EClinicalWorks Will Pay $155 Million to Settle DOJ False Claims Act Allegations

EClinicalWorks will pay $155 million to settle a federal False Claims lawsuit alleging that ECW misrepresented its EHR product and paid customers kickbacks for promoting it, the Department of Justice announced today.

The government claims that ECW fraudulently obtained certification for its EHR by hard coding some of the testing elements as provided to its certifying entity. It also says ECW’s software did not accurately maintain a user audit log, did not reliably record diagnostic imaging orders, failed to perform drug interaction checks, and failed to meet interoperability requirements, thus causing false claims for HITECH incentive payments to be paid by HHS.

According to ONC’s Certified Health IT Product List, ECW’s Authorized Certification Body is Drummond Group.

The company and three of its founders will pay the $155 million settlement.

ECW also entered into a five-year HHS OIG Corporate Integrity Agreement that requires the company to have its software quality control systems externally audited and reported to HHS OIG. The company also agreed to provide prompt notice to customers of any EHR-related safety issues, to make software updates available at no cost, and to assist customers in migrating to other EHRs without charging them. ECW is also required to hire an Independent Review Organization to certify that the company’s agreements with providers comply with anti-kickback laws.

The whistleblower lawsuit was filed by Brendan Delaney, a software technician with New York City Division of Health Care Access and Improvement, who will receive $30 million of the settlement.

I’ve run several reader-provided rumors about the Department of Justice investigation, going all the way back to late 2015.

Digital Health Trends – 2Q17

Digital health updates are written by LoneArranger, an anonymous industry insider.

Digital health capabilities are increasingly becoming more integrated with core healthcare platforms and provider workflows, leading to major changes in the way healthcare is being delivered. There have been several recent developments in the application of technologies such as artificial intelligence, virtual and augmented reality, and wearable devices that have been disruptive, have the potential to change the practice of medicine and transform population health management and precision medicine.

Innovations in areas such as mobile apps, the Internet of Things (IoT), machine learning, and artificial intelligence are being incorporated directly into healthcare applications. As the digital health industry moves into the next wave of innovation, the following areas are those that many healthcare providers, payers, vendors, and digital health startups are targeting for development.

Artificial Intelligence (AI)

AI capabilities will become increasingly accepted and used by healthcare professionals as a clinical decision support tool to identify potential risks, mitigate errors, recognize patterns, and improve disease diagnosis and treatment. AI and Machine Learning will increasingly drive population health analytics, clinical decision support, and scientific research.

Blockchain

This technology framework has the potential to allow hospitals, doctors, and insurance companies to share data more securely, assuming the role of a trusted gatekeeper. Using the concept of a shared ledger, it makes it possible to share information selectively with others. Digital records can be stored with variable access controls and digital assets can be exchanged with minimal friction. Organizations are expressing increased interest in the significant potential blockchain has for improving healthcare information management.

Genomics

A substantial amount of funding has gone into the study of genes as researchers and providers pursue new disease treatment options and patients seek more tailored and personalized healthcare plans. Pharmaceutical companies are leveraging genomics research to develop new medications for cancer and other serious conditions as well as other therapeutic compounds for advanced immunotherapy treatments. Many EMRs are now configured to maintain genomic data in the patient record, along with existing medical data, to provide a more complete picture for providers.

Internet of Things(IoT)

The use of data from portable devices and sensors has given providers more real-time information on patient health status and patients the ability to have tailor-made strategies to combat illnesses and to take a more proactive role in managing their health. The connectivity of healthcare solutions and devices improves patient management, disease management, and the outcome of treatments. Since patients and providers both benefit from IoT, it will have a bigger presence and impact within the healthcare sector over time.

Mobile Apps

The major shift in this area is the evolution from standalone applications to ones that are more tightly integrated with legacy healthcare platforms and the clinicians who use them. Apps that connect providers and patients are gaining traction. These are being used to help coordinate and manage patient care, increase patient engagement, and support more effective treatment of chronic disease conditions.

Telemedicine

As technology becomes more affordable, remote treatment options continue to grow in popularity for both doctors and patients. For the elderly and those living in rural areas, telemedicine provides increased access to healthcare services that otherwise might not be possible, from remote diagnostics and monitoring to medical education and outpatient services. Both public and private payers are also starting to provide increased reimbursement for telemedicine services and state laws are changing to remove restrictions and facilitate the provision of telemedicine services.

Virtual and Augmented Reality

The use of VR and AR technologies will expand in healthcare for medical education and training, surgical support, other types of decision support, and pain management. They can be used for simulation of scenarios, decision support for providers performing procedures, and distraction, education, and entertainment of patients.

These technologies are enabling a variety of new applications in areas such as:

Behavioral Health

Behavioral health conditions are increasingly prevalent and challenging to treat. The insurance industry and self-insured employers recognize that the costs of treating mental health conditions, including depression, are increasing. Although long-term efficacy has yet to be demonstrated for most digital solutions, insurers and employers are increasingly willing to pay for digital behavioral health pilots. It is increasingly reimbursed by Medicare and investors are beginning to fund this sector. The hope is that more engagement and interaction, facilitated by digital technologies, may help patients with depression, anxiety, substance abuse, PTSD, and other behavioral health conditions.

Chronic Disease Care Management

Chronic care interventions use a combination of health, behavioral, and contextual data – such as glucose levels, sleep patterns, weight, food consumption, activity, social factors, time of day, and weather — to improve patient treatment plans. Digital health tools can also be used to improve care team communication and coordination. These applications have demonstrated such compelling clinical efficacy that insurance companies are starting to pay for them because of improved patient outcomes at reduced cost. Pharmaceutical companies are also interested in integrating digital interventions with their drugs to improve outcomes, differentiate their products, and engage directly with patients.

Data Aggregation and Analytics

In the past few years, there has been a dramatic increase in the amount of digitized health data stored in EMRs and ancillary systems, fitness and health data captured from mobile devices and wearables, and genomic data. There are many potential uses for this explosion of new healthcare data. Insurance companies and companies that pay for employees’ health care directly can use additional data to help refine actuarial models. Physicians can use analysis of this data for diagnosis, quality improvement, and decision support. Patients may benefit from the mining of data for predictions of their propensity for acquiring certain health conditions. As a result, real-time alerts and guidance to patients and healthcare providers are becoming more feasible and useful.

New Payer Models

A recent and intriguing area of investment in digital health is in alternative insurance companies. These startups often compete directly with major industry players, which have also been exploring and deploying digital health solutions. However, these new insurance industry entrants have some advantages over the incumbents. These entrants are unencumbered by existing infrastructure and relationships and thus can establish tighter relationships with provider networks and provide more flexibility. They can also build their technology stack from the ground up which enables them to more effectively use digital health data and solutions to target specific, stratified patient groups. Their primary challenge is achieving sufficient scale and differentiation to compete effectively against the larger, more established payers.

Provider Workflow Enhancement

Digital technologies can help give time-constrained healthcare professionals the ability to see more patients in less time, while delivering a better patient experience, by using data analytics for decision support, more efficient workflow, and different forms of mobile communication and collaboration.

Additionally, the cost curve can be shifted by leveraging less expensive resources. Given decision support tools, artificial intelligence, and data analytics, primary care physicians should be able to do some of the work specialists currently do. Nurses and case managers will be able to reduce a physician’s workload, and increasingly, patients will be able to manage their own care at home with mobile devices.

Collectively, these new applications will dramatically transform the delivery of healthcare services.

Recent Investment Trends

According to a recent report from CB Insights, large technology companies are increasingly focusing on investing in new initiatives in the healthcare domain. Since 2012, the top 10 tech corporate players in the US invested $6.2B over 143 healthcare deals according to CB Insights. Deals and funding into the sector with participation from these corporate entities has increased every year since 2012 to hit a high of 41 deals last year and $2.7B in funding, triple the funding total in 2015. In their report, CB Insights summarized the healthcare activities of the major tech companies:

Google

Google is the most active tech corporate investing in healthcare in the United States. Virtually all of its activity has gone through GV. CapitalG, Google’s growth equity fund, has made investments into Oscar Health and Practo Technologies while Google itself has co-founded Calico Life Sciences and acquired Lift Labs. Lift Labs develops a swiveling spoon that makes eating easier for patients with neurodegenerative hand tremors.

Recent GV investments include everything from health insurance (Clover Health) to gene therapy (Fulcrum Therapeutics) to vaccine development (SpyBiotech).

Google has not been shy about investing in therapeutics. In addition to Fulcrum Therapeutics, GV has made deals to Magenta Therapeutics, Spero Therapeutics, Arcus Biosciences, and Forty Seven all in the last year. Magenta is working on stem cell transplantation, Spero is focused on bacterial infections, and Arcus Biosciences and Forty Seven develop cancer immunotherapies.

GE

Once focused on lighting and electricity, the modern GE is a multinational conglomerate operating across many sectors. It is also one of the most active healthcare investors among US-based tech corporates. Recently, the company has made deals to HealthReveal, which monitors and predicts adverse health events, EMR data analytics company Arcadia Healthcare Solutions, and primary care provider Iora Health. The largest deal with GE Ventures participation was the $220M Series B of genome sequencing company Human Longevity in 2016.

Apple

Apple has made very few investments in healthcare startups despite diving into the sector internally with services such as HealthKit, CareKit, and ResearchKit. Apple has made two recent acquisitions in the space, however. In August 2016, the company acquired Gliimpse, developers of a personal health data platform, and in May 2017 acquired Beddit, which developed a sleep monitor that tracks heart rate, breathing, snoring, and sleep quality.

IBM

IBM has invested through both its corporate entity and the IBM Watson Group. While IBM Watson is an natural language AI platform, the company has made deals to both pharmaceutical and genomics companies such as Pathway Genomics (2014, 2016), Lodo Therapeutics (2016), and Petra Pharma (2016), and ApoGen Biotechnologies (2016).

Amazon

Amazon’s only healthcare investments in the past four years have been cancer diagnostics company GRAIL and baby monitoring startup Owlet Baby Care, the latter being backed by the Amazon Alexa Fund. Steve Rabuchin, VP of Amazon Alexa, has stated that the company will integrate Owlet with Alexa. In March of this year, Bezos Expeditions and Amazon participated in GRAIL’s $914M Series B.

Intel

All of Intel’s investments in healthcare startups have gone through its venture arm, Intel Capital. The corporate entity has made two acquisitions in healthcare, Basis Science (2014) and IDesia (2012). Basis Science develops heart rate and activity monitors, while IDesia offers security identification technology based on a person’s unique heartbeat. Intel has participated in numerous rounds to both CareCloud and Sotera Wireless. CareCloud is a provider of cloud-based medical record and billing software, while Sotera Wireless develops wireless devices for in-patient monitoring of blood pressure, heart rate, oxygen saturation, and other biometrics.

Others

Facebook, Amazon, Microsoft, Cisco, and Oracle have all demonstrated limited private market activity in healthcare since 2012. Below are listed a few deals with participation from these corporate entities.

