Curbside Consult with Dr. Jayne 7/10/17

I saw this CPR training kiosk in an airport on one of my recent travels. It got me thinking about how we train people for various tasks, whether in the healthcare IT world or just in general.

There has been a tremendous amount of research over the last several decades about learning styles and individual strategies for education. Part of this has stemmed from the recognition and diagnosis of more conditions that require adaptive strategies. Other forces shaping it include various pieces of legislation, such as IDEA, the Individuals with Disabilities Education Act. Most of the discussion in these areas has been around children and young people, however. The body of knowledge looking at adult workers and adult education is still there, although smaller.

Some people can absorb knowledge readily from printed material and others need to see a demonstration. Some need to learn by doing, and others by doing a task over and over until they feel they have mastery, especially if they work in a high-pressure environment or one with many distractions. Some people shut down in a group environment, where others thrive in that type of collaborative setting. Others need to learn in a very focused environment with few distractions to do their best.

I’ve worked with dozens of healthcare and vendor organizations over the past two decades and have only encountered a couple that seriously considered the idea of different learning styles or learning abilities when creating training for their adult employees. It seems like most training is designed with efficiency in mind – namely, efficiency for those presenting or delivering the content.

Another pressure is the ability to track consistently in training, which leads to more packaged offerings. I can attest to the fact that it’s harder to ensure consistency in training when you’re sitting with a physician in his office eating spicy chicken wings while covering the finer points of the EHR rather than in a classroom environment. Sometimes, however, creative strategies are required to ensure that physician makes it to training at all.

When I was a CMIO, I had to push for approval to offer training through multiple modalities. Let’s face it — some people don’t do well in a classroom setting and others don’t do well with self-directed learning. Regardless of individual learning styles and abilities, others are going to just goof off regardless of how or where you try to deliver training.

I had a boss who loved the idea of conference calls, especially for a geographically distributed organization where managers didn’t want to pull people out of the office. Although some people can learn on a conference call with a couple of dozen people, others find it a recipe for distraction and lack of engagement. My experience is that most adults know what type of training is better for them, and if given the option, they will gravitate towards an environment where they will be successful.

In addition to providing training through multiple modalities, organizations have to work hard to make sure that the people delivering training are strong educators, not just subject matter experts. There’s an assumption that is sometimes made that because someone is knowledgeable, that they have the skill to share information with others in a way that is engaging and effective. I could provide testimony from a good majority of my medical school class that found they learned more efficiently from reading course transcripts than from sitting in a darkened lecture hall. These people are now out in our healthcare IT classrooms, and given other work pressures, are looking for the most efficient and effective way of learning material.

Due to these pressure, many organizations turn to e-learning options. Some of these are little better than recorded webinars with some questions thrown on at the end. Others are fully-baked interactive sessions where attendees are required to replicate workflows and prove some level of mastery before they can advance. I do enjoy the latter kinds of sessions, although they have to be constructed carefully with the emphasis placed on the right portions of the workflow.

I recently QA’d a client training module where the physicians were forced to replicate a complex set of steps around laboratory processing, which wasn’t even part of their workflow. But due to the cost and labor intensity of creating those types of sessions, the organization had settled on a single track for clinical resources, which ultimately wasted the time (and cognitive energy) of many of their end users one way or the other. In all, when you looked at the number of wasted training minutes, it would have been better to put together separate sessions. But since those wasted training minutes fell on the cost centers of the end users rather than the IT budget, the decision was made strictly based on IT resources.

I do a lot of work with organizations that are threatening to switch EHR vendors or who feel that their software isn’t up to par. When we actually roll up our sleeves and assess the clients, we find there are operational or training issues at play the majority of the time. Particularly with stalled EHR adoption, a lack of training and/or proof of mastery leads to reduced schedules that never quite get ramped back up or to features that never quite get implemented.

Often when we look at causality, we find that providers were not required to attend training or show mastery, even when other users may have been held to those standards. I understand dealing with physician attitudes, but letting them take a pass on training isn’t the answer.

The other issue I see frequently is that there has been staff turnover and the new staff hasn’t received the same level of training as others did at go-live, or that they are just expected to try to learn the system during an on-the-job orientation. Often these organizations seem surprised when I recommend what seems like a straightforward solution to ensure everyone in the organization has received an appropriate amount of training.

Another area where we help clients is in formulating training strategies,  not only on what types of modalities they should use, but also how to deliver the training content in a way that is engaging and includes the right kinds of clinical pearls and examples that will keep the attendees engaged. Sometimes when you’re presenting the driest material, having a good story can make the difference. I’m happy to share my tales from the trenches and let the clients take them as their own.

Most smaller organizations (and many large ones) don’t have anyone on staff who is an expert in adult learning and may not have even heard of the idea of differing learning styles, so we’re happy to fill that niche. Like the CPR training kiosk in the airport, we have to strive to meet our students where they are.

What strategies does your organization use to maximize training impact? Email me.

Email Dr. Jayne.

HIStalk Interviews QuHarrison Terry, Marketing Director, Redox

QuHarrison Terry is marketing director at Redox of Madison, WI. He has co-founded several companies and is a 2016 graduate (computer science) of the University of Wisconsin-Madison.

I rarely reach out to ask someone to be interviewed, but Lorre talked to you and said you are fascinating. You have a lot of interests and accomplishments for someone fresh out of college – volunteer work, art, advertising, fashion, and now working for a healthcare technology startup. How did you get interested in all these seemingly unrelated areas?

As you probably can tell from my interests, I love creating. When I got to college, I was either going to be an engineer or a computer scientist. The reason for that is that with engineering, you make things with your hands. As a computer scientist, you create these digital experiences that either live on the back end, or extended interactions that we interact with and engage with from the front-end perspective.

One thing I noticed in college was that I didn’t want to sit at a computer screen 12 to 15 hours a day and let that be my only interaction with creativity and making things. But I did want to understand the logic of how you build things from a digital perspective. That’s what got me to where I am today.

I’m very grateful for my learning the behind the scenes and the logic of how you make an app, or how you integrate an API with a third-party service or provider platform, because it’s super helpful for automating things such as marketing. Or even in fashion, when I worked in that area. I was able to automate the process of making line sheets. It’s like the blueprint. If you want to make a garment or do anything in the cut-and-sew world, they have to make it to specifications and none of that is digital. Having the computer background and bringing it to these non-traditional platforms or areas that you don’t traditionally see a computer in was super helpful. 

I see healthcare as the same thing. I’m at Redox. We happen to be an API platform, but healthcare itself is not digital.

How did you get yourself up to speed on healthcare?

Honestly, Mr. H, I wouldn’t even put myself in the same league as anyone that does healthcare IT or is familiar with the ins and outs of healthcare. I’m very much new to the field, very much still learning every day.

What I’ve done to get up to speed and stay afloat thus far is following a lot of the industry publications. At Redox, I’m blessed to work with a lot of people that are not only proficient in the field, but also have opinions. That’s one thing about our team –everyone knows what they do very, very well. Healthcare expertise is something that I’m surrounded by daily, so if I have questions, I can literally send off an email or a Slack message and get a response or find some materials where I can get even more of an in depth of an answer.

How do you apply your experience with marketing and social media to healthcare, and how does your approach contrast with that of companies that have been in healthcare IT for a long time?

The first thing I would say about healthcare IT is there are very few marketers, which is inspiring, because you get to set the path that everyone else is going to eventually go down or pave new paths off of. The first thing that stuck out to me is that healthcare people traditionally speak the healthcare vernacular that they’re taught. They live in that world. But it’s very hard for a person that lives outside of the healthcare realm to interface and engage with what’s going on.

The first thing I did from a marketer’s perspective was say, how do we get across our professional message, but do it in a way that it’s not audacious, it’s not boring, it’s not the proverbial healthcare jargon that you’re familiar with? We’re not knocking the industry. That’s just how it is. But from an outsider’s perspective, we do need to make it so that people can become interested in healthcare and bring some of the innovative technologies to the space. That’s where I started.

What is it like working in a startup environment?

The startup life is not for the weak-hearted. [laughs] If you have a weak heart, you probably should get something that’s a bit more stable, where your job doesn’t change every six months. Because in a startup, we’re very much creating and building the company from nothing to something. The culture around it is fast paced. There’s a lot of ambiguity associated with the culture. At most times, you’re learning 24/7 and you’re applying what you’ve learned in real time as well.

From an outsider’s perspective, the cool thing about working in a startup is you can see your impact a little bit quicker than if you were working in a big corporation. Oftentimes a startup has fewer people, so you have a bit more responsibility. Startups are magnets for Millennials, because Millennials traditionally want results now. They want to see immediate impact. They want to get real-time satisfaction. Other markets and other generations are used to the concept of putting in hard work and seeing a return over time.

I think that’s why there are more Millennials in startups traditionally today. Also, big startups are a bit newer. Previously, if you wanted to start a startup, access to venture capital wasn’t probably as easy as it is today.

How do you see your generation as being different from those in healthcare IT who are their 30s or older?

I’m a marketer, so I always go back to the people and the emotional side of things. As people, I don’t think we change. We like different things for different time periods, and things were different in certain time periods. We’re more receptive to the culture from the time period that we grew up in and that formulated our childhood. For Millennials in the workforce, we are a part of the first generation to grow up with the Internet from birth to now.

We have opportunities that weren’t offered beforehand to the incumbents before us. If you are a VP of marketing today, you probably didn’t have access to Google. You could go and research every single campaign that was ever run in healthcare. Or if you’re in the automotive industry, that industry as well. Millennials have access to these large databases where there’s just a plethora of knowledge that allows us to move a little bit quicker, but it also takes away from the experience bucket, because you can go Google something today and get an immediate response or answer to whatever question you have. You don’t have to really search or experience it as much. So we’re rich in knowledge, but weak in experience and actual lessons learned.

I think that there’s a gift and a curse associated with that. We’re going to fall a little bit harder than the people before us. But at the same time, we’re going to move a little bit faster.

I read your piece on citizen journalism upending the traditional journalism model. Is your generation inherently less trustful of big corporations, both as employers and as information sources?

Totally. When we look at journalism today and we look at journalism in the future, the one thing that everyone is aware of is brands like CNN, brands like the New York Times and the Wall Street Journal, they’re not reaching the Millennials in the same capacity that they had previously done for generations beforehand.

I think there’s two reasons for that. One, we have an information overload, to the same concept that I just explained earlier where we as Millennials can go and Google something and get an immediate answer. We don’t have to rely on one source of truth for certain answers. Whereas previously, before the Internet, you watched CNN. That was one of the few options that you had amongst ABC and NBC and whatever other channels were available at the time to get news information. Whereas now, you can go to a very specific source that only covers technology news or healthcare news, such as HIStalk, or even automotive news if you wanted to learn about cars.

There’s a lot of sites and publications that only offer that information. That was there 10 to 20 years ago, but it predominantly existed in the form of magazines. Magazines were monthly, annual, biannual. They weren’t a publication that’s 24/7/365 in real time. 

What I’m most excited about on the solo journalist and just the future of journalism is that you no longer have to be associated with a big brand like a Hearst or a Vox Media to have a journalism career. You can  have a blog, and as long as you can figure out the distribution part of that equation, you can have an impact and have readers that come directly to you, which is interesting because now the solo journalist is also responsible for selling ads and making income off of that.

