high-risk patients who may need clinical intervention.

Glytec integrates AgaMatrix’s wireless blood glucose monitoring app with its EGlycemic Management System, giving providers the ability to offer patients more mobile and tailored insulin dosing management between appointments.

Government and Politics

Vice President Pence stresses the president’s focus on repealing the Affordable Care Act during remarks to HHS employees. His main points focused on rising premiums, reduced coverage options due to payers leaving the exchanges, and the number of people dropping out of ACA insurance plans – figures that some have called into question. He emphasized that the Republican-crafted American Health Care Act quietly working its way through the Senate will “transition our healthcare economy away from the regulations and mandates and taxes of Obamacare to a patient-centered healthcare system built on personal responsibility, free-market competition, and state-based reform.”

Innovation and Research

A survey of just over 1,000 consumers finds that only 17 percent believe health-related industries are the most innovative compared to sectors like consumer electronics, telecommunications, and media. Respondents have high hopes for healthcare innovation, though; 70 percent believe health IT will eventually make the biggest impact on their personal health management. They cite wearables, robotics, 3D printing, smart home devices, and AI as technologies likely to make the most waves.

Vanderbilt University Medical Center (TN) researchers create an algorithm based on hospital admissions data that is “80-90 percent accurate when predicting whether someone will attempt suicide within the next two years, and 92-percent accurate in predicting whether someone will attempt suicide within the next week.”

Drones carrying defibrillators to the scenes of heart attacks arrive five minutes after launch – 12 minutes faster than local ambulance services, according to a study featured in JAMA. Drones were launched from a fire station within six miles of where previous cardiac arrests had occurred.

Other

The New York Times looks at the growing role the Dark Web plays in helping opioid-pushing drug dealers sell and ship their products. Thanks to increased potency and decreased size, “enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.”

Sponsor Updates

• The Millenium Alliance advisory firm interviews Arcadia Healthcare Solutions VP Michael Meucci.
• Besler Consulting releases a new podcast, “Completing your Medicare Occupational Mix Survey.”
• CareSync publishes an infographic on annual wellness visits.
• Docent Health will participate in Boston TechJam June 15.
• EClinicalWorks will exhibit at The Private Healthcare Summit 2017 June 20 in London.
• FormFast joins the Salesforce AppExchange.
• HCS will exhibit at the Texas Hospital Association Behavioral Health Conference June 15-16 in Austin.
• The HCI Group customer St. Luke’s University Health Network achieves HIMSS Analytics EMRAM Stage 7 status.
• InterSystems will exhibit at the HIMSS NY Chapter Annual Conference June 20 in the Bronx.
• Meditech South Africa celebrates 35 years.
• InstaMed releases its Trends in Healthcare Payments Annual Report.

Blog Posts

• How 3 P’s Can Transform Your Hospital (Access)
• NCPDP: Engineering Manager, Mark Harris, Presents on Open APIs (CoverMyMeds)
• Enabling the “Data-Driven Organization” – Making the Most of Your Data: The Importance of Metadata Management and Business Intelligence (CTG)
• Catching Up at C-Live (Culbert Healthcare Solutions)
• 7 Hottest Jobs in HIT (Direct Consulting Associates)
• Integrating Statistics into Diver with R (Dimensional Insight)
• Interoperability – Medical data at the point of care (EClinicalWorks)
• What’s the Secret to Effective Physician Alignment? (Evariant)
• 9 Questions to Ask When Winding Down Your Accounts Receivable During an IT Transition (Hayes Management Consulting)
• Valuations Round 2: Health IT SaaS vs. Health IT Non-SaaS (Healthcare Growth Partners)
• The Report on Improving Cybersecurity in the Health Care Industry – where and how to start updating your cybersecurity strategy (Imprivata)
• Healthcare Marketers can Maximize CRM for a Better Consumer Experience (Influence Health)
• What are Omnichannel Payments and Why Do They Matter to Healthcare? (InstaMed)
• Is Health IT Really Ready for a FHIR Takeover? (InterSystems)
• Integration Doesn’t Have To Be Difficult (Access)
• How to Make MyChart as Indispensable as Amazon (Nordic)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 6/13/17

Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements

An OIG report concludes that CMS inappropriately paid eligible providers $729.4 million in EHR incentive payments who did not meet meaningful use requirements.

FBI is investigating an Oregon health care startup

Oregon-based health insurance startup Zoom is under FBI investigation for retrospectively altering medical claims to make its patient population look sicker in an effort to avoid paying into risk adjustment pools.

Iowa Seeks to Revamp Affordable Care Act

Iowa state officials are seeking permission to make signification changes to its ACA marketplace in an effort to protect residents at risk of losing their insurance due to payers backing away from the exchanges.

CRISPR May Cure All Genetic Disease—One Day

CRISPR pioneer Jennifer Doudna, PhD. discusses the future of genetic editing, saying “I think it’s really likely that in the not-too-distant future it will cure genetic disease.”

Curbside Consult by Dr. Jayne 6/12/17

Last week, CMS kicked off a multi-pronged outreach program to help providers prepare for the transition to the new Medicare Beneficiary Identifier (MBI). New Medicare cards, to be issued starting in April 2018, will have a new identification code for each beneficiary, which is not based on the Social Security number. Congress mandated that all cards be replaced by April 2019, and vendors have been working on adding functionality to hold the new identifiers for some time. There will be a nearly two-year transition window where providers can use either the MBI or the old Medicare number, as well as secure lookup tools for both providers and patients. The ID will include both numbers and letters – along with many others, I’ll probably still call it a “Medicare number” regardless of the presence of letters.

