News 3/8/19

Top News

Amazon, Berkshire Hathaway, and JPMorgan Chase decide to call their healthcare venture Haven.

The bare-bones website launched along with the brand is light on concrete details about the company’s plans, though visitors can glean a few details about its goals and structure if they dig deeply enough:

• Haven will focus on offering employees of the founding companies easier access to primary care, easier-to-understand health insurance, and affordable medications.
• It will use data and technology in unspecified ways to meet those goals.
• Haven seeks to become an ally of rather than a competitor to healthcare stakeholders.
• Profits will be reinvested.
• It may one day share its solutions with other interested parties.

Of its nine-member team, only CEO Atul Gawande, MD and Head of Communications Brooke Thurston have health system experience. CTO Serkan Kutan comes from Zocdoc, Head of Measurement Dana Safran from BCBS, and COO Jack Stoddard and Chief of Staff Megan McLean from Comcast.

Reader Comments

From La Vida Loca: “Re: [company CEO name omitted]. Have you seen his arrest record?If I were on the board, which he controls, I would be investigating moral turpitude as a cause. What does that do to the business?” I hadn’t heard that, but Googling turns up a September 2018 arrest and his co-founder wife has since left the company. I’m not naming him because I don’t see that he ever went to trial.

From Cranapple: “Re: CareTrac HIE. Reading between the lines, it is folding because the big Epic hospitals in Minnesota won’t share data.” The forwarded announcement from Southern Prairie Community Care says the HIE doesn’t have a business case because large health systems won’t share their data, adding that HIE’s technology vendor Change Healthcare won’t devote the resources to connecting the HIE to the EHealth Exchange (which the state requires of HIOs) that would have given the smaller players at least some big-hospital data.

From Amy Gleason: “Re: healthcare costs. Check out what my daughter wrote about her monthly infusions. Her newest insurance pays $202K per year more than the last insurance. She is horrified and doesn’t understand why there isn’t an app that would help her.” First off, Amy has moved on from the shuttered CareSync and is now working for the White House’s US Digital Service on HHS/CMS interoperability projects. Her daughter Morgan’s write-up describes the situation – she gets the same infusion every month from the same doctor, same hospital, and same nurses, but the three insurers that have covered her have paid wildly different prices. Like normal humans, she’s wondering exactly how forcing hospitals to publish their chargemasters accomplishes anything when the healthcare world revolves around confidential discounting with each insurance company. I wish I had something encouraging to say, but Morgan has already wisely concluded that “I am thinking that we might really need to just burn the healthcare system to the ground and completely start over,” although I won’t burst her bubble by mentioning that fire trucks – in the form of politicians who are well paid by the profitable status quo – always manage to squelch those flames.

From Odd Bedfellows: “Re: Molina Healthcare. Offering its Washington State Medicaid members a free 90-day subscription to Amazon Prime.” There’s so much wrong here that I don’t know where to start, so I’ll save my snarkiness for this – even after the free subscription ends, the Medicaid members pay just $5.99 per month and that’s a lot less than I pay. You folks in Washington are generous to provide your less-fortunate neighbors with two-day delivery and Prime Video streaming while you’re off working. Still, I’ll table my cynicism temporarily in noting that for those who have transportation issues and who live in food desert neighborhoods, Prime could indirectly improve health and lower costs and I assume that Amazon is footing some or most of the cost in its attempt to get every American on Prime (and 100 million of us have already signed up).

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Artifact Health. The Boulder, CO-based company made headlines this week for its just-announced work with AHIMA to deliver compliant physician query templates (documentation clarification) via its cloud-based platform. Health systems using Artifact reduced their AR days by increasing response rates to nearly 100 percent and reducing average response time by 80 percent. Doctors can respond from their computers or smartphones (often in just three taps) and appreciate receiving the same format for all queries (CDI, inpatient, outpatient, and pro fee). Their responses are recorded directly in Cerner, Epic, or Meditech to become part of the legal medical record with no manual recordkeeping by CDI specialists and coders. Thanks to Artifact Health for supporting HIStalk.

I decided to leave my HIMSS19 burner phone active for a bit longer, just in case you want to text me something interesting.

I’ve received a few reader inquiries lately about not getting my email updates because of spam-blocking or other email filtering on their end. Sign up again if you are among them – you only need to enter your email address and there’s no risk otherwise.

Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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

Acquisitions, Funding, Business, and Stock

Long-term and post-acute care software vendor PointClickCare acquires LTPAC-focused medication management company QuickMar.

Chronic disease management-focused digital health company Livongo hires underwriters to prepare a Q3 IPO that’s expected to bring in $1 billion. The company has raised $240 million since former Allscripts CEO Glen Tullman started it in 2014.

Philips acquires Carestream Health’s imaging IT solutions business – which includes VNA, diagnostic and enterprise viewers, and clinical, operational, and analytics tools — for an unspecified amount.

People

Impact Advisors hires Jay Backstrom (Schumacher Clinical Partners) to lead its newly expanded telehealth consulting service.

Apixio hires Jennifer Pereur (Hill Physicians Medical Group) as VP of solutions and Terry Ward (Change Healthcare) as SVP of solutions.

Sales

• Allina Health (MN) selects patient engagement software from PatientWisdom.
• In Texas, Arise Austin Medical Center and The Hospital at Westlake Medical Center will adopt Allscripts Sunrise.
• The Escambia County Healthcare Authority in Alabama will implement Cerner Millenium at D.W. McMillan Memorial Hospital, Atmore Community Hospital, and four clinics. Atmore appears to be running Epic under Infirmary Health. The hospitals will also run Cerner RCM, ancillary, and ambulatory as well as outsource its business office to Cerner.
• The University of Kansas Health System chooses Connexient’s MediNav digital wayfinding software.
• WakeMed Health & Hospitals (NC) selects PeraHealth’s Rothman Index predictive analytics.

Government and Politics

VA officials tell members of a House appropriations committee that it will roll out its new Cerner EHR at three facilities in the Pacific Northwest early next year. John Windom, head of the VA’s EHR modernization effort, told lawmakers the pilot had been slowed down to give end users more training time. Also on the VA’s to-do list: finish converting VistA data into a Cerner-friendly format for migration, getting a permanent deputy secretary installed to oversee the roll out, and ensuring VA providers have security clearance to access DoD health records.

This op-ed lays part of the blame for the spectacular rise and self-destructive fall of Theranos at the feet of the US Patent and Trademark Office, which it says has done “a terrible job” of ensuring that whether inventions actually work. The office has admitted to operating on an honor code, a system that worked well for founder Elizabeth Holmes:

Yet more than a decade after Holmes’ first patent application, Theranos had still not managed to build a reliable blood-testing device. By then the USPTO had granted it hundreds of patents. Holmes had been constructing a fantasy world from the minute she started writing her first application, and the agency was perfectly happy to play along.

Privacy and Security

Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett, who was treated in its ED following his claim of being attacked in a racially motivated incident. One terminated nurse says that she and co-workers were fired for simply scrolling past the actor’s name on an EHR list while looking for other patients. The real crime in this story is that a grown man named Justin thinks Jussie sounds better.

Medical billing vendor Wolverine Solutions Group notifies hundreds of thousands of patients from an undisclosed number of providers and health plans of a ransomware attack that occurred last September. The company has been sending out notifications on a rolling basis since December, and expects to wrap up messaging by the end of this month, at which point it will have a better idea of how many people were affected.