In that article, I touch on the journalist engineer. They have to be well versed at sales, computer science, journalism of course, and a few other things in order to really manifest all the gifts that are there. But the coolest thing about it is the brands like New York Times, CNN, Vox Media, and Hearst are no longer at the go-to source. It’s actually people. It’s going to be interesting to see that transition unfold and be uncovered. I think it’s going to happen within the next five to 12 years.

The argument against that change is that people tend to follow people whose beliefs match their own instead of seeking unbiased, professionally researched information that could change their minds or make them smarter.

I say you have partisan and non-partisan beliefs in contemporary media, so I’m less worried about that. There was a huge spotlight put on that side of the industry due to our previous presidential election, but humans are smart. We oftentimes say people are dumb, but people are smarter than we think.

There’s a reason why certain television programming and content that is put out there appeals to a certain audience and demographic. But the people that want the knowledge that they’re seeking — that’s either unbiased or is presented in a way where they can develop their own opinion — that that will be out there. Journalists that continue to uphold the journalism integrity that is associated with modern-day journalism will have large, large, large followings. Then, for the journalists that are opinionated, they’ll be very much like the modern TMZs of the world, because that’s just how it goes. It’s like yin and yang. You need the opinionated person and you need the unbiased “Here’s the raw facts” like the BBC. You can’t have one without the other.

Oftentimes, when we put a spotlight on it, it seems like the TMZs of the world garner all of the attention. But then you’re not looking at who’s actually looking at the BBC. There’s no spotlight put on, like, “What did BBC break, or what did CNBC break yesterday?” I think it’s twofold. We’re going to have more opinions, but we’re also going to have more reliable sources on very niche subjects and topics that we didn’t have before.

A good example of this is Wikipedia. Most people, in the early stages of Wikipedia, were worried about the integrity of an open-source model, especially an encyclopedia. When I was growing up in grade school, we couldn’t use Wikipedia, and now my little brother can. But it’s very similar. Anyone can go and edit a Wikipedia article and write whatever they want on anyone on Wikipedia, but we’re basically relying on the community to keep it intact and to keep the integrity of that data true.

You wrote about your experience in using an AI-powered app rather than a trainer to dramatically decrease your time to run a mile. What potential do you see in healthcare?

That’s the reason I’m working in healthcare today. Technology such as artificial coaches, Elon Musk’s Neuralink that merges the human brain with artificial intelligence, augmented reality, reprogrammable human cells, brain-operated prosthetics, and the list goes on … all of that technology excites me because we are at the precipice of the next frontier in computing —  humans as the computer, or we as cyborgs, whatever you want to call it. In order for us to evolve to the next state in Darwin’s theory of natural evolution, we’re going to have to figure out how to merge the human brain with the technical side. How do we put computers in the human?

That’s one area where you’re going to see me focused on a lot in the next year or so. I have this concept of the inevitable human. Slowly but surely, we’re going to get to a point where computers and humans are synonymous. They’re one. We’re already kind of there, because if you take a cellphone from a lot of kids, they would feel like they’re losing an arm or a limb already because they would feel disconnected. I know that’s especially true for my little brother, who is 14. It’s especially true for some of my peers who are addicted to Facebook already.

But the thing about it is, in order for this to actually happen, healthcare has to evolve and catch up. We have to bring some of the innovative technology, such as the AI assistant and even the actual mechanical technology like prosthetics, to this space. We have to get them caught up to speed. They need health data. They’re going to need access to the medical record. They’re going to need access to the health system. 

That’s an area where we’re going to have to advance. I think that there’s going to be a lot of money and a lot of pressure put on that. Look at Apple. They’re coming in to the interoperability space. Elon Musk is finally kind of moving into healthcare. It’s an exciting time for healthcare technology.

What does your ideal life look like?

Ideally, I’m going to start another company. That’s probably three to four years down the road.

Twenty years out from now, I want to be a master creative. Not just an artist, where I’m going to just make things, but someone that creates things from zero to 100 and has experience working at all facets of building something. I want to be able to have the ideas, but also work with the person to build the idea, and also work with the people to distribute the idea, and also work with the people that have to implement the idea, et cetera.

I  see myself as an artist, a creative person that expresses themselves. It’s very Millennial of me to say that, right? But it’s like, you can’t take the creator out of the man, but you can take the man out of the creator.

Morning Headlines 7/10/17

Cerner Announces Passing of Chairman and CEO Neal Patterson

Neal Patterson, co-founder, chairman, and CEO of Cerner, died Sunday of cancer complications. Fellow co-founder and Vice Chairman of the Board Cliff Illig has been named interim CEO.

Nuance Healthcare: Impacted Customer Update

Nuance issues an update on its hosted services outage reporting that Dragon Medical Practice Edition servers have been restored.

Jawbone to Be Liquidated as Rahman Moves to Health Startup

Consumer electronics manufacturer Jawbone plans to shut down following years of financial pressures. CEO and co-founder Hosain Rahman has opened a new business called Jawbone Health Hub that will make health-related devices.

UnitedHealth, Vista Said Near Deal to Split Advisory Board

UnitedHealth is working with Vista Equity Partners in a deal that would allow the two to acquire the Advisory Board Company and split it, with UnitedHealth taking the healthcare division and Vista Equity Partners taking the education business.

Monday Morning Update 7/10/17

Top News

Neal Patterson, co-founder, chairman, and CEO of Cerner, died Sunday of cancer complications. He was 67.

Arthur Andersen consultants Patterson, Paul Gorup, and Cliff Illig founded the company in 1979.

Patterson’s “treatable and curable” cancer was announced in January 2016. His wife Jeanne is a metastatic breast cancer survivor.

Vice board chair Illig will serve as chairman and interim CEO. Cerner says its succession plan will allow it to name a new CEO shortly.

A gaunt Patterson made an unscheduled appearance at the Cerner Health Conference in November 2016, when he vowed to return to work in January 2017. He told the crowd, “I made a plan, got a strategy for treatment, and then went to execute it. I realized God had a sense of humor: he put me in a place undergoing an EHR conversion.”

UPDATE: a reader suggested that I set up a guestbook for folks to leave their thoughts and memories about Neal. You can send your thoughts here and I’ll run them later in the week.

Reader Comments

From Cab Heater: “Re: Twitter live-tweeting from conferences. ADA doesn’t allow.” The American Diabetes Association warns attendees of its Scientific Sessions that photography is not allowed, to the point that staffers monitored use of the #2017ADA hashtag and warned people individually to remove their tweets that contained photos of on-screen slides.  ADA says it is concerned about its legal obligations to grant-funded presenters, although it did not cite those concerns specifically, while others assume the sponsor-enriched ADA panicked over an incident last year in which a conference attendee tweeted out study results an hour before they were officially released, sending a drug company’s share price down.

HIStalk Announcements and Requests

Half of the relatively few Nuance users who responded to last week’s poll say they’ll send less business to the company following its malware-caused cloud services outage.

New poll to your right or here, following up on research showing that the more time people spend on Facebook, the worse they feel about themselves: how much time do you spend on Facebook each week? Click the poll’s Comments link after voting to explain.

Readers funded the DonorsChoose teacher grant request of Ms. G in Virginia, who asked for hands-on math centers to replace her “tragically bare-bones and outdated” ones. She reports, “Having access to educational games like Shape Matching, Sorting, Patterning, Measuring, and Counting hands-on activities make learning both visual and social. We can introduce important science and social studies skills while practicing important life skills like turn-taking, waiting, losing, and much more. Thank you for providing such entertaining materials to my students!”

I’m in a bit of shock over Neal Patterson’s death, feeling similarly to when I heard that Steve Jobs had passed away. I never met Neal other than a brief encounter at some kind of Cerner CIO executive retreat that I once attended (and my impressions then were mixed, although he seemed to be enjoying himself and was pretty genuine), but I interviewed him a couple of times and found him to be thoughtful and patient even though he was clearly no-nonsense. Like most significant leaders who get big things done, the man who was raised on a pig farm had a reputation of being ruthless and egotistical, and certainly the company flourished in some part due to its “Vision Center” executive schmoozing strategy in which Patterson and other company bigwigs wooed customers into signing up without looking too closely beyond the big-picture promises and glossy PowerPoints that made them feel important, at least until the deal was done. Industry newcomers won’t recall the huge Wall Street hit Cerner took when Patterson decided to re-architect Cerner’s entire product line into Millennium in the 1990s, one of few times in corporate history where a ground-up software rewrite turned out to be the key positive event in a company’s future. Patterson took Cerner into the stratosphere, accomplishing the unusual in remaining in charge the whole time and reshaping the company’s strategy to grow consistently and to move into new markets tangential to healthcare IT. He was also loyal to Kansas City, passionately supporting local causes and creating a respected technology firm in an unlikely location. I certainly had a lot of fun with his famous “tick, tock” email that in retrospect was probably entirely appropriate given the circumstances even though it was uncomfortably (and in my mind, admirably) blunt for the CEO of a publicly traded company, but looking back on where he took Cerner and the industry, the “tick, tock” might now serve as a reminder to us all that our time here is limited. I’ve rarely said this about someone I didn’t know, but I will miss him.

This Week in Health IT History

One year ago:

• Thoma Bravo announces plans to acquire Imprivata for $544 million.
• England scraps plans to create and EHR-fed national database of patient information after a commissioned report criticizes its opt-out and consent policies.
• NIH awards $55 million in grants to four universities and the VA to study the contributed information of “citizen scientists”, while Scripps and Eric Topol, MD get another $120 million to develop related apps, sensors, and recruitment processes.
• CMS bans Theranos CEO Elizabeth Holmes from clinical laboratory involvement and stops all payments to the company.
• HHS issues HIPAA guidance for ransomware attacks.
• President Obama writes a JAMA paper describing the impact of the Affordable Care Act.
• Evolent Health announces that it will acquire Valence Health for $145 million.

Five years ago:

• University of Virginia settles its $47 million breach of contact lawsuit against GE Healthcare involving the acquired IDX, which UVA says botched its implementation.
• E-MDs fires CEO Michael Stearns after what it said were employee accusations of inappropriate behavior, replacing him with board chair David Winn.
• CSC begins laying off employees following the UK’s failed NPfIT project.

Ten years ago:

• Dossia files a restraining order against Omnidmedx Institute after payment squabbles involving a personal health record development project.
• Sage Software Healthcare President and CEO Andrew Corbin resigns.
• ISoft shareholders vote to have IBA Healthcare buy the company.
• A Kaiser Permanente study finds that outpatient visits and telephone calls are reduced when patients can email their doctor.