There are nearly 58 million people on Medicare, and the goal of the program is to fight identity theft, fraud, and illegal use of SSNs. Unfortunately, this doesn’t help the rest of us who are constantly asked to provide our SSNs across the rest of the healthcare space. I checked with a couple of my clients to see if they have plans to phase out use of the SSN in general and they haven’t really thought about it. I’ve had quite a few adventures in healthcare this year, and every single one has asked for not only my SSN but also had fields on their patient data forms to gather the SSN of a guarantor where one exists.

Even with a Congressional mandate, this process has taken years. It was in the works prior to the passage of MACRA, but that law accelerated the timetable. Although CMS has had a website about the project for some time, it’s unclear how much providers understand at this point. Providers and their office leaders have been through a lot of federally-induced change in the last few years, including the prolonged ICD-10 transition and now the distraction of MIPS, along with continued Meaningful Use pressures for our Medicaid friends. It could be that people just aren’t planning to pay too much attention until it gets closer. The other piece of it is that vendors aren’t entirely ready yet, so it’s not yet “real.” Once the new ID field starts appearing in systems, then perhaps it will be worth thinking about. I searched my email archives and found a notice from our vendor a few months ago, mentioning that it will be added to the system towards the end of 2017. One of the benefits (and sometimes challenges of) a vendor-hosted, cloud-based system is that features just appear after a brief announcement, so we’ll have to see what other communication we receive as it gets closer.

The migration to the new MBI is not just a digital change but one that will require operational and process changes as well. Practices may want to consider proactive outreach to their patients to educate them about the new cards and the need to bring them to the office, as well as to allow for additional check-in time on their first visit after they receive their new cards. Sites will need to educate staff about their cutover plan and the need to maintain both identifiers during the transition, and the fact that they can’t simply remove the old IDs from the system since claims may still be working their way through the system. Everyone should be readying a plan, even if it’s just high level at this point. I’d be interested to hear what organizations of varying sizes are doing at this stage in the game.

In other CMS news, Tuesday is the last day to submit formal comments on the FY18 Inpatient Prospective Payment System and Long Term Acute Care Hospital proposed rule. The rule also includes language around Indian Health Service and other Tribal facilities. Most notably, it modifies the EHR reporting period from full calendar year to 90 days, which many of us are eagerly awaiting. Other nuggets include a new exception from the Medicare payment adjustments for eligible professionals, hospitals, and critical access hospitals if they demonstrate that they can’t comply with being meaningful users because their EHR has been decertified. There’s always a path for no payment adjustments for EPs who furnish all their covered services in the ambulatory surgical center setting. Even if you don’t have any comments to offer, the closure of the comment period is a milestone in the countdown to a final rule, which many of us are eagerly awaiting.

I spent some time this weekend at a continuing education conference at one of the local medical schools. I was looking forward to it, since it was targeted towards community physicians and was an opportunity to engage with some of the leaders in the field about the best ways we can co-manage patients. The content was outstanding, with concise presentations offering real-world advice rather than the more esoteric academic discussions I’ve seen in some of their sessions in the past. However, it was marred by attendees behaving badly. The worst example was a physician who was clearly responding to emails and/or transcribed phone messages, and who was using the voice recognition features on his phone to do so. If you have to multitask, you need to either do it non-verbally or you need to step out of the room.

The first couple of times he did it, I’m not sure people understood what was going on, because it looked like he might be having a sidebar conversation with the person next to him and was just being loud. As it continued, it was more obvious what he was doing, yet no one close to him said anything although there were plenty of people giving him dirty looks. Finally, one of the CME door monitors came forward to address the situation and he quit. Still, you have to wonder in what universe someone thinks that’s OK and how we’ve arrived at a place where people’s need to try to do it all interferes with them being a considerate member of society.

Email Dr. Jayne.

Morning Headlines 6/12/17

Cost of HSE’s €35m IT system continues to rise

Ireland’s countrywide Maternal and Newborn Clinical Management System project, which includes Cerner clinical software and Deloitte project management and implementation staff, is reportedly overrunning its budget at every site that implements it.

Artificial intelligence can now predict suicide with remarkable accuracy

Researchers at Vanderbilt University Medical Center have created an algorithm that was “80-90% accurate when predicting whether someone will attempt suicide within the next two years, and 92% accurate in predicting whether someone will attempt suicide within the next week.”

Amazon poised to deliver disruption in medical supply industry

Amazon plans to use its massive distribution network to enter the medical supply distribution market.

Opioid Dealers Embrace the Dark Web to Send Deadly Drugs by Mail

Drug dealers selling opioids are turning to the Dark Web to move their products as potency increases, as the New York Times reports “enough fentanyl to get nearly 50,000 people high can fit in a standard first-class envelope.”

Apple just hired the star of Stanford’s digital health efforts

Apple hires Sumbul Desai, MD and former executive director of Stanford Medicine’s center for digital health, to its healthcare team.

Monday Morning Update 6/12/17

Top News

Cork University Maternal Hospital and University Hospital Kerry in Ireland report significant added expense as a result of their implementations of the nation’s first Maternal and Newborn Clinical Management System. The initial $39.2 million price tag has increased by $785,000 in Deloitte consultancy fees, with millions more expected as 17 additional hospitals prepare to go live on the Cerner-powered system over the next several years. Ireland’s Health Service attributes the over-budget, delayed implementations to a lack of expertise on the part of its clinical and business staff.

