News 4/4/18

Top News

GE Healthcare will exit the health IT market by selling its revenue cycle, ambulatory care, and workforce management software business to Veritas Capital for $1.05 billion in cash.

Veritas Capital’s previous health IT acquisitions include Verisk Health (2016, renamed to Verscend) and the healthcare unit of Thomson Reuters (2012, sold to IBM for double its acquisition price in 2016).

GE Healthcare joins previous healthcare IT acquisition-fueled dabblers (McKesson, Siemens, Misys, Sage) in wrecking a bunch of acquired companies and then cutting and running when the expected massive profits didn’t materialize. Or as I wrote a long time ago, “conglomerate vendors that seem to be happy milking the wrinkled, desiccated udders of their thinning herds of malnourished and badly aging cash cows,” to which I added further back in 2006, “ Healthcare IT customers carry little weight with toe-dippers. Are GE brass more worried about the flatlining former CareCast or sagging toaster sales at Wal-Mart? Does patient safety come up in Siemens corporate meetings as often as power generators?”

Reader Comments

From Penultimate: “Re: EMRs as a research database. I looked at the article you linked to in your tweet about conglomerate vendors. That took me to the one where you predicted that EMRs linked to genomic data and social determinants of health would give drug companies valuable information they would be willing to pay for.” I forgot about that piece from 2006, in which I said, “Drug companies and device manufacturers need the data that lives in your clinical systems. How else will they be available to target research to a very narrow range of patient types, maybe even those with a rare genomic profile? It could help them identify appropriate research subjects, design post-marketing surveillance, study population-based outcomes, and catalog adverse events. The information you provide could either be de-identified or made available only if individual patients opt in. The benefit to patients is access to a wider variety of treatments and protocols, most likely free to them if tied to a research project.” Your inquiry led me to look at the other editorials I wrote long enough ago that I can enjoy them as something new.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Qventus. The Los Altos, CA-based company’s AI-powered technology – which serves as virtual air traffic control for hospital operations — helps healthcare teams turn data into action and action into results. Its real-time decision management platform improves efficiency, patient experience, and clinician satisfaction by predicting issues, recommending immediate actions, alerting the right team members, and coordinating response. Success stories include El Camino Hospital (reduced falls by 39 percent), Stanford Children’s Health (increased patient satisfaction by 18 percent), Mercy Hospital Ardmore (reduced patients who left the ED without being seen by 55 percent), and Mercy Hospital Fort Smith (reduced unnecessary lab tests by 40 percent). Hospitals have rolled out countless dashboards and analytics reports from competing companies without success because those on the front line still have to make operational decisions with incomplete insight. The company’s platform is quickly deployed, easy to use, and easy to integrate with EHRs. Check out your own hospital’s efficiency ranking. Thanks to Qventus for supporting HIStalk.

Here’s a Qventus intro video I found on YouTube.

Listening (and watching): “Long Time Running,” an outstanding documentary streaming on Netflix that covers the bittersweet 2016 farewell tour of Canadian rock band The Tragically Hip after singer-songwriter Gord Downie was diagnosed with terminal brain cancer (he died a year later). The super-talented group has been intact since 1986 and the members agreed early on to share all songwriting credits (a la the Doors) to avoid dissent. The band’s love of country and affinity with their fellow Canadians (including Prime Minister Justin Trudeau, who appeared in the film) was a joy to watch, albeit with envy.

I had a routine appointment with a specialist today and saw the usual pointless form entry repetition first hand. They copied my insurance card, but I still had to manually write the information down on their paper form. Same with my referring doctor’s information. Every form asked me again for name, date of birth, age, and current date (apparently nobody was able to subtract B from D to calculate my C). Form fields weren’t big enough for the information requested. I had to sign in on the clipboard upon arrival, and of course I could see every person’s name and doctor. Then after filling everything out – medical history, family history, meds, social habits, etc. – the MA in the exam room asked me the same questions all over again so she could enter it into the EHR. However, healthcare is so defiantly and illogically inefficient that this process seemed streamlined and sensible in comparison.

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

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Enterprises; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populateeions holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Acquisitions, Funding, Business, and Stock

Orion Health Group announces poor annual results and implementation of a cost-saving restructuring as it reorganizes into three business units – Rhapsody, population health, and hospitals. Share price hit an all-time low on the New Zealand stock Exchange following the financial report, reducing the company’s market cap to $100 million.

Ninety-two of the 104 doctors of Charlotte, NC-based Mecklenburg Medical Group sue Atrium Health (the former Carolinas Healthcare System) to leave the health system and operate independently following contract changes that reduced the practice’s RN staffing levels, centralized triage and reception functions at a call center, reduced compensation, and added a non-complete clause that prevents doctors from practicing with a 30-mile radius for a year after leaving.

Humana, MultiPlan, Quest, Optum, and UnitedHealthcare launch a pilot of a blockchain-powered project to improve provider directories.

Walmart to be in acquisition talks with PillPack, an online pharmacy that packages individual doses into reminder packs. The rumored price is in the $1 billion range.

The Nashville paper confirms an item a reader submitted a few days ago – Microsoft is suing Community Health Systems for breaching its software licensing contracts.

Hyland completes its acquisition of Allscripts OneContent (the former McKesson Horizon Patient Folders), transitioning its Alpharetta-based employees and 350 customers.

Sales

• Illinois Rural Community Care Organization chooses Cerner HealthIntent for population health management.
• Physicians’ Clinic of Iowa chooses the cloud-based EClinicalWorks v11 for its 84 providers.

People

McLeod Health (SC) promotes Matt Reich to SVP/CIO.

PatientPay hires Vikram Natarajan (Medfusion) as CTO.

Connected health technology vendor ResMed hires Bobby Ghoshal (Brightree, owned by ResMed) as CTO.

Susan Pouzar (Harris Healthcare) joins Genesis Automation Healthcare as VP of sales.

Neal Schwartz (Cerner) joins MedeAnalytics as COO.

Announcements and Implementations

ROI Healthcare Solutions launches a staffing and recruitment outsourcing organization called ROI Resource Group.

St. Charles Health System (OR) will go live on its $80 million Epic system next week, less than a year after choosing the company’s products. 

Population health management solutions vendor Casenet releases its TruCare Opioid Toolkit, which provides a patient assessment, an evidence-based care plan, and education materials.

Government and Politics

President Trump’s proposed CMS operating budget would eliminate funding for insurance exchanges.

Politico notes that the State Department has issued an RFP for a new EHR. It was previously collaborating with the Coast Guard to implement Epic until that project failed. The State Department is specifically interested in how an EHR would provide shared services opportunities with the DoD and VA, which would seem to point to Cerner as the most likely choice among the few capable vendors.

Kentucky passes a law prohibiting federally certified radiologists from interpreting X-rays in black lung compensation claims, allowing only pulmonologists to make those assessments. Of Kentucky’s six certified pulmonologists, four work for coal companies or their insurers.

Privacy and Security

Cloudflare launches 1.1.1.1, a brilliantly named DNS service that improves network performance and privacy (and maybe gain access to geo-blocked content, if that’s your thing). I’ve used DNS proxies before and they work fine, so I took a couple of minutes to set this one. It’s working invisibly, which is exactly what you would expect. 

Other

A Harvard Business Review article says the US spends too much of its healthcare dollar on low-value services that offer minimal clinical benefit, blaming: (a) limited effectiveness data for everything except drugs; (b) doctors make money from performing low-value services that they often can order themselves with payments protected by lobbyists; (c) patients lack the information to make their own decisions or to hold their doctors accountable. It notes that some high-value therapies are underused strictly because they are expensive, such as gene therapy and hepatitis C treatments. The authors propose using the capital markets to give insurers compensation when a patient’s early, expensive treatment results in savings for another insurer (like Medicare) down the road.

Sponsor Updates

• Medecision launches Aerial CarePlanner 360 that supports person-centric care.
• Meditech publishes a video in which hospital customers describe how they benefit from using Meditech.
• HCS will exhibit at and sponsor the NALTH Sprint Clinical Education & Annual Meeting in New Orleans on April 5-6.
• Aprima will exhibit at the OKMGMA Conference April 5-6 in Oklahoma City.
• Bernoulli Health will exhibit at SWUGM 2018 April 6 in Phoenix.
• CompuGroup Medical will exhibit at the ACMG Annual Meeting April 11-14 in Charlotte, NC.
• Everest Group recognizes Conduent as a leader in healthcare business process outsourcing.

Blog Posts

• HIMSS hype or health IT promise: We had 500 people weigh in… (Medicomp Systems)
• Center Stage Executive Spotlight: Shafin Kalyan, Executive Director, Ancillary Services (Optimum Healthcare IT)
• Black Book recognizes Nordic for highest client satisfaction in Epic IT Advisory Services (Nordic)
• Save the Date for Connect 18: The New Frontier of Healthcare Communications (Spok)
• How new nursing roles are shaping the future of healthcare (Meditech)
• 5 Tips for Creating a Successful IT M&A Playbook (Impact Advisors)
• How Integrated Healthcare Systems Impact the Patient Experience (Access)
• The Calm After the Storm (AdvancedMD)
• #BTheBestUCanB – Supporting two talented athletes, showcasing integrated and connected care (Agfa Healthcare)
• Medical Practice Billing Challenges and Some Suggestions to Overcome Them (Aprima)
• Measuring Quality Measures (Arcadia Healthcare Solutions)
• Top 2018 Trends in the Use of Healthcare AI (CareSync)
• Innovation: The Key to Fixing Prior Auth (Change Healthcare)
• How Specialty Tailored Templates Can Help Improve Your Practice (ChartLogic)
• Healthcare Interoperability: Are We There Yet? (Clinical Architecture)
• Patient Engagement, Cybersecurity, AI and More: Health Themes at HIMSS18 (CoverMyMeds)
• Developing a Strong Workforce as We are Faced with Competing Priorities (Culbert Healthcare Solutions)
• Takeaways from the 2018 Gartner Data & Analytics Summit (Dimensional Insight)
• Navigating Healthcare through Today’s Cybersecurity Landscape (Divurgent)
• Switch Survival Toolkit – Part 1: Discovery (DocuTap)

Contacts

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

Morning Headlines 4/3/18

GE Sheds Health IT Assets for $1B, Doubles Down on A.I. and Devices

Veritas Capital will acquire GE Healthcare’s Value-Based Care Division – including ambulatory care, RCM, and workforce management assets – for $1 billion.