Weekly Anonymous Reader Question

Responses to last week’s question:

• My job is 100 percent remote management position with no restrictions or specific requirements, other than having suitable internet connection that I pay for. There is an expectation that I work at least 40 hours a week and be available during normal business hours and reachable by cell evenings and weekends.
• The only requirement is to just get your work done. Physical requirements are a quiet, private place to work.
• None. I travel for work 75 percent of the time and it all blurs. Except weekends. Those are sacred.
• I’m enjoying the phrasing of this question, partly because at least one major employer in the health IT sector is notorious for not ever allowing its employees to work from home, and you know it, and we all know it. I am out of health IT now, and don’t miss my former employer’s lack of flexibility.
• Be here now- work regular hours and be available for questions, problems, issues. I am an integration analyst.
• Sales job. No questions asked if you hit quota. I love it!
• None. Why? Because we are so lean right now due to cuts and attrition that I think (our leader at least) is just grateful that we have stuck it out, especially since our positions require 24/7 call availability and you ain’t lived life to the fullest until you are in a three-person on-call rotation! If you want to get the most out of your people, flexibility is an absolute must. (ha ha, see what I did there?)
• Epic application analyst for a large system. We can work from home two days per week, so most people take Mondays and Fridays (with the exceptions of the lucky ones who live close by and the unlucky ones whose teams had to have SOMEONE in the office on those days). A lot of teams require a “work from home” form submitted at the beginning and end of the day, with your goals/work and then what you actually accomplished. For some people, these are their most productive days. For others, not so much.
• I must be available between 0900-1500, but can set my work hours otherwise. I must be available via phone/email/IM.  If a need arises, I must be willing to come in to the office. I’m a former IS clinician, now working in a new capacity, “Operations Support.”
• No restrictions. I’ve been a full-time work from home employee since 1999 for three different employers. My role is a software product manager, thus I interact heavily with my development team on a daily basis to build software and drive value for our customers. I travel as needed for customer visits or corporate meetings, but mostly am at my desk. I’ve been fortunate to be given the trust of my employers and accordingly have built a reputation for delivering results, thus I’ve never been micromanaged. Time management and an isolated office (or headphones plus white noise) are keys to success while working in a home-environment.
• I’m a remote employee, meaning every day is a work from home day. No restrictions or requirements. I’m in my office every day around 8 and don’t end my day until after 6 or 7 pm with occasional work on the weekends.
• I work in data analytics for a large health system and our work from home day is Friday. On Fridays, we must be as available for Webex meetings as we would be for in-person meetings on a regular day in the office. We also can’t refuse to meet with a customer in-person just because it’s a Friday.
• I’m a consultant. Our requirements are based on what the customer needs. If the customer I’m contracted with wants me to work 9-5 every day, then that’s what I’ll do. But most don’t care that much so I’m generally available from 8-5 in case something comes up, and I attend any meetings they want me to join, but otherwise I can set my own schedule as long as I bill 40 hours. For weeks I’m onsite, it’s certainly more stringent, but I just follow whatever their staff do.
• I work in professional services. I can work from home two days per week. I need to have a presence in the office three days per week in order to retain my assigned workspace. I am required to work in a space where I can have customer calls without crying babies or barking dogs.
• No kids under 10 at home without a sitter. Office with lockable door. Access to printer/scanner.
• Availability for meetings via WebEx or conference call and ability to focus on project and strategy needs.
• Just need to meet the billable hours requirements.
• I work in data analytics. I’m allowed to work from home as much as I like. My employer expects me to get my projects done on schedule, and be easily reachable during business hours.

This week’s question: What software, app, or website is your secret weapon for increasing your professional or personal effectiveness? (excluding HIStalk from any possible consideration, please).

Last Week’s Most Interesting News

• Patrick Soon-Shiong’s NantWorks buys controlling interest in the struggling , six-hospital Verity Health (CA) from its hedge fund owner.
• The Department of Defense says Naval Hospital Oak Harbor (WA) will go live on MHS Genesis this month as the project’s second pilot site.
• Heritage Valley Health System (PA) finishes bringing its systems online following a June 27 cyberattack.
• VA officials warn that its $543 million RTLS project risks “catastrophic failure.”

Webinars

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

Harris’s healthcare group acquires Warwick, RI-based population health management technology vendor Medfx, which it will operate as an independent business unit. 

Bloomberg reports that UnitedHealth Group and Vista Equity Partners are close to striking a deal to acquire The Advisory Board Company, with UnitedHealth proposing to take over the company’s healthcare business that drives two-thirds of its sales. Vista would take on ABCO’s education product line. The potential sale of Advisory Board was driven by an activist investor’s acquisition of 8.3 percent of shares early this year.

Fitness tracker and Bluetooth gadget manufacturer Jawbone, which once enjoyed a valuation of $3 billion, is shutting down. Jawbone’s founder is starting a new company called Jawbone Health Hub. Anonymous reports suggest the new company will focus on validating and reporting sensor-collected health information. Jawbone was rumored to be pivoting into a clinician-focused business in February 2017. Its failure was not a surprise given its series of strategic missteps it made as the public lost interest in me-too fitness trackers.

Decisions

• UnityPoint Health-Pekin (IL) will replace McKesson Paragon with Epic in April 2018.
• Genoa Community Hospital (NE) will switch from Healthland to Athenahealth In October 2017.
• Spectrum Health Pennock Hospital (MI) will implement Epic In May 2018, replacing Meditech.
• Herrin Hospital (IL) replaced Meditech with Epic in June 2017.

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

People

Jeff Felton (McKesson) joins Providence Service Corporation subsidiary LogistiCare Solutions as CEO.

Government and Politics

Kentucky Governor Matt Bevin’s proposed Medicaid changes would require able-bodied recipients to work 20 hours per week when they sign up. He previously proposed that the work schedules of recipients be ramped up slowly, but now says the state’s Medicaid computer system can’t track such a phased approach.

A campaign finance watchdog organization accuses HHS Secretary Tom Price of illegally using $40,000 from his congressional campaign fund to create self-promotional materials to urge the Senate to confirm his appointment.

Other

Steve Orlow, MD, MMI, CMIO at Lutheran Hospital (IN), criticizes publicly traded parent company Community Health Systems in his resignation letter for under-investing in the facility and for retaliating against a group of 10 doctors that had tried to buy the hospital from CHS. Orlow says the financial weakness of 137-hospital CHS threatened to drag the hospital down and says CHS had approved only of the 26 IT-requested Cerner EHR modules until the 10 doctors went public with their gripes, after which CHS approved all 26. Shares of CYH have dropped 28 percent in the past year and 82 percent since their June 2015 high. The company’s market cap is just over $1 billion. 

A woman (and nurse) who tweeted out a photo of the $231,000 hospital bill for her three-year-old son’s heart surgery – of which she credited the Affordable Care Act for leaving her with only  a $500 payment – receives Twitter death threats, arguments that her son’s life wasn’t worth it, and comments that her name Ali (short for Alison, “a white chick from New Jersey,” she explains)) means she must be a foreigner or a terrorist. On the upside, someone who read her tweet correctly diagnosed her son’s genetic condition. Some commenters noted the high prices charged by Boston Children’s Hospital, while others provided shrill political arguments or asserted that they weren’t going to pay for someone else’s medical bills.

Public updates from Nuance regarding its cloud systems outage have been infrequent as it updates customers via private conference call, but a July 6 notice says eScription LH is back online. 

I’m not sure why I find this interesting, but an article notes that England’s NHS would use about $260 worth of electricity to run a single MRI, but it’s using voltage converters to reduce costs.

CNBC profiles John Brownstein, PhD, a Harvard Medical School professor and epidemiologist who advises technology companies that are interested in moving into health-related areas.

Alabama’s state bar reprimands the attorney who in 2014 filed a highly publicized lawsuit claiming that a hospital amputated his client’s penis during a circumcision. The bar found that the lawyer hadn’t even looked at the medical records of his client before filing the lawsuit, and even after he reviewed the records that proved the allegations were improper, he filed another lawsuit.

Sponsor Updates

• Learn on Demand Systems will exhibit at Microsoft Inspire July 9-13 in Washington, DC.
• NVoq will exhibit at AHRA 2017 July 9-12 in Anaheim, CA.
• Experian Health will exhibit at NAHAM Nebraska July 13-14 in Grand Islands.
• QuadraMed, a division of Harris Healthcare, will exhibit at the FHIMA Annual Convention & Exhibit July 11-12 in Orlando.
• ZappRx releases a new podcast, “Living with Systemic-Onset Juvenile Idiopathic RA.”
• Aprima customer Mt. Olive Family Medicine Center wins the 2017 NCMGMA Practice of the Year Award.
• Besler Consulting releases a new podcast, “How medical scribing is utilized at the point of care.”
• CoverMyMeds will exhibit at McKesson IdeaShare 2017 July 12-16 in New Orleans.
• EClinicalWorks will exhibit at the 2017 FSASC Annual Conference & Trade Show July 12-13 in Orlando.
• FormFast publishes a new case study featuring Riverside Community Hospital.
• InterSystems will exhibit at the Population Health Exchange July 10-12 in Colorado Springs, CO.

Blog Posts

• Healthcare & Life Sciences Digital Transformation: Giving You Freedom (Liaison Technologies)
• Image Exchange in Trauma Care: When Timing is Everything (LifeImage)
• The story of one hospital’s 59-minute disaster recovery (Meditech)
• Breaking Through the “Radio Silence” (Netsmart)
• How to tell if a consulting company is “the one” (Nordic)
• Overcoming obstacles with Workflow Automations and Voice Recognition (NVoq)
• How a “Ping” Brings Better Care to Triad HealthCare Network (PatientPing)
• Celebrating Independence from Alarm Fatigue (PatientSafe Solution)
• Physicians Yearn for (EHR) Independence Day (PatientKeeper)
• Improving the Revenue Cycle by Managing Referrals (Sagacious Consultants)
• 6 Ways to Make Work Feel Like Summer Vacation (Salesforce)
• That’s a Wrap! (The SSI Group)
• 17 Provider Reputation Stats That Every Practice Needs to Know (Solutionreach)
• Gartner Research: Healthcare Moment (Sphere3)
• Amid healthcare reform, ACA risk stabilization goes on (Verscend Technologies)
• Can you? Visage can. Regional Enterprise Imaging (Visage Imaging)
• Innovation Week 2017: the aftermovies (Agfa Healthcare)
• How Proposed Changes to Medicaid Might Affect Healthcare (Arcadia Healthcare Solutions)
• 5 Steps to HITRUST CSF Certification (Datica)
• CPC+ and Other Physician Practices: Improving Healthcare Delivery Through PFACs (CareSync)
• The Rising Importance of CDS (CTG)
• 3 Business Intelligence Trends and How They Impact Your Organization (Dimensional Insight)
• Care Delivery Transformation: Four Levers to Enhance Value (ECG Management Consultants)
• The ‘New York Minute’ Difference (EClinicalWorks)
• The Role eForms Play in Patient-Generated Healthcare Data (FormFast)
• Managing a Successful Physician Integration: 7 Lessons Learned (Hayes Management Consulting)
• Cybersecurity in Healthcare: Responding to Petya/NotPetya Attack (The HCI Group)
• Demystifying the Pharmaceutical Supply Chain (HGP)
• Healthgrades Tapped to Help Solve “Wicked” Problems in Healthcare (Healthgrades)
• Data Conversions: What About the Documents? (Impact Advisors)
• Healthcare Marketing That Resonates with Generation X (Influence Health)
• Unlocking the Full Potential of EHRs (InterSystems)
• What to Expect at ATLAS 2017 – Top 5 Reasons to Register Now (Kyruus)

Contacts

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

Cerner CEO Neal Patterson Dies of Cancer Complications

Neal Patterson, co-founder, CEO, and chairman of Cerner, died Sunday of complications following a reoccurrence of cancer. He was 67.