Other

Auditors blame a 2017 implementation of Cerner’s billing system for the $38 million revenue loss of Glen Falls Hospital (NY), which was forced to lay off employees after losing 12 percent of its annual patient services revenue due to bills that went out late or were never sent.  

A brilliant article in Science looks at how the public relations chief of the American Diabetes Association came up with the term “prediabetes” in trying to scare doctors and their patients to take action to address slightly elevated blood glucose levels, a mostly benign, symptom-free condition that had previously been labeled “impaired glucose tolerance.” ADA rolled out the term on a wide scale and keeps broadening the definition to include more people, now counting one in three Americans as being prediabetic even though studies show that only single-digit percentages of them will ever have diabetes. Since then, billions of dollars have been spent to address the observed blood glucose levels – mostly weight loss and exercise programs that have shown few results – and the now-medicalized “condition” has created a cottage industry of fitness coaches, dietary products, glucose monitors, and prescription drugs that now consume at least $44 billion of US healthcare spending each year and line the coffers of the ADA with up to $27 million annually in drug company contributions. A researcher who advocates wider use of prescription drugs to treat prediabetes has earned $5 million from the companies that sell those drugs and many doctors who wrote the ADA’s standards of care have also made millions. A Mayo diabetes clinician concludes, “The people who lose are the people who go from being a healthy person to being a patient. Now, they have the sick role. They have to go for checkups and tests and treatments … I just don’t think we [prevent diabetes] by making every healthy person a patient.” @EricTopol lauded the article, calling prediabetes “mass, dumbed, down medicine and scaremongering one of three (84 million) adults and 1 billion people worldwide, supported by pharma, propelled by guidelines from trusted organizations … with 80 percent of such individuals at no risk.”

Dear HIMSS Media, I’m confused – is this event in Santa Clara or LA?

In an attempt to prevent hospital readmissions, researchers at the Rochester Institute of Technology in New York develop a sensor-embedded toilet seat they say can detect deteriorating conditions in congestive heart failure patients.

Sponsor Updates

• PMC Regional Hospital (IN) completes its Meditech Expand implementation with help from Engage Consulting.
• EClinicalWorks will exhibit at the AAPM Annual Meeting March 7-9 in Denver.
• Ellkay will exhibit at the ACMG Annual Clinical Genetics Meeting April 2-6 in Seattle.
• EPSi will exhibit at the Metro New York HFMA Chapter’s Joseph A. Levi 60^th Annual Institute March 7-8 in Uniondale.
• Healthfinch publishes the third e-book in its refill optimization series, “Achieving Refill Protocol Consensus.”
• Huntzinger achieves a score of 96.4 in the HIT Advisory Services Category of the “Best in KLAS Software & Services 2019” report.
• Hyland releases a new enterprise search solution as part of OnBase content management platform.
• Imprivata will exhibit at SoCal HIMSS March 12 in Duarte.
• Mobile Heartbeat invites vendors with complementary solutions to integrate with its CURE Connect API Suite via its new CURE Connect Interoperability Program.
• NPR profiles Kentucky Hospital Association, Kentucky Office of Rural Health, and Collective Medical efforts to develop a statewide care coordination network.
• Apixio announces that it has grown its customer base to 36 health plans and provider groups, and has analyzed 11 million documents for Medicare Advantage and private plan beneficiaries.
• Netsmart earns multiple top Black Book awards across behavioral health and post-acute healthcare settings.
• Sansoro Health makes available a cloud-hosted test environment for digital health companies and health IT developers to test application workflows in a real EHR environment.
• PatientPing announces that its national network of ACOs generated over $100 million in shared savings for 2017 under the CMMI Next Generation ACO Program.

Blog Posts

• Enhancing the Patient Experience from Start to Finish (Formativ Health)
• How taking my pup to the vet is like an IT solution health check (Hyland)
• Interoperability and Information Blocking Proposed Rules from CMS & ONC (Impact Advisors)
• Balance for Better: Women in Health IT Talk Success and Inspiration (InterSystems)
• 4 common pitfalls to avoid during your EHR implementation [Executive Summary] (Nordic)
• Taking a Consumer-Centric Approach to Access: Insights from Banner Health (Kyruus)
• International Women’s Day 2019 (Optimum Healthcare IT)
• Sometimes When Things Don’t Go As Planned, It Might Be For The Best (PMD)
• 4 common pitfalls to avoid during your EHR implementation [Executive Summary] (Nordic)

Contacts

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

EPtalk by Dr. Jayne 3/7/19

My sci-fi nerd flag was flying high when I heard that the Amazon, Berkshire Hathaway, and JPMorgan Chase venture will be called Haven. That was also the name of a planet featured in “Star Trek: The Next Generation” and one where the Enterprise crew was supposed to have some well-earned rest and relaxation. I’ve perused the website and appreciate the way they’ve spelled out their mission clearly and in a way that most people can understand. It looks like most of the open positions are in their Boston and New York offices. It will be interesting to see what kind of people gravitate there.

Researchers are seeking to use artificial intelligence to help design better vaccines against the influenza virus. Flu is a virus that mutates rapidly. Researchers from two pharmaceutical companies are taking biochemical data from samples of exposed patients and running them through an algorithm in an attempt to understand how an effective immune response forms. Other teams are using machine learning to predict the spread of influenza using training data sets from physician offices, hospitals, and social media. The Centers for Disease Control maps flu trends, but being able to truly forecast flu activity would be an asset. I hope they hurry up and get it right. I’ve avoided flu for most of my medical career, but it hit me this week and with a vengeance.

In Mr. H’s annual reader survey, there were some responses that indicated a desire to see more focus on less-traditional areas of healthcare IT, including telehealth. Since I’ve been doing some of my own explorations in the telehealth realm, I’ll share my observations and findings.

One of the first things I’m finding is that it’s important to understand what you mean when you start talking about telehealth. Is this provider-to-provider, institution-to-institution, or direct-to-consumer? The differences involved in the various approaches are vast.

In talking with physicians, there is good acceptance of the provider to provider offerings, which can help serve rural areas or places that don’t have the specialists needed to care for patients with certain conditions. This typically involves a patient coming in to see their provider, then joining with a subspecialist or other clinician via video call. The provider who is actually with the patient can assist with physical exam findings and vital signs. It doesn’t have to be a physician, but can also be a nurse or other trained member of the care team.

This approach can be huge as far as saving time and money for patients to travel to see subspecialists, understanding that some patients just wouldn’t go because of the burden. I’m seeing this more as academic medical centers partner with outlying organizations and it seems to really be taking flight in the pediatric subspecialist world.

There is also good acceptance of institution to institution telehealth, such as remote ICU monitoring or telestroke management services. This can allow specialists to weigh in on the care of patients at institutions that might not have the level of expertise needed to care for certain conditions. It can also just serve as an extra set of eyes for an already-skilled facility, making sure that nothing is missed in the care of critically ill patients. There are typically deep linkages between the organizations from both contractual and philosophical perspectives, so the level of trust is high.

Telehealth services that are delivered directly to the consumer have variable uptake. Some healthcare organizations have already built robust telehealth programs, allowing their providers to work directly with patients who may have challenges traveling to the office. Devices can be used to report patient-generated data in order to provide better care, such as daily weights for heart failure patients or blood glucose readings for diabetic patients.

Other organizations may be using telehealth strictly for acute visits, allowing physicians to extend their hours, access, and productivity without having staff in the office for an extended session. They may be using a telehealth platform within their EHR or licensing with one of the nationally-known telehealth companies to get this done.