• In 2014, Facebook acquired Finland-based Protogeo, a developer of fitness tracking apps.
• Microsoft has made two healthcare deals since 2012, one from the corporate entity into Advanced Dental Cloud,and one through Microsoft Ventures to Livongo Health. Advanced Dental Cloud makes software for modeling dental implants and Livongo Health combines coaching and connected devices to improve diabetes management.
• Oracle has made one acquisition and one equity investment into healthcare startups since 2012. It acquired clinical trial management software provider ClearTrial in 2012 and participated in Proteus Digital Health‘s $45M Series F in 2013. Proteus has raised on four other occasions since then, with no disclosed Oracle participation.
• Cisco has made no equity investments in healthcare companies since 2012. The one deal shown on the social graph above refers to a grant made to Teslon in January 2017.

According to CB Insights, funding this year has already reached over $1.5B spread across 18 deals. That’s already more dollars to the sector so far this year than in 2015. At the current run rate, 2017 is on track to reach $4B across 48 deals, a five-year high for tech corporates participating in deals involving healthcare startups. The historical and current participation of these companies in healthcare industry investments is summarized below.

Conclusions

Healthcare is increasingly being impacted and disrupted by digital health innovations. The digital health sector has moved beyond the first wave of simple wellness devices and applications to integrated solutions from companies that are beginning to have a deeper understanding of how technology can be used to make healthcare more effective and efficient. Consumer companies such as Fitbit, Apple, and Samsung are beginning to partner with major payers, providers, and pharmaceutical companies. As shown above, major technology companies are also investing large sums in the healthcare sector to augment their existing products and support new strategic initiatives.

Despite this shift, many experts agree that there are too many companies targeting the same narrow problems. Many digital health founders have come from the technology industry and try to solve a problem that they have personally encountered within the imperfect healthcare system, whether it is truly widespread or not. Others may have just graduated from college and have limited business exposure, let alone any healthcare experience, and don’t understand the relevant use cases very well.

The entrepreneurs who research and fully understand the complexities of this industry — including the relevant use cases, current workflows, the needs of providers and patients, and who will ultimately pay for these innovations — will be far more successful. Regardless of what digital health product or services startups offer, they will need to demonstrate a real value proposition and generate some evidence that outcomes are improved, revenues are increased, or costs are reduced or no one will pay for their solution or expend time and effort trying to integrate it within their existing health IT infrastructure.

HIStalk Interviews Andrew Kanter, MD, Chief Medical Officer, Intelligent Medical Objects

Andrew Kanter, MD, MPH is chief medical officer of Intelligent Medical Objects and assistant professor in clinical biomedical informatics and clinical epidemiology at Columbia University.

Tell me about yourself and the company.

I’m an internal medicine physician and a global health specialist. I’ve been  with IMO since its founding in 1994. I’m the chief medical officer. I’ve also spent time as president and chief operating officer and I’m a previous board member for the company. I’ve been full time with IMO since the onset of ICD-10-CM and Meaningful Use.

In 2008, I joined Columbia University and the Earth Institute to help Jeffrey Sachs bring health information technology to less-developed countries. We’re trying to achieve the Millennium Development Goals.

IMO started as a computer science department. We evolved electronic health records, which is now being sold as Allscripts Professional. We’ve taken the company from primarily being a consulting firm and a terminology product company to now a solutions company. We recently received a major investment from Warburg Pincus, which is the fifth-largest private equity firm.

My job as chief medical officer is to ensure that the content and lessons that we’ve learned over the last two decades at IMO transfer to our customers and to our vendor partners. IMO partners with most of the EHR vendors. Our installed base covers about three-quarters of the acute and primary care sites in the United States. Over a half-million doctors use us in the US alone.

Our primary mission is to improve care by helping the health information systems capture clinical intent in the most accurate, specific way possible. We’re about paving the semantic highway and driving downstream workflows and secondary use of data.

Coding and terminology drives billing, but what are the patient and societal benefits?

It’s very much about capturing that clinical intent for these downstream processes, including things like population health, risk management, and predictive modeling. We’re trying to improve care as well as bend the cost curve. It’s through capturing the clinical descriptions — what physicians actually think about in their heads – that is so essential to teasing out that value proposition.

Many people think of it in terms of the big chronic disease areas like diabetes, coronary artery disease, and so on, which certainly does have a reimbursement or billing implication. But for trying to improve care, we’re trying to identify exactly the patients who can most benefit from therapy and the most accurate treatment possible.

Using the high level of granularity that clinicians have to take care of their patients can be used probably even more for driving the identification of high-risk patient groups or specific patients who will benefit from treatment, therefore significantly improving the quality of care.

Assuming that providers are willing and able to physically exchange information, what terminology and semantic interoperability problems remain?

That’s one of the areas that people have often missed in the strive to develop the electronic data interchange part, but not necessarily the semantic interoperability part.

What we’ve seen is that as information tends to move around the health information system ecosystems across enterprises, a lot of that semantic fidelity gets lost. Systems have been designed primarily to support single-term, single-code relationships. With FHIR and CCDA, where more information is going to be transferred, if that fidelity is not maintained, there’s a lot of loss of good data and the ability to act on it.

One of the things that IMO has worked pretty hard on is to first initially capture that clinical intent, but then ensure that it’s maintained as information moves around the health ecosystems. As a matter of fact, IMO has been working with the Structured Documents Group of HL7 to ensure that there’s an approved method of sending the IMO lexical identifier within all of those interoperability messages — whether it’s CCDA or FHIR — to ensure that the full color is not lost.

IMO’s terminology frequently has more than one reference map, whether it’s SNOMED, ICD, or LOINC. We have about 80 maps that come off of our clinical interface terms that ensure that all of those terms are maintained as information moves through the ecosystem.

What’s the best solution for codifying information for specific purposes while retaining the patient narrative to avoid losing the underlying context?

Over the last 20 years, there’s been a lot of lessons learned about forcing physicians into structured data collection. We have the scars on our backs to remember those lessons.

There is a balance between structured and unstructured, although it’s a little bit of a false dichotomy. If you focus on capturing clinical intent and using interface terminology, it should be possible — through structured data and unstructured data — to capture the right content in a clinically granular way.

We work closely with many natural language processing companies to ensure that those engines are able to identify these pre-coordinated or highly physician-friendly terms within both narrative, unstructured text as well as structured text. It’s a key thing to remember that it’s not always in the places that we expect to find that information, where key information will be determined.

There has to be a balance between maintaining the full clinical story in the narrative text as well as the highly codified structured text.

Should clinicians have the ability to electronically highlight the structured or unstructured information that they find most useful so that a colleague covering that patient or receiving a referral could make quick sense of a patient’s chart?

That’s a difficult question. That assumes that the information that clinicians are dealing with within the health information systems is hard to decipher and that their information is not clearly available or can be recognized quickly.

This is something that we’ve been working on a lot. How to organize the data now that we’ve collected it in such a clinically-friendly, granular way. How to then semantically group that to drive various kinds of workloads. How to visualize the problems or the information in the record in a way that’s most relevant to me as a provider, based on my specialty and my experience with that patient. Trying to not lose information that may not be as relevant, but organize it in such a way that it doesn’t distract me, but it also doesn’t hide things that I might be interested in in the medical record.

That’s a real challenge. We don’t always know what is going to be the most relevant for you in the record.

Also, as you start to semantically organize and group things together, you’re going to use that information to drive all sorts of downstream workflows. Things like clinical decision support, which hopefully will help prompt providers for things that they shouldn’t overlook or that would be most relevant to them. As well as driving quality improvement programs, population health, clinical research, and so on.

IMO is spending a lot of time in developing those services. It’s not just about tagging things in the medical record, but about using those tags meaningfully to help organize the data in a better way.

Are patients receiving the expected benefits from the migration to ICD-10?

ICD-10 certainly was a huge burden in the transformation from ICD-9. The 80,000 or so codes added would have normally been a disaster for many providers to deal with.

Most people don’t have to deal directly with the ICD-10-CM codes, so it’s not so much those codes that are improving patients. It’s the clinical concepts and the clinical terminology that are really most relevant to providers and t patients.

There’s no question that the evolution to more granular coding systems will benefit both patients and providers by giving more specific care and being able to perhaps group or subset patients based on more granular concepts. ICD-11 and SNOMED CT are looking to be much more closely integrated so that those two use cases — the billing use case and the secondary use case — will overlap.

That’s going to take a long time, for us in the US in particular, to move to. In the interim, it’s up to vendors like ourselves to try to focus on the level of granularity and information that is most needed by the providers and for the patients. That will improve the quality of care.

You have a background in public health and global social causes, having served as president of Physicians for Social Responsibility. What optimism can you offer in looking at the US healthcare system and our social policy when it’s so easy to find negatives?

There’s an interesting parallel. For me, if we want to get the most value from data — whether it’s big data or small data — it’s about accurately capturing what’s happening with the patient. What we currently suffer from is a distorted view of that reality. Everything that we’ve been trying to do — whether it’s our clinical decision support dashboards or health information technology in general – it’s just not going to perform well if we can’t see the world clearly.

IMO and other organizations are trying to facilitate patient-doctor communication to accurately capture and see the world. It’s through that joint solution that we can transform healthcare.

For me, for someone who’s so active in trying to save the world from global poverty, climate change, and nuclear war, healthcare is actually the easy part. If we establish that pattern of behavior — the ability to share information clearly and focus on solving the problems — we could use that technology and the lessons we’ve learned from working together globally to solve these other grave threats to our society.

Morning Headlines 5/31/17

Characterizing the Source of Text in Electronic Health Record Progress Notes

A study published in JAMA analyzing 23,000 Epic progress notes finds that 82 percent of the note is computer generated or copied forward from elsewhere in the chart, while only 18 percent is entered by the author.

Seton hospitals monitoring ‘suspicious activity’ on computer network

Ascension-owned Seton Healthcare (TX) goes back to paper after detecting “suspicious activity” on its network. Hospital officials are offering no details, but are reporting that “no devices have been reported as encrypted by ransomware.”

Court Documents Shed Light on Theranos Board’s Response to Crisis

Two former Theranos directors, former US Navy Admiral Gary Roughead and former US Secretary of State George Shultz, say they did not question Elizabeth Holmes or other Theranos leaders after allegations were made that the company was not using its own proprietary analyzers to process blood tests.

Insurance CEO: I’m raising Obamacare premiums because of Trump

The CEO of Blue Cross Blue Shield North Carolina reports that the ACA exchange in his state is stabilizing, but because the Trump administration is threatening to withhold cost-sharing subsidies, the organization is requesting 22.9 percent premium increases.

News 5/31/17

Top News

An internal UCSF study finds that 82 percent of the text in a typical Epic progress note comes from copying/pasting or importing from other sources. Clinicians physically enter only 18 percent of the note.

Several hundred of the 24,000 notes reviewed contained no human-entered text at all.

The study is especially interesting because it used a new text analysis tool – apparently provided by Epic – to determine the source of every character of text in the note.