The company announced that co-founder and vice board chair Cliff Illig will serve as chairman and interim CEO.

Illig said in a statement, “This is a profound loss. Neal and I have been partners and collaborators for nearly 40 years, and friends for longer than that. Neal loved waking up every morning at the intersection of health care and IT. His entrepreneurial passion for using IT as a lever to eliminate error, variance, delay, waste, and friction changed our industry.”

Cerner says its CEO selection process is nearly complete.

Morning Headlines 7/7/17

After the Medicare breach, we should be cautious about moving our health records online

The Australian Federal Police are investigating after discovering that Medicare card details of Australians was available for purchase on the dark web.

The MeDoc Connection

An analysis of the spread of the NotPetya cyberattack concludes that a popular Ukranian accounting software hosted on compromised web servers propagated the attack.

FirstHealth completes major project

FirstHealth (NC) goes live on Epic following an 18 month implementation.

News 7/7/17

Top News

Patrick Soon-Shiong’s NantWorks buys a controlling interest in hedge fund-owned Verity Health, which runs six California non-profit safety net hospitals previously operated by Daughters of Charity Health System under the Integrity Healthcare name.

Soon-Shiong pledged in an announcement that the company will apply “the limitless powers of collaborative science and technology to transform healthcare practices and create a more efficient, more effective health system. Medical care is local and we strongly believe that community health systems should be supported with investment, technology, and science to build next generation clinically integrated networks to drive better outcomes at a lower cost.”

Reader Comments

From Pithy Aside: “Re: Cerner wins/losses.Here’s the information from the 2016 and 2017 KLAS clinical market share report.” A reader previously subsetted the KLAS data in an attempt to focus on what he or she thought would be most interesting to Wall Street analysts, but the bottom line per KLAS (as commented here previously) is, “Acute wins for 2015-2016 for Cerner: 249 (this number includes 1 Soarian add on in 2015). Total Millennium losses for 2015 and 2016: 53. Cerner’s net growth is thus 196 acute hospitals for 2015 and 2016.” Certainly further segmentation by deal count vs. hospital count, organization type, bed size, accounting for multi-hospital deals like the DoD and Emerus, net-new customers vs. footprint expansions, migrations either way due to mergers, etc. could lead to further interpretation and speculation that may or may not add value. There’s also the unusual opportunity since CERN is publicly traded to simply look at the metrics Wall Street really cares about that go far beyond hospital count – revenue, bookings, and earnings, all of which reflect Cerner’s overall activities (not all of which involve hospitals) and the efficiency with which it operates its business. For that matter, share price since January 1, 2015 is the ultimate measure of company performance vs. Street expectations and the above real-time graph as I write this shows CERN (blue, up 1.1 percent) vs. the Nasdaq (green, up 29.3 percent). The reader also noted that some Soarian sites are trying to wangle out of their contracts to switch vendors claiming poor support, but I can’t say I side with them – they signed a contract for product that remains supported, and if company change of control was important to them, they should have put that – along with service level agreements if they left those out — into their contract’s terms and conditions. Weirton Hospital has sued Cerner claiming poor support, while Cerner sued PinnacleHealth for trying to walk away from its Soarian contract after signing with Epic.

From Pinkeye: “Re: Epic. Hard to believe they didn’t bid on the Wisconsin DHS project if they have a viable behavioral health strategy. I’m also curious whether Allscripts/Netsmart bid.” Epic sent me a note after I mentioned that the company had chosen not to bid on the project, saying it wasn’t a big enough deal to interest Epic. I haven’t seen a list of the five bidders. Health IT websites created the self-serving notion that it’s cleverly-observed big news when a customer in Wisconsin or Missouri chooses Cerner or Epic, respectively, but that’s ridiculous.

From Nuance Hospital Customer: “Re: Nuance outage. Escription staging environment testing is in process, with plans to bring  the first client on board. Rebuilt speech engines. They just announced that they are in process of updating employee laptop antivirus software and installing encryption (!). Over 200K physicians are on an interim solution, but still no commitment to make clients whole — only offering clients short-term use of Dragon Medical.  I can only speak for our organization, but we have had over 10 staff working around the clock since this outage to review options and stand up outside transcription service. This is very poor remediation.” Unverified, but seemingly solid since the reader emailed from their hospital account. Nuance has issued minimal public information, instead providing status updates via customer conference calls. Some systems remain offline 10 days after the initial malware incident.

From NotPetya: “Re: Nuance outage. People are acting like they’re innocent victims of a cyberattack. Doesn’t this situation show what happens when you don’t upgrade your software? NotPetya exploits the same weakness as the May 4 outbreak and systems should have been patched.” I don’t think Nuance has confirmed that it was hit by NotPetya, but assuming that’s the case given the incident’s timing, it would seem that it had a PC running somewhere that didn’t have Microsoft’s Eternal Blue exploit patch from March 2017 (MS17-010) installed,  which also protects against the WannaCry strain. However, even someone as cynical as I would be hesitant to suggest that the company was negligent given the lack of facts, instead suggesting that every organization check every PC on the network to make sure they are running updated versions of Windows and antivirus.

From Crank Rod: “Re: HIT influencers. What do you think of this list that a Twitter monitoring service company assembled?” I question the premise of this list (and others like it) that assumes that hyperactive Twitter users must, by definition, be influential. I’ve never heard of most of the Twitter accounts listed, follow few if any of them, and note that their Twitter activity is often dominated by attention-seeking retweets and insight-lite comments that fail to rise above the level of social media circle-jerkery. I’ve also noticed that the real-world accomplishments of the anointed Twitterati are often much more modest than their outsized social media presence would suggest and that their self-assigned labels of “disruptor” and “innovator” sometimes ring hollow given their lack of personal success within the system they claim to be qualified to disrupt (it’s perhaps harsh to say that, “those who can’t, Tweet,” but sometimes that seems to be accurate). I’m happy for those named, especially for those whose self-validation demands it, but it’s just not something I care one iota about. I doubt many CEOs and other industry leaders are anxiously waiting for the winners to be named so they can call them up for advice.

From Money In the Banana Stand: “Re: #HIT100. Is it just me, or is this just another glad-handing campaign where the social media-verse celebrates the over-tweeters, many of whom have never even worked within a health system? While I find social media to be an effective medium to share, collaborate, inform, and educate, I am increasingly annoyed as I find folks have gotten away from why we are in this industry in the first place. In fact, I find several of these individuals exclusively making a living by talking about what the industry needs to do in social media and at conferences, but have no successful business or job within the industry. I am appreciative of those who HAVE worked in the industry who share their expertise and strategic thinking, but have had just about enough of the ‘marketers’ who are just recycling marketing and self-promotion. The tipping point for me was receiving countless messages from people ‘campaigning’ for my vote. Seriously?” I received this comment several hours after writing mine above, which was triggered by a similar but different “influencer” measure. Some of those folks don’t seem to have real jobs and are light on (a) healthcare-related education; (b) work experience; and (c) accomplishments. I apply the same standard to those who produce blogs, publication articles, or conference presentations – if you’ve never worked in a position of significant responsibility in healthcare IT, it’s hard to fathom why those who have should trust your assessment or value your opinions.

From In the Beginning, There Were Delays: “Re: DoD’s MHS Genesis. The October 2016 military announcement said the pilot site go-lives would be delayed from December 2016 to June 2017. Should we assume they’re live but don’t want to brag about it with a press release?” Fairchild Air Force Base (WA) went live in February 2017. A tweet this week from the DOD says the the other pilot site, Naval Hospital Oak Harbor (WA), will go live “later this month.” 

From Informatics Professor: “Re: alerting privacy officers of users accessing unneeded patient information. The example of accessing records of a patient not seen in the past six months nor scheduled for an encounter implies that the only rationale for accessing a patient chart is direct treatment. There are other circumstances in which chart access is needed, such as data retrieval and quality audits.” The original poster suggested flagging such access for manual review, which would then uncover the extenuating user circumstances. The alerting could take user role into account, perhaps raising a more vigorous flag if the credentials used to look up inactive patients were those of a nurse aide rather than a quality analyst.

From ECW Watcher: “Re: the HIMSS-owned publication’s ‘breaking news.’ They’re a month late.” The publication ran a piece Thursday (along with breathless tweets and an email blast) indicating that CMS won’t make users of EClinicalWorks repay their incentive payments. The 12-paragraph story (nearly all background filler) contained three quoted sentences that it attributed to “a CMS spokesperson.” A competing publication ran the same information with the same quotes on June 9 (screenshot above), which also helpfully directed readers to a CMS FAQ (from months before that, but not naming ECW specifically) instead of omitting links for fear of looking less than omniscient.

HIStalk Announcements and Requests

It’s early July – do you know where your interns and first-year hospital residents are? (answer: driving your experienced doctors crazy with their inexpert questions, ordering tests and meds better suited for textbooks than a busy ED, consulting all but the most basic problems out, and requiring constant hand-holding to avoid harming patients).

This week on HIStalk Practice: Montana clinics come under fire for lack of interoperability. Hamakua-Kohala Health rolls out Medfusion patient portal. CMS develops new QPP resources for physicians in rural and/or underserved areas. This year’s digital health investments will likely make 2017 a record-breaking year. Physicians – no matter their type of employer – are still frustrated with EHRs. Carepostcard launches to help patients thank, find compassionate providers.

Webinars

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

Home monitoring technology vendor VRI acquires competitor Healthcom.

Sales

In Ireland, Saolta University Health Group chooses the Evolve clinical document management system of Northern Island-based Kainos. 

Dialysis clinic operator Fresenius Medical Care North America licenses Forward Health Group’s population health management system.

Announcements and Implementations

Patient engagement app vendor Fitango Health will use InterSystems HealthShare Connect to develop a post-discharge action plan platform.

Minnesota-based Treatment.com announces its Merlin artificial intelligence platform for diagnosis and treatment.

FirstHealth of the Carolinas (NC) goes live on Epic. CIO Dave Dillehunt is leftmost in the above photo.

Baylor Scott & White Health – Grapevine (TX) goes live on Pulsara, a smartphone-based app that allows first responders who are transporting potential stroke patients to coordinate with the ED on the way to the hospital.

Eisenhower Medical Center (CA) goes live on Epic, apparently replacing McKesson Horizon Clinicals it chose in 2007.

Government and Politics

Politico suggests that the VA’s abrupt announcement that it will implement Cerner under a no-bid contract was influenced by the White House’s Office of American Innovation, run by presidential son-in-law Jared Kushner. VA Secretary David Shulkin met with Kushner’s team, but says the decision was made independently.

Privacy and Security

In Australia, a professor says he’s not convinced the country’s health system is ready for digitization following news that the Medicare card details of all Australians are listed for sale on the Dark Web. He notes that the government’s systems use somewhat primitive security measures, as well as the fact that the information is also stored on provider systems with varying degrees of security. He’s especially worried since the government’s centralized medical record is operated under an opt-in model that will change to opt-out in 2018. The professor advocates the “100 points” identity model as used for firearm permit applicants, in which many forms of ID can be presented as long as their weighted security value adds up to at least 100.

