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Morning Headlines 11/2/18

November 1, 2018 Headlines No Comments

The VA Shadow Rulers’ Signature Program Is “Trending Towards Red”

ProPublica highlights the political power struggles and leadership mismanagement surrounding the VA’s no-bid, $10 billion Cerner project, prompting the software vendor to preemptively warn veterans groups of negative media coverage.

McKesson says Chairman/CEO Hammergren to retire, succeeded by Tyler

McKesson CEO John Hammergren will retire on March 31, 2019, to be replaced by President/COO Brian Tyler.

NextGen Healthcare Inc (NXGN) CEO Rusty Frantz on Q2 2019 Results – Earnings Call Transcript

NextGen Healthcare CEO Rusty Frantz reports Q2 results that beat earnings expectations but fall short on revenue, adding that the company is making a push to upgrade the 50 percent of its clients that are on older product versions.

Allscripts stock drops as quarterly results miss Street view

Allscripts reports Q3 results: revenue up 16 percent, EPS $-0.20 vs. –$0.16, missing Wall Street expectations for both.

News 11/2/18

November 1, 2018 News 4 Comments

Top News

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ProPublica investigates the VA’s no-bid, $10 billion Cerner project, with these findings:

  • Trump advisor and son-in-law Jared Kushner pushed the no-bid selection of Cerner, naively assuming that interoperability would be automatic if VA and DoD used the same company’s product. “The premise of all of this is incorrect,” a former project official now concludes, adding, “We thought it made perfect sense until we looked under the hood.”
  • The VA team, which justified choosing Cerner without a bidding process by claiming it would create “seamless care,” has stopped using that term and now just says VA doctors will be able to see DoD records, which they can already do with their old systems.
  • The White House rejected qualified candidates for CIO and other oversight roles and instead proposed former Trump campaign officials who have no health IT experience.
  • One of those rejected candidates was former Sutter Health CIO Jon Manis, who questioned the role of Bruce Moskowitz, MD — the physician member of the Mar-a-Lago group of Trump supporters that was reported to be meddling in VA affairs – and feared that the project’s politics and instability would make the job impossible.
  • Since-fired VA Secretary David Shulkin, MD sent Cerner reps packing when they showed PowerPoints instead of something real, explaining that he planned to hold Cerner to a higher standard than just installing its standard software. He expected to create a single lifetime health record with computerized decision support.
  • A group of hospital executives warned the VA that Cerner’s off-the-shelf product and VA-DoD data synchronization would not by itself achieve the VA’s goal of seamless care.
  • The VA’s project to mine EHR data for key clinical insights was abandoned with the selection of Cerner, which turned out to not have those capabilities.
  • Cerner was found to be missing key VA capabilities such as Agent Orange exposure, spinal cord injury, and PTSD.
  • Intermountain Healthcare CMIO Stan Huff told the VA, “If you install Cerner as an off-the-shelf product, your clinicians are going to be extremely unhappy and everybody is going to ask why did you spend billions of dollars for a crappy system.”
  • The DoD has proposed sending only 1-3 years of service member and dependent records to the VA’s new system.
  • Since-resigned VA CHIO Genevieve Morris could not get VA clinicians to participate and found herself in a political power struggle with new CIO Camilo Sandoval (no health IT experience), John Windom (whose expertise is procurement), and Rich Stone, MD (the VA’s top health official).
  • The VA spent at least $874,000 on a kickoff event held at Cerner’s headquarters, where Morris and Windom argued over stage time and walk-on songs and tried to gloss over the project’s convoluted org chart.
  • Cerner’s internal progress report rates the project’s alert level as “yellow trending towards red.”
  • The DoD is so concerned about VA’s project oversight that they have proposed taking the project over, although the Pentagon’s lawyers said that probably isn’t legal.

Cerner has reportedly emailed veterans groups to warn them of “negative media coverage, including a piece from ProPublica.”


Reader Comments

From Fortune Teller: “Re: Medicare’s Patients Over Paperwork initiative. Do you have a prediction on what to expect?” I’ll let readers and Dr. Jayne chime in on the proposed changes to E&M codes, office visit documentation, and other paperwork that were first floated by CMS a year ago. It’s hard to separate meaningful HHS/CMS announcements from the political rhetoric spouted by its campaigner-appointees, so I’ve quit trying.


HIStalk Announcements and Requests

I added a “Add/Read Comments” button at the bottom of this post. It will make it easier to add a comment after reading. Let me know what you think.

Mrs. HIStalk shamed me into accompanying to seeing yet another movie (a rarity for me), in which case I give “First Man” a B- for being dull, presumably accurate, and nausea-inducing for using the “shaky cam” such that living room scenes are far harder to watch than when Gemini and Apollo spacecraft are careening wildly through space (“The Right Stuff” is about a hundred times better in every way). Before that, I laughed out loud at the preview of awful-looking sing-along, Queen-approved puff piece “Bohemian Rhapsody” as the audience all reflexively ducked to avoid being gored by the massive fake teeth of Freddy Mercury (Rami Malek).


Webinars

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Orion Health finalizes its sale of Rhapsody to technology investment firm Hg, enabling Rhapsody to launch as an independent company in Boston under the leadership of former McKesson executive Erkan Akyuz. The company, which offers health data integration software, plans to increase staff by 40 percent over the next 18 months.

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Bloomberg reports that Elliott Management and Veritas Capital have teamed up to bid on Athenahealth. Veritas acquired GE’s ambulatory care, revenue-cycle, and workforce management software business for $1 billion in April.

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Allscripts reports Q3 results: revenue up 16 percent, EPS $-0.20 vs. –$0.16, missing Wall Street expectations for both. Shares were down 9 percent in early after-hours trading Thursday following the announcement.

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NextGen Healthcare, in its first quarterly report since changing its name from Quality Systems, Inc. on September 10, reports Q2 results: revenue down 2 percent, adjusted EPS $0.24 vs. $0.22, beating earnings expectations but falling short on revenue. Shares dropped 24 percent on the news, valuing the company at $968 million. From the earnings call:

  • Customer attrition rate in the trailing 12 months was higher than expected at 13.9 percent, as “Epic clients continue to sweep through their physician practices and as Cerner continues to convert the Siemens ambulatory base post-acquisition.”
  • The company will “sort of be proactive. We’re actually getting in and optimizing those clients long before they ever even think about whether or not there is a different opportunity available for them within their local ecosystem.”
  • The company has eliminated the COO role that was vacated with Scott Bostick’s resignation in September 2018, with sales and services now reporting directly to the executive team.
  • The company will add new financial services and contract management offerings.
  • Long implementation cycles with all-in customers reduced the conversion of bookings to revenue.
  • President and CEO Rusty Frantz said in response to an analyst’s question about one-time accruals that it was “my least favorite one-time accrual … lowering the management incentive plan because our expectations on revenue are not what they were at the beginning of the year.”
  • NextGen isn’t seeing any sales benefit of Athenahealth’s tribulations, saying that ambulatory physicians look purely at products rather than investor-side activity.
  • The company is making a push to upgrade the 50 percent of its clients that are on older product versions and will eventually implement end-of-life support.

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Meditech reports Q3 results: revenue down 2 percent, EPS $0.52 vs. $0.47. Product venue slipped 7 percent due to implementation delays.


People

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McKesson CEO John Hammergren will retire on March 31, 2019. to be replaced by President/COO Brian Tyler.

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PeraHealth hires industry long-timer Greg White (PerfectServe) as CEO.


Sales

  • Hawaii Health Information Exchange will implement NextGate’s cloud-based provider registry and enterprise master patient index.
  • Asquam Community Health Collaborative (NH) signs a managed services agreement with Huntzinger Management Group for LRGHealthcare and Speare Memorial Hospital. Asquam’s IT staff will become Huntzinger employees.
  • Citizens Medical Center (TX) selects automated pre-bill coding analysis software from Streamline Health Solutions.
  • Lake Regional Health System (MO) will implement Cerner Millennium in collaboration with University of Missouri Health Care.
  • Inova Health System (VA) will expand the rollout of Spok Care Connect clinical alerting beyond its initial implementation at Inova Fairfax Hospital.

Announcements and Implementations

Adventist Health System (FL) implements Glytec’s EGlycemic Management System at 33 facilities in seven states.


Government and Politics

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Cerner Government Services President Travis Dalton provides an update on the company’s DoD and VA software implementation efforts, highlighting workflow and care improvements made at the initial DoD implementation sites and the company’s receptiveness to progress reports from those facilities, which, as he acknowledges, have been seen by some as setbacks. He adds that the company is ready to kick off implementations at military medical facilities in California and Idaho.

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HHS re-launches the Healthcare Cybersecurity and Communications Integration Center as the Health Sector Cybersecurity Coordination Center. HC3 will operate under the authority of the Department of Homeland Security. The initial HCCIC suffered from organizational delays and leadership setbacks tied to allegations of ethics violations that led to an OIG investigation.


Privacy and Security

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A reader sent this Reddit-posted breach item claiming that employee and dependent information from Cerner’s health plan was posted to a company wiki and had been visible internally for nearly a year. I reached out to Cerner and received this response:

Some data about associate benefits was posted on a password-restricted intranet site. The personally identifiable information was not exposed or accessed by anyone from outside the company. The data was viewed by a small group of associates, all of whom have had extensive HIPAA training. Due to the limited nature of the exposure, we determined that this did not constitute a data breach and we are not formally reporting this matter.


Other

IBM’s Red Hat acquisition will enable it to move Watson Health services to a hybrid cloud model, which the company says will give customers easier access to data for analytics and AI projects. Initial converted data sets will include claims and patient data from IBM’s Truven Health Analytics, Explorys, and Phytel acquisitions.