St. Charles’ new $79.5 million record system going online

St. Charles Health System (OR) brings its “slightly under budget” Epic system online after a two-year implementation process.

Insurers will study blockchain to fix their provider lists

UnitedHealth Group, Optum, Humana, Quest Diagnostics, and Multiplan embark on a pilot project to determine if blockchain technology can streamline the process of verifying and updating their provider lists.

Merged Aurora Health Care, Advocate Health Care consider clinic expansion near Foxconn

Advocate Aurora Health co-CEO and co-President Jim Skogsbergh says the newly merged entity’s biggest priority will be converting Advocate facilities to Epic – a three-year project with an as yet undisclosed cost.

Curbside Consult with Dr. Jayne 4/2/18

Spring is here, or at least sort of. We’ve had 17 straight days of rain, finally followed by one sunny day that was decent enough to migrate from the treadmill to the streets. The daffodils were blooming and everything was greening up, and then we got the April Fools’ joke of snow. Still, the transition to spring is a good one and hopefully the snow won’t stay around for long. Watching the outdoors perk up tends to give people energy to take on new projects and embrace new things. In that spirit, I’m going to offer some challenges to the healthcare IT leaders out there.

Challenge #1

Look through your library of applications and find a feature that you’re not using but that might benefit your users. Maybe it’s a feature that you didn’t need at the time it was created, so you didn’t implement it. Since then, your business might have changed, or maybe healthcare in your community changed, and it might be a good thing to roll out now. We also see organizations not implement features because they’re forced to upgrade on a specific timeline and don’t have time to address everything that comes with a new release.

I often challenge organizations to do this and the results can be impressive. One group originally shied away from allowing user-level personalization even though the EHR supported it. They were afraid that allowing users to reorganize icons and set too many preferences would make it difficult for the help desk team to provide support. Over time, the lack of willingness to allow user personalization hampered workflow, leading to many meaningless clicks that didn’t contribute to an individual user’s workflow. Even where personalization was allowed, it wasn’t encouraged – the majority of physicians didn’t have user-specific medication favorites that they could use to quickly enter drug orders nor did they have links to their preferred patient education materials. (Some of them were even still pulling paper photocopies from a file cabinet.)

If you’re really nervous about rolling out a feature, consider piloting it, perhaps selecting one clinical division or practice location to use a new feature. This allows you to not only complete a proof-of-concept exercise, but to ensure your training and implementation approach is solid before you roll it to the rest of your organization. Although sometimes we will see a failure, in most cases new features that are carefully rolled out will be embraced and can save end users time and frustration.

In addition to user personalization features, other features we often see put on the back burner: e-prescribing; e-prescribing of controlled substances; real-time eligibility checking; patient portal appointment scheduling; online statements and bill pay; secure messaging; clinical decision support; and condition-specific documentation favorites.

Challenge #2

Review your policies, procedures, and processes and find one that isn’t required and doesn’t add value, then eliminate it. In observing clinical workflows, I often find data collection points that aren’t used and no one questions why they are gathered. Maybe it was a grant that your practice had three years ago that wasn’t renewed; maybe the data is now automatically fed from another system (such as registration or the bed board system) and no longer needs to be collected separately in the EHR.

I often suggest that organizations review their patient intake forms and look for redundancy. At a recent physician office visit, I was asked to write my pharmacy information on three separate sheets of paper. It was clear that the office had evolved their intake forms, but had done so in a siloed fashion. The “front desk registration sheet” asked for it, the “clinical history” sheet asked for it, and they “why are you here today” sheet asked for it. For a returning patient where only the “why are you here today” sheet might be filled out, that might make sense, but for a new patient filling all three sheets out, it was a bit much. Not only does asking for data multiple times irritate and inconvenience your patients, but it increases the risk of error as people are overwhelmed and are copying information multiple times.

In a typical clinical / financial workflow analysis, I usually find close to a dozen processes that could either be eliminated or benefit from significant streamlining. Processes that can be eliminated often grow from distrust of electronic systems. For example, making patients verify paper copies of their history forms even though they just filled them out online within the past 48 hours and already electronically attested to their accuracy. Or making patients completely fill out new patient paperwork annually rather than printing them a copy of their current information and asking them to confirm and update.

Other processes might be unrelated to patient flow but important to business. I see a lot of waste in processes that organizations use for shift scheduling, time-off requests, expense reimbursement, and more. I also see a lot of policies that are “required by HIPAA” or “required by OSHA” that are truly nothing of the sort. Make sure if something is “required” that it really is, unless you want to be called out on it.

Challenge #3

Spend time as a leadership group reviewing organizational values. There are a lot of mission statements and vision statements out there, but in many cases, they are so remote from day-to-day business operations that they’re not having any influence on how people work or how they interact with patients or other clients. I still remember the mission statement of my first EHR project at Big Medical Center – probably because we actually believed it and lived it on a daily basis, rather than just seeing it posted in the hallway or once a year in some slide deck. If your vision has gotten hazy or cloudy, maybe it needs an update. If people don’t know what the mission is, then your corporate culture might need some attention.

Organizational values should be more than just a plaque on a wall somewhere. They’re more than a logo or brand statement. Values should be easily understandable and should guide the actions of people doing business whether with internal customers, patients, family members, or anyone else. If you find people in your organization conducting themselves outside of the values, be open to addressing it rather than taking the easier road of letting it go by or being glad it’s not happening on your team.

Spring is here and it’s a great time to make a change. Is your organization up to the challenge? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/2/18

23andMe Plans To Hire 200 People In 2018. Here’s How To Be One Of Them

23andMe plans to hire 200 employees this year as it looks to expand its consumer genetic testing and research capabilities.

Did Shulkin get fired or resign? This is why it matters

The White House insists that VA Secretary David Shulkin, MD resigned, disputing Shulkin’s own account of being fired.

Hey, Alexa, What Can You Hear? And What Will You Do With It?

Patent filings from Amazon and Google suggest that their digital assistants could do a lot more than obey pre-programmed commands, suggesting potential uses to monitor conversations for ad-serving ideas and body sounds for potential medical situations.

Accolade Announces $50 Million in Financing, Supports Solution Innovation and Growth to More than 1.1 Million Members

Personalized health and benefits solution vendor Accolade raises $50 million in a Series F funding round, increasing its total to $217 million.

Monday Morning Update 4/2/18

Top News

The White House insists that VA Secretary David Shulkin resigned, disputing Shulkin’s own account of being fired. Shulkin did not submit a resignation letter and wasn’t allowed to return to his office after being told he was being replaced.

The reason: firing Shulkin would have automatically made VA Deputy Secretary Thomas Bowman – with whom the White House has clashed over VA privatization– the VA’s acting secretary. Claiming that Shulkin resigned allowed the White House to hand pick the DoD’s Robert Wilkie as acting secretary.

There’s a health IT aspect in play. If Wilkie signs the VA’s Cerner contract as acting secretary, it could be challenged on the grounds that he isn’t serving in his role legally.

Shulkin said on Sunday’s “Meet the Press,” “I came to fight for our veterans and I had no intention of giving up. There would be no reason for me to resign. I made a commitment, I took an oath, and I was here to fight for our veterans.” He was emphatic in saying on another Sunday talk show that, “I did not resign,” adding that he was told in a telephone call from White House Chief of Staff John Kelly shortly before President Trump tweeted that he was nominating White House physician Rear Admiral Ronny Jackson, MD to replace him.

HIStalk Announcements and Requests

Two readers responded to my Vietnam Veterans Day pondering if anybody still actively working in health IT was deployed there. Checking in were: 

• Navy Petty Officer John Humm
• Army Intelligence Specialist Vince Ciotti

The most common online sources used by poll respondents to find a doctor are their insurer’s provider list, Healthgrades, and Google Reviews (that last one was surprising to me), although “none of these” was the #1 answer. Commenters mentioned that most doctors have few reviews with relevant details, also noting that insurance company lists are outdated, fail to describe what types of patient that doctor sees, and are full of doctors unwilling to accept new patients. A reader suggests going the other direction – ask around for recommended doctors and then call them up to see if they accept your insurance. 

New poll to your right or here: what’s your most-valued use of LinkedIn, if any?

I received fascinating responses to my question about “What I Wish I’d Known Before … Retiring or Career Downsizing.”

My next question involves what you wish you’d known before serving on the board of a company or non-profit. I see quite a bit of the latter on LinkedIn profiles and I’m interested in how that works.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Acquisitions, Funding, Business, and Stock

Japan’s Panasonic Healthcare Holdings renames itself to PHC Holdings.

Personalized health and benefits solution vendor Accolade raises $50 million in a Series F funding round, increasing its total to $217 million.

People

Consulting firm 314e hires Douglas Herr (Leidos Health) as SVP.