Then there are the independent telehealth organizations that may contract with employers or payers, or may market directly to patients as consumers.

I think providers are skeptical of the independent telehealth organizations. There was recently a raging editorial from one of the leaders of the American Academy of Family Physicians on the topic. However, there’s no question that these services are filling a gap in services that aren’t being provided by brick and mortar clinics or traditional primary care practices. Although there are some direct-to-consumer organizations that seem fairly profit motivated, others have significant interest in measuring clinical quality and patient outcomes along with patient satisfaction and efficiency metrics, just like an in-person practice would. These organizations are doing work to explore how they can fill gaps in care while maintaining antibiotic stewardship and clinical quality. They’re also working to ensure that the loop is closed with reports to primary care physicians so that there is continuity of care.

The challenge for these organizations is the lack of data looking at telehealth care of various conditions. There simply isn’t a body of research (yet) that looks at the effectiveness of a telehealth history and examination vs. an in-person examination. We know that physicians have treated certain conditions over the phone for decades, yet there are challenges when it is a brand-new patient-physician relationship rather than an existing one. Smart organizations are gathering data on their outcomes and their approaches and using it to drive future care pathways.

I think we’re going to see a continued boom in telehealth including expansion into the primary care and chronic care space. There will also be plenty of room for specialized telehealth organizations to flourish. Patients are voting with their pocketbooks on convenience and access and I hope traditional organizations are making note.

The Epic campus has made it into Atlas Obscura,one of my favorite sites for internet time-wasting. I had heard about many of the features, but not the medieval drawbridge, which caught my attention. I’ve never been, but I hear it is something to behold.

Email Dr. Jayne.

Morning Headlines 3/7/19

Health records giant Epic temporarily halts additions to its app store because of privacy concerns

Epic confirms it stopped accepting new apps into its App Orchard last December while it reviewed the security and privacy policies of some third-party developers. We reported and confirmed this with Epic on February 18.

VA to Pilot Health Records System in March 2020

The VA will begin piloting its new Cerner EHR next year at three facilities in the Pacific Northwest.

Amazon-JPMorgan-Berkshire Health-Care Venture to Be Called Haven

Amazon, Berkshire Hathaway, and JPMorgan announce via a new website that their year-old healthcare venture will be called Haven.

Readers Write: HIMSS, Innovation, and the Infomercial

HIMSS, Innovation, and the Infomercial
By David Lareau

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Nothing compares to the annual HIMSS conference in terms of providing educational and networking opportunities for health IT professionals. The recent event in Orlando included 300+ educational sessions, dozens of receptions and parties, and multiple days for scheduled and impromptu meet-ups with other attendees.

And then there is the Exhibit Hall. Perhaps I am jaded from my many years in the industry, but I can’t help but feel that the exhibition portion of HIMSS is a bit like a three day-long infomercial, with vendors pitching solutions to problems that many don’t realize they have (the Wearable Towel, anyone?), or for products that sound too good to be true (can you really say goodbye to flab with the ThighMaster?)

Interestingly, many of the “solutions” I saw at HIMSS were designed to fix problems that were created by other “solutions.”

Case in point: EHRs. The inefficiencies and deficiencies of EHRs are well documented. We’ve all seen the surveys about how frustrated doctors are with EHRs, which add to administrative burdens and contribute to physician burnout. Of course, EHRs have long been touted to be time-saving tools that improve patient care and allow physicians to go home earlier. The reality, however, is that few EHR implementations have lived up to all the hype.

But wait, there’s more

Full disclosure: my company was one of the 1,300 exhibitors at HIMSS this year serving up our own brand of infomercial, though I’d like to think we fall more in the Roomba category (innovative and useful) than Chia Pet (just why, people?)

We conducted a non-scientific survey in our booth to better understand providers’ biggest EHR challenges. When asked “Which health IT challenge are you most surprised is still an issue for the industry?” our 361 participants (all of whom were given a chance to win a prize) indicated the following:

• Lack of interoperability between EHRs and between providers: 36.1 percent
• Clinician dissatisfaction with EHRs: 27.7 percent
• Difficulties using data to improve clinical and financial outcomes: 22.6 percent
• Lack of innovation compared to other industry sectors: 13.5 percent

What these results tell me is that despite years of hype, EHRs still need fixing on multiple fronts in order to meet the needs of users and advance clinical and financial incomes.

Money-back guarantee

Providers have spent billions over the last couple of decades implementing EHRs that have failed to adequately deliver the efficiencies that clinicians require. Even if health systems and physicians could take advantage of money-back guarantees, few could afford the time, disruption, and additional investment required to rip out legacy systems and implement new solutions.

What are frustrated providers to do?

Not available in stores (but perhaps as seen on the HIMSS exhibit floor)

Despite the industry’s failure to realize the promise of EHRs, at HIMSS this year I saw increased interest from providers looking to improve the usability of their existing EHRs. More vendors are offering app-based solutions that extend the value of EHRs without the disruption of implementing a brand, new platform.

Some of these technologies are designed to fix inefficient workflows that diminish physician productivity. Others focus on organizing existing data so that clinicians can easily access the right data at the right time for the right patient – even if that data is coming from an outside system. Additional offerings enable more complete and accurate documentation to facilitate quality care, correct reporting, and better clinical and financial outcomes.

You can do it

I am encouraged that despite the plethora of pitchmen hawking products almost as seemingly frivolous as the Snuggie, I saw more signs of innovation at HIMSS19, especially for solutions that consider the needs and desires of clinicians and support better outcomes for patients.

The HIMSS Exhibit Hall may indeed be reminiscent of a marathon infomercial, but consider this: without infomercials, millions might never have enriched their lives with George Foreman Grills, P90X workouts, or the ShamWow.

HIStalk Interviews Randall, An Anonymous Health System CIO

I invited health system CIOs to interview with me anonymously, knowing from unfortunate personal experience that health systems don’t like their executives going off script to a national audience. Randall (not the interviewee’s real name) offered to spend 20 minutes on the phone with me to talk about what it’s like on the front lines. CIOs willing to do the same can contact me to arrange a fun conversation.

What are the hardest parts of being a health system CIO?

You serve many masters. The administrative area — the CEO, CFO, CMO — each have different objectives, goals, areas of influence, and levels of influence. Then you have your physician population, both from the acute care setting and employed physicians in the clinics. You have the masters of the regulators and dealing with the Promoting Interoperability Program at both the federal and the state level. You have operations, the directors and managers who are dealing with patient care or the revenue cycle or finances for the hospital. You also have another group to deal with in vendors and contractors.

At the end of that, you have your staff. You have a workforce that’s dealing with the same types of pressures you are at the CIO level, but they get it day-to-day in the field. You have to encourage them, empower them, and coach them to deal with that environment. That takes a very special set of people with their goals and their work ethic aligned with the organization to keep them going. Otherwise, they’re looking at it as just an IT job. They probably won’t survive in the healthcare space very long.

It’s a challenge and it’s a lot of juggling, but I chose this industry because it is challenging. It changes and requires you to think on your feet, to plan, and be strategic. It is not a boring job, that’s for sure. It can be frustrating at times, but it can also be very rewarding. You go through these challenges with people who you spend quite a few hours with, do a lifetime of work with, and you can identify with each other on each other’s challenges. You build some pretty strong relationships.

At the executive table, how do you reconcile what everybody wants in making sure that IT’s contribution fits into the overall health system strategy?