A Kaiser Health News report says that precision medicine for cancer treatment sounds good, but insurers cover the cost poorly if at all because the treatments are off label and evidence is lacking that they extend lifespan. The article profiled a breast cancer patient who can’t afford the $17,000 per month cost of AstraZeneca’s drug, and after the story ran, the drug company immediately offered to comp it (thus proving that in our unbelievably screwed-up healthcare non-system, the biggest shortage we have isn’t of doctors or other clinicians, but rather reporters).

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A nurse in Germany who is serving a life sentence for killing two hospitalized patients confesses to killing at least 100 more in two hospitals, explaining that he enjoyed trying to resuscitate the patients he chose randomly to inject with arrhythmia-inducing drugs. Authorities and the families of his alleged victims question why he wasn’t caught sooner, even in one case in which he was caught in the act of injecting a patient but was allowed to work for another two days, during which time he killed another one. Hospital records showed that death and resuscitation rates doubled when he was working, a nice piece of analytical work in every way except timeliness.


Sponsor Updates

  • Mobile Heartbeat attains 100,000 monthly active users of its MH-CURE unified clinical communications platform.
  • EClinicalWorks will exhibit at AAP 2018 November 3-5 in Orlando.
  • Allina Health CIO Jonathan Shoemaker and Health Catalyst win CHIME’s 2018 Collaboration Award.
  • Nuance shares results following Piedmont Healthcare’s implementation of the company’s clinical documentation products.
  • Formativ Health publishes a new white paper detailing ways providers can grow and maintain their patient panels.
  • Kids Rock Cancer Center shares how FormFast has benefitted its care team.
  • Glytec publishes a new e-book, “Hypoglycemia in the hospital. Why is it costing you millions and what can you do?”
  • CHIME names Nuance Communications VP Kali Durgampudi its 2018 Foundation Industry Leader.
  • Bumrungrad International Hospital in Thailand implements the InterSystems TrakCare EHR.
  • ChartLogic parent company MedSphere supports federal efforts to alleviate the opioid epidemic.

Blog Posts


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EPtalk by Dr. Jayne 11/1/18

November 1, 2018 Dr. Jayne No Comments

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November is Home Care & Hospice Month, so let’s give a shout-out to members of the healthcare informatics community who work in those environments. From my time at Big Health System, it seems like hospital projects get all the recognition and the lion’s share of the budget, while ancillaries like home health and hospice are struggling to even get support.

There are a number of challenges faced by these disciplines that make their work tricky – connectivity issues, mobile documentation, chart fragmentation, lack of coordination among prescribers and referring physicians, and more. Plus, there are the challenges inherent with going into people’s homes and dealing with unpredictable (and sometimes dangerous) situations.

Our occupational health clinic works with a home care group and I’ve heard stories about home care teams that go the extra mile bringing food and personal care items to patients who are struggling to stay out of the hospital. Hats off to these vital members of the healthcare team and the informatics personnel who support them.

Whether it’s related to the month of recognition or not, CMS released a rule finalizing changes to the Home Health Prospective Payment System. Claiming it will “strengthen and modernize Medicare,” it made changes to coverage for remote patient monitoring, added home infusion therapy benefits, and updated payments for home health with a new case-mix system. Burden is also supposed to be reduced through fewer reporting measures for certifying physicians. The changes begin in calendar year 2020.

Building on the legacy of EMRAM, HIMSS Analytics releases a new Infrastructure Adoption Model called INFRAM. Along with AMAM and CCMM, the models are designed to measure organizational efforts to improve processes and outcomes through technology implementation and adoption. INFRAM is designed to assess technical infrastructure within health systems, benchmarking prior to go live on EMR (as HIMSS still calls them) systems. Subdomains assessed as part of the model include security, collaboration, wireless capabilities, data center, and transport.

The American Medical Association is providing $15 million in grants over five years to fund innovations in residency training. The Reimagining Residency Initiative aims to transform residency training to better prepare graduates for the healthcare system of the future. Depending on the specialty, graduating residents are often unprepared to operate in the “non-system” that we have going in the US – they may not have been trained on value-based care, coding in such a way that one can actually be paid, and working collaboratively with other physicians and members of the healthcare team.

AMA did this previously in a $12 million program with medical schools, leading to development of a “Health Systems Science” textbook and curriculum to teach physicians to work with emerging technology and how to participate in patient safety, quality improvement, and team care projects. The Request for Proposal will be distributed on January 3, 2019 with letters of intent due February 1. Medical schools, health systems, and medical specialty societies are invited to participate along with graduate medical education sponsors. Awards will be announced in June 2019.

NCQA announces availability of various datasets to help us with our analytics endeavors. The Quality Compass 2018 dataset includes HEDIS and CAHPS data, aiding benchmarking. The current set includes data for commercial, Medicare, and Medicaid submissions. Separate data is also available for CAHPS 5 OH Adult survey results for commercial and Medicaid payers. Also, there is a CAHPS Booklet includes benchmark data for Adult and Child CAHPS surveys. Last, the Health Insurance Plan Ratings 2018-2019 results include scores similar to the Medicare Five-Star Quality Rating System.

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The American Medical Informatics Association announces its Inaugural Class of Fellows for the newly established FAMIA Applied Informatics Recognition Program. The program is designed “to recognize AMIA members who apply informatics skills and knowledge within their professional setting, who have demonstrated professional achievement and leadership, and who have contributed to the betterment of the organization.” The recognition is open to physicians, nurses, pharmacists, and others within clinical informatics. Formal recognition will occur at the AMIA 2019 Clinical Informatics Conference in Atlanta, April 30-May 2, 2019. Some of my favorite people are on the list – congratulations to all!

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As I’ve worked with youth in various community organizations over the last decade, I’ve seen the expansion of smartphones, with both positive and negative impacts on youth knowledge, exploration, and relationships. Time magazine reviews recent research on the impact of technology on young people’s mental health, noting increased rates of diagnosis for depression and anxiety in those using screen-based devices for more than seven hours per day. The data is from a 2016 study looking at more than 40,000 children ages 2 to 17.

When doing a sanity check on the data, I originally balked at the seven-hour figure as an outlier, but the study notes that around 20 percent of youth aged 14 to 17 spend this amount of time on screens each day. Youth in this use category were also more easily distracted, had emotional lability, and had difficulty finishing tasks compared to those who spent only an hour a day on screens. Adolescents were more likely to have issues than younger children.

Every time I’m in an airport and see toddlers and young children glued to a phone or tablet while their parents are also glued to a phone, I want to scream. Maybe I’m turning into the local curmudgeon, but childhood is a time for wonder and explanation. I want to tell them to take their children over to the window and look together at what is going on around the airplane. Watch the baggage handlers and look for your bags. See how the plane gets refueled. Talk about the jobs people do and how everyone plays a part in getting you to your vacation or grandma’s house or wherever.

Those behaviors in young childhood influence how individuals will use phones and devices as teens, and we know from numerous pieces of research that social media use is linked to low well being in teens and adolescents. There’s nothing funnier than watching a group of teens stand in a circle and “group chat” instead of actually chatting face-to-face with each other. Funny, but sad. I’m glad that one of the organizations I work with is a no-phone zone for the most part, forcing young people to interact with each other and also with the adults supporting their adventures.

Weird news of the day: Having one’s appendix removed has been linked to a nearly 20 percent lower risk of developing Parkinson’s disease. Researchers noted that the appendix holds alpha-synuclein, which is thought to influence Parkinson’s development. One working hypothesis is that the appendix participates in immune surveillance “contributes to Parkinson’s through inflammation and microbiome alterations.” It’s not compelling enough to run out and have surgery, but I’ll be interested to see where the data takes us.

What is your organization doing to celebrate Home Care & Hospice Month? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/1/18

October 31, 2018 News 1 Comment

Athenahealth Is Near Deal With Veritas Capital, Elliott

Bloomberg reports that Elliott Management and Veritas Capital have teamed up to bid on Athenahealth.

DoD and VA Update: Early Results, Fine-tuning and Next Steps

Cerner Government Services President Travis Dalton updates stakeholders on the company’s DoD and VA software implementation efforts, noting it is “well positioned” for the DoD’s next phase at medical sites in California and Idaho.

HHS rolls out cyber center successor (to criticism)

Government officials cry foul over long-delayed HHS efforts to re-launch the fractious Healthcare Cybersecurity and Communications Integration Center as the Health Sector Cybersecurity Coordination Center.

Rhapsody Announces Completion of Acquisition by Hg, Launches as Independent Company Under New Leadership

Orion Health finalizes its sale of Rhapsody to Hg, enabling Rhapsody to launch as an independent company in Boston under the leadership of former McKesson executive Erkan Akyuz.

HIStalk Interviews Peter Butler, CEO, Hayes Management Consulting

October 31, 2018 Interviews No Comments

Peter Butler is president and CEO of Hayes Management Consulting of Wellesley, MA.

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Tell me about yourself and the company.

I’ve been at Hayes for 25 years. We are a technology-enabled company leveraging our MDaudit software platform to drive billing and audit compliance productivity as well as revenue integrity solutions across healthcare organizations.

Is it hard to retool a consulting firm into a software vendor?

It’s challenging. After a long corporate career in consulting, you develop a name for yourself in that area. We got our start with IT consulting, then over a period of time, moved into revenue cycle consulting and EHR implementations and so forth. Our MDaudit platform took a greater foothold in the industry and we were experiencing quite a lot of trust with it.

We saw this, years ago, as the future direction of the company. We foresaw health IT consulting needs diminishing and becoming commoditized. We wanted to leverage our strength. That’s when the software piece came in.

It was a difficult journey trying to change the mindset of a 25-year-old company and people who have a lot of longevity in it, asking them to think differently, more like a software company. It came with a lot of challenges.

Are you happy that you made that decision early when you see other consulting firms just now starting to react to market changes?