Ireland experiences similar woes with its eHealth project, which is “not in a good place,” according to Chief Scientific Adviser Mark Ferguson, adding that the project is moving forward with several initial pilots to help alleviate patient concerns about  the digital storage of PHI. The project will ultimately include the launch of a nationwide EHR, unique identifiers for patients, and capacity for genome-sequencing.

Providers at University Hospital Limerick are particularly depressed with projections that eHealth implementation at their facility could take up to 10 years. The hospital uses a number of different data-sharing systems, and is still plagued by an inefficient paper record-keeping system. “We have many, many computer systems in the health service,” says the hospital’s founding president, Ed Walsh, “but they don’t talk to each other. [The health service is] consumed by inefficient bureaucracy, which is based on a Victorian paper system. And until we move that, we won’t be able to move the resources necessary to provide the healthcare that the patient requires.”

Reader Comments

From Kiwi: “Re: Orion Health’s financials. It seems to be letting an error by HCIT go uncorrected. Their Healthcare Informatics 100 listing cites $193 million in revenue in 2016, but reported financials show a different story (and the company is publicly traded). If my math is correct, the New Zealand dollar has moved between being worth about $.68 to $.74, making their earnings anywhere from $140M to $152M in 2016 and even less this for FY 2017.”

HIStalk Announcements and Requests

The anonymous vendor who donated $500 to my project to fund DonorsChoose teacher grant requests in return for mentioning a survey they’re interested in tells me they’ve almost hit the 100-response mark, which will trigger a second donation even bigger than the first. Providers, please click here and spend just a few minutes to help a classroom in need. Thank you.

Over 75 percent of survey takers would consider switching systems if their vendor became involved in a situation akin to that of EClinicalWorks. It’s All Good contends, however, that “the basis of the allegations/settlement is not a reason to switch. There were defects. They’ve been fixed. But …  a switch could be considered because such a settlement could force the company into insolvency. Or at least support and innovation will suffer as the company tightens its’ proverbial belt so it can pay the fine.” Ross Martin wonders if this will be the tip of the health IT iceberg – one that’s similar to finding out VW wasn’t the only carmaker to game the emissions compliance system. He suspects that, “in the context of the Great Meaningful Use Land Grab of 2009 and the spend-stimulus-fast development of certification criteria, we will find a good amount of fudging among the vendors. Even vendors who complied with the letter of the reg are nowhere near enabling the plug-and-play level of interoperability we need.”

New poll to your right or here: Do you take research studies into consideration when making health IT purchasing or clinical programming decisions? Given the Washington Post’s piece last week on the tendency of journalists to make headlines out of studies they don’t truly understand and/or that are poorly designed in the first place, I’ve been wondering if hospital executives look at them with the same skeptical eye that I do. Your comments, as always, are appreciated.

I decided early on to have only two HIStalk Founding Sponsors, spots held by Medicity and Nuance since around 2007 or so. Nuance’s new marketing crew has decided that sponsoring HIStalk doesn’t interest them, meaning that their Founding spot is therefore available to the first company who commits to taking it over. Contact me at mrhistalk@gmail.com to grab Nuance’s premiere ad position on the page along with the usual Platinum sponsor benefits. Thanks to Nuance for supporting HIStalk for 10 years.

Welcome to new HIStalk Gold Sponsor ZappRx. The Boston-based company solves the inefficient workflow and time drain involved with prescribing specialty drugs. Its platform modernizes the multi-step, manual prescribing process – often involving multiple platforms – to automatically populate prior authorization information, obtain digital patient consent, track prescriptions, and communicate bi-directionally with the specialty pharmacy, reducing administrative burden and improving team collaboration without resorting to phone calls. Patients get their critical therapy faster and more accurately with complete transparency. Practices can estimate their time savings using the company’s online calculator – the average prescription order requires just three minutes of provider time with ZappRX. Thanks to ZappRx for supporting HIStalk.

This Week in Health IT History

One year ago:

• Connecture, a technology company that builds online health insurance marketplaces, acquires ConnectedHealth, a benefits technology platform that helps employers choose health plans.
• Cerner launches a one-year pilot study that will help determine whether patient’s genetic data can play a motivating role in promoting behavior change.
• The VA fires three more administrators within the Phoenix VA Health Care System for “negligent performance of duties and failure to provide effective oversight.”
• In light of voided test results and potential CMS sanctions, Walgreens ends its relationship with Theranos, closing all 40 of its Theranos Wellness Centers in Arizona.
• South Australia looks for a spokesperson to reassure the public that its over budget, behind schedule 80-hospital Allscripts EHR implementation is still a worthwhile investment.

Five years ago:

• Private equity firm TPG Growth acquires critical care systems vendor iMDsoft.
• NIH and the National Cancer Institute announce grants to fund development of tools that empower consumers, patients, and/or their providers.
• A CareFusion site from which medical equipment firmware updates are distributed is found to be loaded with malware, triggering a Department of Homeland Security investigation.
• Steve Larsen, the federal government’s most powerful health insurance regulator responsible for consumer protection and insurance exchanges, quits to become EVP of Optum.