Reader Comments

From Jack Fruit: “Re: CommonWell. Who were the original members?” CommonWell Health Alliance was founded in March 2013 by Cerner, McKesson, Athenahealth, Greenway, and RelayHealth (which is also owned by McKesson) as the Epic fears of the publicly traded competitors intensified to the point that they cooperated (and pony up a rumored $2 million each) to have something to announce at HIMSS13. Since then, McKesson has mostly pulled out of healthcare IT by spinning off Change Healthcare and looking for a buyer for its enterprise business and Greenway Medical Technologies was taken private by Vista Equity Partners a few months after the CommonWell announcement. Athenahealth shares are up 38 percent since the announcement, those of Allscripts are down 10 percent, and Cerner shares have risen 41 percent as all the founding companies have tried to diversify themselves out of a HITECH-free EHR market. CommonWell later added CPSI (now Evident) and Sunquest as founding members in mid-2013, but Sunquest is no longer listed as such on its site even though Sunquest’s site still says it’s a member.

From Kathy: “Re: CommonWell survey. It would be most accurate for me to vote that it performed exactly as I expected – which was very little. CommonWell was never going to work. It was a political and business tactic.” Above are the early poll results.

From Tammy: “Re: CommonWell. I work for RelayHealth supporting the CommonWell network. CommonWell is not one EHR, it’s a network. It brings together multiple health IT systems and helps to solve the challenge of connecting disparate software run by different companies, using different technology. People’s definitions of numbers are different depending on what and how they count. What really is important is that we are all working towards helping providers and people get access to important health data that they previously couldn’t. CommonWell is definitely moving the meter in the right direction on this. What is different about what CommonWell is doing is that providers don’t have to search for records and guess where they might be located. They also don’t have to download and store every document for their patients – we’re about making it more efficient to get the data that is most valuable to the provider when they need it. Providers can query and view what documents are available, similar to a search engine, and only download those they need. I have seen 2x the volume of query and retrieval growth in the past year.”

From David McCallie (Cerner): “Re: CommonWell. It seems like a case of apples to oranges – it would be bad math to compare numbers that aren’t measuring the same thing. For Cerner, CommonWell queries are a small (but important) fraction of Cerner’s overall document exchange interoperability. We don’t know exactly what counts as a ‘record’ or gets included in Epic’s CareEverywhere statistics, but for Cerner, document exchange includes not only CommonWell, but also many existing point-to-point query interfaces (via Cerner Resonance, including many connections to Epic clients) as well as local HIE-based document queries, and data routed to providers through the ‘Cerner Hub’ services.  Cerner also supports a growing Direct-based document exchange.  To the clinician, these are all equally available sources for external documents and data. In general, the user interface does not distinguish the means of transport. CommonWell in many ways represents a national-scale ‘back stop’ for data that can’t be found via local queries. Now that CommonWell and Carequality have committed to mutual interchange, we expect that the number of CommonWell-mediated transactions will grow, since CommonWell will provide a common gateway to both its own network as well as any requested Carequality sites. CommonWell automatically bundles an MPI and a national Record Locator Service, so the clinician does not need to spend time deciding where to look for documents that aren’t local. Don’t count CW out … the network is growing, and any numbers they report represent a very high quality of interoperability use case.”

From Spiker: “Re: health IT writing. Biggest problem is advertiser-friendly puffery. And mistakes like this one.” I disagree. The biggest problem is writer naiveté even in the absence of advertiser bias (unintentional or otherwise). Gushy, “world peace” kinds of health IT articles are always written by folks who have never actually worked in a health IT or clinical leadership role and thus have not learned from hard-won experience to distrust vendors, politicians, and health system executives until they provide a reason to believe otherwise. They’re also scared of being called out for lack of knowledge, so their writings tend to be harmless little bubbles floating aimlessly above the fierce, patient-impacting HIT battles being fought. The bar I set for everything I read regularly (especially if it expresses editorial opinion) is:

• Does the writer enough knowledge and experience to be trusted?
• Does the article tell me something I didn’t already know?
• Can I really use the information?
• Does the writer present the information clearly, concisely, and at my level, without time-wasting padding or distractingly unskilled writing?
• Am I entertained, amused, or emotionally motivated in a positive way that makes me want to read more by the same writer?
• And for the specific user-provided example above, make sure the author knows the difference between “pared down” and “parsed down” and doesn’t misstate “rev cycle” as “rest cycle.”

From FlyOnTheWall: “Re: Mary Piepenbrink, RN. Joined a startup called Pieces Technologies as SVP of sales. What do you know about them?” I’ve heard of the Dallas predictive analytics company, but only barely. They’re a Parkland Health spinoff as I recall. Founder and CEO Ruben Amarashingham, MD, MBA has good credentials in informatics. The company raised $21.6 million in a single Series A round just over a year ago and apparently has earned a couple of customers.

HIStalk Announcements and Requests

The web hosting company is migrating the site to a bigger server, so let me know if you see anything weird, other than the fact that I’m posting this later than usual to accommodate the switch.

You’ll see some inarguably huge news related to a Meaningful Use-related EHR vendor settlement coming out, possibly as early as later today. The financial terms are mind-boggling. More to come once the Justice Department’s announcement is released.

Listening: The Stanfields, Nova Scotia-based hard-working rockers who wrap thoughtful, lyrically rich biographical stories with searing guitar (and mandolin) riffs. like AC/DC covering an Irish pub’s house band. It’s sonically spectacular poetry. You’re a poser rather a musician if you can’t play and sing acoustically in a bare room, to which I submit the amazing “Vermilion River.”

Webinars

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

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

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

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

Acquisitions, Funding, Business, and Stock

Health management software vendor Mediware Information Systems acquires Kinnser Software, which offers home health and hospice systems.

Two former Theranos board members – former US Navy Admiral Gary Roughead and former US Secretary of State George Shultz – say they didn’t ask founder Elizabeth Holmes about media reports stating that the company wasn’t running many tests on its proprietary Nanotainer finger stick technology but instead was using commercially available analyzers. Legal experts question whether the company’s board failed to meet their responsibilities in providing checks and balances to Holmes, who controls 98.3 percent of voting shares. To paraphrase “Animal House” in work-friendly terms, “You messed up … you trusted us.”

Consumer health information site Sharecare, founded in 2010 by Dr. Oz and WebMD founder Jeff Arnold, receives an unspecified investment from Summit Partners, increasing its total to more than $300 million.

Announcements and Implementations

Google launches the free Data Gif Maker, a data illustration tool aimed primarily at journalists who need to tell data-driven stories but potentially useful to a wider social media audience. 

Medisolv chooses CloudWave’s OpSus Healthcare Cloud for making its quality management system available to customers as a SaaS offering.

Nordic announces that it has grown to 700 consultants serving 200 clients.

Reaction Data publishes a new report on patient referrals and self-scheduling.

Government and Politics

The CEO of Blue Cross Blue Shield North Carolina says that the ACA marketplace is stabilizing in price, utilization, and risk to the point that an 8.8 percent premium hike would have sufficed for 2018, but instead the company has filed for a 22.9 percent increase because the White House keeps saying that it may not continue paying the premium subsidies that have been challenged legally. “The information we’ve seen coming from the administration actually creates more uncertainty,” the CEO says.

Privacy and Security

Other

A study finds that hospital EDs charge an average of 3.4 times the Medicare-paid rate for services they provide, providing as an example EKG interpretation, for which Medicare pays a median of $16 but for which hospital EDs charge other patients anywhere from $18 to $317, averaging $95. The highest-charging hospitals are for-profit, mostly in the South and Midwest, and serve more uninsured and minority patients.

USA-based Syria medical aid group UOSSM launches Syria Solar, a project to install solar power systems in the country’s hospitals, which run generators that use erratically available diesel fuel. Much of Syria’s electrical grid has been destroyed by bombing, leaving already struggling hospitals to deal with power outages for incubators, dialysis machines, and other vital equipment. 

Rapidly rising drug prices are hitting seniors hard with higher co-pays even as Medicare’s share of the Part D cost has become its fastest-growing expense.  Novartis AG has raised the price of cancer drug Gleevec 77 percent in the past five years, increasing Medicare’s annual cost from $500 million to $1.23 billion and leaving the average Medicare patient paying $4,400 per year out of pocket.

I’ve read that Europe has become even more overrun with summer tourists in the past few years because huge-population countries like China and India are moving up the economic food chain and their now-wealthier citizens are joining the lines in Rome, Paris, and London. A New York Times article says that’s also true in healthcare, as frustrated, affluent citizens of China are bypassing the country’s overloaded hospital system and paying cash for care in the US and other countries despite the inevitable problems with transoceanic care coordination.

A Wall Street Journal article questions whether towns should continue operating tax-supported nursing homes, seven percent of which are government-owned. Their financial losses are increasing due to a glut of Baby Boomer residents, a high proportion of Medicaid residents as those with more assets seek out tonier facilities, and the White House’s proposal to cut Medicaid by nearly a trillion dollars. Cities are selling their nursing homes to private operators with mixed experience. The article profiles the city-owned, 45-bed nursing home in Cape Cod’s Nantucket, MA, which is losing $3 million per year, needs major repairs as the city grapples with other huge infrastructure upgrades, and attracts only the financially struggling year-round residents who would have to move out if the city’s only nursing home shuts down or raises rates.

Sponsor Updates

• AdvancedMD publishes a MIPS Improvement Activities fact sheet.
• Aprima will exhibit at the Associated Professional Sleep Societies Annual Meeting June 5-7 in Boston.
• Audacious Inquiry publishes a series of white papers on what HIOs need to know about the 21st Century Cures Act.
• Bernoulli publishes a new case study, “Achieving medical device connectivity across a multiple-hospital enterprise.”
• Datica will present at the Wisconsin Entrepreneurs’ Conference June 6-7 in Madison.
• Carevive Systems will exhibit at the ASCO Annual Meeting June 2-6 in Chicago.
• Casenet will exhibit at AHIP Institute & Expo June 7-9 in Austin, TX.
• Docent Health is featured in Redox’s “Digital Health Done Right” series.
• The Jacksonville Business Journal includes CSI Healthcare IT in its list of “Best Places to Work 2017.”
• Dimensional Insight will host its annual User Conference June 5-8 in Boston.

Blog Posts

• On-Call Scheduling 101: Your Guide to Supporting Care Providers and Patients (Spok)
• The New CISO Leader (Orchestrate Healthcare)
• Can Risk Adjustment Help Address Physician Burnout? (Arcadia Healthcare Solutions)
• Government Ramps up HIPAA Enforcement (Besler Consulting)
• MIPS and the Business of Healthcare (Caradigm)
• CPC+ At Its Best (CareSync)
• Value in Healthcare – Part 3: Alternative Payment Models and Enabling Technologies (ClinicalArchitecture)
• MACRA Overview – Is Your Organization Prepared? (Culbert Healthcare Solutions)
• Robots Take Jobs but Also Create Them (Direct Consulting Associates)

Contacts

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

Morning Headlines 5/30/17

Silicon Valley is trumpeting A.I. as the cure for the medical industry, but doctors are skeptical

CNBC interviews six physicians on their opinion of artificial intelligence and its potential use in healthcare.