Very happy. When we were going through that transition, the hardest part was that it wasn’t happening fast enough. I look back in the rear-view mirror and say, OK, we did it. We got there. This is good. Where do we go from here? It’s important for us to stay relevant in the industry and in our client organizations.

We’ve turned the corner. We are looking forward to building ourselves as a software company and continuing to make a difference in healthcare.

What are the top issues in billing compliance?

Years ago, the top issue was how a healthcare organization with 2,000 providers could audit all of them annually. Then they acquire two more medical groups of a couple of hundred providers. How do they get through those audits with limited resources? Their organizations weren’t giving them the staff since they were really seen just a cost center.

Now the trend is, I have limited resources, so let me take a step back and look at all of the billing compliance risk areas to my organization. Bubble those to the surface so that I can take my limited resources and go tackle those challenges. Are they really risk areas that I should be concerned about, or are we a billing outlier for good reason because we are multi-specialty and we specialize in this type of service? In the old days, they were looking for fraud and abuse inside their organizations.

Now it’s taking a different turn. Where can I sharpen my attention to the revenue cycle? What am I actually providing for service, but not billing for? Compliance officers stay in the mindset of looking for areas where they can ensure that their organizations are billing appropriately, not over-billing Medicare things and like that. But they’re partnering with revenue integrity leaders inside their organization who are looking at the same data. What are we leaving on the table? We’ve delivered these services. There’s more pressure on reimbursement. We want to make sure we’re getting paid for everything we’ve done.

Is anybody doing a lot of billing compliance work as due diligence before provider acquisitions or mergers?

They are, but they should be doing more. I’ve had conversations with compliance officers who said, I just got a message from the CEO that we’ve signed our letter of intent. We’re moving forward with buying this practice or hospital. They aren’t paying attention to making sure that, as part of the due diligence process, they are billing and coding appropriately. Let’s understand the risks of acquiring this organization. It’s almost been an afterthought from senior leadership that the compliance professionals find themselves in post-transaction.

Is the focus different when a private equity firm is the buyer, such as the trend of acquiring dermatology practices?

We’ve had some of those PE-backed companies call us and say, we’re about to make an offer for this dermatology practice. Before we finalize it, can you do some diligence around their revenue cycle and their billing practices? Make sure that they are billing and coding appropriately and that what they are telling us and what we’re reading in the reports is actually what’s happening.

Those are mini-assessments. They don’t take a lot of time, but they give the buyer an opportunity to understand where the risks and opportunities are. Once they finalize the deal, if they go forward, where can they find revenue opportunity and operational efficiency? There’s definitely a lot of that from the financially-minded buyers.

What trends are you seeing that aren’t getting much attention?

A lot of revenue cycle leaders in years past ran their organizations based on metrics. They would tell their staff, you need to make X number of calls or you need to touch X number of claims. A trend I’m seeing that will pay dividends later is that instead of looking at volume-based metrics or metrics for the sake of metrics inside those revenue cycle follow-up departments or patient access departments, ask that if you touched a claim, what did you do with it? Did you make changes to it that positively affected the organization? Were you able to identify root cause and go back and make changes that actually stuck so that we’re not seeing these problems over and over?

Some of our clients are assigning audit-minded people to look at the goals and responsibilities of those who support the day-to-day operations. Looking at whether their daily tasks drive positive change, the quality outcome in the operation. They are using spreadsheets to document who they’re working with, the types of audit completed, the follow-up, and the result.

It can become an arduous task, but the concept is, are you driving better quality outcomes in your role, or are you just saying you made your 50 calls or worked your 10 work queues? What was the result of that? That’s an important trend and overdue in healthcare.

Hopefully we can instill some best practices in the industry so that we have less need for those auditors. You’ve done your training and you’ve built some great training programs to educate the people who are touching every aspect of the business operation.

Do you have any final thoughts?

Some interesting things are happening that we’ll see more of as quality reimbursement plays a bigger role in healthcare. CMS recently proposed some E&M simplification rules with the concept that it will save money and provider coding time. They’ll save 50 hours a year or something like that, taking away all of the detail-level E&M coding and documentation you have to do. CMS is also looking for ways to save money for the taxpayers and the government, so it has to be viewed through that lens as well.

It will come at some point, probably not in January, but it will come with challenges that the healthcare industry needs to walk through. If you’re billing Medicare, you’ve got Blue Cross Blue Shield as secondary, and you’re doing simplified billing for Medicare, what do you do with that claim? It gets passed down to a secondary payer. There are other issues around RVUs and how you reimburse your doctors that will be impacted by changes like this from CMS. We have a lot of work to do as we think about simplifying the billing process in the industry. It won’t come without challenges.

A Machine Learning Primer for Clinicians–Part 3

Alexander Scarlat, MD is a physician and data scientist, board-certified in anesthesiology with a degree in computer sciences. He has a keen interest in machine learning applications in healthcare. He welcomes feedback on this series at drscarlat@gmail.com.

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Previous articles:

  1. An Introduction to Machine Learning
  2. Supervised Learning

Unsupervised Learning

In the previous article, we defined unsupervised machine learning as the type of algorithm used to draw inferences from input data without having a clue about the output expected. There are no labels such as patient outcome, diagnosis, LOS, etc. to provide a feedback mechanism during the model training process.

In this article, I’ll focus on the two most common models of unsupervised learning: clustering and anomaly detection.

Unsupervised Clustering

Note: do not confuse this with with classification, which is a supervised learning model introduced in the last article.

As a motivating factor, consider the following image from Wikipedia:

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The above is a heat map that details the influence of a set of parameters on the expression (production) of a set of genes. Red means increased expression and green means reduced expression. A clustering model has organized the information in a heat map plus the hierarchical clustering on top and on the right sides of the diagram above. 

There are two types of clustering models:

  • Models that need to be told a priori the number of groups / clusters we’re looking for
  • Models that will find the optimal number of clusters

Consider a simple dataset:

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Problem definition:

  • Task: identify the four clusters in Dataset1.
  • Input: sets of X and Y and the number of groups (four in the above example).
  • Performance metric: total sum of the squared distances of each point in a cluster from its centroid (the center of the cluster) location.

The model initializes four centroids, usually at a random location. The centroids are then moved according to a cost function that the model tries to minimize at each iteration. The cost function is the total sum of the squared distance of each point in the cluster from its centroid. The process is repeated iteratively until there is little or no improvement in the cost function.

In the animation below you can see how the centroids – white X’s – are moving towards the centers of their clusters in parallel to the decreasing cost function on the right.

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While doing great on Dataset1, the same model fails miserably on Dataset2, so pick your clustering ML model wisely by exposing the model to diverse experiences / datasets:

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Clustering models that don’t need to know a priori the number of centroids (groups) will have the following problem definition:

  • Task: identify the clusters in Dataset1 with the lowest cost function.
  • Input: sets of X and Y (there are NO number of groups / centroids).
  • Performance metric: same as above.

The model below initializes randomly many centroids and then works through an algorithm that tells it how to consolidate together other neighboring centroids to reduce the number of groups to the overall lowest cost function.

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From “Clustering with SciKit” by David Sheehan

3D Clustering

While the above example had as input two dimensions (features) X and Y, the following gene expression in a population has three dimensions: X, Y, and Z. The mission definition for such a clustering ML model is the same as above, except the input has now three features: X, Y, and Z.

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The animated graphic is at www.arthrogenica.com

Unsupervised Anomaly Detection

As a motivating factor, consider the new criteria for early identification of patients at risk for sepsis or septic shock, qSOFA 2018. The three main rules:

  • Glasgow Coma Scale (GCS) < 15
  • Respiratory rate (RR) >= 22
  • Systolic blood pressure (BP) <=100 mmHg

Let’s focus on two parameters, RR and BP, and a patient who presents with:

  • RR = 21
  • BP = 102

A rule-based engine with only two rules will miss this patient, as it doesn’t sound the alarm per the above qSOFA definition. Not if the rule was written with AND and not it had OR between the conditions. Can a ML model do better? Would you define the above two parameters, when taken together, as an anomaly ? 

Before I explain how a machine can detect anomalies unsupervised by humans, a quick reminder from Gauss (born 1777) about his eponymous distribution.

One-Variable Gaussian Distribution

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You may remember from statistics that the above bell-shaped normal Gaussian distribution can accurately describe many phenomena around us. The mean on the above X axis is zero and then there are several standard deviations around the mean (from -3 to +3). The Y axis defines the probability of X. Each point on the chart has a probability of occurrence: the red dot on the right can be defined as an anomaly with a probability of ~ 1 percent. The dot on the left side has a probability of ~ 18 percent,  so most probably it’s not an anomaly. 

The sum (integral) of a Gaussian probability distribution is one, or 100 percent. Thus even an event right on top of our chart has a probability of only 40 percent. Given a point on the X axis and using the Gaussian distribution, we can easily predict the probability of that event happening.

Two-Variable Gaussian Distribution

Back to the patient that exhibits RR = 21 and BP=102 and the decision whether this patient is in for a septic shock adventure or not. There are two variables: X and Y, and a new problem definition:

  • Task: automatically identify instances as anomalies if they are beyond a given threshold. Let’s set the anomaly threshold at three percent.
  • Input: sets of X and Y and the threshold to be considered an anomaly (three percent).
  • Performance metric: number of correct vs. incorrect classifications with a test set, with known anomalies (more about unbalanced classes in next articles).

The following 3D peaks chart has X (RR), Y (BP), and the Gaussian probability as Z axis. Each point on the X-Y plane has a probability associated with it on the Z axis. Usually a peaks chart has an accompanying contour map  in which the 3D is flattened to 2D, with the color still expressing the probability.