Ten years ago:

• IBA is considering suing CSC and Connecting for Health after CSC blocked its bid to acquire ISoft.
• The Northeastern Pennsylvania RHIO shuts down.
• DoD’s AHLTA EMR system (formerly CHCS II) is running in 138 military treatment facilities.
• Henry Schein tries to expand its medical software line with an offer for Australia’s Software of Excellence International.
• The South Australian Department of Health launches big upgrades of its patient and nursing systems.

Weekly Anonymous Reader Question

Last week’s results: Would you recommend to someone that they switch careers to health IT?

This week’s survey: What characteristics made the worst doctor you’ve ever had so bad?

Last Week’s Most Interesting News

• The VA announces it will shut down its VistA EHR and join the DoD in implementing Cerner Millennium.
• HHS appoints Bruce Greenstein CTO.
• Athenahealth acquires Praxify Technologies for $63 million.
• The Health Care Industry Cybersecurity Task Force releases its report to Congress.
• HHS alerts providers that the WannaCry ransomware attack is still causing problems for several US hospitals.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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

People

Michael Hyder, MD (Southcoast Health) joins Clearsense as president. He will also take on the role of EVP of healthcare delivery at sister company Optimum Healthcare IT.

Apple hires Sumbul Desai, MD (Stanford Center for Digital Health) to join its healthcare team in an unidentified role.

Arik Anderson (Terumo Cardiovascular Systems) joins smart inhaler company Adherium as CEO.

Government and Politics

In a first for the FDA, it asks Endo Pharmaceuticals to stop selling Opana ER – an opioid that has become a favorite among drug users who have taken to crushing it and injecting it or snorting it. If Endo fails to withdraw the drug voluntarily, the FDA will force its removal by revoking its market approval. “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh its benefits,” says FDA Commissioner Scott Gottlieb, MD “not only for its intended patient population but also in regard to its potential for misuse and abuse.”

The Secretary of the Navy recognizes Naval Hospital Bremerton (WA) sailors for the parts they played in an ongoing process-improvement program that has so far reduced the Patient Administration Medical Records Division workload by 40 percent, and saved $156,400 and 7,300 man hours a year. In their downtime and with little prior coding know-how, the sailors developed a Medical Records Data Automation Program that now automates the daily operations of the hospital’s medical records department. MRDAP will soon serve as a transition program between the hospital’s Composite Health Care System and the forthcoming Cerner-powered MHS Genesis system. Cmdr. Robert McMahon, Director for Administration, refreshingly adds:

“What is most impressive is these young sailors had no fear of failure and despite no personal or monetary gain they continued to capture the ideas of their coworkers to improve workflows in their department that benefited everyone. Promoting innovation is like growing grass. Sometimes you already have the soil, water and sun. All that is needed is a safe and supportive environment to grow.”

Technology

Healthcare app development company Medable creates Synapse, a cloud-based tool that enables providers to launch CareKit apps for their care teams.

Privacy and Security

After Bronx-Lebanon Hospital Center (NY) and its contractor IHealth sent threatening cease-and-desist letters to the author of DataBreaches.net (who let them know that their PHI was exposed due to an improperly configured server), the hospital tucks tail and asks her to go through the 500 mb of data she used in her original investigation to let them know which patients were affected. The audacity of the request, which did not come with an apology and with which she refuses to comply, prompts her to offer this advice:

• Don’t rush to send legal threat letters. What your mother taught you about catching more flies with honey than vinegar appears true here, too.
• If you wouldn’t send a legal threat to the New York Times over their reporting, don’t send one to me. This site may be small, under-funded, under-staffed, and under-appreciated, but with the support of great law firms like Covington & Burling, this site will always fight back against attempts to erode press freedom or chill speech.

Decisions

• St. Mary Corwin Medical Center (CO) switched From Meditech to Epic in April 2017.
• Perry Memorial Hospital (OK) will switch from Evident to Athenahealth in August 2017.
• Jefferson Regional Medical Center (PA) is switching from Omnicell to BD Automated Dispensing Cabinets. The conversion process started last month.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

Innovation and Research

A survey of executives from 104 healthcare organizations points to AI as the next big thing when it comes to transforming the way the industry interacts with patients: 84 percent believe AI will “revolutionize” their encounters with healthcare consumers, while 72 percent report already using virtual assistants. Their interest in AI will likely fuel their near-term efforts to better understand what consumers want even before they articulate it. Eighty-one percent feel organizations should shape digital health tools based on patient preference rather than their own. A similar percentage believe those that understand the motivations behind consumer behavior will ultimately win the day.

Other

McKesson CEO John Hammergren drops the price of his $22 million compound in San Francisco by $6 million after watching it sit on the market for a year. The solar-powered estate consists of a main house with six bedrooms and 10 bathrooms; a sports complex with tennis, bocce, racquetball, and squash courts, plus a gym, rock climbing wall, steam room, sauna, yoga center, and spa; and a carriage house with a five-car garage, car wash station, and banquet hall. The accompanying pool and spa have their own pool house.

Sponsor Updates

• QuadraMed, a division of Harris Healthcare, will exhibit at the MaHIMA Annual Conference June 11-13 in Boston.
• Salesforce publishes its “2017 Connected Patient Report.”
• Kyruus wins the “Best Healthcare Big Data Platform” Award from MedTech Breakthrough.
• CRN names Impact Advisors to its 2017 Solution Provider 500 list.
• Senator Cory Booker (D-NJ) helps to christen Conduent’s new global headquarters in New Jersey.
• Gartner names AdvancedMD a leader in its FrontRunners for Mental Health Quadrant.
• Encore publishes a new white paper discussing the role of data governance in the shift to value-based care.