That’s the unique position that we are in as IT. We are exposed to all the workflows, especially on the applications side. We know the upstream and downstream effects that changes have. We know the benefits of using a technology, but we also know the downfalls of not planning it out well.

Those around the leadership table have a difficult time. They have to consider the mission and strategic plan while compromising around a single goal of achieving that strategy, but they have their own needs in their departments or with a particular physician.

We talk about flexibility all the time. But we have to set a course and not just stay the course. We have to support each other through those difficult decisions, what might be great things to do that would detract from what we already agreed are our priorities.

In each senior leadership team meeting, I say, here are all the things we’ve committed to. Here are the estimated hours the IT team alone needs. But we’ve already committed more hours than are available over the next six months. Then the CEO starts to look down the list of projects to ask for each one, why are we doing this?

When they start to dig into the projects, they circumvent the original decisions that were made by the VPs to execute on those projects. They are looking to the CIO to say what the priority should be. The other side of that sword is that two years ago, there wasn’t much governance going on in this organization. Senior leadership and directors were complaining, “IT is telling us what to do.”

OK, which is it? Do you want us to provide the guidance or do you want us to just facilitate it? That’s a challenge. There’s a balance there. This particular organization is having a lot of struggles getting into a more formalized initiative and governance process around their projects — not just in IT — and understanding what resources are involved with those. When they make changes, what impact does that have on projects that have already started?

Are executives worried about high software maintenance costs?

I don’t necessarily see that as an issue here. We cover that pretty well during the budgeting process for capital stuff. Maintenance is budgeted. It is a big nut, a large number. The board sees the percentage of operating expense coming from the IT area on things like maintenance continuing to climb, so they are aware of it.

The bigger challenge for this organization on its maturity curve is that when they look at a solution and they’re working with a vendor, it tends to be siloed around just the solution. What about the upstream effects or needs for your system and the downstream effects?

I’ll give you an example. We have a rather old cardiology rehab system that is documenting patient care. It needs to be replaced because it is no longer supported, but they want to interface that information into the main hospital system. But what they submitted for consideration was just the software and the maintenance for just that piece of software. Nothing about the IT hours needed for integration and the cost for the other system to do the integration.

IT ends up becoming the bearer of bad news on every single project for unplanned cost. It’s not just maintenance, but presenting the entire package of everything that’s involved with a particular initiative so that we don’t have any surprises.

Unfortunately, we’re still having surprises. Vendors don’t want to share that information. The sales folks want to close that deal as quick as they can, The standard feedback from them is, “You won’t need any IT support.”

What is good and the bad about having a few limelight-seeking CIOs representing those who just stay home and get their employer’s work done?

The good is that they sometimes expose you to other things that are available. The bad is that they represent themselves as the experts based on experience and most of them don’t have the experience. They are out there interacting with vendors and other industry people who have a particular agenda to address. Rarely have those who are popping up all the time been involved in implementations and dealing with the interactions with the physicians and the staff, both their own staff and the staff in the hospital. They are ego stroking. Hey, look what I know.

For me, it doesn’t necessarily translate into experience, lessons learned, and how I might be able to do that in my particular environment at a community hospital or a large health system. Other CIOs have actually been in the field, but they are few and far between and also in high demand.

I liken them to the chief medical officers that have grown up through an organization. They have a difficult time balancing the days that they’re in the clinic and treating patients with all their administrative responsibilities of the medical staff and administration. It’s a tough job. I always appreciate when those kinds of individuals who have real-world experience are willing to share that information.

The guys that are out there on LinkedIn and all the publications out there, telling you that “this is what you should be doing,” I have to take that with a grain of salt. It’s great to hear about what things are available out there, but sometimes they have to bring it back to bit of reality and what hospitals can actually do.

What kind of information sharing is most effective for a CIO who has to work for a living and who doesn’t have unlimited budget or time to self-promote?

CHIME has been a pretty good forum for CIOs to share information, although I’m starting so see it morph a little bit towards what HIMSS has become. I’m hoping they hold the line and don’t go that far. Those interactions between CIOs, one on one and sometimes in smaller groups, tend to be most valuable to me.

Every once in a while, I will reach out on the MyCHIME bulletin board to explain something I’m trying to solve and ask, has anybody gone through this? Some people like to share what they have done and what they have been challenged with, but not in an open and public environment out there like a magazine or something like that.

Is it too late for HIMSS to reel in vendors and is CHIME is too far along the path to do the same? Or is there no inherent conflict between what vendors want and what provider members want?

That’s the hard part. I don’t know that I have a solution for that. Vendor involvement is somewhat of a necessarily evil. Their motivation, no matter what they say, is that they have a business to run. They have to grow. They have to generate sales. They may have a great product, their company may have started off with a great idea and just grew from there, but in the end, they have to generate more leads. That’s the nature of our economic engine.

I find it a really difficult job for HIMSS to do. But at this year’s HIMSS, I was actually a little bit pleasantly surprised by the education sessions that I went to. Vendors weren’t running those presentations like they did in the previous couple of years. It was a little bit more low key with the vendors this year.

CHIME does a pretty good job of asking vendors to establish relationships with CIOs rather than coming in and doing hard sales. They do that through their focus groups, which is a pretty good idea, having five or 10 CIOs or senior IT leaders talking with a vendor about what their future plans are and what problem they are trying to solve.

I’ve been to a few focus groups that involved a solution looking for a problem. But in those focus groups, the CIOs are emboldened by each other being in that room and helping each other out. They give the vendor feedback and sometimes tell them straight up, this isn’t a problem we’re trying to solve. Or they’ll tell them, this is a great idea, but have you thought about it in this area? Trying to tweak or mold their solutions to that particular problem.

A good example from CHIME is that a year or two ago, I was on a focus group with the IBM Watson people. The entire room kept saying, what are you really delivering here? IBM Watson basically ignored all the feedback, at least based on the public perception that’s out there now. They still haven’t delivered. It’s a great idea in terms of what it might hold in the future, but overhyping on the front end doesn’t really help them. It destroys your reputation when you can’t deliver.

Health systems claim to embrace innovation, consumerism, and value-based care, but they still use fax machines, offer a poor visitor experience, and make a fortune by cranking out fee-for-service work. Is there a difference in what hospitals say versus what they are motivated to do?

Value-based care is BS. You are talking about trying to get to a subscription model with a patient. If your clients, your patients don’t want that and don’t feel a need to do it, then you are forcing a business model on them that won’t work. They don’t want it. They don’t feel the need for it. They just expect delivery of high-quality care episodically when they are ready and they need it. I don’t know that a hospital can solve that problem.

Hospitals and clinics can become more consumer-centric. As an administrator or an IT person, when you go to a clinic or hospital, what do you expect as a patient to be delivered that you might get from other types of industries? You would like to be able to do things on your smartphone. You’d like to be able to schedule appointments online. You’d like to be able to get your medical records freely and easily.

We have to back away from the regulatory demands and the billing demands and get on the front end of the consumer. Because in our environment, in our US of A, everything is based on capitalism, and he who builds the better mouse trap is going to draw more customers.

I don’t know how we will ever make that transition to value-based care unless you have a single-payer system, which I’m not an advocate of. But I don’t know how else you can do that. You are forcing patients into having to become subscribers to a healthcare service rather than episodic paying for what I need, when I need it. That’s my opinion, but the current environment pays my paycheck and I have to operate within it.

Morning Headlines 3/6/19

FDA chief Scott Gottlieb resigns

FDA Commissioner Scott Gottlieb, MD resigns, effective next month.