Note the elongated, oblong shape of both the peaks chart and the contour map underneath it. This is the crucial fact: the shape of the Gaussian distribution of X and Y  is not a circle (which we may have naively assumed), it’s elliptical. On the peaks chart, there is a red dot with its corresponding red dot on the contour map below. The elliptic shape of our probability distribution of X and Y helps visualizing the following:

  • Each parameter, when considered separately on its own probability distribution, is within its normal limits.
  • Both parameters, when taken together, are definitely abnormal, an anomaly with a probability of ~ 0.8 percent (0.008 on the Z axis), much smaller than the three percent threshold wee set above.

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Unsupervised anomaly detection should be considered when:

  • The number of normal instances is much larger than the number of anomalies. We just don’t have enough samples of labeled anomalies to use with a supervised model.
  • There may be unforeseen instances and combinations of parameters that when considered together are abnormal. Remember that a supervised model cannot predict or detect instances never seen during training. Unsupervised anomaly detection models can deal with the unforeseen circumstances by using a function from the 1800s.

Scale the above two-parameter model to one that considers hundreds to thousands of patient parameters, together and at the same time, and you have an unsupervised anomaly detection ML model to prevent patients deterioration while being monitored in a clinical environment. 

The fascinating part about ML algorithms is that we can easily scale a model to thousands of dimensions while having, at the same time, a severe human limitation to visualize more than 5D (see previous article on how a 4D / 5D problem may look).

Next Article

How to Properly Feed Data to a ML Model

Morning Headlines 10/31/18

October 30, 2018 Headlines No Comments

Healthcare tech startup 98point6 raises $50M, led by Goldman Sachs, to expand its ‘virtual clinic’

Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service that costs a flat $20 per year for the first year, then $120 in following years.

Secret report raises questions about Queensland’s medical records system

In Australia, a report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the health system’s initial claim that the downtime was caused by ransomware.

EXCLUSIVE: Cincinnati executive launches tech firm to prevent suicide

Mason, OH-based Clarigent Health will commercialize technology developed by Cincinnati Children’s Hospital that assesses suicide risk by analyzing conversations between patients and their therapists or doctors.

LabCorp Enables Health Records on iPhone

LabCorp adds support for Apple Health Records, which will allow patients to send their lab results to their IPhones.

News 10/31/18

October 30, 2018 News 3 Comments

Top News

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Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service that costs a flat $20 per year for the first year, then $120 in following years.

The company’s 15 doctors serve patients in 38 states.

Millennials and others for whom convenience is paramount will probably love turning a doctor visit into a text chat, but calling it “primary care” seems like a stretch since it’s just responding in kneejerk fashion to user-reported symptoms, with no effort made to provide continuity of care or chronic condition management. Anyone want to spend $20 to give it a test drive and let me know how it turns out? I bet the $20 deal doesn’t last long. 

I’m interested that the company’s terms of use include a binding arbitration clause, leading me to question (a) does that clause really prevent malpractice lawsuits and instead force plaintiffs into arbitration with no class action option? (legal precedents suggest yes), and if so, (b) why don’t more doctors include binding arbitration clauses in their “new patient” forms with hopes of getting more reasonable judgments than are often awarded by juries made up of mostly retirees, students, and the unemployed?


Reader Comments

From Doyenne: “Re: Cerner share price. It’s dropping due to ‘Cernover,’ in which whole metropolitan areas like Seattle, Chicago, and the Bay Area are switching. Contracting: Seattle Children’s and University Washington. Implementing: University Illinois Chicago, Northwestern. Implemented: Dallas Children’s, Packard Children’s, Royal Children’s (Melbourne), University of Utah, Loma Linda, John Muir.” Unverified, and I agree only somewhat. Certainly Epic’s focus on academic medical centers has given it high-profile customers that created regional momentum, but Cerner is still turning in good numbers due to diversification even as Epic has inflicted obvious pain. Cerner talks less these days about big hospital wins, ambulatory, revenue cycle, and CommonWell and instead reassures investors about population health, IT services, non-US sales, sales outside the Millennium base, and its perfectly timed contracts with the DoD and VA (all of which conveniently avoid butting heads with Epic). The biggest questions are how the company will perform given the questionably credentialed replacements it chose for Neal Patterson and Zane Burke; the good or bad PR that will result from whatever happens with DoD and VA; and diversifying its business to meet Wall Street growth expectations while avoiding becoming a GE-like unfocused conglomerate that behaves like a dull mutual fund. Quite a few companies stumble after they lose a fire-breathing visionary leader, but like Apple, Cerner can always keep booking add-on sales of services, accessories, and questionably improved new models to an existing client base that is reluctant to shop elsewhere. My bottom line: while Epic’s business is solely focused on EHR customers and it’s hard to beat (and getting harder) in that market, Cerner is not limited to EHR sales, and investors price its shares accordingly even though we hospital-centric insiders see Epic as the unstoppable juggernaut.

From Splainin’ to Do: “Re: startups. This health IT site is charging startups to have their updates and company profiles published as fake news. Do it!” No thanks. That site didn’t even register in the Reaction Data survey of C-level health system executives and charging vendors to run their biased content seems to be yet another way to send readers fleeing. You can sell your integrity only once and you can’t buy it back afterward. I take an infrequent look at the content, advertisers, and overall excellence of sites similar to mine and I don’t see many ideas I’d want to emulate.


Webinars

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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IBM will acquire Red Hat for $34 billion, apparently hoping to reverse years of declining revenue by trying to compete with entrenched cloud computing competitors such as Amazon and Microsoft. IBM’s bet-the-farm investment in Watson Health may well become the Previous Shiny Object as the company moves to its more familiar roots in enterprise software in hopes of placating impatient shareholders. I’m pretty sure Red Hat customers aren’t thrilled.


People

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Cantata Health promotes Krista Endsley to CEO. NTT Data sold its healthcare software business to GPB Capital to create Cantata Health in April 2017, which tapped former NTT Data SVP/GM Mike Jones as CEO through April 2018 when Endsley joined Cantata as president.

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Oncology analytics vendor Cota Healthcare hires industry long-timer Mike Doyle (QPID Health) as president and CEO.

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PatientSafe Solutions hires Tim Needham (Burwood Group) as chief commercial officer.


Announcements and Implementations

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A KLAS report on secure communication finds that while ambulatory providers are focusing on simply exchanging messages securely, health systems are moving toward broader, enterprise-level platforms that include interfacing and support for multiple workflows (Voalte and Vocera are furthest along in offering a true communication platform, KLAS concludes). The top vendors (in terms of market consideration, customer retention, and performance) are TigerConnect, Voalte, and Epic. Potential disruptors are Telmediq and PatientSafe Solutions, which have high win rates and quality scores, while KLAS says Spok and Imprivata are losing business due to lagging development.

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Mason, OH-based startup Clarigent Health will commercialize technology developed by Cincinnati Children’s Hospital that assesses suicide risk by analyzing conversations between patients and their therapists or doctors.

Dimensional Insight launches Measure Factory, an automation engine that extends its Diver Platform to support data governance and data integrity.

LabCorp adds support for Apple Health Records, which will allow patients to send their lab results to their IPhones. Some Twitterati were puzzled why it only supports IPhones, with the obvious answer being that while Apple is #2 in mobile phone OS behind Android, there’s no Apple Health Records counterpart in Android (Google Fit is mostly just activity tracking).

Partners HealthCare and Lifespan end their merger talks, with Partners forging ahead with plans to acquire Lifespan competitor Care New England Health System. 


Other

In Australia, a report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the health system’s initial claim that the downtime was caused by ransomware. Investigators say Cerner has refused to provide system logs covering the incident. Cerner is the leading candidate to win a new bid for a patient administration system and insiders report executive pressure to avoid putting the company in a bad light.

Fascinating: a Utah insurer rolls out a “pharmacy tourism” option in which patients who take expensive drugs will be given plane tickets to San Diego, a ride across the border to Tijuana, and $500 as a cash bonus to buy their drugs in Mexico, where they are so much cheaper that the insurer still saves money. Hopefully Mexico won’t build a big, beautiful wall to keep medical tourism invaders out. 

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Weird News Andy comes up with a seasonally appropriate thriller that leads him to conclude, “Always go for the $5 teeth; the $3 teeth will get you every time.” An Alabama woman completes her Halloween ensemble with $3 fake teeth, only to find that the included temporary glue was (at least in her case) permanent. The emergency dentist, in true Halloween fashion, debated whether to saw or drill away the plastic with the risk of making her permanently scary, but as the woman describes, he eventually “picked and pulled and I squealed like a baby.”

And in a WNA Halloween Two-fer, a surgery professor says students have spent so much time in virtual worlds that they fare poorly at hands-on surgical work that requires thinking in three dimensions and “actually doing things.” The instructor recommends pumpkin-carving as good training because it is “one example of using sharp instruments with great delicacy and precision on a hard surface with a soft inside to create something that you have got in your mind and then you have to make it happen.”


Sponsor Updates

  • Glytec publishes an ebook titled “Hypoglycemia in the Hospital: Why Is It Costing You Millions and What Can You Do?”
  • EClinicalWorks posts a podcast titled “Tools and Training to Target Physician Burnout.”
  • Vocera will resell QGenda’s provider scheduling system in the federal healthcare market and the companies will integrate their systems.
  • CarePort Health expands its product, analytics, and customer success teams.
  • Impact Advisors is named to Modern Healthcare’s list of largest revenue cycle management firms.
  • AdvancedMD will exhibit at APTA PPS November 7-10 in Colorado Springs.
  • Waterloo MedTech awards Agfa Healthcare with its 2018 Award of Distinction.
  • Aprima will exhibit at the AAP National Conference & Exhibition November 3-5 in Orlando.
  • CarePort Health will exhibit at the ACMA 2018 Leadership Conference November 5-7 in Huntington Beach, CA.
  • CompuGroup Medical will exhibit at the AMP 2018 Annual Meeting & Expo November 1-2 in San Antonio.
  • CoverMyMeds will make its RxBenefit Clarity real-time benefit check tool available to Allscripts users.
  • CTG, Cumberland Consulting Group, and Dimensional Insight will exhibit at the CHIME Fall CIO Forum October 30-November 2 in San Diego.
  • Diameter Health will present at the AMIA 2018 Annual Symposium November 3-7 in San Francisco.