In England, the Information Commissioner’s Office chastises Royal Free NHS Foundation Trust for inappropriately providing patient information to Google-owned DeepMind Health without their consent, requiring the trust to align its procedures with law, complete a privacy assessment, and commission an audit of its DeepMind trial project.

Speaking of DeepMind Health, the hired independent review of the company’s activities finds that “the digital revolution has largely bypassed the NHS” as doctors use Snapchat to insecurely share patient photos and NHS holds “the dubious title of being the world’s largest purchaser of fax machines.” It notes that the original, much-criticized agreement with Royal Free Hospital contained a “lack of clarity” that has since been corrected in a new agreement and recommends that DeepMind cooperate fully with the ICO’s recommendations. Panel members also voted to have DeepMind Health pay them an honorarium instead of donating their time for free.

A Cisco investigation finds that the Ukraine-based tax software company whose updates were used to globally propagate the recent NotPetya malware attack had not updated its servers since 2013, resulting in at least three penetrations in the past three months. Police raided the office and seized its servers, with the unintended consequence that customers who are required to use its software are now sharing older versions of it via Google Drive and Dropbox links, exposing them to potentially booby-trapped copies.

Other

A team from Marine Corps Base Quantico develops Infrascanner, a portable infrared device that allows detection of intracranial hematomas on the battlefield, replacing the old system of a paper-based evaluation form and potentially avoiding evacuation for unnecessary CT scans.

Epic’s non-marketing department is getting bolder about calling out CommonWell, I noticed, with the company noting on its website that, “Care Everywhere exchanges every 12 minutes what CommonWell exchanges in a lifetime.”

A New York Times report about low-quality nursing homes concludes that stricter oversight (fines and seldom-enacted threats to halt CMS payments) don’t seem to deter them since they just keep operating with poor metrics. The lawyer of a resident who is suing one of them says fines are just a cost of doing business for their large-corporation owners, especially since federal budget cuts allow only 88 nursing homes to be labeled as “special focus” even though regulators recommend such scrutiny for 435 facilities. 

I missed this originally, so maybe it’s appropriate given the pandering for social media influencer votes: a study finds that people who use Facebook more extensively feel worse about themselves. Previous studies found that excessive Facebook use detracts from face-to-face relationships, reduces meaningful engagement, and erodes self esteem, but the new study additionally found that real-world social networks were positively associated with well-being while Facebook use was associated with negative well-being, particularly in mental health. Interestingly, time on the site was more predictive of negative impact than the level of Facebook activity (liking, posting, and clicking). The authors conclude,

Exposure to the carefully curated images from others’ lives leads to negative self-comparison, and the sheer quantity of social media interaction may detract from more meaningful real-life experiences.  What seems quite clear, however, is that online social interactions are no substitute for the real thing.

Sponsor Updates

• Aprima customer Mt. Olive Family Medicine Center wins the 2017 NCMGMA Practice of the Year Award.
• Visage Imaging releases an update for its Ease mobile app that adds support for video and encounters-based workflow.
• Besler Consulting releases a new podcast, “How medical scribing is utilized at the point of care.”
• CoverMyMeds will exhibit at McKesson IdeaShare 2017 July 12-16 in New Orleans.
• EClinicalWorks will exhibit at the 2017 FSASC Annual Conference & Trade Show July 12-13 in Orlando.
• FormFast publishes a new case study featuring Riverside Community Hospital.
• InterSystems will exhibit at the Population Health Exchange July 10-12 in Colorado Springs, CO.

Blog Posts

• MACRA 2018: More flexibility, Improvements, and Updates on the way! (Optimum Healthcare IT)
• What to Expect at ATLAS 2017 – Top 5 Reasons to Register Now (Kyruus)
• Data Conversions: What About the Documents? (Impact Advisors)

Contacts

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

EPtalk by Dr. Jayne 7/6/17

I’ve been watching a dialogue about medication reconciliation unfold on one of the AMIA email lists. The general consensus seems to be that medication reconciliation is a “wreck” and that there is tremendous variation in how/when organizations apply it.

In the various EHRs that I’ve used, there are many existing choices in reconciliation pick lists, and they may not always apply to a given care setting. For example, “substitute per formulary” might make sense for a hospitalized patient when they may go back on the original medication at discharge. But in the outpatient setting, if you’re doing a formulary interchange, you’re actually going to discontinue one medication and start another, which requires a different set of documentation.

There are also situations where you need to hold a medication because it’s not essential or could lead to complications (for example, oral contraceptives or daily aspirin) but still want it reflected as something that might have an ongoing influence on the patient’s current state (ongoing clotting or bleeding risk), but I have yet to see an EHR medication list that manages this well.

One respondent commented that there are options needed that don’t traditionally appear as choices during the medication reconciliation process, such as “the patient was never on this medication.” There are other choices such as, “patient’s family member says they are taking it, but patient claims they have never seen the pill,” and “patient taking every other day due to cost” that we’ll never see reflected on a reconciliation list but have to be added as a free-text or “other” type comment.

There are many patients for whom medication reconciliation is an impossibility due to dementia, psychiatric issues, or other medical conditions impairing memory and thought processes. Some of these patients have caregivers who can provide the information, but others don’t.

In the urgent care setting, we rely heavily on the medication history information available through our EHR, but unfortunately, it doesn’t always have the information for cash prescriptions since it often feeds from pharmacy benefit managers. The state prescription drug monitoring program helps fill that gap for some medications, but as a provider I often end up looking in multiple places or asking staff to call pharmacies or family members to try to get an accurate history.

For us, every patient is a transition of care for regulatory purposes as well as an opportunity for error when a medication gets lost in translation. The need for a formal reconciliation varies with the patient and their complaint. What if a visit is a transition of care but doesn’t require prescribing? Clinically a reconciliation really isn’t needed for an episodic complaint (laceration closed with glue), but there are challenges associated with saying staff can do it sometimes but not others.

The discussion brought other points about lack of functionality in EHRs in general, including the ability to trend increasing or decreasing doses over time. I know it took the better part of a decade for my previous EHR to get functionality that allowed prescriptions for different doses of the same medication to link, so that you could see the patient who started on 10mg of blood pressure medication and was gradually worked up to a higher dose. This was tricky because the system relied on NDC numbers initially, which are different not only based on dose, but also on how the medication is supplied. Personally, I don’t care whether the medication came in a blister pack or a stock bottle, but that’s how NDC worked. It was only after the system converted to RxNorm codes that things started making sense. Still, it’s hard to track things like when the patient is taking half of a 20mg tablet then starts taking a whole one, etc. That kind of documentation often winds up as unstructured data that can increase patient risk unless that unstructured data is kept attached to the medication list, which some systems don’t allow.

There were also comments about the fact that some providers don’t have any concept of ownership of the medication list. I saw this often in my past life as a primary care physician, when I would receive dictated letters from consultants that were missing most of the medications the patient was actually on. When transitioned to the EHR, these providers still didn’t feel the need to participate with the medication list, let alone try to perform a reconciliation. I saw at one hospital when they made reconciliation the job of the admitting physician of record that the procedural subspecialists (particularly orthopedic surgeons) developed a new habit of having the patients admitted under the PCP with themselves as consultants. In that case, no good policy goes unpunished.

At the same time this discussion was unfolding, I was contacted by a client who recently implemented functionality that allows them to electronically cancel prescriptions. Unfortunately, their local pharmacies don’t yet support this feature, which led to several days of confusion until they figured out what was going on and returned to their phone-based process. Until the pharmacies upgrade their systems, there’s little more I can recommend other than calling the pharmacies and discussing the impact and asking them to lobby their corporate bosses for an upgrade.

This has been the plight of physicians for some time now, as EHR vendors are forced to add functionality that isn’t supported in the real world. Despite electronic prescribing of controlled substances being required in several states, it’s not required in my particular locale. As a result, only a little more than half of pharmacies support the functionality. It’s kind of like being required to have LOINC codes for interfaced lab results but there not being a requirement for vendors to send the codes with the result transmissions.

I’ll be interested to see what comes of the medication reconciliation discussions and whether there is scholarly activity that might push vendors or regulators to change how they hope to steer medication reconciliation in the future. I was encouraged by the number of people willing to engage in the discussion or collaborate in future projects. A group of motivated clinical informaticists is a powerful thing indeed.

How do you feel about the current state of medication reconciliation? Email me.

Email Dr. Jayne.

Morning Headlines 7/6/17

Heritage Valley Health System Restores Services at All Locations

Heritage Valley Health System (PA) announces that it has restored network services across all of its hospitals and clinics following a June 27 “NotPetya” cyberattack that forced operations back to paper.

What Jared’s office actually does

Poitico reports that Jared Kushner and his Office of American Innovation worked behind the scenes with VA Secretary David Shulkin and DoD Secretary James Mattis to resolve the agencies longstanding IT issues, brokering an agreement between the two to consolidate on a Cerner EHR platform and approving the VA’s request to side-step normal procurement procedures.

Million Veteran Program Surpasses 580,000 Enrollments; Faces Cut

The Million Veteran Program, a large-scale research project being launched by the VA to study how veterans’ genetic profile, medical history, and military service affect their health, has recruited 580,000 participants, but faces challenges amid cuts to the VA’s research and IT budgets.

Patrick Soon-Shiong’s NantWorks to take over St. Vincent and 5 other California hospitals

NantWorks, the health tech startup of Patrick Soon-Shiong, acquires six California hospitals, to which Soon-Shiong notes “I’ve spent the last decade of my life quietly building this infrastructure. This system will provide an experiment at scale.”

Readers Write: Moving the Adoption Needle on Electronic Prior Authorization: What Stakeholders Can Do

Moving the Adoption Needle on Electronic Prior Authorization: What Stakeholders Can Do
By Tony Schueth

Tony Schueth is CEO and managing partner of Point-of-Care Partners of Coral Springs, FL.

Prior authorization (PA) is a major pain point for both prescribers and payers (health plans and PBMs). That is because there are significant administrative costs and patient-safety issues associated with today’s antiquated paper-phone-fax PA processes. The number of PAs is increasing, causing stakeholders to look for a solution to keep ahead of the PA curve. The answer is electronic PA (ePA), which is available today. Yet, while headed in the right direction, uptake isn’t where we’d like it to be.

Manual prior authorization and utilization review create burden on providers and payers alike. According to a recent article in Health Affairs, physicians spend $37 billion annually ($83,000 per doctor) thrashing out PA and formulary issues with payers. According to another estimate, doctors spend 868.4 million hours on PA each year, not counting time devoted by other staff members. Payers incur up to costs of $25-$40 per PA, plus risk to downstream CMS rebates and medical cost savings.

Perhaps most importantly, the difficulties inherent in trying to obtain a PA significantly affect the quality of care and patient safety. According to a survey by the American Medical Association (AMA), most physicians experience a delay in excess of a week for their PA request to be processed. Some 70 percent of prescriptions rejected at the pharmacy require PA; of those, 40 percent are eventually abandoned due to the complex, paper-based PA process. The PA process impacts more than 185 million prescriptions each year and results in nearly 75 million abandoned prescriptions.  

These issues will only be exacerbated as demand for PA increases. This is due to several factors. First is the robust pipeline of new specialty medications, the majority of which require PA. Second, the demand for specialty medications is rapidly increasing because, in large part, of the rising number of chronically ill patients who rely on specialty medications.