ZOLL Acquires Golden Hour Data Systems

Medical device maker Zoll Medical acquires Golden Hour Data Systems, which offers charting, RCM, and hospital integration software for EMS companies.

TRHC Announces Acquisition of PrescribeWellness Expanding its Medication Risk Mitigation Offering

Medication safety software vendor Tabula Rasa HealthCare acquires pharmacy-focused patient relationship management technology business PrescribeWellness for an undisclosed sum.

News 3/6/19

Top News

FDA Commissioner Scott Gottlieb, MD resigns, effective next month. He resignation letter did not indicate the reason for his departure from the job he has held since May 2017.

Gottlieb was a supporter of digital health technologies and modernization of FDA’s approach to regulating them. That included development of FDA’s Digital Health Software Precertification Program that allowed certified software vendors to fast-track their products to market. He also advocated using EHR data for post-market electronic safety surveillance of drugs and medical devices.

The 46-year-old Gottlieb previously worked for FDA in 2002-2003 and 2005-2007 and was a venture partner specializing in healthcare from 2007 until he was appointed FDA commissioner.

Gottlieb tweeted on January 3 that he was not leaving FDA, a denial that was apparently greatly exaggerated.

Reader Comments

From Minor Trauma: “Re: HIMSS Analytics. Now that it’s owned by Definitive Healthcare, should they still be using the HIMSS ‘not-for-profit’ position in soliciting survey responses, especially when working with PwC, another commercial org?” Definitive Healthcare didn’t buy HIMSS Analytics – they bought the HIMSS Analytics provider data business. HIMSS kept the consulting business, mostly involving its various Adoption Models, and that work (including this survey) will continue under the HIMSS Analytics name. Definitive CEO Jason Krantz responded to my inquiry on your behalf as follows:

Definitive Healthcare bought the data services part of HIMSS Analytics, which collects and provides data and analytics on the healthcare provider community. The data assets and clients of this part of the business will be entirely integrated into the Definitive ecosystem, which should be massively beneficial to those clients as we combine the best of both products. HIMSS Analytics will, however, remain an ongoing concern with a renewed focus on their mission of helping healthcare providers utilize technology more effectively to drive improved patient outcomes. In essence they are providing consulting services to providers with a focus on goals that are consistent with their non-profit objectives.  

From Digital Native Uprising: “Re: HIMSS. How much did it receive for its sale of the data business of HIMSS Analytics?” The number wasn’t announced and Jason Krantz from Definitive Healthcare (as I asked him the question above) was obviously not willing to provide details. Long-timers will remember that HIMSS originally bought that business from someone else whose name I’ve forgotten in 2003 and renamed it the HIMSS Solutions Toolkit. I always wonder how much HIMSS paid for acquisitions such as Healthbox and Health 2.0’s conferences, not to mention the mostly forgotten acquisitions of the rights to Disruptive Women in Healthcare, the MHealth Summit conference, the Medical Banking Project (apparently still around with HIMSS under John Casillas), Health Story Project, Microsoft Healthcare Users Group, and several other organizations that were rolled up into something bigger that no longer use their original names.

From Bohn E. Maroney: “Re: Orlando Health’s venture capital arm. Is it ethical for health systems to create or invest in for-profit businesses?” I admit that it makes me nervous when someone who is making healthcare decisions on behalf of a patient – whether it’s a hospital with private company investments, a doctor earning royalties, or the average for-profit medical practice — stands to benefit financially from ordering a particular course of therapy. I don’t think financial influence would encourage them to knowingly harm a patient, but it might sway them toward overuse, especially if the patient risk is low and their insurance company is footing the bill. That’s why we have a zillion times more diagnostic imaging machines than pure science says we need and armies of drug company reps living in mansions. We set ourselves up for disappointment in hoping that doctors and hospitals will act more nobly than the rest of society in declining to take the perfectly legal action that benefits them most. In all aspects, conscience has proven to be an ineffective deterrent to questionably ethical behavior.

HIStalk Announcements and Requests

I just read this book that Datica was offering at HIMSS19 and found it to be very good, especially given my modest knowledge of the technical underpinnings, business imperatives, and legal considerations of cloud computing. The authors are Datica CEO/Chief Privacy Officer Travis Good, MD and Chief Marketing Officer Kris Gösser. It finally convinced me that cloud isn’t “someone else’s hard drive.” Coincidentally, I just read that Lyft’s IPO documents reveal that it pays $100 million per year to Amazon Web Services for cloud computing services. 

Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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

Acquisitions, Funding, Business, and Stock

Medical device maker Zoll Medical acquires Golden Hour Data Systems, which offers charting, revenue cycle management, and hospital integration software for emergency medical service companies.

People

ROI Healthcare Solutions hires Jeff Tennant (Leidos) as executive director of revenue cycle IT services.

Practice Velocity hires Deven Shah (FTD) as VP of software development.

Announcements and Implementations

AHIMA and Artifact Health will offer templates and a mobile app for delivering compliant physician query templates, which means coders asking doctors to clarify their documentation for accuracy and maximum payment.

The Sequoia Project will hold a public forum webinar on the federal government’s proposed information blocking policies on March 19 as part of its Interoperability Matters initiative.

A smallish survey of senior healthcare leaders finds that two-third of health systems have rolled out executive dashboards to aid in decision-making, but rarely use them daily. The survey also found that healthcare systems use an average of four analytics tools, while one in six of them use 10 or more.

Privacy and Security

This is true of healthcare, too, where collecting and selling patient data is everywhere. In related news, Facebook gets caught for its practice of harassing users to provide their telephone number to support two-factor authentication, then immediately using that number to target ads, with the newfound twist being that Facebook allows looking up users by their telephone number with no opt-out provision. Also like healthcare, Facebook does little to correct wrongdoing until it makes headlines.

Other

A Health Affairs article warns that “consumer-driven healthcare” is an appealing-sounding but potentially harmful health reform concept because healthcare isn’t a classic market that can be shaped by consumer actions. Patients don’t understand healthcare, they don’t choose providers based on quality and price, and their insurers don’t have enough bargaining power to drive down prices, so health reform that is based on consumerism is likely to fail. It also notes that, unlike in other markets, giving patients what they want in a “customer is always right” model can compromise provider integrity and result in patient harm.

A startup in Japan develops AI-powered software for existing closed-circuit security cameras that can detect shoplifters by their suspicious body language such as fidgeting, potentially allowing employees to deter their crime by asking them if they need help. The company’s website lists possible healthcare uses, such as detecting poor physical condition, and I can see hospitals using it to identify hospital visitors who are struggling to navigate the usual consumer-unfriendly hallways, although if hospitals cared that much, they would probably address the problem rather than the symptom.

Another interesting Health Affairs article looks at how patient portals have been integrated into the care processes of four health systems:

• Ochsner Health System has created a hypertension program in which patients complete surveys about their diet, exercise, medications, and social determinants of health via Epic’s MyChart; are issued a blood pressure device that sends their readings directly to MyChart; are offered help with using digital tools via a Genius Bar-type desk; and are monitored by a care team that includes pharmacists and health coaches. Blood pressure control and patient satisfaction have improved and PCP visits have been reduced by 29 percent.
• Sutter Health has convinced 79 percent of ambulatory care patients to use its Epic patient portal and has motivated clinicians to respond to patient  messages by using a triaging system and offering them incentives for answering messages within one business day. Patients are also using the portal for online scheduling, appointment wait-listing, and booking video visits.
• Stanford Health Care invites patients to sign up for MyChart via a text message and automatically verifies their sign-up identity by asking questions about publicly available data, which has increased primary care patient enrollment to 87 percent. The portal also allows patient check-in, facility way-finding, and Open Notes chart information access. It is also being used to survey patients about unaddressed symptoms and needs. Stanford also shares all physician notes, other than those related to mental health, across all disciplines.
• UC San Diego Health offers inpatients the use of tablets from which they can manage room settings (lights, shades, thermostats) and access Epic’s MyChart Bedside inpatient portal to review meds, procedures, test results, care team members, and educational materials.