Blog Posts


Contacts

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

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Morning Headlines 10/30/18

October 29, 2018 Headlines No Comments

Carrot Inc. Raises $25 Million to Commercialize Pivot, the Company’s Digital Health Solution for Smoking Cessation

Carrot secures $25 million to develop a digital smoking cessation program that will incorporate a breath sensor, app, coaching, and drug therapy.

New mobile assessment saves brain cells during stroke

Mayo Clinic’s Center for Connected Care in Jacksonville, FL launches a telemedicine project that will give physicians access to stroke patients en route to the hospital.

Forget Watson, the Red Hat acquisition may be the thing that saves IBM

Analysts speculate that IBM’s $34 billion acquisition of Red Hat may signal a Watson wind-down and a return to enterprise software and services.

HIStalk Interviews Kurt Garbe, CEO, IMAT Solutions

October 29, 2018 Interviews No Comments

Kurt Garbe is CEO of IMAT Solutions of Orem, UT.

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Tell me about yourself and the company.

IMAT Solutions solves the core data problems of healthcare companies. We focus on how to improve data quality, data currency, the amount of data, and the type of data that companies can look at.

How do you position the company among competitors?

Many companies look at different parts of data — analysis, cleanup, or integration. We take a more comprehensive approach. This is a data platform. What are the requirements for the different types of data you’re trying to bring in, the comprehensive data? How do you look at cleaning up the data that’s coming in? How do you look at the currency? How do you make sure you can quickly access that data in a comprehensive way? We look at all of those components, not just some individual pieces and parts.

How would you assess healthcare in terms of your C3 framework of data that is clean, comprehensive, and current?

Healthcare is still, unfortunately, at the early stage. We know this from talking to our customers. It’s across the board. Different companies have different strengths and focus on different things, but we haven’t found a lot of evidence that people have taken the full picture and made a lot of progress.

Are healthcare organizations making decisions using data that is either bad or incomplete?

Absolutely. The core question is, what data are we even talking about? The data related to healthcare and the health of an individual includes a lot of free-text data, unstructured data from lab reports, notes, and so forth. When we talk to people through surveys and discussions, 80 percent aren’t looking at that data yet. They don’t apply natural language processing to figure out what insights they could get from that data.

It’s the old story about the elephant. We look at data as this big elephant. Some people look at data as just the foot or the trunk. They’re only looking at the pieces and parts. They don’t usually say their data is good — they admit it’s a challenge, something they’re looking at, or the subject of some new initiatives. We don’t find a lot of complacency and satisfaction.

It gets more complicated where a health system has several groups. Each says they have clean data, and they probably do to a great extent, but the data is not coordinated. How they describe their data and how this other group describes their data are not consistent. It’s therefore not particularly useful in having a real impact.

What due diligence is required before accepting a new source of data to understand its semantics rather than just finding matching columns that can be joined to create a bigger database?

I wish we identified some rules of the road out there. This is a major effort and a major problem. Like everyone in data and healthcare, they’re doing the best they can. Often they’re just prioritizing. They are saying, we can’t absorb all the data, but can you give us the following type of data so we can work on that first? Let’s cut the problem into small pieces.

That’s a practical approach that works, but it takes a long time. They are often disappointed with the impact of those efforts. You get the greatest impact when you’re using the largest amount of data to make decisions.

Will artificial intelligence and machine learning help solve the problem?

We’re in an unfortunate race. People talk a lot about AI and machine learning. But with these systems, as much as they’re making great progress in AI and machine learning, the inputs — unstructured and free-form data — are still weak. An AI engine or machine learning algorithm can’t necessarily turn it into something meaningful and useful.

Years ago, everyone was talking about predictive analytics. We have these great models, but the source data isn’t very good. You’re trying to do more analytics and use more of these advanced tools on poor data to get to that answer faster, as opposed to getting a better answer. People still have to spend a lot of effort to to turn unstructured data into something useful and meaningful that a predictive analytics engine, AI algorithm, or machine learning can do something with.

The challenge, and it’s a big one, is that the unstructured data multiplies the amount of data you have by a factor of five or 10. It’s 10 times more than you used to have, so how do you get meaningful results from it in a meaningful time frame? If it takes a week to process through all that data every time you run a report, create a model, or do some analytics, you’re not going to do it often. That’s why we talk about the currency, meaning how quickly you can get insight out of all of this data that you have.

That’s why we talk about the C3. It’s not just the fact that you have comprehensive data. You’ve got all of your data in an unstructured form, and through an NLP process or even manually, you’ve cleaned it up. It’s consistent, it works well. But now, how do you get results out of that in some meaningful time frame, where you can run reports, look at the reports, and say what works, what doesn’t work, or look at these fields instead? You’re now interacting with the data. That’s where this third C of currency comes in. That’s the only way you get high impact from whatever tools you have, whether it is predictive analytics, AI algorithms, or machine learning.

What lessons did you learn from connecting the aggregated datasets of two HIEs together after Hurricane Florence and validating that the result was accurate at a patient level?

The historical approach to interoperability or interconnecting data is to tell Company A, “Here is how we want you to give us output.” That’s historically a huge problem. Company A doesn’t have the time or they don’t see the value of doing that. Our approach is, just give us what you have. We won’t ask you to change your formats, your fields, or anything else. You give us what you have, this other organization does the same, and we’ll re-index that data and provide one comprehensive view.

The major lesson that we’ve learned in integrating new clinics and new hospital groups into these data pools is that we have to lower the bar of what they have to do. We’re not asking them to change their format, because those IT discussions are often where interoperability gets bogged down, where you ask people to change what they do. We don’t do that. Just provide us what you have and we will make it work for you.

How do you see the company and the general areas of data interchange, quality, and interoperability changing in the next five years?

Our aspiration, and the hope that we have for healthcare, is that tools such as AI, machine learning, and predictive analytics can help deliver real results now. We need to raise a bar on the baseline of getting comprehensive data, making it current so it can be analyzed in real time, and making sure it’s clean, consistent, and makes sense.

If we can get to that baseline, those other tools will get you what you want in healthcare — bending the cost curve, improving outcomes. Without that, we’re still in some ways guessing. If we can address the core data issues, those tools, as well as others that we can’t envision today, can help us make decisions on what it actually happening instead of guessing, which is what’s happening now in healthcare.

Do you have any final thoughts?

The topic of improving healthcare through data is not new. It has been envisioned, talked about, and hoped for for 20-plus years, if not longer. What is exciting now is that the technology, the ability to actually get there, has caught up to that vision. We look forward to helping make this vision come true.

Curbside Consult with Dr. Jayne 10/29/18

October 29, 2018 Dr. Jayne 1 Comment

I happened to be in New York this week during the pipe bomb scare, close enough to the CNN offices to receive an emergency alert on my phone advising me to “shelter in place.” The presenter in the continuing education seminar I was attending must have seen everyone checking their phones even though they were supposed to be silenced, so she stopped the presentation to find out what was drawing everyone’s interest.

People were texting friends and family members to let them know that they were OK or were looking for news on what was happening in the neighboring building. It was clear that with everything going on there wasn’t going to be much learning happening, so the conference organizers wisely instituted an unplanned break.

Although most of us were from out of town, several physicians at the table in front of me were residents of the city who had been in practice there during the World Trade Center attacks in 2001. They began talking about what it was like that day, being put on alert by their hospitals that they should prepare for a mass casualty event. They talked about the preparations to receive hundreds of patients, including possible air transports to hospitals outside the city, as the events began to unfold. They also talked about the horrible experience of waiting for patients who never arrived and how that affected them as clinicians. It was clear that even after so many years, they are still profoundly impacted by the events of that day.

The conversation moved into one around disaster preparedness and what is different for them now compared to what was in place then. As we talked, they were checking in with their hospitals to let them know their location and status should there be an actual bomb detonation. By that point, we were informed that our building was on a modified lockdown procedure, with guests and employees being encouraged not to leave and no one allowed to come in. I assume they would have allowed physicians to leave in the event they were needed emergently, but I’m glad the incident was resolved relatively quick and we never had to find out how the lockdown really worked in the lobby.

There was a side conversation about the fears that clinicians and others that work in hospitals carry with them. People are afraid of how they might react to a disaster or mass casualty situation, whether they would be able to stay the course and care for patients or whether they would want to focus on making sure family and other loved ones are safe. A few mentioned episodes of violence they had experienced in their own hospital workplaces, including assaults on patients and staff and even an active shooter event. Nearly everyone mentioned a higher frequency of drills and discussions of potential dangers, with several in the conversation noting that the ongoing drills and reviews are likely contributing to the anxiety.

The fear of violence has influenced technology purchasing decisions. Hospitals are installing advanced security systems and some require visitors to present identification so they can be credentialed to enter the facility. Visitors are wearing stickers with their names, pictures, and sometimes their destination, such as a room number or office suite. It’s different from back in my Candy Striper days when we looked up the patient’s name on a printout, told the visitor the room number, and pointed them towards the elevators without a second glance. I don’t think there are too many facilities that would leave a lone 13-year-old girl manning the front desk any more.

We talk a lot about EHRs, revenue cycle platforms, clinical and financial analytics, telehealth platforms, and the numerous systems that support our hospitals and practices. Although I’ve seen the booths for security vendors at HIMSS, I’ve not had the chance until recently to reflect on those additional systems that CIOs might be called on to select and support in order to ensure business continuity for the facility. One vendor’s website notes their commitment to using big data to analyze incidents and predict patterns in order to better protect patients and staff. That’s a tall order to consider for those of us who are more used to contemplating PHI breaches than we are to thinking about breaches of the physical perimeter.