Because of increased specialty medication utilization — coupled with the reliance on today’s antiquated paper-based processes — prescribers, pharmacies, and payers will be unable to keep pace with the anticipated flood of new specialty prescriptions and related PA requirements. Patients will have delays in obtaining needed therapies or will forego them altogether if prescriptions are abandoned due to administrative delays. Quality and patient safety are at stake.

Now that the need for process improvement and efficiencies is imperative, stakeholders are beginning to coalesce around the promise of electronic prior authorization (ePA). This solution is in keeping with the trend toward automation of healthcare and the wide-spread adoption of electronic prescribing, which is used by 75 percent of ambulatory physicians. Standards to support the ePA transaction are in place. Vendors are emerging that can handle the transaction. States are jumping on the ePA bandwagon, with several requiring use of ePA in the near future and others expected to follow suit. It won’t be long before the federal government is expected to mandate ePA as well.

That said, use of ePA is not to the point of bringing robust value for all stakeholders. Electronic health record (EHRs) can support the ePA process, but not all of them have that capability. Physicians may not know that their EHR supports ePA and it could be integrated into the workflow.

What can be done to move the ePA adoption needle? Here are some things stakeholders can do now.

Prescribers should:

• Ask their EHR vendor about their system’s ePA functionality. If it is not available, push for it as an enhancement request.
• If integrated ePA is available, start using it as a way to improve return on investment (ROI) in the EHR. Electronic PAs get adjudicated much more quickly than prior authorizations submitted on paper via fax. ePA also can reduce costs and improve the quality and safety of patient care. These metrics are increasingly important ingredients of value-based care, alternative payment models, and related reporting requirements.

EHR vendors should:

• Make prescribers aware of their product’s ePA functionality and how it is used. This educational component provides value to the buyer and also could be a differentiator in the market.
• Get ahead of regulatory mandates by either the federal government and the states. Savvy vendors will not wait for the regulatory shoes to drop and then play catch up. This can be costly and affect market share.
• Build competitive advantage. While some of the major EHRs have incorporated ePA, many of the small and medium-sized EHRs have not. Practices and integrated delivery networks are overwhelmed by the growing number of PAs. They are demanding relief, which can only be solved through the availability of ePA. This also is an attractive selling and retention point.

Health plans and PBMs should:

• Adopt ePA functionality that is beyond the basics. Research shows that many PBMs have minimal ePA processing capabilities. Improving ePA processes and question sets will improve efficiency, reduce costs, and add value.
• Push prescribers to adopt and use ePA. A legitimate ROI can be demonstrated, but only if functionality is used.
• Take full advantage of the feature set included in the NCPDP SCRIPT standard for ePA. Supporting more of the features available in the standard will reduce the need for attachments, thus reducing turnaround times and increasing efficiencies. This translate into cost savings.

Advancing ePA requires focused effort by all stakeholders, but the time is right and the technology is ready.

HIStalk Interviews Peter Smith, CEO, Impact Advisors

Peter Smith is co-founder and CEO of Impact Advisors of Naperville, IL.

Tell me about yourself and the company.

Impact Advisors is a full-service healthcare consulting firm. We specialize in strategy, process improvement, technology, and implementation. We work primarily for the healthcare provider segment, so all flavors of hospital systems as well as large providers and physician practices. I’ve been at it for about 10 years now. I’m looking forward to continuing our service to the industry.

What are the most pressing problems of health system CIOs?

There’s are a couple of things, and these are driving our business as well. If you look at the context of where people are, that will help understand where they’re going. Many of our clients have already implemented their core transactional systems, whether it’s EMRs or revenue cycle systems. Now they’re looking to harvest and move to the next generation of information. 

One of the biggest challenges is that now that the transactional systems are stabilized in many environments, how do you use all that information to create a valuable experience and valuable best practices for medicine and valuable interactions with your patients and community? Really turning that corner. You’re seeing things like analytics and business intelligence become very important. You’re seeing things like the patient /consumer experience and digital transformation driving the industry right now.

Are health systems really interested in interoperability and are they and their EHR vendors making progress to make it happen?

Interoperability is a huge hot topic in the industry. It’s critical for enabling the strategies of both health providers and beyond just the single providers in terms of creating an ecosystem of health across large communities and regions. Interoperability remains at the forefront. There has been tremendous progress. The major vendors are both adding capability and interest, and more importantly, energy to creating interoperability platforms.

As these ecosystems get larger and the need for organizations to trade information among partners — whether they’re payers, other healthcare providers, or the patient themselves — you’re seeing a real push for providing open and transparent information to a much larger community, such as healthcare partners, patients, and families.

Interoperability still remains at the forefront and there’s been tremendous progress. The industry and the environment will continue to demand it.

Have hospitals become more cautious about their technology spending as they wait to see how Affordable Care Act changes will affect them?

Everybody’s in a state of uncertainty as to what the new legislation might bring. Many of our clients in the provider segment of the industry are reacting in the exact way you described. They’re waiting to understand what it is, so there’s almost a little bit of a pause right now in terms of thinking about what the future might bring and waiting to see how this will unfold.

That being said, some of the fundamental things that need to be done in healthcare are still going to be here, independent of the legislation. Organizations continue to be conscious of cost and expense as their reimbursement models change. No matter what the legislation will bring specifically, you’ll continue to see this trend from volume to value. With that comes some significant implications to the organization. How do you deliver care in a more efficient, higher-quality manner? Those fundamental characteristics will remain important to our organizations.

Even though there’s a slight pause in a moment of uncertainty, people are still moving ahead fairly actively with the foundational things. Process improvement and new technology solutions will continue to be important no matter what the legislation might bring. Healthcare is obviously very dependent on legislation and policy, but it’s also dependent on the fundamental undercurrents of economics — doing the right thing at a better price point and a higher quality.

Is Epic starting to look more like Cerner as it broadens scope to offer hosting and revenue cycle services?

I don’t know if their specific strategy is to look more like Cerner. It might be more happenstance of the environmental factors that are driving them. I can’t speak for Epic, but I imagine that their clients are asking them to do more given the relationships they’ve had with them historically. Hosting was a natural evolution for them. Providing some level of business process services is also an evolution for them.

My guess is that it’s being driven by a couple of factors. Obviously there’s some gaps in the industry around that and some of those services are probably ripe for the same level of aggregation, consolidation, and high-quality services that Epic has historically brought to the table, as well as Cerner. That and the fact that there’s probably client demand, and if you look at Cerner and Epic particularly, they have both been fairly consistent at the higher end of the market, the larger, more complex organizations. If they move into the middle market, combining a package of services is probably going to be important going to that segment of the industry.

It all made logical sense to us and we wish them both well. Cerner has had a long track record of being very successful and I suspect Epic will as well.

What was your reaction when the VA announced that it was going to implement Cerner before it negotiated a contract or developed a broad project plan?

I was encouraged that the VA and the DoD went in the same direction. Granted, it’s very different patient populations. We recognize that, but having some consistency in solutions across our Armed Services support environment could eventually pay some dividends. I didn’t have a dog in the fight either way, but I appreciate the consistency of having the potential for a single platform across the entire environment.

What will be the industry fallout following Nuance’s cybsersecurity-related cloud services outage?

It’s unfortunate for Nuance that they are in the news. Any vendor, particularly those providing ASP cloud services, is ripe for breaches and security issues. It’s just so prevalent right now. Our expectation is that threats will increase and get more serious, more complex, and more sophisticated. Obviously this has been a bad week for Nuance, but this could happen to almost any vendor given the scale and magnitude of what’s going on.

The event will will raise awareness and visibility. Nuance will obviously react appropriately. It’s going to hurt, but they’ll be able to survive that and learn from it and provide better, more secure solutions moving forward. The industry is going to learn from it. These high marquee visible threats and breaches will make everybody stronger. Its unfortunate that Nuance will have some significant issues as a result of this, but it will ultimately make the industry stronger.

I don’t think anybody — whether you’re a vendor or you’re a client or a provider — will be impervious to this. It’s something we have to deal with on a day-to-day basis. We work with our clients to prepare themselves, but the message is to understand that it’s not a matter of if, but rather when you get hit, unfortunately.

What are the characteristics of startups that are finding success working with health systems?

You’re going to continue to see innovation, and I hope we do. It’s an important part of the industry and an important part of the growth of the industry. Innovation around the periphery will extend and grow. 

You’ve obviously seen a lot of innovation in the BI and analytics space and a lot of vendors moved into that space. Not all of them will survive, but the good ones will. You’re seeing who can bring a better product to the market that has the opportunity to aggregate, as an example in this case. Those products will come in in a focused way and then expand based on their ability to deliver in the marketplace. It’s similar on the patient / consumer experience side.

How will the agenda of vendors and customers change in a post-Meaningful Use environment?

The vendor marketplace is seeing a stratification of vendors. A couple of vendors continue to gain market share and continue to sell. Then there’s a tier of vendors that are probably a little less dynamic, more static in terms of their market share. My guess is that their primary strategy is to preserve their existing client base and then add around the margins to that space. The strategy of the vendors that have been dominant over the last couple of years is to develop new, interesting products and extend their continuum of product and services.

There’s another factor here, too. Everyone has assumed that the EMR market has diminished. It has. It has not grown as substantially as it did in the Meaningful Use era, but there’s still a lot of work out there deploying EMRs. One of things that is driving that is all the mergers and acquisitions. You’re seeing a tremendous amount of aggregation in healthcare, both locally and regionally, and that is fueling the replacement of a number of EMRs as you move to the hosts or the acquiring provider’s platform. There’s still a lot of work out there to be done.

What trends are you and your competitors seeing that will drive the consulting business?

From a consulting standpoint, the most important thing is to continue to innovate your services as to what the market needs. Per the previous question, we’re incubating and delivering services now around things we think will be important to our clients in a year or two. We’re actively working on digital transformation, patient / consumer experience, BI, and analytics.

We still do a lot of work in EMR replacement. There won’t be as many huge implementations as there were in the Meaningful Use era. They’re more likely to be smaller or medium-sized implementations and in smaller providers, smaller community hospitals who are a little late to the game in terms of transitioning. We re-architect our services to be nimble, quick, and efficient for that market.

What trends will be the most important to follow in the next five years of healthcare IT?

The infusion of information into the healthcare delivery process is of tremendous importance. That infusion of information will come in many ways. We’re seeing the tip of the iceberg of what information can do to healthcare. You are going to see standards and best practices around treatments and delivery of care. That clinical and economic information will make a tangible difference in how you diagnose and treat patients as it works its way to the point of care. Not retrospective information, but point-of-care information based on best practices, based on very customized, personalized medicine and genomics.

Another trend is that we will see tremendous digital relationships that organizations will have with both patients and their families. We’re on the cusp of that. Not just portals and things like that, but a real relationship with the patient, and probably more importantly, their families to deliver care. Not only the information exchange, but wearables and discrete technologies that we’re going to be using. All those components of healthcare will revolutionize how we deliver care.

Those are the things I’m excited about, that we’re shaping our services around, as they will drive demand for the next couple of years.