Sponsor Updates

• Cantata Health’s NetSolutions and Optimum platforms win Black Book’s highest satisfaction awards for ERP, long-term care, and hospital revenue cycle management.
• OptimizeRx will present at the annual Roth Conference March 17-19 in Orange County, CA.
• Healthcare Growth Partners posts its February health IT insights.
• Bernoulli Health receives ISO 13485:2016 and Medical Device Single Audit Program certifications from Intertek.
• Nancy Landman (IBM) joins The Chartis Group’s Information & Technology Practice leadership team.
• DrChrono expands its partnership with CoverMyMeds, offering end users electronic prior authorization and support services, and prescription pricing transparency.
• STAT profiles Nuance’s new ambient listening system for patient encounters.
• Aprima will exhibit at the LHC Group Revenue Cycle Leadership Conference March 11-12 in New Orleans.
• Atlantic.Net CEO Marty Puranik weighs in on a Facebook feature that lets people look up users by their phone number or email address.
• Bluetree donates 624 trees to the National Forest Foundation at HIMSS19.
• Healthfinch publishes an ebook titled “Achieving Refill Protocol Consensus – Best Practices for Creating and Maintaining Protocol Content.”
• DrFirst’s RCopia is certified as compliant with the NCPDP Script 2017 e-prescribing standard.
• NJ Biz profiles CarePort Health.
• CareVive names Ethan Basch, MD (UNC School of Medicine) director of its Scientific Advisory Board.
• ChartLogic will exhibit at the AAOS annual meeting March 12-16 in Las Vegas.
• The Silicon Slopes podcast features Collective Medical CEO Chris Klomp.
• CoverMyMeds will exhibit at the MHA Business Summit March 6-8 in Las Vegas.

Blog Posts

• Access Signature Solutions: Easy to Get to and Use (Access)
• #ECR2019 – Impressions (Agfa Healthcare)
• Optimum Healthcare IT Surpasses 100 Go-Live Projects (Optimum Healthcare IT)
• Using AI to Solve Healthcare’s Data Problem (Apixio)
• New study demonstrates the threat of respiratory compromise (Bernoulli Health)
• The CIO’s Guide to Security Frameworks in Healthcare (Spok)
• Managing Providers like Products – The Digital Catalog and Intelligent Provider Search (Phynd)
• HIMSS 2019: A Sea Change (Datica)
• Let’s celebrate nurses in 2019 (Meditech)
• Survey Says: Less Than 1 in 4 Senior Hospital Execs Use Executive Dashboard Daily (Dimensional Insight)

Contacts

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

Morning Headlines 3/5/19

Red flags for Nova Scotia’s electronic health records mega-deal

Critics of Nova Scotia’s One Person One Record project, for which Allscripts and Cerner are the vendors being considered, note Cerner rollout problems in Australia’s Queensland Health, South Australia’s planned overhaul of its Allscripts-powered EPAS project, and a poorly run Cerner implementation at British Columbia’s Nanaimo Regional General Hospital. 

This hospital modeled itself after the Apple Store, and lets pregnant mothers use gadgets to monitor their health at home

Ochsner Health System (LA) develops Connected MOM, a free remote patient monitoring program for expectant mothers that incorporates digital health tools accessible at a Genius Bar-styled area of the hospital.

Amazon Gives AI to Harvard Hospital in Tech’s Latest Health Push

A $2 million grant from Amazon enables AWS and Best Israel Deaconess Medical Center (MA) to determine how machine learning and AI can help improve workflows, diagnoses, and treatments.

Curbside Consult with Dr. Jayne 3/4/19

Due to bad weather, I was gifted a fairly quiet and unremarkable urgent care shift today. I definitely appreciated the time to allow my brain to play catch-up. Word of advice: if you get blackout drunk at a Mardi Gras party and wind up with a visibly deformed leg, I hope you have sober friends who can take you to the emergency department immediately. Waiting until the next day and then going to urgent care for your nine-way fracture isn’t going to be as helpful.

I’m working on a couple of projects, one involving creation of some new educational resources for an organization that is pursuing EHR optimization. It’s often difficult to figure out the best way to train people, and successful organizations will use multiple methods to ensure that everyone is receiving information in the way that best suits them. Those organizations also use frequent retraining to ensure the information is retained.

Out of all the organizations I’ve worked with over the years, only two had individuals with advanced training in adult education involved in the creation and upkeep of the training process. Too often, training is done “like we did it last time” and doesn’t take advantage of different types of media and experiences.

Some people are visual learners who are going to respond best to well-delivered presentations and written materials, often taking notes on the content. These folks may do well with classroom presentations as long as they’re organized and concise and have dynamic presenters that don’t bore the audience to death. Others are auditory learners who may also do well with a classroom format. Still others are kinesthetic learners – they need to touch, feel, and do to absorb workflows they are trying to learn. They do best in a lab setting. There are also variations on the various learning styles, including whether people learn better individually or in a group setting.

Too often leaders make assumptions about how their people should learn,  limiting the options that are offered and potentially to negatively impacting a subset of their users. Savvy organizations poll their users and see what kinds of training materials they would like to have.

LOINC recently surveyed their core users and the breakdown was interesting. Of nearly 500 users:

• 48 percent preferred a published guide available as a PDF
• 25 percent wanted written documentation as a web page
• 6 percent preferred slide presentations
• 17 percent wanted video presentations with audio
• 3 percent wanted in-person training

It would be useful for leaders to survey their users to see what kind of training is preferred.

Leadership should also be aware of the corporate culture and how different types of training will be received in the field. For example, one large health system I worked for decided that they didn’t want to expend the resources to bring everyone together for training. They decided to train via web meeting with people at their desks. Participants were not aware that the training team had attentiveness tools, including being able to see whether the window in which the presentation was occurring was the primary focus on the desktop.

Within 15 minutes of the start of the webinar, hardly anyone still had the session in primary focus, and of those who did, they were most likely multi-tasking based on the lag in their responses to interactive polling questions. Others never even signed in to the webinar because they were sidetracked in the office with the urgent issues that occur on a minute-by-minute basis. Had they been allowed to leave the office and attend classroom training, those interruptions and distractions would have been minimized. Needless to say, the training was a flop, and for our next upgrade, we returned to classroom-based training.

One of the things that bugs me the most is training sessions that lack of materials for the participants. Back in the days after the demise of the Kodak slide carousel and following the rise of PowerPoint, lecturers often handed out copies of their slides for attendees to take notes on. As we became more environmentally conscious, people stopped handing out copies, but this left students frantically scribbling and trying to capture concepts and ideas. Some presenters balk at handing out the slides before a lecture for fear that it will make the audience inattentive. This completely ignores the subset of learners that benefit from seeing an overview of material before they’re confronted with a deep dive.