Although we have a panic button under the front desk of each of our clinic locations, I’ve been fortunate in not being at work in a situation where the staff had to use it. The staff has activated it on accident and based on the anxiety level while they worked to get it resolved, I can’t imagine what they would feel like in a live-use scenario.

In past clinical positions, I’ve worked at facilities where I had to park my car in a chain link enclosure inside the parking garage. I have staffed emergency departments where metal detectors and armed guards were just part of the daily scenery. We performed “fit for confinement” examinations on prisoners being transported by law enforcement, so on any given shift, there might be a patient handcuffed to the gurney. In those situations the potential risk was visible and fairly obvious and we grew to accept it as part of the job, but we didn’t think much about some of the other dangers that might come our way.

I would be interested to hear from readers on the state of security in their facilities and whether their organizations are using technology to help mitigate threats to patient and staff safety. In the times we live in, there is more to think about then tornadoes, fires, floods, and hurricanes.

What keeps you up at night about safety or potential disasters that might impact your organization? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/29/18

October 28, 2018 Headlines 1 Comment

Epic chops down App Orchard fees

Epic will reduce its fees for listing third-party software in its App Orchard.

Individuals Charged With Defrauding Non-Profit Health-Care System

A federal grand jury indicts a former IT employee of Catholic Health Initiatives for allegedly issuing $72 million in phony purchase orders to a co-conspirator’s IT consulting firm for integration services, then splitting the take.

Cerner (CERN) Q3 2018 Results – Earnings Call Transcript

The company expects its DoD and VA business to drive growth as financially-challenged providers and lack of regulatory incentives reduce private sector market urgency.

HHS CTO’s office to support Indian Health Service IT modernization study

The CTO’s office at HHS will support consulting firm Emerging Sun in a research project focused on updating the Indian Health Service’s Resource and Patient Management System.

Monday Morning Update 10/29/18

October 28, 2018 News 8 Comments

Top News

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From the Cerner earnings call following a small revenue miss that sent shares down 11 percent on Friday: (CERN shares are down 19 percent so far in 2018 vs. the Nasdaq’s 2 percent gain):

  • Q3 bookings were up 43 percent over last year, although revenue was up just 5 percent due to lower-than-expected software and technology sales.
  • The company expects its DoD and VA business to drive growth as financially-challenged providers and lack of regulatory incentives reduce private sector market urgency (“there isn’t anything that’s forcing clients to get deals done.”)
  • The company expects the federal government business, along with the replacement market, to carry the company until HealtheIntent revenue grows. It notes that its population health business has grown slower than projected.
  • Chairman and CEO Brent Shafer says Cerner will be the partner of choice for healthcare innovation.
  • Chief Client Officer John Peterzalek says Cerner is a leader in interoperability and expects to benefit if the government issues interoperability mandates.
  • The company expects its $10 billion VA contract to deliver $1 billion in annual revenue by 2022, although task order timing makes the growth irregular.
  • CFO Marc Naughton says that selling population health tools can deliver $3-4 per member per month, but adding services such as those enabled by its deal with Lumeris could increase that PMPM amount to $15.
  • The company’s ITWorks outsourcing business generates single-digit margins, but selling software and services into that client base can yield 40 percent margins.
  • Naughton, responding to a question about monetizing the data Cerner holds, says he sees eventual opportunity, but regulatory limitations make it a non-focus area for now.
  • Four more DoD sites will go live in early 2020.
  • The company hasn’t decided how the VA work will be divided among Cerner and its partners even though the company originally mentioned a 50-50 split as a placeholder.
  • Cerner will continue with its R&D spend and will focus on business segments that can deliver $100 million in revenue.

Reader Comments

From Jules Verne: “Re: webinars. What advice do you have for getting more registrations?” I get insight from the webinars we do since I see the stats for clicks, registrations, and attendance. My conclusions:

  • Make the goal to educate, not to sell something (we struggle endlessly trying to make this point with the junior marketing people of vendors). Potential audience members won’t sign up for what promises to be a sales pitch and they won’t sit through a webinar that turns into one.
  • Get customers or outside experts as presenters. Nobody will give up an hour of their day to hear a company marketing person’s perspective on population health or analytics.
  • Make sure the presenter is prepared. It’s shocking when during rehearsal the presenter (usually enlisted from a health system) has never seen the slides, doesn’t know what they’re supposed to talk about, or delivers a presentation that doesn’t match the abstract.
  • A product overview or demonstration is not a broadly educational topic and won’t generate many signups. On the other hand, even a handful of attendees is fine if they become prospects. Evaluate success accordingly. We did one super-specialized webinar that drew only five attendees, but they were good leads for the niche product and the vendor was smart to realize that a couple of self-qualified prospects was much better than 100 uninterested attendees (but a marketing person might have, from their perspective, seen it as a failure).
  • Include on the registration page a descriptive abstract and an honest description of the target audience. Sometimes companies get only a small percentage of those who looked at the registration page to actually register, which means something on that page made most of them bail (most likely the webinar description, speaker bio, or asking for too much information to register).

HIStalk Announcements and Requests

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Previous polls found that most of us health IT people don’t really care whether our doctors use EHRs and we prefer old-fashioned doctor-patient relationships over evidence-based medicine and technology. Last week’s poll demonstrated more of the puzzling “do as I say, not as I do” dichotomy between our jobs vs. what we want for ourselves and our families as patients, as nearly none of us (me included) keep their own medical information in electronic form.

New poll to your right or here: are you proud of the products or services your employer offers?

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Mrs. H bribed me to see “A Star Is Born” with her, and while the movie was good and the acting was terrific (actor-director Bradley Cooper admirably mimicked a singer and singer Lady Gaga excelled as an actor), the key moment for me occurred early in the movie, when I excitedly elbowed a startled Mrs. H to point out that Gaga’s character Ally was wearing a Yes tee shirt (although from their forgettable 1978 “Tormato” tour, I later found by Googling).

Listening: Rebelution, a California-based, highly literate reggae band whose UC Santa Barbara-graduated members are described in articles decrying cultural appropriation as “fratty white guys” (apparently those magazines believe that reggae is the exclusive domain of dreadlocked, spliff-brandishing Rastafarians who refer to everyone as “mon” and whose rainbow-colored clothing and revolution-inciting musical messages are obscured by ganja clouds). At least the bass player’s first name is Marley. Sample lyrics: “Whether you want love or money, good fortune or fame, you want a brand new car, you want the world to change. You better take some action right now, because there’s nothing in the world that you can’t get, so don’t fill your life with confusion and regret, you better take some chances right now.” I’m listening to more reggae these days because it’s one of few genres that haven’t been overproduced into unlistenable vacuity. I’m also enjoying refreshingly non-explicit hip-hop from Common, who I also liked in AMC’s western series “Hell on Wheels.”


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Politico reports that Epic announced at its annual developer meeting that it will reduce its fees for listing third-party software in its App Orchard. One software company’s CEO had previously said that listing a simple HHS family planning questionnaire on the the app stores of Epic and Cerner would cost $750,000 per year. With the change, early-stage startups will pay just $100 per year to gain access to Epic’s API documentation and testing sandbox, then will pay an unstated higher amount once their product is released.

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From the Roper Technologies earnings call, following a Q3 report in which it beat both revenue and earnings expectations (the diversified company owns Sunquest, Strata Decision, Atlas Medical, SoftWriters, CBORD, and several other health IT vendors):

  • The company promoted COO Neil Hunn to president and CEO in late August, moving Brian Jellison to executive chairman due to health problems. Hunn came from MedAssets
  • The company’s Medical and Scientific Imaging segment, which represents 29 percent of Roper’s revenue, increased quarterly revenue 11 percent to $380 million.
  • Sunquest’s US business declined in “mid-single digits” while expanding globally, with 2019 expectations for Sunquest continuing to trend down due to competitive pressure. Roper says it will be “rebasing the North American business” of Sunquest. It also notes that it paid only 10 times EBITDA to acquire Sunquest for $1.42 billion in cash in 2012. 

Decisions

  • Crossing Rivers Health (WI) replaced Evident with Epic in June 2018.
  • Ferrell Hospital (IL) will switch from Medhost to Epic in fall 2019.
  • Chatuge Regional Hospital (GA) will replace Allscripts with Cerner in October 2019.

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


Announcements and Implementations

Vanderbilt University Medical Center gets a federal grant to mine its 20-year EHR database and biological samples to look for biologic and genetic markers of Down syndrome.


Government and Politics

The Spokane newspaper interviewed just three veterans for its story on implementing Cerner in the VA, but those they chose were perceptive:

  • Army vet Charles Bourg, 64, questioned why Cerner got a no-bid $10 billion deal, adding that while it’s nice that the VA and DoD are trying to integrate their respective Cerner systems, it’s more important that Cerner connect to outside doctors.  He adds, “You have to go in the basement of the VA to get the records … and it can take weeks. I did get electronic records from the VA to take to the [private practice] doctor, but he couldn’t even open them up.”
  • Former Navy Seabee Charlie Monroe says he’s skeptical about the new system and fears it will take away from the time doctors spend with patients.
  • Air Force veteran Bob Brodie says the VA never paid the bill for his VA-approved stay at a private hospital, which then turned his account over to collections.

Other

A federal grand jury indicts a former IT employee of Catholic Health Initiatives for allegedly issuing $72 million in phony purchase orders to a co-conspirator’s IT consulting firm for integration services, then splitting the take.

AMIA publishes core competencies for master’s-level applied health informatics programs that can be tested after graduation.

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The Journal of the American Academy of Dermatology takes down a research paper that analyzed the effect of private equity firms buying up dermatology practices after it receives complaints from several dermatologists who have PE ties. One of them is the Academy’s incoming president, who sold his own practice to a private equity-owned management company on whose board he sits. The peer-reviewed article observed that PE firms selectively acquire practices that perform high volumes of procedures covered by private insurance and Medicare, also noting that quite a few of those practices also run profitable pathology labs.