Morning Headlines 7/5/17

Google DeepMind trial failed to comply with data protection law

In England, the Information Commissioner’s Office concludes that Royal Free NHS Foundation Trust broke data privacy laws when it handed 1.6 million patient records over to DeepMind, a Google business unit applying AI to healthcare problems.

Chief medical officer calls for gene testing revolution

England’s Chief Medical Officer Sally Davies, MD focuses the entirety of her annual report on the potential of genetic testing, calling for an increase in the routine use of genomics testing in treatment and preventative care.

T-MSIS Data Not Yet Available for Overseeing Medicaid

An OIG report concludes that adoption of the Transformed Medicaid Statistical Information System, a database comprised of state and federally reported Medicaid data, is behind because there is no fixed deadline for when States and CMS must begin participating.

Morning Headlines 7/4/17

Roche buys diabetes app firm in digital health push

Swiss pharmaceutical company Roche acquires mySugr, a Vienna-based diabetes management platform, to expand its patient-facing app offerings. Financial details were not disclosed.

The ice bucket challenge, made famous by ALS patient Pete Frates, raised millions. Here’s how the money was used

Pete Frates, the ALS patient behind the Ice Bucket Challenge, has been hospitalized. STAT recaps how the $115 million his idea raised was used.

Building Unity Farm Sanctuary – First Week of July 2017

John Halamka, MD and CIO of BIDMC updates readers on recent improvements he has made around his 60 acre farm.

Curbside Consult with Dr. Jayne 7/3/17

No surprise here. A recent survey by the American Medical Association finds that physicians don’t feel they are prepared for quality reporting rules. The survey reached out to 1,000 practicing physicians who have been involved in discussions and decisions related to the Quality Payment Program within their practices. Nearly 90 percent of the physicians find MACRA’s requirements burdensome, with fewer than one in four feeling well prepared to meet those requirements in 2017. Specific areas cited as burdensome included the time required to report performance, understanding requirements, MIPS scoring, and the cost to capture and report data.

The AMA data notes that a little more than half (56 percent) of physicians plans to participate in the Merit-based Incentive Payment System (MIPS) with 18 percent expecting to participate in Advanced Alternative Payment Models (APMs). There were also some interesting statistics on how well physicians feel they understand MACRA and the QPP. Although 51 percent of physicians feel they are somewhat knowledgeable about the topics, only 8 percent describe themselves as deeply knowledgeable.

Although previous participation in quality programs such as PQRS and Meaningful Use seems to have helped physician readiness, only 25 percent of those with prior reporting experience feel well-prepared for the QPP. There were also concerns raised that those who may be prepared for 2017 reporting may not have the long-term financial strategies in place to succeed in 2018 and beyond. Small practices were called out as needing more assistance to be prepared, where large practices were more likely to be concerned about the organizational infrastructure needed to effectively report data.

Where the larger practices were more likely (79 percent) to have previously met Meaningful Use Stage 2, the smaller practices were mixed with 45 percent yes, 44 percent no, and 12 percent not knowing whether they had previously complied or not. Not surprisingly, primary care specialists were more likely to participate in APMs than non-primary care specialists (22 percent vs. 15 percent respectively). Multi-specialty practices seemed to be better prepared than hospital-based, solo, or single-specialty practices with greater participation in Advanced APMs and more optimism around a positive payment adjustment in coming years.

The report notes that its findings support assumptions that although some challenges are universal, small practices will need more assistance in meeting their goals. There is opportunity for CMS, medical societies, and other stakeholders to educate physicians and to help practices prepare for success.

Although the report doesn’t mention them specifically, some of those other stakeholders include vendors and consultants. I’ve seen a pretty significant uptick in messaging from the latter, although nearly all the emails I receive seem to be for clients on Epic. The vendor emails I receive are mostly targeted towards smaller practices who may not be on an EHR or who are looking to switch. These communications make everything look pretty rosy as far as ability to report on their platforms, but neglect to mention the amount of work needed to complete a conversion or bring a practice live on EHR in the first place.

My vendor is actually pretty good at providing information around the various quality and regulatory programs out there, even though it’s a niche specialty vendor and many of its clients have opted out of Meaningful Use in the past and plan to opt out of quality programs in the future. Whether your practice has opted out or not, there needs to be an ongoing dialogue and analysis to make sure that their plan still makes sense. Payer mixes can shift over time, especially with an aging population, and what may have made sense a couple of years ago may not make sense moving forward.

For independent practices, ongoing dialogue is also needed with local health systems or hospitals to determine how their strategy for value-based care will impact everyone else. There are several major players in my area, and none of them seem particularly interested in sharing data with the little guys, especially when smaller groups are potential competitors for procedural volume. It still seems to be less about the patient or controlling costs than it is about market share. I have yet to see any medical staff meetings devoted to helping admitting physicians stay in business by learning how to handle Meaningful Use or MIPS. I do see a lot of attempts to purchase practices, however.

CMS does seem to be trying to do its part to educate physicians, and recently released some new resources on its Quality Payment Program website to try to help us through the maze. At least two of the new resources – MIPS Measures for Cardiologists and Advancing Care Information Measure Specifications/Transition Measure Specifications – are updated versions of previous documentation. This highlights the difficulty in staying up on everything, and the fact that even when you think you have the game figured out and have put processes in place, the game can change. Other resources include vendor lists for Qualified Clinical Data Registries (QCDRs) and Consumer Assessment of Healthcare Providers & Systems (CAHPS) for MIPS. This highlights the complexity of the program, where many participants need to work with multiple vendors to even have a chance of doing it right. The list of new documents is rounded out with an Introduction to Group Participation in 2017 MIPS and a MIPS Measures Guide for Primary Care Clinicians.

I was a little disappointed in the primary care document, which seemed to be overly general and was described as a “non-exhaustive sample of measures that may apply to primary care.” It seemed to be more of a filler to point physicians to the main QPP.CMS.GOV site for more information. Even for those of us who have been steeped in the content, requirements are pretty complex and implementing them is daunting if you haven’t done the pre-work to get all your clinicians on the same page and operating as a cohesive organization. The majority of the consulting work I’m doing these days seems to be in the change management / change leadership space, where I spend a fair amount of time trying to convince reluctant providers that having standardized care plans and office processes really is a good idea and not an infringement on their individuality.

Regardless of our feelings about it, MIPS, the QPP, and Meaningful Use (Medicaid-style, at least) are not going away. It will be interesting to see how physicians feel about their level of understanding a year or two from now.

Are you ready for MIPS? If not, why? Email me.

Email Dr. Jayne.

Morning Headlines 7/3/17

Nuance Healthcare: Impacted Customer Update

In Nuance’s most recent cyberattack update, the company says that its Emdat eScription RH service is being brought back online.

Department of Veterans Affairs IT Project In Danger of ‘Catastrophic Failure’

A $543 million project to implement real-time location service tracking software across VA medical facilities to help track medical equipment has been setback by a slew of previously undisclosed problems, including failed operational tests and questions over whether VA WiFi networks can adequately support the new tracking equipment.

Day 4: Princeton Community Hospital diligently rebuilds network after cyberattack

Princeton Community Hospital (WV) continues to manually rebuild its network following a cyberattack that forced clinicians back to paper. The hospital’s  IT department is installing new hard drives across all of its computer and reports that “fifty-three new computers have been installed throughout the hospital offering clean access to Meditech.”

Patients are losing patience, and they’re speaking out

The Boston Globe reports on patient satisfaction amid the tendency of practices to double book provider schedules, sometimes leaving patients waiting an hour past their scheduled appointment.

Monday Morning Update 7/3/17

Top News

Nuance’s post-malware update says the company is bringing Emdat (aka eScription RH) clients and MTSO partners back online, but eScription Large Hospital remains down. 

Nuance advises transcription customers that use BeyondText or iChart Hosted Solutions to have their physicians re-dictate their documents going back to 48 hours before the incident that occurred this past Tuesday, June 27. 

Reader Comments

From Judy Fake-ner: “Re: Hoag Health (CA). Will be leaving Allscripts Sunrise to join Providence-St. Joseph Health’s Epic system. Heritage Medical group is also transitioning from Epic to Allscripts.” JF sent over an internal Hoag memo from February 2017 that explained why it’s moving away from Allscripts.

From Amphibious Assault: “Re: [company name omitted]. I asked the CEO what publications his team reads. He said that everybody just reads HIStalk.” Thanks. We have that in common, then.

From Gitche Gumee: “Re: EHR access rules. Why can’t EHRs include an alert notifying the privacy offer if staff look at information without need, such as someone accessing records from a patient last treated six months ago with no treatments scheduled? There’s a legal case pending where we found 252 breaches in confidentiality on 12 patients over a 12-month period, where we can’t determine why someone would need to access their clinical information.” 

From EMRDoc: “Re: Nuance outage. It is interesting and somewhat ironic how providers who were not previously interested in templates, smarttext, autotext, etc. are suddenly hungry for education about those tools for creation of documentation. This outage may be the best thing yet for user adoption! We also appreciate Nuance’s action to make voice recognition licenses and microphones available to assist with the outage. Ironically, this outage may inadvertently result in a decrease of our overall transcription volume in favor of front end voice recognition.”

From EHR Datahacking MIPS Solutions: “Re: MIPS data submission. Is it ethical to skim EHR database schema? This is being offered as a service and professional societies are lapping it up since it is cost effective (offshored). The database design allows intelligent guessing of which data fields house the patient-specific data needed for MIPS/PQRS quality submission, which appears unethical. Only Epic is smart enough to have controls in place to ward off unauthorized use of its databases. The accuracy of the data extracted and submitted to CMS is a different can of worms.”

HIStalk Announcements and Requests

One-fourth of poll respondents say they’ve lost an IT job due to a new system’s implementation. Just a Nurse Analyst says she walked away from her job (and her five Epic certifications) after seeing the “creepy” situation in which Epic was directing hospital staffing decisions and pushing the CIO with threats to go to the CEO. Furydelabongo experienced poorly executed layoffs at a previous health system employer that was desperate to find operating dollars to support “an Epic project run amok with consultants” once requesting more capital dollars became distasteful. Greek CIO says he/she was displaced when Eclipsys convinced hospital management to outsource all of IT to the company at a 300 percent increase in staffing cost.

New poll to your right or here: For Nuance users: how much business will you give the company following its cloud services outage?

My “summer doldrums” special deal on newly booked webinars and sponsorships is winding down after a few companies jumped on board. Contact Lorre.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Listening: new from Iowa’s Stone Sour, moving away from their last couple of progressive-type albums to pure alternative metal that invites vigorous, four-limbed desk-drumming (as I can attest). Also: Diablo Blvd, catchy hard rock from Belgium with a singer who – no joke – is a stand-up comedian. 

This Week in Health IT History

One year ago:

• Allscripts sues former chief marketing and strategy officer Dan Michelson and his new employer, Strata Decision Technology, claiming that Michelson and the company used confidential information to displace Allscripts as the top-ranked product in KLAS’s “Decision Support – Business” category.
• McKesson announces that it will spin off its Technology Solutions business into a new company that it will co-own with Change Healthcare.
• Definitive Healthcare acquires Billian’s HealthData.
• A study finds that PCs and servers that control hospital medical equipment are often running old versions of operating systems that make them vulnerable to malware attacks.