Government and Politics

California’s attorney general sues Sutter Health, claiming the health system violated antitrust laws in using its market dominance to force insurers to sign “all or nothing” contracts at inflated prices and to charge unreasonable out-of-network prices.

UK’s General Medical Council investigates 30 doctors for unsafe online prescribing after several patients died after being ordered narcotics from online visits. A recent report found that online doctors prescribed opiates and antibiotics without performing due diligence and failed to notify the patient’s PCP in some cases. 

Other

Patent filings from Amazon and Google suggest that their digital assistants could do a lot more than obey pre-programmed commands, suggesting their potential uses to monitor voice and telephone conversations to get ad-serving ideas for both parties involved and listen to body sounds to detect potential medical situations.

An HBR article by Bob Wachter, MD (USCF) and Jeff Goldsmith, PhD (University of Virginia) says the way to reduce physician burnout and increase quality of care is to improve billing-dominated, 1990s-technology EHRs that are “performing several tasks, badly.” They recommend that:

• Caregivers create a “portrait of the patient’s medical situation at the moment,” limited to a fix number of characters to force a concise recap similar to a tweet.
• The patient portrait is frequently updated under rules that also define who is responsible for doing so.
• The patient portrait is used as the patient’s “wall” whose updated information is used as clinician groupware.
• Data importing is limited to prevent chart bloat, with minute-by-minute comments automatically deleted a la Snapchat.
• Voice- and gesture-based interfaces should replace keyboards and mice, including voice-powered order entry and information recall.
• Order entry should provide clinicians with costs and risks.
• Patients should be able to enter their own information remotely.
• EHR value should be enhanced with artificial intelligence.

Readmissions dropped by half after Intermountain Healthcare implemented its “Partners in Healing” program, which places family members on a patient’s care team to prepare them to provide post-discharge care.

Epic did its usual home page makeover for April Fools’ Day (which I’ve spelled correctly).

Vince and Elise continue their look at 2018’s largest vendors by revenue and digging deeper into Cerner, Epic, and Allscripts. 

Sponsor Updates

• Research and advisory firm SiriusDecisions recognizes Huron Consulting, Imprivata, and Vocera as winners of the 2018 Return on Integration Awards.
• WebPT becomes the first rehab therapy EHR to achieve Platinum Standard ISO Certification.
• WiserTogether and Myewellness partner to provide wellness solutions to employers and employees.

Blog Posts

• Building a Brand with Creative Copywriting (Salesforce)
• Blockchain Healthcare Disruption in 2018? (The SSI Group)
• HIMSS18 Panel Gets Candid About Prescription Price Transparency (Surescripts)
• Ending Physician Burnout: It’s Time for Physicians to Take Back Control of Their Environment and How They Deliver Care (Vocera)
• More Than a Number: Personalizing Patient Care in Your Growing Therapy Practice (WebPT)
• What does the C-suite want? (Philips Wellcentive)

Contacts

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

What I Wish I’d Known Before … Retiring or Career Downsizing

Clearly the hit on the paycheck is the first thing that comes to mind. But honestly, when I look at ROI between continuing to work and no longer working, it makes it all worthwhile. Which is to say, the incremental difference in the paycheck to continue to work does NOT offset the pain and retiring and giving up that paycheck was the right thing to do. As much as I enjoyed my job in the latter years, it was not so much because of my managers, but because I figured out how to make it work. I’m glad to be retired honestly. And don’t even miss the paycheck!

Wish I had known devastating effect of having your life and ego wrapped so tightly around the work you’ve done or who you do it for. Working for a prestigious company gives you an identity to colleagues, friends, and family. When that goes away, part of you goes with it. You quickly realize that you no longer have a big name attached to big resources.

How much I would miss the daily interactions and problem-solving. The sense of trying to accomplish something as part of a team is difficult (impossible?) to recreate sitting at home. Also, my failure to create a meaningful alternative hobby during my (limited) spare time while working. Be sure to get an engaging interest outside of the office and family.

Perfect time to pick up a new hobby such as programming, web / app development. If you already know a computer language, learn a new one. There are some amazing new tools to play with out there: Python, SQL, Angular, MongoDB, Web2Py, etc. All free, open source. Pure fun. Expanding your mind to new levels, not to mention acquiring some needed skills as well. As the song goes:

“Go ask Alice
I think she’ll know
Remember what the dormouse said
Feed your head
Feed your head”

https://www.youtube.com/watch?v=WANNqr-vcx0

I went from working full-time to retirement in two days. Wish I would have / could have worked part-time for a while to ease myself into it. I also should have tried harder to find another job before I retired. Biggest reason I decided to go when I did (which was about three years before what Social Security considers full retirement age) was because of an insufferable department director and an incompetent CIO, both of whom were gone roughly a year after I retired. But it’s all good now. I love retirement.

Although the finances are OK, I think I’d like to have built up a little bit more reserve and know how busy I’d be. It has been nearly 10 years since leaving the workforce. Time is spent on things that I never even thought about doing (genealogy research is a huge time-suck), and at the same time, being more “available” for whatever short- or long-term project needs to be done among friends and family versus trying to squeeze it into weekends. Some of these (house fix-up) projects span a few weeks, others a few years. Have not been bored at all, but also have not had time to take a nap, which was a weekly thing after a 65-hour work week.

I wish I’d known how much I would enjoy downsizing my career from being a large system CIO. The quality of life improvement made me realize how much I was missing, and not having to constantly play politics was a huge relief. Having said that, I do miss a lot of the people that I worked with, truly some dedicated professionals who are really trying to make a difference in healthcare.

That once you have a “5” in front of your age, you suddenly become the least desirable applicant for any job in your profession. It seems employers think that once you hit 50, all your knowledge disappears. I would never have downsized had I known that I could never go back.

I retired “early” primarily because I was on the verge of burning out, both professionally and personally. So it’s more what I did know before retiring and that I had prepared myself for the transition. Best move I ever made. I am a recovered workaholic and quite content.

I haven’t done it yet, but an planning on getting off the corporate (software vendor) rat race as soon as my youngest graduates high school in three years. I’ve been through countless acquisitions, layoffs, VC, PE, and makeovers over my entire career. It takes its toll. Career downsizing will be a sacrifice, but selling the house, not buying a new car, and moving back to Florida and living out on the slow lane near the beach is my dream. My advice to the young up and comers: the price is not worth the prize.

I wish I had known before retiring that retirement REALLY would be one more of life’s major change experiences, similar to entering kindergarten, going away to college, beginning the first job, getting married, having a baby, getting a divorce, losing a loved one through death, etc. No matter how much I planned or expected certain events to occur, it was (and is) challenging.

Even though I had prepared myself before retiring, I was surprised at how quickly I became irrelevant.

Weekender 3/30/18

Weekly News Recap

• South Australia reportedly halts the rollout of its troubled, Allscripts-powered EPAS systems.
• President Trump fires VA Secretary David Shulkin via Twitter and nominates as his replacement White House Physician Rear Admiral Ronny Jackson, MD, who has no significant management experience.
• Investors in the largely defunct lab startup Theranos sue the company, hoping to get some of their money back from the proceeds of selling the company’s patents and by going after the rumored $100 million fortune amassed by former President Sunny Balwani.
• FDA says it will expand its digital health pre-certification program to more companies by the end of the year.
• Finger Lakes Health (NY) pays a hacker an unnamed sum to recover its systems after a week of ransomware-caused downtime.
• Israel announces plans to make the health data of its 9 million citizens available to researchers and private companies for work on preventive and personalized medicine.

Best Reader Comments

Can someone explain the value of LinkedIn? It’s handy when looking someone up at times, but the amount of spam and vendors asking to make a connection is overwhelming. (2 antisocial?)

Women tend to use LinkedIn differently – more privacy settings and fewer public announcements, posts, or interactions. I wouldn’t be surprised if this extends to other aspects of online identity, like being less likely to email Mr. HIStalk to notify him of a promotion. (People/ LinkedIn)

Market Research Study Reader Feedback

Reader Steve works for a market research company and applauds my calling out of offshore firms whose reports – written in nearly undecipherable fractured English — fail to notice that companies they cover have been acquired or have exited the market. He provides this commentary.

I’m increasingly seeing the industry plagued by “report factory” outsourced studies. As you rightly state, the model seems to increasingly involve investment in masses of PR on every topic and keyword imaginable, yet always with high growth forecasts to entice busy health tech execs and VC’s desperate for data to reach for their Amex. More interesting is that if you dig into many of these firms, their report announcements are copycat replicas (same forecast title and keyword, just different company name).

Here are five quick pointers to aid in calling BS on these cowboys.

1. Contact the analyst behind the report. A quick email conversation or phone call is the quickest way to know (a) if they know what they are talking about, and (b) if they even exist. Also check their LinkedIn / Google press mentions. Good analysts should build up a reasonable online presence of industry press mentions and well-written market insights.
2. Ask for a detailed view of how the data is put together. The best analysts and firms are acutely aware of the accuracy of their data and both the pros and cons of their chosen methodology. I expect every party that is seriously interested in my research to grill me on methodology behind it.
3. Beware of big growth rate headlines. Markets go both up and down. I’m still yet to see one of the report factories putting out PR showing a market decline.
4. Buying market research should not be a single interaction. You are buying a report, but also included should also be analyst time and support to help you disseminate the information, ask questions, and mine the knowledge of the author. The best analysts I know are not just good at producing reports and PR, but as advisors to their customers. Avoid firms where analyst access is restricted or interaction is limited to an account manager or salesperson.
5. Question timelines. Good data and insight takes time to put together. Market research based on primary research (vendor or consumer) involves investment financially as well as established industry relationships. There are rarely shortcuts that can be made. Compiling a high-quality, detailed report on complex markets is not possible in a few weeks. Short timeline reports usually resort in low quality, mistake-laden research or a very expensive bookend.