Two years in, what has Apple ResearchKit accomplished?

STAT covers the short history of Apple’s ResearchKit as scientists incorporate the platform into increasingly more complex studies.

VA looks at cut in tech funding

The VA’s IT budget is reduced as it grapples with the decision to either modernize VistA or implement a commercial EHR. VA Secretary David Shulkin is reportedly comfortable with the budget decrease, saying “What I think you’re seeing in this budget is a recognition that we do not want to continue to ask for more money and invest more money in fixing broken systems.”

Rebuilding the foundation of health care under MACRA

Deloitte and Network for Excellence in Health Innovation co-author a paper on the anticipated challenges health systems will have implementing MACRA.

Morning Headlines 5/29/17

Better Healthcare for Albertans

In Canada, a report by the Albertan auditor general questions expected return on investment for the province’s proposed $1.2 billion clinical information system implementation because it does not incorporate primary care doctors and relies on view-only software that does not support real-time analytics. .

Speeding prescription process brings success to CoverMyMeds

A local paper profiles prescription prior authorization startup CoverMyMeds, which was acquired by McKesson for $1.1 billion. CEO Matt Scantland says the startup’s success was based on a simple formula, “Start with a big problem and solve it not by disrupting anything but by finding a way that everyone wins.”

Vanderbilt LifeFlight launches app for emergency responders

Vanderbilt LifeFlight launches an Uber-like app that allows first responders to request a helicopter and then sends the location of the emergency directly to dispatchers.

Ft. Myers-Based 21st Century Oncology Files For Bankruptcy

21st Century Oncology (FL) files chapter 11 bankruptcy, noting that the move will reduce more than $500 million of their long term debt. The company’s 2016 data breach exposed over 2 million records, leading to 13 federal class action law suits.

Monday Morning Update 5/29/17

Top News

In Canada, a report by Alberta’s auditor general says the government’s $1.2 billion proposed project to replace the clinical and administrative systems of Alberta Health Services with a single system is not likely to generate the expected $900 million in cost savings because it doesn’t include primary care practices.

The project, announced a year ago, would replace 1,300 individual AHS systems.

The report notes that Albertans pay the highest healthcare costs of all provinces in Canada, yet the quality and integration recommendations of previous reports have been mostly ignored. It observes that despite claims of how good healthcare is in Canada, it’s almost as bad as in the US, which finishes dead last among 11 developed countries despite spending far more than any of them.

The Auditor General also notes that fee-for-service payments have hampered accountability and integration. It also says that health leader turnover is high due to political cycles, with the average AHS hospital CEO lasting just 1.2 years.

Province physicians use at least 12 incompatible EHRs. Canada-wide, 94 percent of hospitals use IT only for administrative tasks.

The report observes that if banks used IT like Alberta Health Services:

• Each branch bank would have its own systems that can’t communicate with other branches.
• Systems at some branches would be so prone to failure that paper files would be kept ready.
• Tellers, mortgage officers, and investment specialists wouldn’t be able to access each other’s information.
• The only access to banking information would be via faxing.
• Customers would be required each time they visit a branch to fill out the same form asking for name, address, employment information, and financial history.
• Traveling customers could not withdraw money without opening an account first because the branch would not know who they are.
• Applying for a mortgage would require visiting each prospective lender individually and completing their proprietary application package.
• Online banking would not exist.
• Obtaining an account balance would require making a written request and waiting two weeks for the mailed information to arrive.
• Bank managers would not have enough information to understand the performance of individual branches.
• The banks would spend $600 million per year to maintain IT systems but without a plan to standardize them and keep them up to date.

Reader Comments

From More Math: “Re: CommonWell’s 60,000 documents downloaded. Looking at the latest from Epic’s website, it appears that Care Everywhere hits CommonWell’s lifetime exchange number every 15 minutes. Sounds like Epic is willing and able. Bigger question is whether the CommonWell is drying up.” CommonWell’s March 2017 fact sheet says that 5,100 provider sites have gone live and have generated 85 million queries, although I don’t know how “queries” translates into “documents.” The quoted figure of 60,000 documents retrieved doesn’t indicate the time frame involved, but if that’s all of them since CommonWell’s beginning in 2013, that’s a pretty anemic number. Cerner said in a HIMSS16 presentation that it had 4,000 providers live on CommonWell, which suggests that almost all live CommonWell members are Cerner users; that those providers enrolled only an average of 50 patients each; and that only eight documents per provider were actually retrieved. EHR vendors pay a per-transaction cost to CommonWell and providers don’t really like sharing their patient information with competitors, so there’s not a lot of economic incentive for anyone other than the patient to use CommonWell’s services.

From Laura Palmer: “Re: Cure Forward. Has shut down, according to its site.” The Boston startup offered a platform that matched patients with clinical trials, although previous announcements suggest that its system may never have graduated from beta testing status. The company raised $19 million in a June 2015 investment and nothing since. Sole investor Apple Tree Partners has expunged Cure Forward from its website, omitting the company from its “legacy investments” section and removing previous Cure Forward press releases (thereby practicing the investing world’s legendary 20-20 hindsight). Cure Forward founder Martin Naley, who launched the company as a entrepreneur in residence at Apple Tree Partners, says on his LinkedIn profile that the company “ceased operations at the end of May 2017 due to financing difficulty.”

HIStalk Announcements and Requests

Readers funded the DonorsChoose grant request of Mrs. M in Ohio, who requested math fluency games and fitness-related “brain breaks.” 

Two-thirds of the 247 poll respondents who say they have certification or fellowship credentials don’t list them on their business cards or in their email signatures. KG says credentials should be listed only on CVs other than for practicing clinicians, while Sue says her earned credentials are important to her work and her clients use them as well. John opines that healthcare people deploy “a fruit salad of acronyms” such that the more of them someone lists, the less he believes what they say.

New poll to your right or here: to what extent has CommonWell benefited patients since its 2013 founding? I appreciate your vote and, even more so, your comments explaining it.

Gregg Allman died Saturday at 69, leaving zero of the two brothers who founded the Allman Brothers Band in 1969 still alive (also making Cher the ex-wife of two deceased celebrities). I’m not a fan at all of the retired band’s music since I really dislike Southern boogie and country music even when it’s bluesy (other than Lynyrd Skynyrd, anyway), but it’s apparent that hard living took its toll on the founding members — Duane Allman died at 24 in 1971 in a motorcycle accident, bass player Berry Oakley died a year later in the same manner and location, and drummer Butch Trucks killed himself earlier this year. That leaves guitarist Dickey Betts (73) and drummer Jaimoe Johanson (72).

I’ve had problems for years where I leave the laptop running and Firefox is open to pages that refresh (like Twitter or news sites) – Firefox gets sluggish and Windows Task Manager shows it eating up a huge amount of memory and CPU, requiring me to hard-cancel it. The solution – I finally switched to Chrome for everything browser related, which makes even more sense now that I’m using a Chromebook and an Android phone. My only non-Google technology is an iPad Mini and the Windows laptop, both of which will move to a Google platform when it’s time to replace them.

In Flanders Fields
By John McCrae, MD (1872-1918)

In Flanders fields the poppies blow
Between the crosses row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

This Week in Health IT History

One year ago:

• Forbes revises its estimate of the net worth of Theranos founder Elizabeth Holmes from $4.5 billion to zero.
• An ONC study finds that 84 percent of US hospitals are using at least a Basic EHR, a nine-fold increase since HITECH’s adoption in 2009.
• DrFirst acquires Meditech-focused consulting firm The IN Group.
• CHIME awards $30,000 each to the two finalists in the concept round of its national patient ID challenge, with those contestants moving to the final $1 million round.

Five years ago:

• Allscripts caves in to a proxy fight and adds three new board members advocated by key shareholder HealthCor Partners, which had publicly called for Allscripts to fire CEO Glen Tullman.
• Three-fourths of respondents to my poll disagree with Neal Patterson’s assertion that Cerner and Epic will end up being the only hospital EHR survivors.
• Fired HCA doctors say the hospital chain hired huge numbers of physicians to prepare for an ACO environment, then terminated those whose practices weren’t profitable.

Ten years ago:

• A research article finds that few hospitals are using bedside barcode-checking of medications and that nurses bypass those systems frequently.
• An article describing problems with Kaiser Permanente’s shuttered kidney transplant program blames information management problems and its paper-based systems.
• A rumor suggests that Misys is trying to sell its hospital systems.
• Former National Coordinator David Brailer launches the $700 million private equity fund Health Evolution Partners.
• MED3OOO takes a majority ownership position in InteGreat.

Weekly Anonymous Reader Question

Last week’s results: job promotion factors.

This week’s survey: what is the role of the person you most value as a mentor and/or professional peer, how did you connect with them, and how do you maintain the relationship?

Last Week’s Most Interesting News

• The Wall Street Journal notes that uncertainty surrounding the Affordable Care Act has forced some health IT startups to change their strategies.
• Five hospitals in Australia experience an IT incident cause by applying security patches to protect against WannaCry ransomware.
• Apple acquires sleep monitoring sensor and app vendor Beddit.
• The Congressional Budget Office estimates that the Affordable Health Care Act would increase the number of uninsured Americans by 23 million by 2026 in reducing the deficit by $119 billion.
• The Bipartisan Policy Center calls for private-public efforts to improve health IT safety, but does not mention ONC’s proposed EHR safety center.
• The director of Denmark’s equivalent of the FDA warns that big US tech companies like Google and Apple are rolling out health apps without demonstrating their efficacy and safety and that those companies are gaining permanent access to patient data.
• The local paper says that Erie County Medical Center’s ransomware infection is still affecting the hospital six weeks after the hospital decided not to pay the demanded $44,000 ransom, also running a screenshot provided by a hospital employee that suggests that the culprit was Samas, the same malware that took down MedStar Health in 2016. 

Webinars

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

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

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

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

Acquisitions, Funding, Business, and Stock

Debt-ridden Florida-based clinic operator 21st Century Oncology – which was breached by hackers in 2016 in exposing the records of 2.2 million patients and resulting in at least 13 federal class action lawsuits – files Chapter 11 bankruptcy. As companies tend to do, 21st Century calls the bankruptcy a “positive development,” brags that it is “fundamentally strong and profitable,” and claims that “very little, if anything, should change during the Chapter 11 process,” calling into question either the credibility of the company or of the US bankruptcy process that is often used as a shrewd corporate strategy to legally screw employees and creditors for the benefit of executives.

Decisions

• Fitzgibbon Hospital (MO) will replace Meditech and GE Healthcare with Cerner in November 2017.
• Pinnacle Hospital  (IN) will go live with Prognosis Innovation Healthcare in June 2017.
• Illinois Valley Community Hospital (IL) will implement Athenahealth’s EHR in November 2017, replacing McKesson.
• Pioneers Medical Center (CO) will go live with Athenahealth in 2017.
• Riverside Tappahannock Hospital (VA) will replace Siemens 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.

Announcements and Implementations

Vanderbilt LifeFlight develops an Uber-like app to allow first responders to request a helicopter, sending the service an the GPS coordinates and and requestor information while giving the emergency responder a real-time flight map and estimated arrival time.