In Russia, a woman shows up a hospital with an ultrasound order she had changed to a different procedure, then attacks the hospital doctor who refused to perform the test, throwing the order’s clipboard at him and then beating him over the head with his computer keyboard.


Sponsor Updates

  • LiveProcess will exhibit at the Delaware Healthcare Forum October 30 in Dover.
  • Meditech will exhibit at the 2018 AMIA Annual Symposium November 3-7 in San Francisco.
  • Netsmart will exhibit at the NHPCO Fall Conference November 5 in New Orleans.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Annual Perinatal Partnership Conference October 28-30 in Myrtle Beach, SC.
  • OmniSys will add ScriptPro’s SP Central Pharmacy Management System to its Fusion-Rx interactive voice response solution for pharmacies.
  • PatientSafe Solutions, Pivot Point Consulting, Redox, and Surescripts will exhibit at the CHIME18 Fall CIO Forum October 30-November 4 in San Diego.
  • Patientco publishes a new white paper, “Improving Patient Financial Experience Through Smart Payment Technology.”
  • Voalte will exhibit at the OONE Fall Conference November 1-2 in Columbus, OH.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 10/26/18

October 26, 2018 Weekender No Comments

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Weekly News Recap

  • Nova Scotia’s province-wide EHR selection nears completion, with all vendors except Allscripts and Cerner failing to make the cut in a process that has raised questions about possible bias
  • Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr
  • VC-backed Naya Health, which developed a $1,000 smart breast pump, apparently shuts down after user complaints that its product does not work
  • Vatica Health makes a $1 million bid to acquire the assets of chronic care management company CareSync, which abruptly closed its doors in June
  • Politico reports that Pentagon investigators have found Madigan Army Medical Center’s new Cerner-based MHS Genesis software lacking in effectiveness, suitability, and interoperability
  • Deborah DiSanzo, general manager of IBM Watson Health for the past three years, will step down

Best Reader Comments

What the US has now is elements of several [healthcare] systems, As T.R. Reid described in “The Healing of America; A Global Quest for Better, Cheaper, and Fairer Health Care,” for veterans and their families, we’re Britain or Cuba. For those who receive health insurance through their employer, we’re Germany or France. For people over 65 on Medicare, we’re Canada. For the percent of the population who have no health insurance, the United States is Cambodia. (Wadiego)

Very nice of IBM to allow Deb DeSanzo to keep her job and take a demotion despite her lack of success in turning the corner. I wonder how the thousands of IBM’ers who were laid off at the end of each quarter the past three years when the numbers weren’t good feel about this? (The More Things Change)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. H in Alabama, who asked for STEM maker kits for her fifth grade class. She reports, “This project has been a lifesaver. My students were so surprised when we received the kits. They were so excited to know they had something that they could actually build by themselves without my instruction. My students are using the K’NEX STEM Education Kits during our science intervention.”

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The US Military Academy uses a robot to co-teach an ethics philosophy course, feeding Bina48 data about wars and philosophy as well as an instructor’s lesson plan to allow it (her?) to deliver a lecture and answer student questions. The AI developers blocked her access to the Internet fearing that, like many students, she would take the lazy way out and simply regurgitate Wikipedia. She has her own Facebook page and completed a “Philosophy of Love” college class a year ago. Developers patched her rather stern countenance into a smile a couple of months ago.

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23andMe CEO Anne Wojcicki says one of the company’s biggest competitors is Gwyneth Paltrow’s Goop — which specializes in wacky products that have zero scientific basis — and fake, clickbait news about health that draws in naive eyeballs. She summarizes Goop’s “faux science,” such as anti-vaccine advocacy, as benefitting from Paltrow’s celebrity in a way that the CDC can’t counter with actual facts. Goop paid civil penalties and offered customer refunds to settle a lawsuit over the company’s promotion of a floral blend to prevent depression and jade vaginal eggs to regulate menstrual cycles.

Analysis finds that eliminating the requirement that all Americans carry health insurance and allowing the sale of policies that don’t cover pre-existing conditions have caused a 16 percent jump in premium cost for exchange-based silver plans. 

Wired takes a contrarian view of Silicon Valley’s obsession with disruption in reviewing three books, noting:

  • Technology’s promise to lead us into the future turned out to be all about those companies – taking our personal data, eating up our time and creativity, and invading our homes and cities
  • They promised an open web and individual liberty while trampling on both
  • They created rising inequality, not because it was inevitable, but because they used old-school capitalism in dodging regulation and squashing competition
  • They squeezed labor markets by hiring obedient, flexible, and poorly paid subcontractors and unofficial workers – many of them immigrants – who are not covered by wage and safety protection
  • Venture capitalists make massive profits by arriving late to the party after companies have already taken risks and developed something innovative
  • Much of the hard work of innovation is accomplished using government grants and research for which taxpayers receive nothing
  • Science-based philanthropy rewards causes favored by tech donors who prefer life-extending technologies for themselves rather than a better healthcare system for all

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A report by Truth in Advertising titled “Cancer Care: The Deceptive Marketing of Hope” finds that cancer centers have exponentially ramped up their advertising in competing for patients, with 90 percent of them using emotion-tugging but deceptive stories in which outliers who survived high-mortality cancer (at least in the short term) imply that the specific cancer center saved them despite poor odds (example: “statistics mean nothing to believers.”) For-profit chain Cancer Treatment Centers of America leads the advertising pack. Following CTCA’s lead are mostly non-profits, which unlike CTCA, are not subject to Federal Trade Commission actions for deceptive advertising. All advertise clinical trials, immunotherapy, and genomic testing that aren’t always effective and carry their own risks.

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Doylestown Hospital (PA) installs a free short story dispenser in its ED, which gives visitors a short read printed on non-toxic, recycled paper that can help them pass the time. It’s a nice thought, although convincing Americans to look away from their phones or ad-filled TV junk shows to actually read something is a tough sell.


In Case You Missed It


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Morning Headlines 10/26/18

October 25, 2018 Headlines No Comments

Bid process ‘stunning’: Management of multimillion-dollar Nova Scotia health records contract questioned

In Canada, the 16-month bidding process for Nova Scotia’s province-wide EHR project comes down to the wire, with Meditech, Epic, Evident, and Harris Healthcare Group failing to make the final cut.

Cerner (CERN) Q3 Earnings Match Estimates

Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.63 vs. $0.61, meeting earnings expectations but falling slightly short on revenue.

AWS Opioid Crisis Council Committed to Help Solve the Opioid Epidemic

Shortly after the passage of the SUPPORT for Patients and Communities Act, Amazon stresses its commitment to combatting the opioid epidemic via new Alexa capabilities and AWS endeavors.

Black Book™ Announces Eighth Annual Revenue Cycle Management Technology and Outsourcing Solutions Top Client-Rated Honors

Optum360, Waystar, and TruBridge take top spots for customer satisfaction and client experience across multiple categories in Black Book’s latest RCM survey.

News 10/26/18

October 25, 2018 News 1 Comment

Top News

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In Canada, the 16-month bidding process for Nova Scotia’s province-wide EHR project called OPOR (One Person One Record) comes down to the wire, with Meditech, Epic, Evident, and Harris Healthcare Group failing to make the final cut.

Only Cerner and Allscripts were allowed to bid based on results from a qualification round that was apparently based entirely on their Request for Supplier Qualification submissions, a document of around 50 pages describing each company’s qualifications. Vendors were not allowed to provide detailed documents or to demonstrate their systems. 

Evident, a smaller vendor that was an original contender, has become vociferous in its allegations of what boils down to cronyism and an unfair procurement process.

Even Epic, which wasn’t even approached by the government for a proposal, seems to have suffered from mysterious postal mishaps in not being made aware that Nova Scotia was considering its project until someone let them know in late 2016, then having its documents package delivered in time but not internally routed to the correct office by the deadline.

Meditech, which is the incumbent vendor for many of Nova Scotia’s hospitals, did not make the short list despite no particular complaints from existing users.

Vendors were told that the authority was not meeting with vendors, but Evident claims to have evidence that people involved with Cerner and Allscripts gained unfair access in social and educational settings, with Allscripts in particular having had executives participate in health authority’s “Let’s Talk Informatics” education events.

A final decision is expected by the end of the year on the project, which could cost several hundred million dollars.


Reader Comments

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From Spanker: “Re: HIMSS. Did you get this email?” HIMSS now claims that it is not only a “partner in the creation of transformative change,” but is also a leading “health and wellness association.” Any claims of health and wellness expertise or accomplishment by HIMSS or its members should be taken with a truckload of salt. It sounds good on a vision statement, but it’s insured sick people who make it rain for all of them.

From Leading Indicator: “Re: IT advice. Links here.” LI calls out three recent examples in which people who have never worked in a health system IT department – much less run one – apparently feel qualified to tell CIOs how to manage their IT organizations, dispensing painfully obvious, simplistic recommendations that usually involve soft subjects like management style or consumerism. I’m all for pontification based on experience and accomplishments (and have seen plenty of it), but possessing a TV, armchair, and beer does not make one a coach.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.63 vs. $0.61, meeting earnings expectations but falling slightly short on revenue.

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Tesla CEO Elon Musk mentions during an earnings call that the company offers onsite clinics, a relatively new employee perk at its Fremont, CA facility that has helped the high-end auto manufacturer decrease its lost work days and days missed by 10 percent. A job posting on the company’s website hints at the need to find someone who can assist with the “development, implementation, and management of Tesla’s electronic medical record (EMR) system by developing standardized processes for on-site medical staff.”

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Medicare quality reporting company Mingle Analytics merges with care management software company SilverVue to form Mingle Health.