Blog Posts

• Why you shouldn’t delay your EHR upgrade (Nordic)
• 2017 Healthcare Revenue Cycle Management Challenges Met by Technology (The SSI Group)
• Why Group Messages are Better Than Mass Messages (Solutionreach)
• Why providers burn out on EHR documentation – and how to fix it (Nordic)
• How surveillance tools help nurses to focus on their patients (Meditech)
• Better Actionable Intelligence Means Better Healthcare for All (Surescripts)
• Better healthcare in Boise. (Voalte)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Reader Survey Results: Would you recommend to a relative or colleague that they change careers to health IT?

I asked if readers would recommend to a relative or colleague that they change careers to health IT.

As I approach retirement, I enjoy having this debate with colleagues my age and with 30-somethings. I was initially involved in healthcare delivery, graduating to healthcare IT over time. My observation is that most of the senior workers recall what we would call a "good job," where you left work at a reasonable time, valued your home life, and were active enough that you didn’t have to pay huge fees to a gym in an effort to stay in shape.

It does not appear the majority of younger staff have ever experienced a job where they felt valued, where the company invested in them, where there were true career paths. Few report a job where a sense of loyalty was engendered. At a certain point, healthcare IT (and IT in general) evolved into this organism that demands 24/7 availability and accessibility, freely doles out periods of excessive hours, covertly considers a commitment to family an impediment to success, provides minimal mentoring and training, and where the management mantra boils down to "do more with less," "work smarter," or some similar analog. The question we deliberate: Which of the groups is happier with their career?

I would not recommend a career in health IT, with a few specialized exceptions.

Why: growth industry. Also the ability to be creative. Room to innovate, or coast or dabble, whatever fits your interests.

My wise old Italian immigrant father told me long ago when I started this crazy ride in healthcare IT that "people will always be sick and people will always need computers". Job security, there’s that. Although the ride has been bumpy at times, I look back fondly at my 25+ year career in this industry. I’ve met some fantastic people (and some not so fantastic people), and some really smart people. I’ve learned a lot, travelled a lot, and am passionate about what I do.

Went to school for finance/accounting and made the switch myself after chatting with a neighbor who was a healthcare IT guy. I thought he was pretty smart and he got me my first interview, and off I went from there. So yes, I would, but only if people were looking for something new.

An IT career professional needs to transcend any primary allegiance to IT and become a healthcare professional with an IT specialty, and become customer-focused. Depending on the person, that may be a stretch – especially mid-career.

Yes, I would. There are significant opportunities for those, particularly with a healthcare background, to contribute to on-going needs of health IT. As a licensed pharmacist who worked in retail for 18 years, then moved to the IT space, I’m finding much more satisfaction and sanity in working in the IT space than I ever found working the bench in McPharmacy. As data sharing continues to develop, it will be amazing to see what population health details will develop over the coming years.

Maybe. I enjoy working in the field because I love feeling like I can make a difference in peoples’ health even though I am not a clinician, and of course, it’s exciting to be in a growth industry. That said, it can be frustrating that not having a clinical background can mean always being seen as less credible, no matter how long you’ve been in the industry.

I just did, actually, to a friend who’s studying to be a software engineer (and who had previously considered healthcare). I told him it was an interesting and ever-changing field with enormous breadth, and that it was a way to be paid well while still doing something truly important.

My caveats: It will also make you want to rip your hair out, and possibly ruin most of your faith in doctors. (#NotAllDoctors)

No – I got in 22 years ago and having been trying to get out ever since! It’s like The Godfather III …

No. The demands are outrageous, the funding for IT initiatives takes the back seat to clinical initiatives, and healthcare is in the middle of a major upheaval based on budget and governmental initiatives. I would suggest something more stable.

Yes, absolutely. Health IT is and will continue to grow. Given how behind the times we are with regards to so many of the technologies available, there is ample room to jump in and make a big difference. Also, it just feels good to know you are making a meaningful difference to people doing good work. I’m not just clocking in to help people find a good restaurant, respond to the latest Internet meme, or play the cool new game. We are making a difference in the health of our communities.

I don’t know that I would recommend a career change, but I would encourage recent graduates to explore health IT as a career option. My own daughters have had the pleasurable (torturous) experience of my 20 years in HIT, they aren’t so impressed with my career choices. I remind them that it kept a roof over their heads, and computers in their rooms.

There is nothing wrong with changing careers to a specific industry. It’s not like it hasn’t been done before with other industries. We all at one point reinvent ourselves. Why should healthcare be any different?

YES: You will always have a job/career where you know it matters whether or not you come to work. You will be busy beyond your wildest imagination. And if you are good, there is never a day when you will be unemployed, wonder where you will work next, or not have the ability to be challenged.

NO: In the 30 years I have worked in this industry, I have had few days “off.” The pace is grueling, the management short-sighted or not focused on the mission, and the initiatives are always under-resourced.

Nope. It’s just a negative, stressful industry. Doctors resent EHRs and hate being forced to use technology, practices are overworked and understaffed, vendors haven’t been able to add too many cool features because they need to keep up with government regulations, and now all the hacking and ransomware scares …

Not in a traditional health IT role because of the constant pressure to cut costs and shave corners. One area I would recommend as a viable opportunity would be any position related to health analytics, artificial intelligence, and machine learning.