Other

A co-founder of startup Iodine — which published patient-submitted experience with medications — says his company, as well as other digital health startups, were naive in thinking that their technology could create a healthcare revolution. Iodine quietly sold itself off to drug discount coupon publisher GoodRx a few months ago. Thomas Goetz says not only did disruption not happen, it probably never will, because:

• Healthcare regulation hinders rapid transformation.
• Entrenched players are huge and have their hands in multiple aspects of healthcare.
• Nobody cares about better-faster-cheaper in healthcare.
• There’s no ability to shop prices.
• The government is the biggest customer.
• Incentives are misaligned.

The Columbus, OH paper profiles prescription prior authorization system vendor CoverMyMeds, the first local startup to sell itself for at least $1 billion (to McKesson in January of this year for $1.1 billion, this case). CEO Matt Scantland says the company’s formula for success was, “Start with a big problem and solve it not by disrupting anything, but by finding a way that everyone wins,” adding that it wasn’t the first company to tackle the problem, but rather the first to develop a scalable solution. The article notes that CoverMyMeds has over 500 Columbus-based employees who get a free gourmet lunch each day and have a virtual reality room to play video games with peers in its Cleveland office. I interviewed Matt in September 2014 when the company had just 73 employees and $19 million in revenue, but he was predicting bigger things:

Prior authorization seems like a very niche thing. It kind of is, but at the same time, it’s also right at the intersection where a doctor is making a decision about the tradeoffs between the cost of a treatment and its efficacy. We think that that’s a fundamental problem in healthcare. We have built both the network and the connectivity and then also the relationships with pharma, payers, pharmacies, and providers. We think we can help doctors make more intelligent consumption decisions. We think is a very large opportunity, starting with drug, but helping to get to more personalized medicine in terms of prescribing, and then also other procedures as well. Because of the growth of the size now, we have a lot of interest from the financial and strategic partners. We’re always willing to listen. We think this is a very big standalone company on its own.

He went down, under. In Australia, a member of Parliament laughs so hard while watching the US TV show “Veep” that he chokes on his sushi, passes out, and stumbles through his house before falling face-down unconscious into his granite kitchen island, leaving him with a black eye, three stiches, and a get-well tweet from star Julia Louis-Dreyfus.

Sponsor Updates

• Encore, A Quintiles Company publishes a white paper titled “Care Management Framework – The Critical Path to Implementing a Care Management Strategy.”
• QuadraMed, a Harris Healthcare company, will exhibit at the NYHIMA Annual Conference June 4-7 in Rochester.
• Salesforce announces strategic agreement with Dell Technologies.
• Solutionreach expands leadership team with new promotions.
• Summit Healthcare and Access will exhibit at the 2017 International MUSE Conference May 30-June 2 in Dallas.

Blog Posts

• How IT Leaders will Guide Digital Transformation (Salesforce)
• Is Hospital Pricing Transparency Possible? (The SSI Group)
• Three Ways to Take Appointment Reminders to the Next Level (Solutionreach)
• How Secure are Your Backups? (Summit Healthcare)

Contacts

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

Reader Survey Results: Job Promotion Factors

I asked what factors affected a job promotion.

Being humble, but speaking up in meetings (especially with solution ideas for important problems).

Many factors worked together to promote me through three levels in five years. An ability and willingness to drive change and tackle challenges in areas traditionally labeled as “impossible” because they required revamping entrenched negative habits. An unflinching determination to get tasks done on time (with no short cuts) and work out compromises even with the most difficult stakeholders. The ability to get to the root cause of an issue and focus on how to avoid future snafus with education and documentation without dwelling on placing blame. Consistently keeping EVERYONE very well aware of a projects progress and problems – so everyone felt in the know. Taking copious and diligent notes so as to instill trust and confidence when making statements at meetings, allowing decision makers to move forward more quickly. It also didn’t hurt getting another master’s degree specializing in a key niche area! Never let your skills become stale or your attitude become obstinate.

Proving myself works in getting more responsibilities. Moving to a new company was required to get a promotion.

Paying attention. I don’t believe in random luck, I believe that if you keep your mind open, you will be able to see the opportunities that are all around you. Luck is the ability to see the doors that are already open, waiting for you to step through. Also, be kind and generous.

I do not seek a promotion as something to have, a title to add to my business card or resume. I do not seek a promotion as a reward for time served or deeds already done. I seek a promotion for the opportunity to connect with new people to share ideas, the ability to move forward with new kinds of projects, the ability to tap into new resources. If you can articulate your desire for promotion in the context of moving forward instead of looking backward (a reward) or appearance (new business cards), then your organization will see you as a part of their future as well.

Always doing what I think is the right thing,and the best things for my customers. Always be honest and when I see a problem or an opportunity for improvement, regardless if I am responsible for it or not, I try to identify a solution.

Not looking for the promotion and focusing on making my boss(es) look good. Supporting their ideas and approaches.

I’ve had three offers to get a significant bump in salary and/or role. Every time was when I threatened to quit.

Receiving offers from other companies willing to pay me more.

Job changes, willingness to take on new projects, show value and communicate it.

Building relationships and consistently delivering results.

Who you know and certifications. Also geographical location seems to be a factor — if the person who is doing the hiring is from the same area of the country as you, then that helps with a connection.

Being better at the job than all the other people around me.

I’m a white male. I am also smart, talented, and hard working. But judging from my colleagues, being a white male is often all that is needed to climb the ladder. Competency does not seem to be a requirement.

A good boss. There are ideas, and there is doing. Do. Prompt responses to your boss and your boss’s boss.

#1: Asking for them. Having competing offers (that helped with salary level). Having (at the time) a relatively unique background with IT and medical experience. Having the right networks of people who give your request credibility

Company laid off one-third of people. We all applied elsewhere, they begged us to stay. To stay, I requested improved salary, vacation, and title. They obliged.

Leaving.

Most of my promotions have occurred when I’m working for someone who gets things done and cares about my career. Lesson: Think about who you are aligned with professionally.

Self-sufficiency and a willingness to figure things out on my own.

The ability to lead others, even if not in an appointed leadership role. Last promotion to Lead Analyst role earned by demonstrating ability to assist new and current co-worker analysts to achieve positive results. Sometimes though one is born with an innate nature to lead and enjoy doing so (without be overbearing – i.e., “bossy”). One can always possess a technical ability to perform job duties, but needs guidance and mentoring to achieve success.

My ability to smile while professionally dealing with the jackasses that infest our fine HIT industry.

Being a woman. Just kidding!

My top 3: specific measureable business results from work. The ability to communicate effectively with both non-IT and IT people. Reasoned risk-taking.

Integrity, dedication to performing at the best of my ability, and respect for everyone’s role and contribution to delivering quality services.

Being in the right place at the right time. Having a track record of delivering results. Being helpful and useful. Thinking critically and anticipating my next action. Dressing nice, being well groomed and presentable, speaking clearly and confidently, having a sense of humor, and being able to relate to everyone, not just my peers.

Morning Headlines 5/26/17

Health-Tech Startups Pivot as Obamacare Uncertainty Mounts

The Wall Street Journal profiles health IT startups funded during the ACA boom, and how they are pivoting their business models to survive the ongoing legislative uncertainty around ACA’s repeal.

Townsville Hospital responds to major cyber incident

In Australia, five hospitals within Queensland Health suffer network downtime stemming from issues installing the WannaCry security patch.

Synopsys and Ponemon Study Highlights Critical Security Deficiencies in Medical Devices

A survey of medical device manufacturers finds that 67 percent believe that an attack on one of their devices is likely to occur in the next 12 months,  but despite the risk only 17 percent are taking significant steps to prevent cyberattacks.

Health Care Providers Must Stop Wasting Patients’ Time

Harvard Business Review profiles Kaiser Permanente’s efforts to coordinate care outside of the hospital setting effectively enough to discharge surgical patients earlier, in many cases on the same day of the patient’s surgery. .

News 5/26/17

Top News

The uncertain future of the Affordable Care Act is forcing some health IT startups – especially those that sell mostly to hospitals – to change their strategies, according to a Wall Street Journal report.

The political turmoil has also raised the funding bar as investors seek out companies with solid revenue and market validation, thereby putting their money into fewer but larger deals.

These companies are reported to have made changes due to ACA uncertainty:

• Smart pill bottle maker Pillsy is refocusing its sales efforts on consumers rather than providers.
• Diabetes management technology vendor Omada Health is increasing its sales emphasis on clinical evidence and return on investment.
• Pregnancy tracker app vendor Babyscripts is concentrating on large health systems instead of physician practices.
• Take Command Health, which helps people who can’t get employer-provided health insurance find coverage, is revamping its platform to target small businesses that reimburse employee healthcare costs.
• Amino, whose tools target specialty care, raised $25 million after changing its platform to analyzing the cost of preventive services that may no longer be free with ACA changes.

Reader Comments

From Ex Epic: “Re: CommonWell. In the Madison consultant community, it’s pretty much understood that CommonWell is/was a Cerner marketing campaign to win the DoD. They tweeted these numbers at their collaboration forum last week, with quick math showing they have roughly one document retrieved per customer facility.”

HIStalk Announcements and Requests

This week on HIStalk Practice: Solutionreach’s Jim Higgins highlights the importance of patient relationship management in attracting and keeping millennial patients. Qliance Medical Management abruptly shuts down clinics amidst financial and legal difficulties. Lemonaid Health raises $11 million. Harbin Clinic adds PrecisionBI analytics to its Athenahealth tools. School nurses up in arms over incentivized telemedicine consent. Femwell Group Health will offer HealthGrid patient engagement tech. ClearHealth Quality Institute looks for telemedicine committee candidates.

Webinars

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

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

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

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

Acquisitions, Funding, Business, and Stock

Clinical trials software vendor Medrio receives a $30 million equity investment from Questa Capital Management.

Apple acquires Finland-based Beddit, which offers a sleep tracking app that uses mattress-attached flexible sensors.

People

Jessica Campbell (Leidos Health) joins Nordic as VP of client partnerships.

Announcements and Implementations

Elsevier will add its ClinicalKey clinical search engine to the World Health Organization’s Research4Life journal access program for developing countries. 

The DiamondView HIE of South Country Health Alliance (MN) goes live with Medicity Notify, which provides electronic notification services for population health management that will be rolled out across its 11 counties.

Government and Politics

ProPublica reports that some Republican lawmakers who are being called out on social media for their support of the American Health Care Act (and their sometimes incorrect statements about it as copied and pasted from White House talking points) are blocking their vocal constituents on social media after deleting their comments. An example is Congressman Peter King (R-NY), who not only appears to be censoring critical comments, but is also declining to conduct in-person town hall meetings because attendees scream at him.

Privacy and Security

In Australia, Queensland Health experiences a major EHR failure after applying WannaCry security patches from Microsoft, Cerner, and Citrix that slowed down systems and affected the ability of users to log on.  