For this new project, I’m working on the scripting that will be used to retrain physicians, including a compilation of the clinical scenarios that are the most relevant to each physician who will attend an in-person session. They will be experiencing a classroom portion followed by a lab, followed by time for individual questions and interaction with the trainers. All of the sessions will be recorded and we’re distributing the materials, both before the class and after. The slides that are sent before the class will allow people to bring a printed copy if they want to, and those distributed after the class will contain notes and annotations from questions and discussion held during the session. Not everyone wants a big shelf full of binders and manuals, but the reality is that some people still like hard copies.

The other project I’m working on is more creative in nature, a communication and marketing plan for a practice that is planning to launch virtual visits. They have decided to try to do them in-house using their EHR, which doesn’t have great telehealth functionality, but at least they’re willing to dip their toes in the water to see whether patients are interested in it. We’re putting together communications to make sure everyone in the office is aware of the project and the plan to launch it as well as the questions they will need to be able to answer when patients ask.

Figuring out the best way to market it to the patient population is also a challenge. The majority of them are tech-savvy, but will need some education on why they will be billed for a virtual visit that in the past would have been handled as an unreimbursed phone call. It’s been fun to come up with the flyers illustrating the difference as well as doing some role-play with the leadership to make sure they can articulate all the goals and objectives before we roll the materials out to the front-line staff. I’m enjoying working with people who are willing to lead by example and to roll up their sleeves instead of just delegating something this major to someone down the line.

A nice creative project helps get my brain working again after this long awful winter. Even though snow is still on the ground, I’m starting to feel like spring might finally be around the corner.

Email Dr. Jayne.

HIStalk Interviews Michael Schmidt, Managing Director of Strategic Innovations, Orlando Health

Michael Schmidt, MBA is managing director of strategic innovations at Orlando Health’s Strategic Innovations program in Orlando, FL.

Tell me about yourself and the organization.

I’m the managing director of Orlando Health’s Strategic Innovations program. My responsibility is to coordinate our internal and external innovation efforts.

My colleague Callie Patel from Healthbox and I just presented at HIMSS19 on developing internal innovation competencies. We did a case study of Orlando Health’s journey over the past two years in going from having no formal innovation program – no structure, resources, or any of that — to having a formalized program where we run an annual internal incubator. We have various pathways for different types of projects. Then we have a venture fund to invest in external healthcare startups that align with what we’re trying to do.

Many health systems are experimenting with incubators, accelerators, and innovation funds. What are they trying to get out of that, and what have we learned so far?

There was a quote that was a theme during HIMSS that if you’ve seen one innovation center and program, you’ve seen one innovation center and program. Everybody’s trying to tackle similar concepts and strategies, but the execution looks pretty different. The more I’ve started scan the horizon and look at other health systems, I’ve been surprised how many have a program like this. Maybe not the same setup or focus on internal and external at the same time, but most of the major health systems in the country have moved in this direction somehow.

We might be a little different. First and foremost, our goal with an innovation program is culture change. We’re a $3.2 billion community health system across central Florida and operate at a very effective level, but we have never had a lot of the core competencies that a university hospital system or big hospital system in a large metro area might have. We’re playing catch-up a little bit.

We realized that a lot of what we needed to accomplish was education and acclimation for a lot of our physicians and team members to understand what innovation means to us and why we’re doing what we’re trying to do. Then, how they can play an effective role in that. Secondary to that for now is the ROI on the initiatives. Over time, that will change, but we’ve been trying to focus on engagement with our employees and our physicians.

I credit our partner Healthbox for their structure and their philosophy. Technically they’re a consulting group, but they’ve partnered with us. It’s almost like I added 10 to 12 people to my team from Day One in working with them. We’ve set up a consistent process, a thought structure and philosophy on what types of ideas we are looking for, and the criteria we used to assess those and to decide which ideas advance.

For our internal incubator, which we call the Foundry, we only accept four ideas each year. We would rather have a small number of successful projects than dozens that are stalled out in some different phase of development. We ask our team members and physicians to look for ideas that solve pain points that they’re experiencing. We have criteria that we assess these ideas on. Throughout the entire fall, the application window is open for people to submit their ideas, providing rationale as to what impact it will have internally. Will it save us money, help us consolidate the supply chain, or improve quality?

We look at five facets of that application and score the idea and the innovator across these things. What is the commercial potential? Is this idea eventually going to fit in a market that’s super competitive, or is there a decent-sized niche that we could carve out based on how unique this idea is? How innovative is the idea? Is it a small iteration on an existing idea or product, or is this big-shift, game changer, completely new type of product or service?

We also look at the person who brought the idea forward. Not everybody has the same natural entrepreneurial skills, so part of what we assess is what type of support structure, education, and team we will need for this person to be able to drive their idea forward.

Finally, we look at the potential internal impact and how it aligns with our strategic plan and the pillars of that plan.

We score everything across those five categories. We rank them, and then I have a committee of about 30 senior leaders and physicians from across every major area of the organization. We sift through those ideas that are currently ranked based on those numerical scores and then we start to challenge assumptions. We ask each other what we think will work with this particular idea and try to whittle that down to the top four or five that we’ll end up choosing from to go into the program.

We do things a little bit differently than some of the other systems I’ve seen. This incubator is just for our employees and our physicians. It is specifically designed to develop Orlando Health’s intellectual property. The person who brought the project forward will drive it. They will be in charge of budget, if it gets to that point, and coordinating with the work group.

But at the end of the day, it is Orlando Health’s intellectual property. We will work with them to license it out or sell it. We will pursue those paths before spinning out something as a separate business. Then if it is profitable in some form or fashion, the person who brought that idea forward gets a significant portion of those those royalties.

A number of our key physicians said over the years, I’m working on stuff, doing research, coming up with these ideas, and I have nowhere to take them. I would love for Orlando Health to be the organization that drives this stuff forward. But until a couple of years ago, we didn’t have anywhere for them to go or any support to offer. Now they are excited that there’s a pathway for this stuff.

What kind of employees or physicians bring in ideas and what stage are those ideas in?

A year and a half ago when we first started this process, announced the concept, and opened up applications, we had no idea what we were going to get. We were pleasantly surprised across all fronts. Last year we had just over 60 applications. I would say probably 10 percent of them had a working prototype or very thoughtful design.

The rest were early-stage, sketch on the back of a napkin sort of concepts. That helped up shift a little bit to accommodate ideas at that stage. They need a lot more due diligence and a lot more planning to get to a place where we can start to build prototypes and things like that.

We’ve gotten ideas from almost every corner of the organization. Physicians have definitely been a lot heavier in the mix than other types of team members, and the physician ideas tend to be more developed. Sometimes they have put their own personal funds into developing it just to see if the concept works.

How do you determine which ideas have commercial market potential beyond solving Orlando Health’s problem?

My selection committee helps assess it. We pick people with different types of experience and backgrounds. We have a handful of people here that have worked in early-stage companies and have some of that insight. That’s where Healthbox as our partner comes in. Behind the scenes, they’re helping us guide the whole process, helping us with our criteria to move ideas forward. They also produce some pretty comprehensive research on each of the idea, such as a market scan and competition analysis, so we know what we’re looking at. Then an assessment of the resources the project might need to get each of those ideas to prototype and minimum viable product.

Do you get involved in whatever happens next in terms of actually creating a company around the idea?

We’ve staged it out appropriately to account for making sure that we’re staying on track, that things aren’t getting ahead of where they should be, and that we’re not setting aside too much in the way of funding. Each year, the four projects that go through the foundry process can come back and do a “Shark Tank”-like pitch to our executive team and other senior leaders and ask for a budget for the next 12 months.