Morning Headlines 6/9/17

athenahealth Agrees to Acquire Praxify Technologies to Advance Cloud Platform and Mobile Innovation

Athenahealth acquires Palo Alto-based EHR optimization vendor Praxify Technologies, which analyzes the way doctors interact with EHRs and uses machine learning to optimize workflows.

One Person-One Record Clinical Information System

Nova Scotia narrows the list of vendors that will compete to implement its province-wide “one person-one record” system to Cerner and Allscripts.

Epic, Allscripts and Cerner Signal Paradigm Shift in Population Health Management

A Black Book Report lists Epic, Cerner, and Allscripts as mindshare leaders in the growing population health software vendor marketplace.

Bruce D. Greenstein: Chief Technology Officer

HHS names Bruce Greenstein as CTO. Greenstein leaves his role as President at Quartet, a data integration company working in behavioral health.

News 6/9/17

Top News

Athenahealth acquires EHR optimization vendor Praxify Technologies for $63 million. The six year-old company employs 80 at its office in Palo Alto, CA and maintains a development presence in India. Athenahealth CTO Prakash Khot is enthusiastic about the benefits Praxify’s machine learning and natural language-processing capabilities will bring to the company’s cloud-based products. Praxify is perhaps best known for its Mira voice-enabled charting technology.

Reader Comments

From AirStrip Technologies CEO Alan Portela: “Re: Rumored NantHealth acquisition. AirStrip has not been acquired and continues to gain momentum in the industry. AirStrip has formed a strategic alliance and commercial agreement with NantHealth that leverages synergies between the AirStrip One mobile interoperability platform and the Nant platform, particularly in the areas of data aggregation, normalization, real-time data streaming and visualization. Our alliance will focus initially on supporting clinical workflows in acute-care settings, with a gradual move toward post-acute and community-based care settings.”

From GraySky: “Re: Athenahealth/Medhost deal. Athenahealth is in due diligence conversations to acquire all or part of the Medhost products. It’s looking to get access to the small community and rural hospital market that Medhost has access to with its inpatient and ED solutions. Cerner officially passed up Medhost late last year after doing due diligence. Valuation was too high in the area of $200M-$400M. Shrinking customer base that includes only a few large customers that are evaluating conversion to Cerner or Epic. Aging product suite.” Athenahealth declined to confirm or deny.

HIStalk Announcements and Requests

This week on HIStalk Practice: Siemens Healthineers finalizes its acquisition of Medicalis. Merritt Hawkins releases its annual physician recruitment/salary report. Mindcotine hopes to use virtual reality to help smokers kick the habit. Brad Boyd outlines ways to leverage MACRA to support long-term strategic goals in the Consultant’s Corner. Plaintiff dismisses lawsuit against MDLive. Hematology-Oncology Associates of Central New York nearly suffers a $250k loss due to clerical error. Salus Telehealth finds an untapped telemedicine market in summer music tours. EClinicalWorks adds telemedicine capabilities to its app. Thanks for reading.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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

People

Former CMS Chief Data Officer Niall Brennan joins the Health Care Cost Institute as president and executive director.

Digital diagnostics services company Analyte Health appoints Kevin Weinstein (Valence Health) CEO. Former CEO Frank Cockerill, MD will take on the position of CMO.

Announcements and Implementations

Einstein Healthcare Network (PA) selects Teladoc to help it jumpstart a telemedicine program that will initially focus on the health system’s 8,500 employees.

Rush University Medical Center (IL) starts a three-month pilot of Proteus Digital Health’s Discover smart pill sensor, one that is added directly into traditional pills. The sensor detects when the pill has been ingested via a patch worn on the patient’s stomach, and then sends a signal updating an app with medication adherence data.

Humber River Hospital in Toronto works with GE Healthcare to build a 4,500 square-foot digital command center that will aggregate and analyze real-time data from systems across the hospital to help improve staff workflows and patient care.

Technology

Meditech adds MModal’s Fluency Direct speech-recognition dictation capabilities to its Web EHR.

Apple updates the ResearchKit app to include new tests related to range of motion, and selective and visual attention.

Cerner will integrate CareVive’s care planning software with its PowerChart Oncology EHR.

Nuance adds PowerScribe Workflow Orchestration and PowerScribe Lung Cancer Screening to its line of screening program tools for radiologists.

Nuance seems to have quietly acquired San Mateo, CA-based radiology solutions company Primordial, its partner in developing the aforementioned technologies.

Privacy and Security

From DataBreaches.net:

• Southwest Community Health Center (CT) notifies patients of a potential data breach resulting from two separate break-ins during which burglars took several computers. No mention is made of whether or not the devices were encrypted. The center is offering affected individuals free identity monitoring and restoration services.
• Mississippi’s Medicaid Division alerts 5,220 people of potential PHI exposure stemming from six online forms managed by a third party that were sent to staff via unencrypted emails for nearly three years.
• Public school guidance counselor and West Carolina Counseling Services owner Joseph Korzelius admits to using information from his sessions with elementary students to file $450,000 worth of false Medicaid claims. He faces up to 10 years in jail and a $250,000 fine.

Innovation and Research

A team of researchers from MIT and Harvard develop a proof-of-concept tattoo ink that changes color based on metabolism changes in the body, allowing the tattoo to act as a low glucose or dehydration indicator.