A survey finds that only 9 percent of medical device manufacturers test the security of their products at least once a year, with nearly half saying they don’t perform security testing at all. One-third of both manufacturers and health systems say no single person is in charge of device security and half say they don’t follow the FDA’s guidance to reduce security-related risk.

A security researcher finds that medical claims processed by insurer Molina Healthcare were freely accessible over the Internet simply by changing the number at the end of any claim’s URL to bring up a different claim, with no authentication required. The company fixed the problem after being notified and has shut down its portal pending a security review.

Other

NantHealth CEO Patrick Soon-Shiong announces plans to open a cancer center, saying that the city has a great basketball team and newspaper (he owns a chunk of both), but not a great cancer center.

Slides from Cerner’s investor conference presentation show that Cerner and Epic (which Cerner references by name, which doesn’t happen often) each hold 24 percent of the acute EHR market. Cerner won decisions involving 109 hospitals in 2016 vs. Epic’s 91, although it was 69 vs. 66 when excluding existing customer add-ons. It also notes that 2,400 hospitals are using legacy systems that offer a replacement opportunity, with more than one-fourth of them running Meditech Magic or C/S.

A group from Kaiser Permanente writes a Harvard Business Review article about KP’s efforts to get surgery patients out of the hospital quicker by using standardized processes and team coordination. The authors honor Jess Jacobs, who at the time of her death in 2014 at 29 had measured that in her 20 ED visits, 54 inpatient days, and 56 outpatient visits, only 0.08 percent of her time was spent actually treating her medical problems.

The State of New Jersey temporarily suspends the medical license of a psychiatrist who had prescribed thousands of doses of oxycodone for a single patient, with the attorney general announcing, “Our message to these doctors is clear: if you are not checking the Prescription Monitoring Program database as required by the new law, we will take swift and punitive action against you.”

The Wall Street Journal profiles CVS Health EVP/CIO Stephen J. Gold, who says that 30 percent of the company’s pharmacy customers use its text messaging system for prescription refills. He mentions CVS’s Fast Mobile Prescription Pickup, which allows customers to pick up their refills at the counter or drive-through by scanning the barcode sent to their phones. The company is also using a proprietary health engagement engine to look for intervention opportunities, such as sending a message to patients who aren’t taking medications as prescribed or reminding diabetics to test their blood glucose. Another CVS digital tool allows patients to synchronize the refills of all of their prescriptions to save a trip and to improve adherence.

The State of Minnesota, admitting that it can’t keep up with complaints about nursing homes that mistreat their residents, warns nursing homes that they cannot harass families who install “granny cams” in the rooms of residents to document the care their loved one receives. The ruling came after a woman who had placed a $199 video camera in her mother’s room complained that nursing home employees frequently covered it with a towel, unplugged it, pressured her mother to remove it by refusing to speak to her when entering her room, and eventually seized it.

The US finishes in its customary back-of-the-pack spot in a new global health measure that looks at: (a) how well countries prevent deaths by applying known medical interventions; and (b) how health measures improve with increasing national wealth. The author says it’s “an embarrassment” that the US spends $9,000 per citizen annually on healthcare while failing to improve its lagging world health position.

Sponsor Updates

• The Chartis Group publishes a white paper titled “Performance Transformation: An Undeniable Requirement in Uncertain Times.”
• GE Healthcare previews its upcoming film, “Heroines of Health.”
• Meditech announces that it sold systems to five customers representing 16 hospitals in Q1.
• EClinicalWorks will exhibit at the 2017 MPHCA Annual Conference May 30-June 2 in Biloxi, MS.
• FormFast, HealthCast, Iatric Systems, Imprivata, and Intelligent Medical Objects will exhibit at the 2017 International MUSE Conference May 30-June 2 in Dallas.
• As of May 18, people have counted on Healthwise information 2 billion times.
• DrFirst is sponsoring next week’s MUSE conference, where its executives will present seven medication management sessions.
• InterSystems will exhibit at the DoD/VA and Gov Health IT Summit May 31-June 1 in Alexandria, VA.

Blog Posts

• Prevention is Better Than a Cure: An In-Depth Look at Proactive Health (Evariant)
• From working with the pediatric population to diving into technology (Infor)
• 3 reasons why the CBO score should be a wake-up call for hospitals (Advisory Board)
• Four Considerations for CJR Payment Reconciliation: Is Your Organization Prepared? (ECG Management Consultants)
• Recap of expanded Community Giveback Week (Nordic)
• Why Healthcare Technology Innovation Must Consider the Patient Story (Hayes Management Consulting)
• Responding to the WannaCry Cyber Attack (The HCI Group)
• 4 Questions with Joan McFaul, Former CIO of Southcoast Health System (Optimum Healthcare IT)
• Houston. Healthcare. Fossils. Profits. (Healthcare Growth Partners)
• Smart Pumps at MUSE 2017 & how this topic relates to all of us (Iatric Systems)
• Patches aren’t the silver bullet; hospitals can keep systems running when hit by ransomware attacks (Imprivata)
• Why Horizontal Martech Won’t Work for Healthcare (Influence Health)
• 3 Key Security Threat Trends Healthcare Organizations Can’t Ignore (InstaMed)
• Overcoming Entropy: Cultivating Care Coordination at eHealth Week (InterSystems)
• Five Must-Track Digital Marketing Metrics for Health Systems (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.

EPtalk by Dr. Jayne 5/25/17

I’d wager that 99 percent of people who have worked with me wouldn’t classify me as a delicate flower, a special snowflake, or someone who is easily offended. I’ve spent the majority of my academic and professional careers in male-dominated fields and have been on the receiving end of sexual and other harassment.

I take issue, however, with organizations that pay lip service to diversity and inclusiveness when their actions say otherwise. Not everyone has a thick hide, however, so when one of my consultants reported that a client was behaving badly, I wanted to gather some evidence.

I spent a good chunk of today listening to recordings of conference calls, which unfortunately demonstrated everything my consultant said was going on and more. Boorish and unprofessional are the mildest adjectives I could come up with as I prepare my letter terminating our professional relationship.

We had been hired to assist a small practice with their workplace dynamics and to help try to correct some issues they’ve had with staff turnover. Our first onsite assessment revealed countless sports and gambling analogies (in nearly every conversation) that had a tendency to alienate members of the staff who might not find stories about betting at the dog track to be amusing or in harmony with their religious beliefs. Based on our findings, we agreed that you can coach your way through a lot of that, and we persisted because they seemed willing to participate in making things better.

Many of their issues were process related, with staff being frustrated by lack of policy and procedure documents that would explain why they were constantly being told by one partner or another that what they were doing was wrong. My consultant worked on getting an employee handbook together and at standardizing their office workflows knowing that reduced variation would make things less stressful and perhaps increase retention. She did some stakeholder assessments that identified many of the issues being attributed to a couple of the physicians, with the rest of the providers being highly respected.

The two physicians who needed the most work have been abrasive to my team, but within the realm of what the team felt they could handle. Plus, they were treating both male and female consultants badly, so we chalked it up to boorishness rather than discrimination.

Over the past few weeks, though, the behavior has escalated. One consultant (who happens to be a man) never complains about anything, so I knew that there was more to the story when he described some of the behavior as “unseemly.” We discussed strategies for discussing it with the managing partners and office manager and that we’d monitor how things were progressing.

At this week’s management meeting, however, some comments were made about certain office responsibilities being “women’s work” and one of the managing physicians told a young female physician to stop bringing her complaints to office meetings and maybe bring some cookies or cupcakes instead. It may have been meant in jest, but I doubt he would have said the same to a junior male physician. In fact, after reviewing the recording of the meeting, he didn’t say anything of the sort to a male peer who was also complaining. He listened to the same types of concerns from one while chastising the other for hers.

It wasn’t just that. The meeting ranged all over the place, with outright mocking of the regional dialect of one staff member and some snarky commentary about various ethnic groups and international political conflicts. There was also some talk that could be graciously referred to as “locker room talk” that was pretty rough.

Listening to some of the banter, all I could picture in my mind was an episode of “The Three Stooges.” Some of the comments were so bad and so highly inappropriate that I felt like the physician in question was trying to sabotage himself. I don’t care who you are, or where you are, or what your beliefs are, some things are just not OK and there are lines that should not be crossed.

I transcribed some of the dialogue and scheduled a call with the head physician to address it. Although he was apologetic, he wasn’t willing to address his partner and essentially told me that since Dr. Lawsuit-Waiting-to-Happen was the top biller and we needed to stop making waves.

At that point, I let him know that I was unwilling to put my team in a hostile environment and that we were done since the entire point of the consulting engagement was to help them get to the root of (and hopefully fix) their office turnover issues. If he wasn’t able to assist with the process, there was little more for us to do. He seemed to take it in stride, said he understood why I was canceling our agreement, and asked me to send a formal written termination notice so he could release us from the rest of the engagement.

It was at that point that I realized the extent of his partner’s bullying. He knows he has a problem and he knows he’s not ready to take on his partner, so he is going to go along with it. I hope he comes to his senses before they get slapped with some kind of lawsuit, but I’m not holding my breath.

For practices struggling with the transition from fee-for-service to value-based care, or dealing with shifting payments and increasing patient responsibility, or all the other pressures, having a physician behave like this is the last thing they need. You need your office running as a finely-tuned machine. But until they’re willing to address it, or let someone else address it, they’re going to get what they get.

Like I said, I’m not easily shocked, but this guy took the cake (regardless of whether a man or a woman baked it). I didn’t have the opportunity to shadow him with patients, but I wonder how he is on the other side of the exam room door and why patients continue to flock to him. He has to have some redeeming value, but after this week I am challenged to figure out what it might be. It makes me more grateful to be in my current practice situation, where this sort of nonsense would never be tolerated.

Since most of us can’t fire our colleagues or co-workers when they act like this, how does your organization handle boorish behavior? Email me.

Email Dr. Jayne.

Morning Headlines 5/25/17

Congressional Budget Office: HR 1628 American Health Care Act of 2017

CBO reports that by 2026, AHCA will reduce the federal deficit by $119 billion but increase the number of uninsured Americans by 23 million.

Putting America’s Health First: FY2018 President’s Budget for HHS

President Trump’s budget proposal includes a $22 million reduction in ONC’s budget.

U of C receives $100 million donation for new wellness institute

The University of Chicago Medicine receives a $100 million donation, the largest in its organization’s history, from Chicago investor Craig Duchossois and his family. The donation will be used to establish a wellness research center.

Patient Safety and Information Technology

Former National Coordinator Karen DeSalvo, MD speaks at the release of Bipartisan Policy Center’s report on health IT safety.

CIO Unplugged 5/24/17

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

Leading with Fear – Not!

Researches say we are born with two fears — fear of falling and fear of loud noises. Every other fear is learned. Fear is developed and reinforced because of the consequences and punishments we experience.

Ironically, 85 percent of our fears are never realized. In fact, many are irrational, often based on emotion, not data. Real or imagined, the consequences of fear, especially in the workplace, are devastating.

Insecure leaders rule with fear. Even when effective, the use of fear to motivate employees is morally corrupt. Fear has no place at work. Confident leaders can achieve better results creating an engaged culture without fear. Who wants to work for a leader whose primary tactic is fear to motivate? Nobody.