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. F in West Virginia, who asked for programmable Lego robots for her special needs high school class. She reports, “We have been very busy learning about coding. My students have learned the hard way that you must follow ALL directions in order or your creation will not work. I get excited when they come in and show their classmates what they have done and what they have learned. When their creations run, they are so proud of themselves, and when they don’t, my students don’t get frustrated (which is a really big deal) —  they just look to see what they did wrong. Thank you for making learning exciting for my students and for building skills and confidence!”

First grade special education teacher Ms. M from North Carolina says of the math games we provided, “My students have a hard time grabbing these new math concepts, but I have learned that learning through play makes retention much easier. The students are showing signs of understanding and they are able to focus on the problem at hand. Some have even told me they did not want my help, that they wanted to try to figure it out themselves, now this blew me away. I am ever so grateful for your generosity with this project and this great new way for my kiddos to learn math concepts.”

The US Attorney’s Office wants to take millions of dollars and several replica cars as part of its investigation into their Cleveland owner’s for-profit addiction treatment companies, which submitted $49 million in Medicaid claims in 29 months of which $31 million was paid. The reproduction cars, which were used in Hollywood movies, include a 1981 DeLorean from “Back to the Future,” a 1959 Cadillac hearse from two “Ghostbusters” movies, and a Batmobile replica.

A California OB-GYN on the first day of his medical malpractice trial rushes to the aid of a prospective juror who is undergoing cardiac arrest, raising concerns that the doctor’s actions might bias jurors in his favor. More interestingly, James Nilja, MD is one of several former drummers for rock band The Offspring and is rumored to have suggested the band’s name. He parted ways with the band in 1987, with front man Dexter Holland explaining in a blog post that, “He was so intent on getting into medical school that he didn’t really even practice with us much, which is part of why he‘s not our drummer any more … I hope his patients don‘t find out that he once helped write a song called “Beheaded!” Here’s video of the now-doctor playing in the band in 1987.

In Case You Missed It

• News 3/30/18
• EPtalk by Dr. Jayne 3/29/18
• News 3/28/18
• Curbside Consult with Dr. Jayne 3/26/18
• HIStalk Interviews Nancy Ham, CEO, WebPT
• Monday Morning Update 3/26/18
• What I Wish I’d Known Before … Being Admitted to a Hospital or Being Seen in the ED

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 3/30/18

Doctors put patients in charge with Apple’s Health Records feature

Apple moves its Health Records app out of beta, with 39 healthcare institutions signing up to make patient records available via the app.

David J. Shulkin: Privatizing the V.A. Will Hurt Veterans

Former VA Secretary David Shulkin, MD explains in a New York Times op-ed that his ouster was the result of political infighting amongst those who want to privatize the VA; a move he soundly denounces as “a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”

Walmart talking with Humana on closer ties; purchase possible

Sources say Walmart and Humana are in talks to expand their partnership beyond a co-branded drug plan that prompts members to visit the retailer’s stores. Walmart’s acquisition of Humana is a possibility – one that sources say would enable the company to better manage prescriptions through access to EHRs.

News 3/30/18

Top News

President Trump fires VA Secretary David Shulkin, MD after a wave of negative press around questionable funding for Shulkin’s trip to Europe last summer. Shulkin believes the ouster came from political opponents who want to privatize the VA, a move he was quick to slam Wednesday in a New York Times editorial.

President Trump will nominate the White House physician, Rear Admiral Ronny Jackson, MD, as Shulkin’s replacement. Shulkin had reportedly recommended Jackson for a VA undersecretary position last fall, but the President wanted him to remain in the White House.

Though Jackson served as an emergency medicine physician during Operation Iraqi Freedom, veterans groups question his nomination, citing concerns over a lack of administrative experience. I tweeted on the news, “Choosing an unbeholden outsider in hoping for disruption or believing that character (good or bad) outweighs experience sounds good. But I’m not sure I’d want as my first management job to be running a $200 billion, politically microscoped organization. Whatever the VA pays isn’t enough.”

The status of the VA’s proposed no-bid contract with Cerner remains cloudy as Shulkin departed without signing it. Experts are expressing confidence that Acting Secretary Robert Wilkie – who has no VA or healthcare experience — won’t want to take on the responsibility of executing the Cerner contract, but I wouldn’t be so sure: Jared Kushner pushed Cerner in the first place and the White House may tell Wilkie to just get it done as a purely administrative chore that lets the White House take immediate credit. That’s the bet I’d make.

Reader Comments

From CanadaEh: “Re: Novia Scotia. Has released its provincial RFP to the two short-listed vendors, Cerner and Allscripts. Demos are planned for May and June.” Unverified.

HIStalk Announcements and Requests

Thursday was National Vietnam War Veterans Day, honoring those who served and died in the conflict that ended 43 years ago. If you were deployed to Vietnam then and are still working in health IT all these years later, fill out my online form and I’ll list you in an upcoming post.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Acquisitions, Funding, Business, and Stock

Intermountain Healthcare (UT) will shift 98 of its 358 IT staffers to employment with DXC Technology, an IT and consulting services company it has worked with since 2012. The health system previously announced plans to transition 2,300 billing employees to employment with R1 RCM beginning April 8.

The FDA approves Dexcom’s G6 interoperable continuous glucose monitoring system.

Mercy Health-Cincinnati invests in local startup Crosswave Health and its FindLocalTreatment.com addiction services look-up tool. Mercy Health formed an Addiction Treatment Collaborative in January to help its patients find longer-term treatment options.

Two hundred investors wonder how their lawsuit against Theranos and its founders will fare once the SEC is done with its criminal investigation. The investors, who bought shares through their investment funds, are looking to graze over the company’s remains, which include dozens of patents and potentially the personal fortune of former President Sunny Balwani, recently estimated by a magazine at $100 million.

Sales

• Tenet Healthcare (TX) selects Inovalon’s VantageCPS cloud-based analytics software for its post-acute care services.
• Western Maryland Health System chooses Artifact Health’s physician query software.
• Plum Healthcare Group will implement FormFast Connect Powered by Salesforce for resident intake across its 65 SNFs.

Announcements and Implementations

Vanderbilt University Medical Center (TN) integrates mobile voice, text, and broadcast functionalities from Mobile Heartbeat with its Rauland-Borg nurse call system and Epic EHR and goes live on the system.

Image Stream Medical develops EasySuite 4K imaging software for the OR.

VA Southern Nevada Healthcare System implements LiveData’s PeriOp Manager with EHR integration help from DSS.

Healthfinch announces GA of its Refills Lite prescription refill management app for practices using AthenaClinicals.

Apple moves its Health Records app out of beta. Thirty-nine healthcare institutions have signed up to make patient records available via the app.

The Patent and Trademark Office awards Glytec two more patent allowances for its FDA-approved EGlycemic Management System.

Privacy and Security

Northwell Health (NY) staffers help concerned citizens at DataBreaches.net and UpGuard alert a New York-based medical group with zero Web presence that it had left 42,000 patient records and millions of patient clinical notes exposed on a misconfigured rsync backup for over a month.

UnderArmour says the information of 150 million users of its MyFitnessPal app was exposed in a February breach, although the information it stores is minimal (username, email, and encrypted password).

Other

A new paper by Google Cloud researchers says that while AI can help radiologists do their jobs more efficiently, it can’t replace them, noting that it can only do a small part of their job.

The only newspaper article I could find is behind a paywall, but it appears that the new government of South Australia will follow through on its promise to halt the SA Health rollout of its over-budget, behind-schedule, Allscripts-powered EPAS system.

A NEJM Catalyst article says the “two-canoe system” — in which nearly all physicians work under both fee-for-service and value-based payment arrangements – encourages doctors to provide suboptimal care at a higher cost. Their moral dilemma of doing what’s best for their patient vs. what’s best for their wallets is contributing significantly to their burnout, the authors conclude, also noting that the public may start pushing back on their focus of generating revenue.

A study of VA facilities finds that reducing low-value EHR inbox notifications saved 1.5 hours per week of PCP time, although the information overload remains unmanageable and will require more work to fix.

Child protection workers across Montana are using Project ECHO’s telemedicine capabilities to compare notes and connect with child psychiatrists and other therapists at Billings Clinic (MT), which launched a Project ECHO hub several years ago.

An analysis of 7 million patient reviews on Healthgrades finds that patients place the most value on the amount of time their physician spends with them, particularly in the areas of their willingness to answer questions, listen to concerns, and ensure they understand their conditions or procedures.

A coroner’s inquest into the death of a knee surgery patient in a hospital in Australia finds that clinicians had a “persistent failure of critical thinking” when an anesthesiologist mistakenly ordered him a fentanyl patch and PCA that was intended for a different patient. The anesthesiologist noticed the PCA later but assumed someone else had ordered it, while nursing and pharmacy employees failed to catch his mistake. The doctor said he was distracted while trying to manage two patients and forgot which patient’s record was displaying on the EHR. He overrode system warnings for overdose, drug interaction, and duplicate therapy. It was his third time using the newly implemented system. The coroner recommend further training, changes to EHR screen and label layouts, and a hospital review of medication administration procedures.

Weird News Andy refers to this story as, “Not going, not going, not gonorrhea.” A UK man receives an unwelcome surprise after a sexual encounter in Southeast Asia – the “worst-ever” case of gonorrhea that is resistant to all common antibiotics.