Five years ago:

• MModal announces that it will be acquired by a private equity firm for $1.1 billion in cash.
• The Supreme Court upholds the legality of the Affordable Care Act, including its requirement that every American carry medical insurance or pay a fine.
• In England, Cerner complains to Cambridge University Hospitals Foundation Trust that its EHR bidding process was a sham and that it had already settled on Epic before launching it.
• The government of Australia admits that the signup function of its just-launched personally controlled record system had to be taken offline when it was found to not support hyphenated patient names, with Accenture getting the blame.

Ten years ago:

• Francisco Partners acquires Dairyland Healthcare Solutions.
• Mediware President and CEO James Burgess announces his resignation.
• PSS World acquires a 5 percent stake in Athenahealth for $22.5 million.
• Apple provides developer information for the just-released iPhone.

Weekly Anonymous Reader Question

Responses to last week’s question:

• 50 hours, six days per month on the road.
• I’m a woman who just hit child-rearing years, so now I’m down from 75 percent max to just above 0 percent. I like having a husband!
• 45 hours, not counting time I spend reading industry, technology, or professional development articles and books. Travel approximately 5 percent or about 2.5 weeks a year
• Work hours should be held around 50. As for travel maximum, it should be 1 1/2 weeks per month.
• 45 hours and 10 percent travel.
• 40-45 hours per week and 20 percent travel.
• Work hours including time in the air? Does this include the number of days that require me to leave my family on a Sunday afternoon? Work hours range from 50-75 depending on where I am traveling. I typically travel 50-60 percent of the days during a month.
• Three days, three nights. What’s that saying? “Fish and company start to stink after three days.”
• 9-5, work from home option. 10 percent travel requirements.
• After years of 80 hours per week and 75 percent travel, I’ve found balance and what’s important in my life. At this point, I wouldn’t do more than 50 hours per week and 25 percent travel.
• 45 hours of work, per week. 10-15 percent travel (1x/month ish).
• 40-45, one week up to a couple times a year.
• In my line of work (consulting), job opening are pretty thin right now so my expectations have changed a bit. I would hope to limit travel to three days a week, and a corporate mindset that if travel isn’t necessary to move the project forward, we don’t travel. I’d hope to find a culture where weekend hours are not the norm.
• About 45 hours per week. Special projects may require more occasionally, but if you need me more than that, then you have an issue with resource allocation. For a position which requires travel, every hour, from the arrival at the originating airport to the destination, should be counted as a work hour, especially since I am expected to be on calls or work while in transit. So, roughly the same hours, with some exceptions. And if traveling on a weekend or holiday—comp time.
• Don’t recall going at it with that focus in mind. However, now that I’m away from the the travel jobs and requirements, I can share that, yes, it’s typically the case that you arrive at client’s site around 7:30-8:00 a.m., usually work through “breaks” and lunch so you can “answer client questions,” you leave around 5:30-6:00 p.m. (maybe later if you need to meet with the doctors after their workday is done). After grabbing some dinner back at the hotel, you go back to your room and start making edits to a template, writing up a report, answering emails, etc. and finally call it a day around midnight. And that is just the M-F schedule, not the catch-up on the weekend. If I added up all the hours, I’m guessing I earned $2.75/hour! I don’t honestly know how I would have limited the weekly work hours and travels requirements and still kept my job. Can’t say I miss it! Not that part anyway!
• 50 percent.
• 50 percent, less than 10 nights out per month.
• 60 hours per week, no more than 75 percent travel.
• Realistic expectation based on 25+ years in travel roles: M-F belongs to your work life. You’ll work as many hours as needed for whatever phase of the project, and travel however many hours are required to get to/from the client site(s) for the week of work. If you are lucky there will be slow-ish weeks where you can get out in the evening and sample the local culture. Be sure to protect your weekends/holidays else the lines will start to blur and you’ll find that your work IS your life.
• 70 hours. What a blessing that would be after working conference meetings while carrying on numerous marketing functions, launching new campaigns, presenting annual budgets with their justification, training sales, producing new materials, securing new clients, and creating new products. During my 25+ years in the healthcare business, I’ve slept possibly three hours a night, missed my child growing up, and have lost more relationships than I can count – never mind the issues this took upon my health. I’m happy to travel at any level and take certain conference calls while on the road. However, when I am on the road and taking two conference calls in each ear while being asked to speak with a prospect or answer sales questions is unreasonable. I travel typically during the evening on my own time. However with time changes, conventions, conferences, prospect and customer meetings, as well as bosses’ schedules, the calls tend to eat up valuable face time with clients and prospects. Working from 5:00 a.m. to 2:00 a.m. simply to meet expectations is unreasonable, then add the travel to that schedule is not an acceptable demand. I don’t mind working a 70 hour week, but 126 hours a week is a two-person job. 70 hours per week, excluding evening travel, seems much more reasonable than 126.
• A limit of 200 work hours per month and 15 days of travel, with the hours spent in transit counting against the work hours limit. If either limit is exceeded, travel in business or first class would be required. Expense limits on hotels, meals, and incidental expenses need to be realistic for the locations visited.
• 50 hours, 50 percent.
• Particularly in light of the efficiencies of teleconferencing , my limits would be no more than 50 hours weekly and 10 days of travel per month. Average should be 40 hours with seven or less days of travel.
• 50 hours per week and travel only seven days out of the month.

This week’s question: for those who are allowed to work from home for at least one day per week, what restrictions or requirements does your employer impose? It would probably be informative to describe (in high-level terms) what your job involves since it’s likely to be a lot different for a software developer than an implementation consultant.

Last Week’s Most Interesting News

• An apparent ransomware attack takes some of Nuance’s cloud-based services offline.
• CMS cancels its scheduled release of Medicare Advantage data to researchers at the last minute, citing data quality concerns.
• The chairs of the Senate Veterans Affairs and Armed Services committees urge the VA to seek the DoD’s advice in its Cerner contract negotiation and implementation.
• Google offers consumers the ability to request that their exposed medical information be filtered from its search results.
• Anthem agrees to pay $115 million to settle a class action lawsuit involving its 2016 hacker breach of 78 million records.

Webinars

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.

Sales

Wisconsin’s Department of Health chooses Cerner for its seven care and treatment centers in a 10-year, $33 million contract. In-state competitor Epic did not submit a proposal for the project, which drew five bidders.

Decisions

• Cedar County Memorial Hospital (MO) will replace NextGen Healthcare with Meditech in 2018.
• Rankin County Hospital District (TX) will go live on Cerner by November 2017.
• Christus Mother Frances Hospital – Sulphur Springs (TX) will replace Meditech with Epic in October 2017.
• Teton Valley Hospital (ID) will move from Healthland to Athenahealth in September 2017.
• Liberty – Dayton Community Hospital (TX) will go live on Cerner in March 2018.

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

People

Sandy Rosenbaum, SVP of contracts at Iatric Systems, died June 21, 2017. The Alzheimer’s Association fundraiser launched in her honor by her husband — Iatric founder and CEO Joel Berman — has raised $223,000 vs. his goal of $10,000.

The family of former Sutter health CIO John Hummel launches a fundraiser looking for help covering his rehabilitation costs following a fall-related head injury that has depleted his insurance benefits and personal funds. His LinkedIn profile says he’s now director of IS at Taos Health System (NM).

Announcements and Implementations

Learn on Demand Systems adds an API-accessible instant notification engine to its training management and lab-on-demand learning systems, allowing instructors to send tips to particular students or to send commands that the student can play back in their lab console.

The patent office issues five new patent allowances to Glytec for its diabetes therapy management software, raising the company’s allowed/issued patent total for EGlycemic Management System to 11, with another 50 pending.

T-System integrates EBroselow’s SafeDose and SafeDose Scan medication calculations functionality into its T-System EV EDIS.

Sphere3 releases Aperum Enterprise, which allows health systems to analyze nurse call light data and patient feedback to set patient experience benchmarks.

Government and Politics

Austin, TX-based VA officials warn that the department’s $543 million real-time location (RTLS) system is in danger of “catastrophic failure” as the overdue system has failed operational tests and may not work on the the VA’s WiFi network. The VA pitched the system as the solution for managing inventory and ensuring equipment sterilization, but a DC hospital site visit found that the lack of a functional system has caused supply crises that have required cancelling surgeries and using expired surgical equipment. A VA employee’s email referred to the former HP Enterprise Services (now DXC Technology) as “nitwits” and refused to give the company access to its backup systems, while the company blamed VA incompetence. The company’s RTLS subcontractor is Intelligent InSites. Employees at the same DC medical center are refusing to use Catamaran, a $275 million predictive analytics supply chain system whose contract has since been terminated.

Privacy and Security

Princeton Community Hospital (WV) remains down as its IT department continues to “build an entirely new computer network and install new hard drives on all devices throughout the system” following last Tuesday’s ransomware attack. The hospital lost access to all systems, email, and the Internet but has since installed 53 new computers to provide access to Meditech.

A Connecticut hospital warns local residents that scammers are spoofing its caller ID to demand that they send payment for medical services.

Other

A West Virginia community college hosts a week-long Drone Camp for high school students, with funding for the 12 drones provided by Cabell Huntington Hospital (WV) via VP/CIO Dennis Lee, pictured above with the participants. 

The Boston Globe says consumers are losing patience with waiting room delays caused by intentional provider overbooking to maximize profit. The article observes that many hospitals don’t even monitor delays, possibly because despite alleged consumerism, their waiting rooms remain full. Possible solutions include hiring a patient flow coordinator to monitor delays, giving patients pagers so they aren’t tied to their chair waiting for their name to be called, posting notices on the board when doctors are running late, and tracking patient flow by RTLS.

An Oregon trauma surgeon designs and creates a $50 3D-printed hand and forearm for a six-year-old.

Sponsor Updates

• ZirMed receives HFMA Peer Review Designation for its charge integrity and claims management solutions and also announces that its charge integrity solution has identified $7.5 million in recoverable net revenue for Novant Health.

Blog Posts

• Four Ways to Get Revenue Integrity Right (Sagacious Consultants)
• 4 Tips for Keeping Your Inbox Secure (Salesforce)
• HFMA ANI Day 1 Recap (The SSI Group)
• 4 Simple Tricks to Becoming Everyone’s Favorite Practice (Solutionreach)
• Step up your game: how to improve risk adjustment coding accuracy (Verscend Technologies)
• Can you? Visage can. Chapter 4: In-Viewer Workflow (Visage Imaging)
• Not-so-lazy days of summer. (Voalte)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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Morning Headlines 6/30/17

Nuance Healthcare: Impacted Customer Update

Nuance launches a webpage to keep customers informed of its progress restoring services following a cyberattack that took down its hosted services.

Petya.2017 is a wiper not a ransomware

A blogpost on Petya explains that its not technically ransomware because it does not attempt to solicit money from victims and offers no options for reversing the damage it causes.

Medicare Halts Release of Much-Anticipated Data

CMS cancels the highly anticipated planned release of Medicare Advantage data to researchers, which was scheduled to be released at the annual research meeting of AcademyHealth.

Former DoD acquisition chief Kendall joins Leidos board

Frank Kendall, the former DoD undersecretary for acquisition, technology and logistics, joins the board of directors at Leidos, effective immediately.