Clearly, people still work for fear mongers. Leaders throughout history have leveraged fear. Despite the contemporary focus on management theory and professional development, leadership by fear continues.

Employees feel they may not have a choice but to capitulate to the fear mongers. Others have a victim mentality, feel incapable of escape, and assign the experience to fate. At the edge are those who believe they may deserve the punishment.

Naïve workers who know no difference may believe all leaders rule by fear. A smaller percentage know it is wrong, actively resist, and look for the first opportunity to escape. This reinforces the trend where the best employees tend to leave unhealthy environments while peers begrudgingly accept abuse and stay.

Leadership by fear is a management form of bullying. We spend too much time at work to be miserable and treated disrespectfully. There is a better way, and if you find yourself working for an abusive leader, you must stand up for yourself or leave. Pacifism only reinforces the behavior and nothing changes for you, nor for those who follow. Stay and fight if you have the skills, but move on if you have no support. Nobody deserves to be bullied.

I once observed an iron-fisted peer who ruled by fear. Insecure and simply unpleasant, he would routinely yell, curse, belittle, and threaten his team. I watched otherwise aspiring leaders shake to their core. His team trembled working for him. The more they passively accepted his leadership by fear, the deeper it became ingrained.

His power over them grew. His bullying became the new norm and eventually worked its way down to the depths of his division. Weak subordinates accepted and adopted this style and soon the stain and stench of fear permeated. Engagement plummeted as the culture shifted into the abyss. Next, performance fell. Fear, left unchecked, grows and takes no prisoners.

I felt sad. Heartbroken for the people who came to serve each day wanting to do good work, but were bullied. Torn to see aspiring leaders snuffed too early in their careers. Disappointed for customers who suffered deteriorating service. It became a slow death spiral. Lead with fear, and when performance suffers, add more fear.

By the time our parent organization took action, the damage was profound. The division was rebuilt over time, but the scars and pain from fear never disappear. Healing takes time and love.

Love is the antidote to fear. How can you change a fear-emboldened leader or a fear-based culture? Love does not imply that you overlook poor performers and sing Kumbaya all day holding hands sitting in a circle. No, love is a verb and is action-oriented. Love is discipline. Love is tough. While love is kind and respectful, it is never a crutch or excuse. Love does not accept mediocrity. Love propels performance. Love inspires.

I try to incorporate love into who I am as a person and as a leader. I remain a work in process, but it is easier to love then to hate. Love helps me develop compassion for those dealing with adversity. It increases my empathy towards others, which is why I’ve learned to listen to the heart as much as to words.

I am less judgmental and more tolerant. I am increasingly open to new ideas, diversity of styles and beliefs. I have embraced others very different from me and am better for it. Embracing love as a leader quickened my healing of wounds from past hurts. My heart aches for those who have not yet found love. Life is short; there is not time for fear to rule us.

It was awkward the first time I introduced love in the workplace. I was a young officer commanding my first platoon. My platoon sergeant was everything you would think of in a professional warrior. Battle-hardened, he chewed up Second Lieutenants like me for breakfast. But our platoon had challenges and we were not getting better by simply amping the fear in our squad leaders and soldiers.

First I and then SSG Hammer stopped yelling and otherwise intimidating our soldiers. While expectations and discipline never waivered, we demonstrated care and compassion to each of them. Word spread that upon an unexpected deployment, I mowed his young family’s lawn each week in his absence. It was small, but embodied the change in culture we sought. We changed, the platoon was transformed, and arguably it became one of the best engineering units in our battalion. Awkward at first, but love worked.

Love transformed me, my teams, my divisions, and my organizations. Love reached our customers and improved service. It created better opportunities for individuals to become whom they were created to be. It helped foster a culture of civility, setting a firm foundation for individual, team, and organizational success that exceeded expectations.

I learned of love from many sources and I continue to dig deep to find more. My mom loved me and believed in me before I believed in myself. My dad, who bared his soul in a TED Talk about his concentration camp escape while his family was left behind…and how he chose love over fear and till this day he has not once showed anger towards those responsible. Those family and friends who love me despite my failures. My life mentor led with love in a fear-based society and changed the world. Love wins.

Love chases away fear. The two can’t coexist. Where there is love, there is freedom. Where there is freedom, we are inspired to do our best. Lead with love and you’ll witness a transformation that may seem small on some level, but will be giant for those you serve.

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.

Readers Write: Technology Can Lift the Veil of Secrecy on Drug Prices

Technology Can Lift the Veil of Secrecy on Drug Prices
By Thomas Borzilleri

Thomas Borzilleri is CEO of InteliScript.

The recent story about the rift over prescription drug prices between insurer Anthem and its pharmacy benefits manager Express Scripts should anger — and frankly, befuddle — any physician or electronic health record (EHR) vendor. Providers and IT vendors should be fed up with payers and patients getting ripped off by inflated drug prices, taking a disproportionate share of the healthcare dollar. They also ought to be puzzled about why, with all of our advances, we are still living in a marketplace where no one knows what drugs really cost.

It’s particularly absurd because technology exists that can put an end to the opacity, overpayment, and oligarchy that characterize prescription drug purchasing today. Providers deserve and EHR vendors can offer tools that deliver the prices for any drug at the five cheapest pharmacies nearby. Doctors can have this data at their fingertips, within a few seconds, at the point of care, integrated into their existing workflow. These technology solutions can also track prescriptions to make sure they are picked up and refilled on a regular basis to gain new insight into which patients are at risk for adverse events due to medication non-adherence.

For years, insurers and patients have just accepted that the price they are getting is the best price, or the only price. However, allegations like Anthem’s — that Express Scripts overcharged the insurer by $3 billion — should make everyone in the healthcare ecosystem skeptical about the fairness of drug prices. But truly lifting the veil on drug prices will take a concerted effort by many stakeholders in the provider and IT vendor communities to take on the PBM juggernaut.

Strangely enough, when PBMs gained widespread popularity in the 1980s, there was an understanding that they worked on behalf of payers to lower prices, both by securing discounts and by steering patients towards lower-cost drugs. The truth, however, is that PBM “discounts” have always included heavy padding in the form of ingredient spreads and per-prescription fees. In fact, while PBMs are typically paying manufacturers 96 percent off the Average Wholesale Price (AWP) —the “sticker price” for drugs —the prices they charge insurers and employers are between 70 percent and 85 percent off the AWP. PBMs are skimming 10-25 percent off each prescription.

Insurers and employers have had little recourse, both because they did not know the true price of prescription drugs and because they did not have a way to easily shop around between competing pharmacies to get the best price on every medication. Instead, complex, opaque package deals with PBMs mean the payer might be getting good deals on some drugs and getting raked over the coals on others.

Drug price transparency and shopping tools are essential for payers to rein in costs and keep both premiums and co-pays from spiking. The urgent need for this data has also intensified recently because an increasing share of prescription drug costs are borne by consumers themselves. Patients simply won’t take their drugs properly, or at all, if they are out of reach financially. Affordability is now the number one reason for non-adherence to medications, which leads to poor outcomes, including avoidable hospital readmissions. A lack of medication adherence is estimated to cause approximately 125,000 deaths, at least 10 percent of hospitalizations, and cost between $100 billion and $289 billion a year.

In the past, some patients have looked to Canadian or other foreign mail-order pharmacies to try to lower drug costs. But these transactions are usually outside the doctor-patient relationship and may cause more harm than good to the patient, either by exposing him or her to dangerous drug formulations or by causing rifts in care continuity.

Doctors and patients, together, must come to the best decision about the right drug for their condition and price must be a part of that equation. We need technology solutions that enable doctors to find the best price on any drug, at local pharmacies that are convenient to the patient. Tools exist to address these concerns. The key is to embed these tools into existing EHR systems. By doing so, we can avoid disrupting doctors’ workflow and can ensure that all e-prescribing information is captured in the patient record.

These solutions must achieve savings for both the payer and the consumer. First, the solution must provide the lowest possible retail price while consumers are still paying off their deductibles, and then provide the lowest negotiated payer price to the insurer or employer once they start picking up the tab. These solutions can also be used to circumvent common PBM strategies, such as excluding low-cost brand and generic drugs from formularies to artificially increase co-pays on these cheaper drugs, which costs insurers and self-insured consumers billions of dollars each year.

Typically, consumers don’t realize that the cash price is in many instances lower than their adjusted co-pay, with the excess going right into the pocket of the PBM. Drug price transparency and shopping solutions should crunch the numbers for the doctor and patient, letting them know when it’s better to pay the cash price and when it’s more cost-effective to pay the co-pay.

Health IT solutions are typically geared towards one healthcare user: hospitals, doctors, patients, insurers, or employers. But drug price transparency technology is one of those rare innovations that will benefit each of those audiences. Doctors and patients, together, will be able to make the best decisions about medication management, at the point of care, during the prescribing process. Hospitals will enjoy better population health management through better medication adherence. Insurers and employers will be able to wring more value from each healthcare dollar.

What we need now is a commitment from EHR vendors to adopt this type of technology. The bottom line is that we can’t succeed in bending the cost curve in healthcare if we don’t know what the costs are in the first place. That includes prescription drugs. We in the health IT industry have the insight and ingenuity to draw the curtain back on drug price secrecy and we have a real obligation to do so.

Morning Headlines 5/24/17

Patient Safety and Information Technology: Improving Information Technology’s Role in Providing Safer Care

The Bipartisan Policy Committee publishes a report on health IT and patient safety, calling for “a coordinated effort—supported by public and private sector funding—to set health IT safety priorities, drawing upon existing reporting and analysis efforts,” in addition to disseminating best practices and continued development of safety standards.

Evaluation of Suicide Prevention Programs in Veterans Health Administration Facilities

An OIG investigation of suicide prevention programs in VHA facilities finds that while veterans account for 18 percent of all deaths from suicide within the US, many VHA facilities still fail to conduct mandatory community outreach activities designed to bolster suicide hotline call volumes.

What Hospital CIOs Think About Data Security and Clinical Mobility 

A survey of 100 hospital CIOs finds that 30 percent of respondents believe PHI is being shared via unsecure methods within their facility.

NantHealth Names Ronald A. Louks as Chief Operating Officer

NantHealth names former BlackBerry President  Ronald Louks as its new COO.

News 5/24/17

Top News

The Bipartisan Policy Center calls for creating a public-private effort to set health IT safety priorities and to disseminate best practices.

The report recommends:

• General patient safety efforts should incorporate the safety of health IT throughout its life cycle.
• Health IT safety should be addressed via a non-punitive learning system similar to medical error reporting.
• Voluntary and mandatory reporting systems should collect de-identified data about health IT safety issues that can drive creation of evidence-based practices and tools.

The report does not specifically address ONC’s proposed EHR safety center.  