Sponsor Updates

• CommonWell Health TV features Ellkay CIO Kamal Patel.
• Consulting Magazine recognizes The HCI Group CEO Ricky Caplin as a global leader in consulting.
• The local news interviews Imprivata CMO Sean Kelly, MD about the company’s palm vein scanner ID technology.
• Liaison Technologies partners with Tierion to extend blockchain capabilities to its Alloy platform.
• Black Book Research recognizes LogicStream Health for highest client satisfaction and clinical process improvement.
• HealthcareNow Radio interviews Medicomp Systems CEO Dave Lareau.
• Mobile Heartbeat will exhibit at the American Organization of Nurse Executives annual meeting in Indianapolis April 12-15.
• Nordic publishes a podcast titled “How to use change champions for a more successful go-live.”
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the annual IA Conference on Perinatal Medicine April 3-4 in West Des Moines, IA.
• Experian Health will exhibit at HFMA Hudson Valley April 5 in Tarrytown, NY.
• In the UK, St. Stephen’s Clinical Research implements Elsevier’s Macro electronic data capture solution.
• The US Patent and Trademark Office issues two more patent allowances for Glytec’s eGlycemic Management System.
• Medicision adds CarePlanner 360 to its line of Aerial care management solutions for payers and risk-bearing organizations.

Blog Posts

• Forgotten A/R: 3 Steps to Getting Beyond “Low Hanging Fruit” (Hayes Management Consulting)
• EHR Support and Optimization: How it affects Your Bottom Line (HCTec)
• Consumer-Friendly Approaches to Curbing Wait Times (Healthgrades)
• A Recipe for Healthcare Success (Hyland)
• Security and Patient Privacy: Just Like Peanut Butter and Jelly (Iatric Systems)
• PCI-DSS Compliance in the Connected Healthcare Environment (Impact Advisors)
• How to Use Relevance to Dominate in Local Search (Influence Health)
• CIO Chat – Jon Burns, University of Maryland Medical System (Huntzinger Management Group)
• Payment Device Questions – What Healthcare Organizations Need to Know (InstaMed)
• HIMSS on Four Wheels (InterSystems)
• New Feature: Intelligent Check-Out/Check-In When Editing Lab Instructions in IDLx (Learn on Demand Systems)
• MuleSoft’s Sale at a Thoroughbred Price is Good News for Data-Centric Companies (Liaison Technologies)
• What it Takes to Make a Sustainable HIE (Lightbeam Health Solutions)
• How Do You Communicate When You Can’t Communicate? (Optimum Healthcare IT)
• 3 Ways Collaborative Communication Improves Healthcare (Live Process)
• Achieving the healthcare triple play: Improving clinician engagement, patient care and utilization – Part 3 (LogicStream Health)
• Docker Orchestration Tools: A Comparison (Logicworks)
• HIMSS18 Wrap-Up: Key Takeaways for Payers and Providers (Medecision)
• 4 must-read blogs to help you avoid clinician burnout (Meditech)
• Dr. Dan Reidenberg Empowers Front Line Nurses with Mental Health and Suicide Facts (Netsmart)
• The key to being a great healthcare consultant: flexibility (Nordic)
• Managing Your Preferred Post-Acute Network (PatientPing)
• Patient Understanding – The Cornerstone of Adherence and Understanding (FDB)

Contacts

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

EPtalk by Dr. Jayne 3/29/18

The obnoxious post-HIMSS vendor behavior I mentioned last week is getting worse. One vendor was already harassing me, having left messages every day or two by both phone and email. After a week of this, one might assume that your potential sales lead is cold and give it up. This guy hasn’t gotten the message, though, and is now leaving messages that don’t even mention the company name. Maybe it’s intentional, like I will assume he’s someone I know and return the call, or maybe it’s just sloppy. But, “Dr. Jayne, it’s Dave. I’ve been trying to reach you. I’ll try again tomorrow if I don’t hear from you” isn’t terribly professional. I recognize the number from last week’s harassment and you’re not going to hear from me.

My suggestion for salespeople: if your lead seems cold, leave one last message and include who you are and what you have to offer, then give it a rest. “Hi, Dr. Jayne, it’s Dave Smith from HotVendor. You might remember speaking to us at HIMSS about our new retina-scanning drug inventory system. We’ve tried to reach you and I know you’re busy, so if you’d like to connect, you can reach me at 888-555-1212 or by email at DaveSmith@hotvendor.com and we thank you for your time.” That message is more likely to get filed for the next client I run into that needs your particular solution.

A few other vendors have called but all have left reasonable messages, so no complaints about those. Also, plenty of emails even from vendors I don’t remember talking to or visiting. Those are interesting, because I almost always visit their website to play the “what was I thinking” game to try to remember if they caught my eye with their advertising, booth presence, or product. Even with the website, sometimes I can’t figure out what a vendor really does. That always makes me chuckle, so it’s a good mood booster.

Speaking of websites, Mr. H mentioned the announcement of Canvas Medical entering the primary care EHR fray. I had mentioned them a few weeks ago, but not by name. I received a mailing from them pre-HIMSS, but they didn’t mention HIMSS and weren’t there. I thought the timing was odd and would have wanted to look at their product. I’ve checked their website a couple of times in the last few weeks because they did get my attention and found it not ready for prime time, with the blog page having several “lorem ipsum” type placeholders. It looks like they cleaned it up in preparation for yesterday’s actual launch, which is good, but makes me question why they did a direct mail piece directing users to the website if they weren’t ready to roll.

I pulled out the original mailing that I had filed in the “keep an eye out” category. I noticed that they use “EMR” rather than “EHR” to refer to their product. Not sure if that is intentional, but might be since it doesn’t look like they offer a patient portal or maybe they just don’t mention it. They’re up to six practices mentioned on the website,  but one is using the Medfusion portal (along with “non-secure email and Skype”), three appear to have no patient portal, one kicked me over to ihealthinterview.com, and the remaining practice doesn’t seem to have a website. The company is very small and I don’t see anything about certification, which makes it a no-go for many practices. They do offer a MIPS guarantee, stating “if you receive a negative adjustment, we will cover it,” but it’s not clear how they’re executing this. Having worked with a startup EHR that died a rapid death due to lack of certification, I wish them well.

Another item that reached the end of the line was the proposed merger between Providence St. Joseph Health and Ascension that would have created the largest hospital operator in the US seems to be over. It appears the organizations will work independently to restructure, feeling that a merger would have taken attention away from the need to restructure as health care deliver moves away from hospitals. Both systems also appear to want to continue to grow, with Ascension acquiring Chicago-based Presence Health earlier this month, even as its CEO told employees via video last week that it will focus on outpatient care and telemedicine.

Ascension has already slashed spending over the last couple of years and plans to save more money by “aligning its pay practice,” which I can tell you from experience at other health systems won’t involve bringing underpaid workers up to the level of their peers. The employee communications mentioned that executives have already taken pay cuts and hinted that employees would be asked to do the same. I touched base with one colleague in an IT-related department and people are already buffing their resumes.

I read with interest Mr. H’s comments on privacy and security and figuring out how much Facebook and Google know about us. I’m relatively “off the grid” despite my being immersed in the tech industry. The fact that I don’t use location services on my phone unless absolutely necessary and rarely identify where I am makes it trickier to know where I’ve been. Since I got new Internet service, my PC thinks it’s in Wisconsin for some reason, so that adds to the mystery as well. If Facebook really wanted to understand our preferences and make sure we saw marketing, maybe they’d give us features such as “hide posts about recipes even if they’re from people we like” and “hide pictures of abused animals.” I have a couple of people I dearly love, but they post so much in these two categories, I worry that I’ll miss something important from them.

Speaking of missing something important, I had the unsettling experience this week of learning somewhat via Facebook that a colleague had passed away. Someone had posted earlier in an email group that we’re part of that he had no-showed a meeting on Monday, which was unusual for him, and wondered if anyone had heard from him. I had corresponded with him last month about an upcoming meeting, but hadn’t heard anything since. One group member had met with him on Friday and things seemed fine. A few hours later, another email popped up with a screenshot from his Facebook page, where someone posted “Can’t believe the news, RIP.” Since he joined the gig economy as an independent contractor, it’s not like there was a corporate office that would notify his customers, so I guess finding out this way makes sense. Emerging technologies and scattered social networks make for some uncharted etiquette waters at times. My condolences to his loved ones, wherever they may be.

Email Dr. Jayne.

Morning Headlines 3/29/18

Trump pushes out Shulkin at VA, nominates Jackson as replacement

President Trump fires VA Secretary David Shulkin, MD after a wave of negative press and nominates his personal physician, Rear Admiral Ronny Jackson, as his replacement.

98 IT employees of Intermountain Healthcare transition to DXC Technology

As Intermountain Healthcare (UT) prepares to shift 2,300 jobs to billing company R1 RCM, it announces it will also shift 98 IT staffers to employment with DXC Technology, an IT and consulting services company it has worked with since 2012.

Theranos Investors Turn Scavengers on Wounded Unicorn’s Remains

Two hundred Theranos investors prepare to vie with the SEC to obtain some type of recompense for the $724 million they helped raise for the private company that is now all but obsolete.

Cyberattack disrupted Baltimore emergency responders

A cyberattack over the weekend forces Baltimore’s emergency dispatchers to revert to manual processes for 17 hours.

Morning Headlines 3/28/18

CDRH to Open Digital Health Pre-Cert Program to More Companies by Year’s End

FDA will expand its digital health pre-certification pilot program by the end of the year, taking on more companies beyond the 10 current participants.

Cybersecurity team will ‘lie, cheat and steal’ to protect Blue Cross patients’ data

The 24×7 regional security monitoring center of Blue Cross Blue Shield of IL, MT, NM, OK, and TX employs 200 analysts to look for foreign access and unusual member activity.