Healthcare researchers call out the tendency of journalists to create headlines out of health studies that are “deeply flawed,” citing several articles related to the tenuous (and later debunked) claim that EHRs do in fact lead to improved outcomes. “Health care already consumes almost a fifth of America’s GDP — two or three times every other nations’ costs despite our often inferior outcomes,” they write in their conclusion. “It is vital that all stakeholders — journalists, scientists, policymakers, editors and the public — have a better understanding of basic research design and data interpretation. During this unusual moment in history, when politicians seek out whichever facts suit their ideology, the role of good science — and good reporting — could not be more vital.”

A Black Book survey finds that an overwhelming majority of hospital executives and managers will ultimately look to population health management-focused IT as patient accounting systems as they continue to shift their organizations to value-based care. Allscripts, Cerner, and Epic seem to have the most mindshare of those surveyed.

Government and Politics

President Trump decides to keep Francis Collins, MD on as head of NIH, a position he has held since 2009.

A VA spokesman confirms that Cerner will replace only the agency’s EHR, and that Epic’s $624 million contract to implement an appointment scheduling program for the VA is not in jeopardy.

HHS appoints Bruce Greenstein CTO. Greenstein was most recently president of behavioral health tech company Quartet Health, and served under Louisiana Governor Bobby Jindal as secretary of the Dept. of Health and Hospitals.

Other

The Government of Nova Scotia narrows the field of contenders for a “One Person, One Record Clinical Information System” to Allscripts and Cerner. Based on the procurement listing sent over by HITGeek, it looks like they beat out Evident, Harris Healthcare, and Meditech in preceding rounds that began last December.

In other northern health IT news, the provincial auditor of Saskatchewan recommends the Ministry of Health replace its 50 year-old IT system with one that can better screen the billing activity of physicians that are still paid on a fee-for-service basis. The auditor also recommends the development of standard criteria to more efficiently identify physicians whose billing practices should be investigated.

E-prescribing of controlled substances increased year over year by 256 percent, according to the latest progress report out from Surescripts. Nearly 75 percent of prescriptions in 2016 were electronic, totaling 1.6 billion.

Sponsor Updates

• Meditech customers lead lists of five-star and double five-star hospitals.
• Liaison Technologies will exhibit at the Cerner North Atlantic Regional User Group June 12-14 in Springfield, MA.
• MedData will exhibit at the Ohio Hospital Association Annual Meeting June 12-14 in Columbus.
• Medecision, NTT Data, RelayHealth, Surescripts, and ZeOmega will exhibit at AHIP Institute & Expo June 7-9 in Austin, TX.
• Meditech releases the latest installment of its video series, “EHealth Partnership Unites Ontario Hospitals on Meditech.”
• Frost & Sullivan recognizes Medicomp Systems with the 2017 Enabling Technology Leadership Award.
• National Decision Support Co. adds Society of Nuclear Medicine and Molecular Imaging Appropriate Use Criteria to its CareSelect Imaging system.
• Navicure will exhibit at the NJ MGMA conference June 14-16 in Atlantic City.
• Experian Health will present at the HIMSS Brand IT Marketing Conference June 15 in Las Vegas.
• YourStory.com profiles GE Healthcare’s efforts to bring healthcare accessibility and skills to rural areas in India.

Blog Posts

• Rockin’ the Suburbs and ESignatures (Access)
• Are You Ready for a Chief Data Officer? (Liaison Technologies)
• Aligning Technology, Leadership and Organizational Culture in Healthcare Providers (NetSmart)
• Defining a Legacy EMR/PM Strategy (Mica Health)
• Meditech 6.x Implementation Phases part 8: Post-Live (Parallon Technology Solutions)
• DocRank: Computer Science Capstone Project with the College of Charleston (PokitDok)
• The 7 health IT presentations you won’t want to miss in 2017 (Advisory Board)
• Are you Investing Time in an Exceptional Training Program? (Optimum Healthcare IT)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

EPtalk by Dr. Jayne 6/8/17

There has been quite a bit of reader feedback about my recent Curbside Consult addressing the ECW settlement. Several readers agreed with my assertion that multiple vendors have gamed the certification process, with one mentioning “extraordinary actions” taken to pass the testing, but that the product was “replaced by corrected code before the production code was released.” Given the way testing occurs, I bet that type of maneuver occurs more often than we’d like. Technically that would be fraud, regardless of how they try to mitigate it. Unfortunately, other vendors haven’t been caught (yet) and/or didn’t allow the products of their deception to go into general release. Hopefully those companies are on notice and will toe the line.

Other readers called for zero tolerance for ECW and other vendors who cheat, including jail time or outright closure of the company. Some felt I was soft on ECW, even “tender.” Let me go on record as saying what they did was despicable – however, I’m a firm believer in the American justice system and we have a couple of things called the law and due process. Whether you think entering into a settlement is tantamount to pleading guilty, there has not been an admission of guilt and no criminal action has been filed that I can find, and trust me, I’ve been looking. My lack of a torch and pitchfork should not be construed as acceptance or approval of what was done. Still, I was surprised by the number of emails I received that attacked me personally or suggested I don’t respect patients. As much as I believe in justice, I also believe in redemption and this is an opportunity for ECW to make things right. As one reader said, “No one benefits if an EHR is litigated into bankruptcy.” Let’s not forget the vendors who have closed their doors abruptly in the past, holding their clients (and the data of tens of thousands of patients) hostage.