Reader Comments

From Vaporware?: “Re: Cerner. How long do they get a free pass on selling interoperability without delivering? Beth Israel Deaconess Care Organization lists just six EHRS of the 40 its providers use – Cerner not among the six – that are willing and able to contribute information to its population health analytics system. Do the live MHS Genesis pilot sites have connectivity to outside EHRs?” I’ll invite readers with the firsthand experience with either project that I don’t have to comment anonymously.

From Chaste Kiss: “Re: this HIMSS-owned publication’s story. I’m embarrassed that I actually clicked the tweet to read more.” No wonder – you were cheated when a publication runs a story titled “Is a takeover of Athenahealth inevitable?” that doesn’t actually answer the question it poses (nor could it). It simply rewords a lazy Bloomberg opinion column in which those original authors speculated  –without using any sources or providing evidence of analytical thought — that maybe Cerner, IBM, UnitedHealthGroup, Aetna, or Epic might be interested in buying Athenahealth (the fact that Epic was named means the authors are clueless). The embarrassingly lazy source article wasn’t improved one iota by having the HIT publication improperly legitimize it by rephrasing its undisciplined conclusions. In both cases, the writers seemed desperate to fill their allotted space with whatever fizzy “news” they could make up with a minimum of expended effort.

From Greg: “Re: sepsis monitoring. The new Meditech 6.1 Surveillance product has a rules-based approach that looks at real-time EMR clinical data in the EMR. There the clinician can be notified and take appropriate action in an efficient and sometimes life-saving manner. These actions can include orders, medications, labs, documentation, problems, interventions, etc. I have personally not seen another EMR that is as far advanced with regards to surveillance.”

From SgtPerkins: “Re: John Brownstein’s tweet about Epic’s App Orchard developer terms. It is no longer available. $50 says he got a C&D from Epic to remove it. Even their awful legalese is intellectual property to them.” Unverified. My screenshot of his tweet from the Boston Children’s chief innovation officer is here. My experience is that such takedown requests often come from an individual’s employer rather than the subject of their comments, especially when the employer is a partner of the company mentioned (as I well know, having been threatened in my early, less-anonymous HIStalk days with being fired by my hospital employer for writing about one of our vendors even though it wasn’t inside information). Also, Epic’s App Orchard legal wording wasn’t really a secret anyway since it’s publicly available and, as other readers have noted, is similar to that of the Apple Store.

HIStalk Announcements and Requests

Readers funded the DonorsChoose grant request of Mrs. D in Arkansas, who asked for writing journals and math activity kits and games for her elementary school class. She reports, “These materials have allowed students to learn using a hands on approach. We love all of our games and our writing journals! Students are so proud to have their own journal to write in each day. You have made all the difference! Thanks again.”

Webinars

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

Acquisitions, Funding, Business, and Stock

Post-acute care software vendor Optima Healthcare Solutions acquires Hospicesoft, which offers hospice software.

Sales

Five Ontario hospitals add PatientKeeper CPOE and medication reconciliation to their existing system and will expand their use of the company’s physician documentation solution, providing an overlay to Meditech Magic and other systems. 

St. Joseph Health (CA) will expand its use of Clearsense analytics in implementing Inception for archiving, access, and visualization of its legacy Meditech data.

Harbin Clinic (GA) chooses analytics from PrecisionBI, a division of Meridian Medical Management.

People

A Philadelphia innovation organization recognizes Children’s Hospital of Philadelphia AVP/Chief Health Informatics Officer Bimal Desai, MD, MBI as its healthcare innovator of the year. He co-founded CHOP spinoff Haystack Informatics, which offers security technology that detects EHR snooping by learning normal staff behavior and calling out exceptions.

NantHealth hires Ron Louks (BlackBerry) as COO.

Announcements and Implementations

Rush Health (IL) launches Rush Health Connect, which aggregates information from its Epic and Allscripts EHRS using InterSystems HealthShare to give clinicians patient information and real-time alerts and notifications.

Change Healthcare joins the Hyperledger open source blockchain project.

The Fresno paper covers the use by Community Medical Centers of RightPatient iris recognition at patient registration, which the article explains isn’t an infrared scan, but rather just a photo of the patient’s eye. It also notes that palm vein ID systems are an alternative. RightPatient can also analyze a patient’s general headshot to identify them going forward.

DrFirst will integrate prescription pricing information from GoodRx into its e-prescribing platform.

Government and Politics

A VA OIG suicide prevention report finds that around 20 percent of inspected VA facilities don’t perform the mandated five outreach events per month, haven’t developed suicide prevention safety plans that are documented in the EHR, and don’t flag high-risk patients in the EHR. More alarmingly, OIG found that while 84 percent of non-clinical hospital hires completed their mandatory suicide prevention training within 90 days, nearly half of newly hired clinicians did not do so.

The director of Denmark’s version of the FDA expresses concern that US tech companies like Google and Apple are rolling out medically-related fitness tools and devices that “have no requirements to demonstrate efficacy and safety, but we are forced into the direction of taking them seriously.” The finance minister warns that while patients are notified by email any time their Denmark-based interoperable electronic medical records are viewed, private services and apps offer no such protection, explaining, “We need to make our citizens aware that there is no free lunch with these big companies. People should make some more demands when they give their data away. These companies want to know what you want before you know it yourselves. We need to look into regulation. These private companies will have this patient data for eternity. Can we be sure they’ll always do good things with it?”

A report by HHS’s Office of the Assistant Secretary for Planning and Evaluation blames the Affordable Care Act for the 105 percent jump in premiums from 2013 to 2017 in the 39 states participating in Healthcare.gov, as the average monthly premium increased from $224 to $476. The report, however, didn’t look at the increase in non-exchange sold individual plans and admits in its “Limitations” section that much of the premium increase is probably due to older, sicker people signing up in 2017 vs. 2013. The analysis also fails to note that pre-ACA policies (Healthcare.gov went live in 2013) were often full of coverage loopholes, exclusions, lack of coverage for pre-existing conditions, and lack of insurer experience with an uncertain risk pool.

HIMSS complains about President Trump’s proposed federal budget that calls for major funding cuts for ONC, CDC, CMS, and NIH along with zero money for AHRQ, which would likely be rolled into NIH. The proposal also calls for cutting Medicaid by $800 billion over 10 years.

Other

A Spok survey of 100 hospital CIOs finds that 40 percent of hospitals don’t discipline staff members who violate mobile policies, 30 percent say a significant portion of hospital data is shared insecurely, and more than half of doctors and nurses are unhappy with the communications methods available outside their EHR. Forty-one percent of hospitals don’t offer secure texting and those that do are equally split between providing it via the personal devices of employees vs. hospital-issued technology. Nearly one-third of clinical staff can’t receive clinical alerts or mobile messages from colleagues. CIOs say their hospitals are still using pagers because they are appropriate for some groups, are reliable, and are cheap and easily supported. More than half of the respondents say their biggest challenge in protecting hospital data is a lack of money and people.

A ProPublica investigative piece observes that the still-increasing US maternal death rate is the highest in the developed world and 60 percent of those fatalities are preventable, profiling NICU nurse Lauren Bloomstein, who died of preeclampsia shortly after giving birth in which hospital medical errors apparently contributed. Factors include women giving birth later in life when their medical histories are complex, the nearly half of US pregnancies that are unplanned, the complications of C-sections, and the fragmented health/insurance system that makes it hard to get prenatal care (likely to get worse with any cutbacks to Medicaid, which pays for nearly half of US births). The article notes that perhaps the healthcare system is focused so much on saving the lives of babies – which it has done well – that it isn’t paying enough attention to the health of the mother. A standardized approach to quickly reacting to possible preeclampsia reduced UK maternal deaths to just two in three years, while up to 70 US mothers die of it annually even as US hospitals push back on implementing evidence-based processes.

All you need to know about US health insurance is contained in this one story. An Army veteran whose wife requires pregnancy-related injections not covered by their medical insurance finds that they make $70 too much per month to quality for Medicaid, so they move from North Carolina to Alabama for a job that offers better insurance. He pays COBRA to cover the one-month lapse before their new insurance kicks in. The baby came in early, the NC insurance wouldn’t pay since Alabama is out of network, and the couple gets a bill for a two-week NICU stay for $178,000, of which neither insurance would pay a penny. They can’t get loans and he will lose his defense-related job if they file bankruptcy. They raised a few thousand dollars in a GoFundMe campaign and are hoping to work out a hospital payment plan for the balance that will probably last the rest of their lives.

Instead of the help desk tech term PEBCAK (problem exists between chair and keyboard), this was PEBCASW (steering wheel). In China, a car show model who is demonstrating Nissans’s emergency braking system by standing in front of the moving car is run over (with only minor injuries despite being thrown 10 feet) after the demo driver – who was not familiar with the system – pushes its button twice, turning it on and then off again.  

Sponsor Updates

• Docent Health assembles bags and lunches for Boston-based charity Bridge Over Troubled Waters.
• The American Association of Critical Care Nurses chooses Kathy Douglas, RN, MHA, chief clinical officer of Abililty Network’s ShiftHound, for its Pioneering Spirit award.
• CSI Healthcare IT provides at-the-elbow support for MaineHealth’s Epic go-live.
• Besler Consulting releases a new podcast, “Lessons learned from the introduction of a physician incentive compensation plan.”
• CapsuleTech and Dimensional Insight will exhibit at the International MUSE Conference May 30-June 2 in Dallas.
• Spok executives will speak at several industry events.
• Direct Consulting Associates will exhibit at the SIIM Annual Meeting June 1-3 in Pittsburgh.
• The American College of Radiology – a National Decision Support Co. partner – wins the ABIM Foundation Creating Value Challenge for its Radiology-Teaches initiative.

Blog Posts

• Hiring the best executives and professionals, monetarily guaranteed to be retained for 1 to 2 years (Direct Consulting Associates)
• EHealth Partnership Unites Ontario Hospitals on MEDITECH (Video Series) (Meditech)
• Specialists Training Specialists (Optimum Healthcare IT)
• Interactive Patient Care Platforms (Sphere3)
• State of the Union Address (AdvancedMD)
• Impressions of a very busy Health IT Expo 2017 in Paris (Agfa Healthcare)
• A Day in the Life of “Death by a Thousand Clicks” (Arcadia Healthcare Solutions)
• Hybrid Cloud is Now the Preferred Option Within Healthcare (Datica)
• Have You Adopted Electronic Prescriptions for Controlled Substances? (Caradigm)
• Prescription Nonadherence: An Infographic (CareSync)
• Growing Pains: A Practical Approach to Managing Your Application Portfolio During Organizational EvolutionGrowing Pains: A Practical Approach to Managing Your Application Portfolio During Organizational Evolution (CTG)
• Healthcare On-Demand: An Experience with Epic MyChart (Culbert Healthcare Solutions)
• 3 Takeaways from the New England HIMSS Spring Conference (Dimensional Insight)

Sponsors named to Modern Healthcare’s “Best Places to Work in Healthcare” 2017 list:

• Cumberland Consulting Group
• Divurgent
• Encore, a Quintiles Company
• Hayes Management Consulting
• Healthfinch
• Impact Advisors
• Imprivata
• Nordic
• PMD
• Santa Rosa Consulting
• The Chartis Group

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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