CFO says hospital district remaining positive

The CFO of Medical Center Health System (TX) blames its credit downgrade to a worsening local economy and the hospital’s Cerner implementation, which he says “has really hurt us from an accounts receivable standpoint.”

Finger Lakes Health pays ‘ransom’ over cyber attack

Finger Lakes Health (NY) pays an unspecified sum to to bring its systems back online after a week of ransomware-caused downtime.

News 3/28/18

Top News

FDA will expand its digital health pre-certification pilot program by the end of the year, taking on more companies beyond the 10 current participants.

FDA says it regrets labeling the project as a “pilot” since it is more of a co-development project that will allow app vendors who earn FDA’s pre-certification to fast-track getting their products to market. 

Reader Comments

From Headcounter: “Re: your ‘People’ section. Today, 100 percent of those listed are men and your overall ration is about nine to one male. I can’t give you a pass any longer. Many women are powerful in this field, but for some reason don’t get the same recognition. Maybe your criteria are male-centric and you need to adjust them?” As the messenger you’ve just shot, allow me to explain my criteria for reporting job changes: (a) full-time VP positions and above, and (b) either the hiring company is one I’ve heard of or the new hire has enough industry history so that readers will likely know him or her (few readers would care about a health IT company hiring an HR VP from a local bank). My sources of information are press releases, someone notifying me directly, or LinkedIn if the person is connected to me. Any gender imbalance you see in the People section reflects the industry, not my coverage of it. That solution lives far above my pay grade.

HIStalk Announcements and Requests

My favorite response so far to “What I Wish I’d Known Before … Retiring or Career Downsizing” notes the impact of “an insufferable department director and an incompetent CIO.” What say you on the topic of getting off the career treadmill?

I’m having a post-HIMSS swag fest in wearing a great Cantata Health sweatshirt and sampling Ellkay flavored honey (the chocolate is way dangerous, but I wouldn’t kick the cinnamon, vanilla, or Himalayan salt versions out of the kitchen either).

In another post-HIMSS moment, I now know what Brianne and Lorre were doing with the Polaroid cameras in our booth – inviting visitors to have their photo taken with the Smokin’ Doc and to write their messages to me on the result. Thanks to the 100 or so folks who participated. Lorre sent me the album in which she mounted the photos in and I’m pretty sure I’ll page through it often since this hobby (sitting alone trying to fill an empty laptop screen with something interesting while remaining anonymous) makes it easy to feel disconnected and to forget that actual people are on the other end. Now I can see them.

Here’s a fun fact told to me by a guy who has used repeated “trial subscriptions” to SiriusXM to get years of service for free (which I’m not advocating). Email servers usually ignore periods to the left of the @ sign, so you can sign up with “thisisme@myserver.com” and then sign up again later with “thisis.me@myserver.com” in looking like a new subscriber while still receiving the confirmation emails.

A fun item I found: Pushbullet, an app and Chrome extension (versions are also available for Firefox and Windows) that automatically mirror your phone’s notifications and SMS messages to your computer and also let you exchange text messages, links, and files right from your computer’s browser to a phone. I didn’t know I needed it as a minimal phone user, but since I’m on Android, I kind of do.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

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

Announcements and Implementations

Gay dating app Grindr will send its male users reminders to get an HIV test every 3-6 months, give them directions to the nearest testing site and allow non-profit testing centers to advertise their services at no charge.

Apple announces a new 9.7” IPad that will start at $329 for the 32 GB model. It lacks some of the advanced features of the Pro, but still has the Retina display, the A10 Fusion chip, and Apple Pencil support. It appears to be targeted to schools since it was announced at an education conference and schools get modest discounts. The IPad Mini 4 — like the clearly obsolete Macbook Air — makes even less sense than it did before since its display is just 7.9 inches and it costs $70 more, although with 128 GB of memory.

Primary care technology vendor Canvas Medical announces GA of its EHR, claiming that its autocomplete-powered documentation is three times faster than the top three EHRs, requires 80 percent fewer clicks, and eliminates the need for separate population health management software. Pricing starts at $599 per month. CEO Andrew Hines used to work for Practice Fusion. The company appears to have about a dozen employees, which isn’t many when you consider ongoing support, further development, and keeping all those bosses of non-concierge doctors (insurers and the government) happy. Cascade Family Practice (WA) was quoted in the announcement, but I notice that its patient portal is still Athenahealth.

Privacy and Security

A fascinating article describes how scammers make a fortune using Facebook (and so does Facebook) by using Facebook’s targeting software to push affiliate ads based on location and language, often buying phony Facebook accounts to keep the ads going. The king scammer — a 31-year-old whose dubious career accomplishments have made him one of Poland’s richest people at a net worth of $180 million (and a billboard purchaser, above) — says Facebook sends a mixed message by claiming to shut down suspicious accounts while it also sends company reps to scammer conferences to encourage them to buy more ads. He admits that affiliates – companies that pay him a percentage of sales when his ad for their product is clicked — are stealing from the poorest people, but says the real problem is a capitalistic society that is based on convincing people to buy things they don’t need. His next idea is creating a cryptocurrency that will turn his business into a billion-dollar company.

I don’t know who Dylan Curran is, but click these links he provided in Twitter to see just how much Facebook and Google know about you:

• https://www.google.com/maps/timeline?pb (every place you’ve been with your phone turned on).
• https://myactivity.google.com/myactivity (your search history from every device combined).
  https://adssettings.google.com/authenticated (your profile as provided to advertisers).
• https://www.youtube.com/feed/history/search_history (every YouTube search you’ve ever performed).
• https://takeout.google.com/settings/takeout (where you can download your entire Google history). Dylan’s 5.5 GB file contained bookmarks, emails (including deleted ones), contacts, Google Drive files (including deleted ones), photos taken, calendar, businesses from which goods were purchased and the items bought, websites create, phones owned, pages shared, and how many steps he took each day.
• Facebook also offers a download that includes every message sent, files sent or received, phone contacts, audio messages sent or received, a list of topics it thinks you’re interested in based on your Facebook interaction.
• Windows 10 enables by default tracking location, installed apps, when the apps were used, access to the webcam and microphone, emails, calendar, call history, files downloaded, photos and videos, and search history.

The Dallas paper profiles the regional security monitoring center of Blue Cross Blue Shield of IL, MT, NM, OK, and TX. The 200-analyst, 24×7 center looks for foreign access and unusual member activity. It’s run by SVP/CISO Kevin Charest, PhD, who held a similar job with UnitedHealth Group and was CISO of HHS. He was also previously a VP of Greenway Medical and a US Army captain. 

Finger Lakes Health (NY) pays an unspecified sum to to bring its systems back online after a week of ransomware-caused downtime.

Other

The CFO of Medical Center Health System (TX) blames its credit downgrade to a worsening local economy and the hospital’s Cerner implementation, which he says “has really hurt us from an accounts receivable standpoint.” The previous CFO attributed the hospital’s 2017 bond downgrade to the $55 million it spent on Cerner.

A poll finds that high costs caused 40 percent of Americans to skip doctor visits, prescribed tests, or treatments in the past year. Around 30 percent said they had to choose whether to spend their money on medical bills or on necessities such as food, heating, or housing, while respondents who faced with healthcare expenses used up their savings (36 percent), borrowed money (32 percent) or saved less (41 percent). Half said the were billed for services they thought their insurance covered and one-fourth of respondents had a medical bill turned over to a collections agency.

NC-based mental and behavioral services managed care provider Cardinal Innovations Healthcare sues former CEO Richard Topping for the $1.68 million he convinced the organization’s board to pay him in the severance agreement he drew up himself. Cardinal’s investigator also claims that former CIO Pete Murphy committed wrongdoing by helping Topping download 1.5 GB of confidential company information a few days before he was fired. The two were apparently planning to launch a privately backed competitor to Cardinal. “I can’t wait until we’re rich,” Murphy said in an email to Topping. The other fired executives who received severance were Murphy ($740,000), the COO ($690,000), and the chief medical officer ($684,000). Topping and Murphy have since started the DC-based Shao, described on LinkedIn as “a technology partnership between health plans and telecom carriers to provide plan members with digital connectivity and the tools to maximize that access for better health and wellness.” The most interesting aspect of this is that fired CEO Topping has impeccable credentials – he earned a JD degree, an MPH from Harvard, was a judge advocate in the US Army, served as legal counsel for Brigham and Women’s Center for Bioethics, and was a US Department of Justice trial attorney.

Belgium-based Materalise earns FDA approval for its 3D printing software that creates anatomical models for planning surgeries.

This offshore market research company’s $4,450 report predicts “incredible” (7.3 percent – is that incredible?) growth for the LIS market, although one might question its qualifications even beyond the fractured English — it lists products from McKesson (sold to Allscripts last year) and Eclipsys (sold to Allscripts in 2010 – Eclipsys had acquired SysWare in 2006 but its LIS seems to be defunct). You get the feeling that the report won’t actually be written until someone orders a copy.

A Brigham and Women’s ICU doctor observes in a New York Times article that patient end-of-life wishes are often not respected because clinicians don’t see them in the moment of need. Reasons: the advance directives are buried in the EHR progress notes and lack of interoperability means that the preferences won’t be seen if the patient falls ill away from home or after transfer to a nursing home. The author likes the idea of patients being able to maintain their own advance care planning documentation on a smartphone app, but wishes that “the EHR isn’t just a clunky online version of a paper chart but actually a tool to help us do our jobs better.”