Announcements and Implementations

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Optum360, Waystar, and TruBridge take top spots for customer satisfaction and client experience across multiple categories in Black Book’s latest RCM technology and outsourcing solutions survey.

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EClinicalWorks adds an opioid risk smart form to its EHR, giving providers the ability to assess a patient’s risk for drug abuse and offer alternatives that align with CDC recommendations.

Philips releases IntelliVue Guardian, an mobile app that allows clinicians to view patient vital signs and early warning scores on their Android mobile devices.

Medication safety technology vendor Tabula Rasa HealthCare creates a technology and consulting division called CareVention HealthCare. 


People

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Peter Pronovost, MD, PhD joins University Hospitals (OH) as chief clinical transformation officer, where he will oversee population health, high-reliability medicine, the ACO, and digital health initiatives. Thanks to the reader who forwarded the internal announcement. Pronovost left Hopkins Medicine after seven years in February 2018 to join UnitedHealthcare as SVP of clinical strategy, was promoted to chief medical officer in June 2018, then resigned three months later.

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Healthwise appoints CMO Adam Husney, MD to the additional role of CEO.

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Health Catalyst brings on Ryan Smith (Banner Health) as SVP of client engagement; Will Caldwell, MD (Novant Health) as SVP of physician and market development; and Cathy Menkiena, RN (Encore Health Resources) and Steven Vance (Intermountain Healthcare) as VPs of professional services.

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ClearData promotes Chad Coder to VP of strategic alliances.


Sales

  • Managed care organization Virginia Premier selects ZeOmega’s Jiva population health management software.

Government and Politics

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Amazon announces that Alexa is now able to answer questions about opioids and the opioid epidemic shortly after President Trump signed the opioids-focused SUPPORT for Patients and Communities Act into law. The company’s AWS Opioid Crisis Council has also pledged to use the cloud to improve first responder access to medical records, and identify fraud using PDMP data and analytics.


Other

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A two-year OCHIN study on the feasibility of documenting social determinants of health in EHRs finds that end users need more training to ensure relevant data is entered and acted upon, especially in the area of referrals for community services. Screenings for community service referrals ended up creating unmanageable workloads.

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The New York Times looks at the ways smart thermometer maker Kinsa licenses its “illness data” – temperatures submitted by users based on ZIP codes – to help companies like Clorox better target ads. The cleaning wipes company saw interaction with its digital ads spike 22 percent with Kinsa’s help, allowing it to target markets suffering from the flu in nearly real time. While Kinsa founder and CEO Inder Singh says he’s likely to sell or share the de-identified data only with companies whose services could help Kinsa’s users, others aren’t so sure public health benevolence will win out over profit and privacy concerns. Christine Bannan of the Electronic Privacy Information Center is one such skeptic: “It’s less of a privacy question and more of an ethical question on what we think is acceptable for targeting people who are ill and what safeguards we want to have around that. I can just think of how cigarette and alcohol companies could use strategies like this, or other industries that could really have more harmful effects on people.”

Weird News Andy’s clickbait headline for this story is, “Physician, Steal Thyself.” A 79-year-old doctor borrows $300,000 from a patient to keep her struggling practice afloat, then when asked to repay the money, diagnoses the patient with dementia without any supporting evidence. The doctor says the accusation is “all lies” and that she’s been making loan payments since she borrowed the money 20 years ago, but she nonetheless voluntarily surrendered her medical license in assuming that her case is unwinnable.


Sponsor Updates

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  • The Imprivata Cares team participates in the Technology Underwriting Greater Good’s annual Tech Gives Back event by hosting a Shark Tank-style event for local middle schoolers and volunteering at a homeless shelter for young adults.
  • EClinicalWorks publishes a podcast titled “Long Distance Relationships Made Easy With TeleVisits.”
  • HCTec publishes a new case study, “Successful Training Optimization Reduces Costs While Improving Learner Experience.”
  • InterSystems will exhibit at the CHIME Fall CIO Forum October 30-November 2 in San Diego.
  • ScriptPro will offer OmniSys’s Fusion-Rx interactive voice response system for prescription refills with its pharmacy management solutions.
  • Meditech posts a video describing how Med Center Health uses quality metrics to reduce sepsis mortality and readmission rates.
  • Formativ Health adds XpertDox data to its patient engagement technology, giving providers the ability to match up patients with best-fit providers and clinical trials.
  • Strata Decision Technology recaps its Lift18 user conference, which drew 650 attendees and offered Paul DePodesta from the movie “Moneyball” (played by Jonah Hill) as a keynote presenter. The company announced Time-Driven Costing that allows health systems to understand operational costs beyond traditional cost accounting.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 10/25/18

October 25, 2018 Dr. Jayne 2 Comments

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ONC has posted the agenda for its annual meeting to be held November 29-30 in Washington, DC. Day One begins with a welcome from Jared Kushner, director of the White House Office of Innovation, followed by a heynote from HHS Secretary Alex Azar. Breakout sessions will cover international health IT efforts, disaster response, HIEs, APIs, FHIR, and an “Ask the ONC Clinical Team” session. Day Two includes a fireside chat with National Coordinator Don Rucker, MD along with Senators Lamar Alexander and Tammy Baldwin.

Value-based care is the chief buzzword for many healthcare organizations and the Comprehensive Primary Care Plus (CPC+) initiative was touted as a way to end the chicken-or-egg struggle faced by ambulatory organizations as they try to figure out how to pay for better care coordination that will lead to incentives that can help them pay for better care coordination and more comprehensive care. The American Academy of Family Physicians has called on CMS to modify the window between when practices have access to their Performance-Based Incentive Payment reports and when they have to repay incentives plus interest.

The reports were to be available around September 26 with interest starting to accrue on October 18. There’s a 19-month gap between performance and reporting, but the CMS piper expects to be paid within a month. The Medicare Shared Savings Program gives Accountable Care Organizations 90 days to repay shared losses. If the current timeline holds, it’s yet another barrier to practice participation in what is supposed to be a driver towards value-based care.

It’s clear that the focus on quality and value isn’t changing any time soon. CMS is hosting a National Provider Call on October 30 to talk about Physician Compare and the upcoming release of publicly available Quality Payment Program data for 2017. A 30-day preview period will allow providers to review their information before it is posted for all to see. The session will include time for question and answer, so if you’re not sure how to navigate the release of information or what to do if you feel it’s not accurate, I’d recommend attending.

Telemedicine is growing and I’ve considered dipping my toe in the waters as an opportunity to deliver patient care without spending 12- to 14-hour shifts in the trenches. Consumer Reports is bringing a recent Annals of Internal Medicine study to the masses regarding increased antibiotic prescriptions issued during telemedicine encounters. The study suggests that there is an association between the length of the visit and the likelihood of an antibiotic prescription. It looked at 13,000 telemedicine visits performed for patients with respiratory complaints. More than 65 percent of phone encounters resulted in an antibiotic prescription. Unfortunately, the research team didn’t have access to the actual encounter documentation so there was not a solid way to determine whether the antibiotic prescriptions were appropriate.

The article offers good information on being an informed telemedicine patient, and notes that “patients often view a telemedicine encounter as more of a consumer transaction than a healthcare visit … here’s an expectation that they get to call a doctor, pay for the visit, and get a prescription.” The author encourages patients to write down their symptoms first including when they started, which is good information for any patient seeking care.

Physician practice management publications such as Medical Economics are encouraging providers to bill telemedicine codes for their own patients. Close to 30 states have so-called telemedicine parity laws, which require commercial payers to reimburse telemedicine services at the same level as face-to-face visits. There are some nuances to coding, though, and physicians are wise to investigate their payer contracts as well as the requirements for proper coding of phone visits.

Many of the scribes in my practice are applying to medical school or physician assistant programs. Those that know I’ve spent time as an administrator often ask about that career path and opportunities in healthcare should they not be admitted to the program of their choice. Money isn’t everything, but I’m happy to share the trend in hospital executive salaries with them. The study looked at CEO and CFO compensation at 22 non-profit medical centers in the US using the “US News & World Report” hospital honor roll list from 2016-17 along with four notable health systems. The authors looked at the growth of clinical worker wages compared to nonclinical workers and management workers.

The rise in value-based care demands administrators with strong financial and quality management backgrounds, which may be driving increased executive salaries. Operational leaders are also in demand as health systems retool their strategic plans. Still, the authors conclude that “there does not appear to be a proportionate increase in healthcare utilization. These findings suggest a growing, substantial burden of non-clinical tasks in healthcare. Methods to reduce non-clinical work in healthcare may result in important cost savings.” I don’t know of too many physicians who would disagree with that sentiment.

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Interesting news for patients who rely on fitness trackers as a tool to assist with their fitness goals. The British Journal of Sports Medicine reports that many trackers aren’t good at measuring energy expenditure. The authors reviewed data from 60 studies looking at 40 trackers worn on the arm or wrist. Devices tended to underestimate energy expenditure, but those that also measured heart rate were more accurate. As an experiment, I used my Garmin watch on the treadmill in “indoor” mode and found that it, too underestimates the mileage my treadmill says I’m logging. The Garmin is accurate in GPS mode when I take it outside for a workout, so it’s still my wearable of choice.

There was quite a bit of buzz in the physician lounge this morning about the FDA approval of Xofluza, which is the first new anti-influenza agent in roughly 20 years. It’s a single dose and can be used to treat patients age 12 and older as long as they’re diagnosed within the first 48 hours of illness, similar to current medications. The wholesale price has been set at $150, but the retail price hasn’t been listed. Genentech makes it and will be offering a coupon for patients with commercial insurance that allows them to purchase it for $30. Now we’ll have to see how quickly EHR teams can get the drug updated for easy prescribing.

How quickly can you get a new drug into your providers’ virtual prescription pad? Leave a comment or email me.

Email Dr. Jayne.

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