Another reader who is in the vendor space mentioned that his employer has already received calls from clients threatening to file whistleblower actions unless specific defects were fixed, regardless of whether they had anything to do with certification or not. Product liability law is a specialized discipline and I don’t think adding potentially hundreds of suits to the environment will result in positive change. Look at how healthcare has dealt with harm in the past: Until you get past the culture of fear and penalty, people are reluctant to report issues or to be part of the solution. Another vendor reader mentioned his company is considering being less transparent with their “known issues” lists because of fear of escalation to frivolous lawsuits. That would be unfortunate as well.

One reader offered an interesting thought around analyzing the percentage of budget that top vendors devote to R&D. There could certainly be some interesting data there and you could come up with some conclusions from annual reports and shareholder documentation. Unfortunately, privately held companies don’t have to disclose anything, so we’d be relying on their report. We’ve heard self-reported statements about this over the last year and many felt they were inaccurate, so it’s not likely that we will get “real” numbers anytime soon. I’d personally like to see the R&D budget compared to support compared to marketing and sales. There are several vendors I work with who spend entirely too much on the latter while shortchanging the former.

Others mentioned my lack of attention to the potential impact on clients. Frankly I think it’s too early to discuss, as we don’t have a full picture of whether those practices will be asked to repay incentive money. Any mandatory repayment would almost certainly create the potential of a class action suit against ECW. That’s precisely why I advised my colleagues on the system to sit tight and see how it unfolds and what remediation is offered and how it actually plays out. They’re in an incredibly vulnerable position right now and it would be easy for another vendor to try to take advantage of their situation. Anyone who predatorily goes after these practices should be ashamed, and I know they’re already out there. The last things these practices need is a hasty move or a poorly considered replacement decision.

Regardless of your position on the guilt or innocence of a vendor and whether the punishment was appropriate, this event has the potential to change the healthcare IT landscape in uncertain ways. I hope that other vendors take the advice of one reader and revisit their compliance programs. Ensuring a culture of honesty, accountability, and understanding of the fact that you hold people’s lives in your hands needs to be at the forefront of thought as corporate decision-making occurs. It’s unfortunately not as common in the US today as we would like, whether in healthcare, the automotive industry, or just about anywhere people are trying to make a profit.

Other readers offered answers to the question of what they’d do with the whistleblower payment, with several noting that legal fees will consume a good portion of it. One mentioned that he would donate to non-profits promoting expansion of EHR systems to practices serving indigent patient populations and that cannot afford to buy them. Or to scholarship funds for computer science students willing to commit to working with those practices to help them implement those systems. Both are great ideas, although I’d like to see vendors contributing to those kinds of initiatives outright, rather than having someone do it as a result of a legal action. Or how about scholarships for patient safety training to ensure caregivers and technology professionals know how to spot these kinds of problems? The reader also noted he’d reserve a few dollars to buy a good bottle of bourbon as a reward for a job well done. Based on the level of documentation and time spent by the whistleblower, I’d suggest more than one bottle would be in the offing.

I don’t think this is the last time we’ll see something like this, and the problem isn’t just on the vendor side. I’ve seen plenty of “creativity” and shortcuts from hospitals and health systems with homegrown systems or with vendors outside the CEHRT space, and although they won’t be caught for fraud during the certification process, they are eventually going to run afoul of patient safety. The question is whether organizations will find the settlement motivational and will clean up their houses voluntarily, or whether more headline-generating actions will need to occur to move the industry where it needs to be. The other possibility is more consolidation in an already shrinking industry, which could have unpredictable effects on innovation and emergence of new vendors. The one thing I can say for sure is that only time will tell.

Email Dr. Jayne.

Morning Headlines 6/8/17

Epic Systems’ $600-plus million contract with VA will hold, officials say

A VA spokesman confirms that Cerner will replace only the agency’s EHR, and confirms that Epic’s $624 million contract to implement an appointment scheduling program for the VA is not in jeopardy.

Health Inequalities in the U.S.: A Good Target for our Work

Former FDA Commissioner Robert Califf, MD discusses his new role at Verily and his perspective on how to consistently translate the potential of new technology into better health

This new smart pill reminds you to take your medicine

Rush University Medical Center (IL) pilots Proteus Digital Health’s smart pill sensor, one that is added directly into traditional pills. The sensor detects when the pill has been ingested, and then sends a signal updating an app with medication adherence data.

MIT and Harvard’s Biosensing Tattoos Will Change Color When You’re Dehydrated

A team of researchers from MIT and Harvard develop a proof of concept tattoo ink that changes color based on metabolism changes in the body, allowing a tattoo to act as a low glucose or dehydration indicator.

Morning Headlines 6/7/17

WannaCry Ransomware Continues to Cause Problems for U.S. Hospitals

HHS issues a cyber notice alerting healthcare organizations that the WannaCry ransomware attack is causing major operational issues for two large, multi-state hospital systems, and reiterates that the virus continues to pose a threat.

ONC announces winners of Privacy Policy Snapshot Challenge

ONC awards a combined total of $35,000 to the three winners of its Privacy Policy Snapshot Challenge, a contest that asked developers to create new Model Privacy Notices generator that helps software vendors create consumer-facing privacy and security policy.

The Tower Of Babel In Clinical Research: PCORnet’s Common Data Model Cracks The Foundation

A Health Affairs article discusses the research potential that EHR interoperability and data analytics will have on generating clinical evidence, saying “the ability to harness good quality, usable data from EHRs will likely be as revolutionary for health care as the Internet was to other industries.”