A small interview study of patient portal users finds that two-thirds of them viewed test results that did not contain an explanation from their doctor, triggering frantic phone calls (sometimes after office hours) and online searches as the patients tried to get more information. The authors conclude that just posting test results on a patient portal without context isn’t adequate. A Kaiser Heath News article describes an internist who checked her husband’s patient portal with his permission and found from it that he had widespread metastatic cancer, after which she kept rebooting her computer and rechecking it in disbelief (he’s OK now).

Sometimes I run across bizarre items that earn the Weird News Andy seal of approval even though WNA didn’t send them to me. Here’s one: surgeons in India determine that a woman’s eye and nose pain are being caused by the wriggling of a 2.5 inch worm lodged right behind her eye, which they remove via nasal surgery. Larvae of the Lua Lua worm (also known as the African eye worm) are spread by biting flies and live under human skin. You can thank me later for not including the BJM Case Reports photos.

Sponsor Updates

• Boston Software System publishes a white paper titled “EHR Migration Guide.”
• Solutionreach integrates its patient relationship management system with Epic and adds its app to Epic’s App Orchard.
• CSI Healthcare IT employees volunteer with Habitat for Humanity as part of its Gives Back program.
• The Sequoia Project re-elects Surescripts Chief Administrative, Legal, and Privacy Officer Paul Uhrig to its board.
• Fortified Health Security partners with Beach Health System to strengthen its cybersecurity program.
• HealthcareNow Radio interviews Aprima COO Neil Simon.
• Chiropractic software vendor EZBIS will integrate Ability Network’s all-payer RCM application into its practice management system.
• Optimum Healthcare IT publishes an infographic titled “EHR Trends – Usage and Adoption.”
• CenTrak empowers IoT solutions in the Australian healthcare sector.
• CTG publishes a new case study, “Inova Health System Relies on CTG for Post-Implementation Helpdesk Solution in a Production Environment.”
• Heather Espino (Centura Health) joins Culbert Healthcare Solutions as Epic manager.
• Dignity Health features Docent Health on the cover of its Hello Health magazine.
• Meditech publishes a case study of patient engagement at Ontario Shores Centre for Mental Health Sciences, which uses Meditech’s patient portal to improve recovery, improve patient self-assessment scores, and reduce appointment no-shows.

Blog Posts

• Keep Relationships from Going Stale (Access)
• Evolve Beyond Museum Relics in Your Practice (AdvancedMD)
• Make EPCS Compliance Easier, Protect Yourself and Your Patients (Aprima)
• How Digital Health Succeeds and Fails – Datica at SXSW (Datica)
• Refreshing Reads: 4 must-read blogs to help you avoid clinician burnout (Meditech)
• CarePort’s New Digs: Come Grow With Us (CarePort)
• Healthcare Advanced Computer Power: Robotics, Medical Imaging, and More (CareSync)
• HIMSS18: Wrap-Up and Charity Raffle Winners (Clinical Architecture)
• 3 Things Healthcare Organizations Can Outsource Now for Lower Costs, Better Care (Conduent Health)
• Meditations on HIMSS18 (Diameter Health)
• How Hospitals are Innovating and Adapting for the Future (Dimensional Insight)

Contacts

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

Morning Headlines 3/27/18

Shulkin survival odds decline

Rumors continue to swirl around predictions that President Trump will soon fire VA Secretary David Shulkin, MD, with the AP reporting that former Cleveland Clinic President and CEO Toby Cosgrove might be a replacement frontrunner.

Data Breaches at Hospitals Associated with Thousands of Additional Patient Deaths

After taking into account quality scores, remediation activities, regulatory inquiries, litigation, and diverted resources, a Vanderbilt University researcher concludes that hospital data breaches lead to 2,100 patient deaths annually.

California Medicaid expansion enrolled hundreds of thousands of ineligible people, federal report finds

Citing deficiencies in the state’s computer system, an OIG report concludes that California spent $1,893,000 on enrolling ineligible or questionably eligible Medicaid beneficiaries as part of its Medicaid expansion.

Consortium led by London CSU wins national contract to build population health dashboard

NHS England awards a consortium led by North East London CSU a contract to build a population health management dashboard built on Cerner’s HealtheIntent software.

Curbside Consult with Dr. Jayne 3/26/18

I received quite a bit of feedback on last week’s piece that mentioned the concept of moral distress. Someone experiences moral distress when they know there is a “right” thing to do, but are blocked from pursuing it by institutional constraints. It was previously spoken of in clinical circles and can contribute to burnout. We’re seeing more and more people experiencing these symptoms even if they’re in support roles as opposed to being frontline clinicians.

One reader noted:

Spot on. Having been in the vendor side of the house for over 40 years, I’ve seen the challenges of performing daily duties grow exponentially, especially in the clinician environment. Volume over value is one direct contributor to this headache. As long as earnings per share remain king in the mind of the C-suite (indirectly, but this is how the folks on the carpet think if you ever have a meaningful discussion with any of them) and maintaining decent margins is the most important focus, the system will never be people-centric. Empowering mid-level leadership has been the nemesis of success for many, many years. We have a disease management system in that generates $3.7 trillion annually; makes this system the largest employer in the domestic US (outside of the US government); and is trying to transition to a true healthcare system. Until the right entities and people are brought to bear and focused upon, status quo will remain king.

With the push towards analytics and true disease management (capturing the most expensive patients and figuring out how to care for them in a way that is less expensive) we’re starting to see some movement, but not enough. Many primary care practices are caught in the chicken-or-egg situation where you have to have money to buy software and hire care coordinators to manage complex patients to get paid for care coordination. Even the “incentives” available as CMS payments don’t cover the overhead of actually performing the care coordination for many practices, and unless you’re involved in full risk contracting, you’re not likely to see that money returned to your practice as “savings.”

On the software front, I see many vendors pushing slick-looking analytics platforms, but they’re not able to deliver the education needed to help practices actually move the needle. It’s one thing to learn how to identify the patients and document on them, but it’s another thing entirely to learn how to interact with those patients and come up with creative strategies to work around their barriers to care. Most of the care coordinators I know are magicians, pulling from a bag of tricks to fight complex situations involving lack of financial resources, unemployment, neglect, depression, anxiety, abuse, trauma, food insecurity, and more. When the frontline team caring for these patients doesn’t have enough “tricks” in that bag, it really doesn’t matter whether you’re working from the shiniest application or from the much-maligned Excel spreadsheet to track your patients.

Still, people are working hard to try to minimize the problems that care teams face. A reader on the Informatics side of the house had this to say:

We implemented quarterly release cycles. We first defined what we considered support and maintenance (change a price on a fee schedule, update a med on an order set, add a new employee to a work queue, etc.) with specific turnaround times. This was ongoing work that was on a daily o rweekly basis. Everything else, including optimization enhancements and projects, were on a strict quarterly release cycle. Originally, we implemented this as a way to achieve economies of scale with our build, testing, training, updates to policies and procedures, etc. For example, prior to release cycles, we ran the same test script multiple times to test a variety of build items for different projects. With release cycles, we streamlined this so we only had to run the script once that would test the build for those same projects. We found that we gained a significant amount of capacity back to those same teams.

In an employee engagement survey conducted approximately nine months after the implementation of release cycles, we noticed an almost 40 percent improvement in scores related to stress, burnout, and anxiety. It was the best improvement across the entire survey. Because of the significant increase, HR conducted many follow-up surveys and focus groups to try to better understand the increase. One of the major contributing factors was the implementation of the release cycles. When asked why, people (nurses, physicians, IT, etc.) almost universally said that the predictability of the release cycles (we started a new cycle the first Monday of a calendar quarter and would go live on the last Tuesday of the quarter) allowed for better change management and to plan their schedules accordingly. Part of their stress levels was that people felt everything changing constantly on them from a day-to-day basis. The release cycles allowed them to better understand the changes to their workflows and adopt the new change before introducing additional changes. We never thought about release cycles in those terms, but it became a significant factor in its continuing success. In fact, when we had to deviate from our cycles for ICD-10 implementation due to external factors, it created significant pushback from operations. I just wanted to share my experience for a potential strategy that other organizations might find useful.

Well said, and solid concepts. I continue to see organizations (and vendors) who don’t have a well thought out release strategy. Or perhaps it’s well thought out but poorly executed. From an end user standpoint, I see the best adoption when break/fix is separated from enhancements and new features, even though that might mean a bit of overlap in training strategies. It’s tempting to say lump it all together, but that can mean users spending more time on broken platforms while trying to save a buck.

Employees are more resilient than we think as far as being able to compartmentalize different types of change. In my CMIO life, we rolled out “urgent fixes” such as new drugs or charge changes after hours on a relatively real-time basis, with notification to those who had logged the issues. The rest of our fixes were deployed monthly, with communication of the emergency items added to that communication so that we weren’t bombarding general users with all the “urgent” items. The monthly package was always deployed the same night as the physician IT advisory board meeting, so that we could re-communicate the changes (and because the analysts were already staying late, so we could save on the catering by feeding both crews at the same time).

Major upgrades to the application happened twice yearly and we opted to hold some workflow changes until those releases — even though they may have been patched earlier — in the event that we thought more intense training was needed for successful adoption. Those major releases included Web training, in-person training, and 1:1 training where needed, whereas the monthly patches were basically described in newsletter format.

It worked well for us and seemed logical, so I was surprised when I went out into the larger world and saw the mess that some groups make of application change management. One organization just threw patches on the system every Thursday night, regardless of whether the patches addressed issues of record. There was no communication to end users. Another communicated every little thing, whether it was relevant or not, causing the users to miss important issues.

Of course, if you’re on a vendor-hosted platform, you might not have the choice to identify how and when you’ll be updated and upgraded. In my clinical world, I often come in to some surprises regardless of how well the team has tried to communicate them. Usually they’re small, though, and our clinicians are adaptable, so not having that level of control isn’t as major of an issue as one might think. Of course I might feel differently if this was software for the operating room, the ICU, or another high-stakes environment, but for urgent care, it works.

I always appreciate hearing from readers, especially when there is concrete advice involved. How is your organization working to reduce burnout? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Nancy Ham, CEO, WebPT

Nancy Ham is CEO of WebPT of Phoenix, AZ.

Tell me about yourself and the company.

I’ve been in healthcare for 25 years now, which is hard to believe. I’ve been fortunate to work my way across the continuum of care, starting with primary care, then specialist, hospital, and now post-acute, with some forays into payer, pharma, and lab along the way. I’ve been fortunate to work in a lot of different kinds of companies, from a startup that became a billion-dollar IPO to VC-backed companies that became part of bigger companies to being in a Fortune 50 division. I’m currently at WebPT, which is the leading EMR for the $30 billion rehab industry.

What are the similarities and differences between software used in an outpatient therapy setting versus that used by hospitals and physician practices?

It’s all about fit for purpose, especially EHR. As the name implies, it is purpose-built for its user base, which in our case is physical therapists, occupational therapists, and speech-language pathologists. You can imagine how different the diagnostics and clinical workflows might be from dermatology to cardiology to physical therapy. That’s why you’re seeing a lot of growth and activity in vertically specialized EHRs, like WebPT, Modernizing Medicine, and others.

Are outpatient therapy clinicians happier with their specialty-specific EHR than EHRs in general?

We were founded by a physical therapist, Dr. Heidi Jannenga. We often hear from our customers that it’s obvious that the product was written by a physical therapist. It supports their clinical workflow and thinks the way they think. We work very hard on that because we want to be as unobtrusive into the patient conversation as possible and be as compliant and efficient as possible to let therapists spend as much time as with their patients and as little time as possible with documentation. That’s a hard task, and something we constantly come back to. How can we improve? How can we make it better? How can we incorporate new, emerging technologies, like voice?

I also think it’s worth noting that there’s a lot of dissatisfaction with EMRs, both general and specialty. In fact, the last survey I saw showed that only one of the eight major general EHRs had a positive Net Promoter Score. We’re very proud to have a strongly positive NPS at 32, which I think is a reflection not only on the software, but on all the other pieces we bring that help our customers achieve their goal and our mission, which is to help therapists achieve greatness in practice. That means clinical greatness, financial greatness, and patient satisfaction greatness and then wrapping all that with stellar service and education.

We often focus a little bit on the product when having this dialogue as an industry. But to me, it’s about the entire ecosystem that you provide to your clients — we call them members — to support them in every aspect of what they’re trying to do.

Is the trend of consolidation at every level of healthcare, from providers to insurers, affecting your customer base?

Very much so. There are about 36,000 to 40,000 outpatient rehab clinics and we’re very privileged to serve 12,000 of them, so about a third of the industry. But as we’ve seen in virtually every other healthcare vertical, bigger companies are now being created. We have customers ranging from a single clinic to our largest customer’s 1,600 clinics. That’s an exciting change for the industry, because as we create more clinic operators of scale, it opens up a broader opportunity to participate in value-based care, for example. You now have some geographic density that matters to an IDN or a payer and you can participate in bundles or an ACO or whatever value-based care arrangement might happen.

We also see larger operators become able to invest more in data-driven clinical outcomes, which is a topic we’re particularly passionate about as a company. They are able to participate more vibrantly in that care continuum. I don’t know if you’ve been to PT, but I myself am PT patient. I spend a lot more time in that clinic than I do in my doctor’s office. We also think there’s an interesting opportunity for physical therapy to have a louder voice in primary care because of the hands-on time they’re spending with their patients. That’s something we want to support.

The opportunity here is that every year, 128 million adult Americans have a musculoskeletal condition that lasts more than three months that would benefit from physical therapy. Only 8 percent of them make it to physical therapy, so the other 92 percent are getting opioids or pain meds. They’re getting imaging, surgery, or perhaps nothing at all and they’re just sitting at home in pain.

As the industry is consolidating and expanding, it affords us a better opportunity to bring more patients to PT and make that 8 percent 10 percent or 15 percent. There’s a growing body of clinical evidence that PT is the best clinical pathway for a number of conditions in terms of cost and quality and in terms of the patient not just getting better, but getting well.

I’ve read that a big problem in physical therapy is that patients don’t complete their treatments, either because of cost or because they feel better. What have you learned about how your provider customers engage with their patients?

I’ll admit that I was initially a PT dropout myself. I quit going after my third visit because I felt better. But I was not well. I’ve since returned, completed my course, and returned to my best health. That’s a common issue. Patients are busy, and if they’re paying out of pocket, it’s expensive, so they tend to quit as soon as they’re seeing some progress.

That’s where we can use technology to help patients understand what their best outcome is. We have a data-driven clinical outcomes product. We can predict how much recovery of function you will gain based on the number of visits. If we can illuminate that to patients — to show them that if they would complete their course of care, their range of motion, for example, might improve another 30 percent — that would be motivational.

We acquired a company last year that allowed us to launch a new digital mobile platform to help patients communicate securely with their clinician to continue their therapy between visits from home exercise programs, or HEPs. HEPs are an important part of the PT story. Also to share their honest feedback on a Net Promoter Score basis.

Patients drop out because they have a bad experience. It could have been parking, the front desk, understanding their bill, or the clinical care. By helping illuminate that in real time to our practices, we’re giving them a real-time chance to intervene with that patient and have that conversation. We’re seeing good data that this combination of tools increases the stickiness of patients with their prescribed therapy. We’re excited about that as a trend for both patients and our clinics.

Is there any movement toward PTs using technology to help patients do their exercises effectively at home, like a video PT visit?

Yes. One of our new products is a robust, video-based mobile platform for patients to understand what they should be doing. To see it, repeat it, and communicate with a therapist how that’s going.

There’s a lot of invention happening in the next wave of virtual rehab, whether it’s using an avatar or using a 3D camera to literally measure your performance. We’re in the early stage of those technologies and maybe a little early stage on the business models to support them, because telemedicine at large has not yet penetrated into the rehab market the way it has in other verticals. There’s a lot of opportunity there for both patients and for sponsors, like employers who want to offer more convenient, more affordable ways for patients to recover from a work injury, perhaps. It’s an area we’re watching very closely.

What are your biggest takeaways from the HIMSS conference?

It was my 25th year attending. I learn less from HIMSS than I used to. It’s more an opportunity to see customers and partners and network with thought leaders in the industry.

I was struck by the amount of virtual assistant technology being shown. This introduction of voice to make technology easier for clinicians to use while they’re in direct patient engagement is encouraging. While perhaps machine learning, artificial intelligence, and big data are being over-hyped, we’re starting to see some real, practical uses of that data. That’s something we’re doing in continually improving our outcomes product — getting more predictive about what’s your best course of care and what is your likely outcome. Blockchain — not Bitcoin, but blockchain — is something that’s very interesting and I’m starting to become more optimistic that we’ll see some real adoption of it in healthcare.

What would you recommend to women who want to move into health IT leadership roles?

I would suggest they watch the amazing HIStalk webinar that Liz Johnson and I did on secrets to success for women in HIT. Thanks to HIStalk for affording us that opportunity.

Things are getting better, but it is incumbent upon women to actively study and learn what they can do to be more effective in their roles, to be more effective in leadership, and to be more effective in managing their careers.

My best advice to everyone is to make networking a part of your everyday life. Healthcare is such a collegial industry. I’ve virtually never been rebuffed when I’ve reached out to someone to say, “I’m interested in learning from you. I’m interested in your career path.” In those connections, you both learn and are inspired by someone else’s story. You make a new friend and maybe come away with a good idea for your project, your company, or your career.

Do you have any final thoughts?

In my 25 years, I’ve been a passionate advocate for interoperability. I started out in the mid-1990s trying to build CHINs — community health information networks — and most recently led Medicity, the large HIE company in our industry, processing billions and billions of real-time clinical transactions a year.

I would like to call upon my fellow EHR and EMR CEOs to continue to open up our platforms to innovators, to data exchange, and to supporting the patient’s journey. It is the patient’s data. We are honored to be entrusted with that data. Our job is not to lock it up, but to digitize it in an appropriate way that helps the patient achieve their best outcome while achieving the Triple Aim. I would love to see my fellow CEOs step up and do more in this regard.

One thing we’ve done here at WebPT since I joined is to create a vibrant partner ecosystem. We are supporting our customers as they find and implement all sorts of innovative, interesting other technologies that help them run their practices and serve their patients.

Morning Headlines 3/26/18

Israel to launch Big Data health project

Israel will spend $287 million to make the health data of its 9 million citizens available to researchers and private companies for work on preventive medicine and personalized medicine projects.

Health IT groups happy with the omnibus

The federal government’s spending bill leaves ONC’s annual budget unchanged at $60 million – at least through September – instead of being reduced to $38 million as requested by the White House.

As Ascension restructures, it hints at smaller hospital footprint

Ascension Health (MO) President and CEO Anthony Tersigni tells 165,000 employees that the 151-hospital health system will embark on a “dual transformation” that will shift its focus from hospital services to more outpatient care and telemedicine.

CMS Deputy CIO to Replace HHS CISO Departing Amid Controversy

HHS CISO Chris Wlaschin announces his resignation, putting the Healthcare Cybersecurity and Communications Integration Center on even more tenuous ground given the departure of its director and removal of its deputy CISO.