We stage it out in 12-month increments to make sure that it’s manageable because these people still have their full-time jobs. Our funding allows them to set aside a set number of hours every week and those funds reimburse their department or practice so that their department is not losing anything with this person working on the project.

Mostly what we set aside funding for is bringing in external resources, whether it’s a software developer or a biomedical engineer to help us draw something out in CAD. We have checkpoints throughout that process where our team, other internal resources that we’ve lined up for assessment, and then Healthbox are making sure that those projects are on the right track and advancing the way we think they should.

But we’ve also said that overall, going through the foundry and getting to the end of that process does not mean that it is market ready. The foundry itself is one of the steps for validation, making sure we can put the idea through the paces. Will it do what we think it needs to do? Does it end up conflicting with other vendors we have or internal resources or processes that are in place? That process helps us understand how this would end up looking if we were to scale it across one facility or the entire organization.

Then if it continues to check out throughout that process, we start looking at who we would likely license or sell this to. What type of partners would be ideal? We haven’t had any projects get to that point yet, but we have a few that we’re starting to scan the horizon.

What does your team look like?

It’s a very small team right now. I feel like a one-man band most days. The senior executive that started this process is essentially our chief strategy officer. His title is senior vice-president of strategic management. Our broader team is responsible for all of the strategic planning and execution across the entire organization and we are tucked alongside that. It’s myself and an analyst who works for me.

But then we have the committee, and then a number of people throughout the organization have expressed a strong desire to partner with us to help the program continue to grow. We lean on a different person across that network based on what we need. What’s helped us be successful in standing this up so quickly is bringing in what I call adult supervision, a partner who’s experienced in this, like Healthbox.

What did you bring back from HIMSS19 that is most applicable to what you’re doing at Orlando Health?

That was my first year going. It is completely overwhelming. It was really hard to take in everything that was there. I almost wish it wasn’t so big.

But it’s fascinating to walk the vendor floor and see who the big players are. We have someone who helps us on our venture fund side and he said, “Start to look at the smaller companies that are on the periphery that have a really small space. When you come back next year, see who’s moved inward a little bit. See who has a bigger footprint. Pay attention to those types of moves.”

We were also looking at broader themes, trying to get a sense of where some of the technology is going, where some of these segments of the industry are going. It is so encouraging that healthcare in general is rapidly changing and the notion of digital health and that entire segment of companies and products and technology has really started to take off.

I sat through a number of presentations on the expo floor where they were demoing. Seeing the way that AI, chatbots, and virtual assistants are starting to impact the patient experience was cool. That was one of the things I took back to our team and relayed.

Patient experience is one of our top priorities this year, to solidify how we deliver a consistently excellent experience. We don’t always have the right tools. Historically we’ve had some silos, where different forms of technology that we had implemented didn’t necessarily talk to one another.

I’m trying to look at things from a 30,000-foot view and figure out where we can start to weave some of this stuff together, to see what’s available on the market that we could plug in and where there are gaps where  we could create something internally that would help us move quicker.

Morning Headlines 3/4/19

Beth Israel Lahey Health is officially one entity. Here’s what happens next.

The newly-combined health systems intend to focus on the interoperability of their multiple EHRs in the short-term, eventually moving everything onto one system.

Microsoft to offer Band refunds, announces end of apps and services

Microsoft will shut down Microsoft Band and Microsoft Health Dashboard apps and services on May 31, following discontinuation of its Band fitness tracker two years ago.

Rhode Island Health Department Backs Away From Punitive Action

After physicians cry foul over being accused of medical misconduct for reporting safety-related EHR errors that didn’t affect patients, the Rhode Island Department of Health dials back its punitive actions and assures providers it will take a more collaborative approach.

Baby born with brain damage after ‘fragmented’ care at Queensland hospital

An Australian hospital’s internal review concludes that “disjointed information flow” in its Cerner EHR, plus other factors, contributed to a newborn baby’s brain damage.

Monday Morning Update 3/4/19

Top News

Beth Israel Deaconess Medical Center, Lahey Health, and three community hospitals complete their merger to form 35,000-employee Beth Israel Lahey Health to better compete with Partners HealthCare.

CEO Kevin Tabb, MD says in a Boston Business Journal interview that the organization will keep multiple EHRs and focus on their interoperability in the short term (Epic, Meditech, and homegrown) because post-merger is the worst time to rip and replace, but “it was always my belief, and is still my belief, that in the intermediate to long term, we will need to standardize on a system. But when and which one, I can’t tell you yet.”

Tabb came from BIDMC. Former BIDMC CIO John Halamka, MD, MS is executive director of BILH’s Health Technology Exploration Center. He commendably declined to wear a tie for the new website’s photo like his fellow male executives, instead wearing his traditional black outfit while sporting a down-filled black outdoor jacket atop. 

Reader Comments

From No-Frills Rills: “Re: experience. I would like to hear examples of where your readers received fantastic patient care in which technology was involved.” I created a survey for readers to describe their technology-assisted positive patient care experience.

From Topicality: “Re: listing new sales. Why didn’t you list this vendor’s contract extension?” It’s not really a new sale when a health system decides not to fire a vendor by instead extending its contract. I consider it a sale when a customer upgrades from a vendor’s older product to their newer one since that requires a new contract and implementation (Soarian to Millennium, Magic to Expanse, Paragon to Sunrise, etc.) Otherwise, nobody other than the customer and the vendor cares.

From HIMSSanity Check: “Re: HIMSS19 exhibit hall. I agree with your poll respondents that it should be limited to pure health IT vendors.” I don’t agree, starting with the idea that the exhibit hall is “too big.” It is bigger than I would like, but HIMSS offers the supply of exhibit space that the market demands – vendors wouldn’t keep coming back and buying bigger booths if they weren’t seeing a return on investment (OK, the clueless ones would, but not forever). While I would enjoy not having to walk endless miles to see it all or even to find a particular vendor, it wouldn’t make sense for HIMSS to turn down the revenue that exhibitors are happy to pay. The exhibit hall is like a mall – the big anchor stores are intentionally placed far apart, smaller ones theoretically enjoy the resulting shopper traffic, and any company that doesn’t see value is free to let its lease lapse and spend its money elsewhere. Malls are struggling, though, as consumers have decided that they no longer value the orgy of chain-shopping or plopping their kids on Santa’s lap while mobilizing the hunt for a discounted Instant Pot, and it could be that conferences are also due some attendee recalibration. I’ve always been struck by people and companies who extol virtual visits and monitoring patients remotely, yet still spend their employer’s money to show up simultaneously at a distant location to discuss those very subjects without apparent irony. Here’s an idea – take three work-from-home days, eat and drink way too much while listening to the audio recordings of the educational sessions afterward and looking at vendor ads, and arrange a conference call with old industry friends as do-it-yourself networking. I’ll add one more point to my overly long dissertation – most of us say with honesty that we value the conference mostly for its networking opportunities, but we also expect vendors to foot the bill, which makes the exhibit hall the profit center whose equivalent (in more ways than one) is the casino of a Las Vegas hotel that you can’t avoid while enjoying everything it makes possible.

From Dojo: “Re: anti-vaxxers. Social media shouldn’t give them a platform. Pinterest has started blocking all searches for ‘vaccination.’” Our global problem isn’t that ill-informed and ill-mannered people have learned to use social media — it’s that our society has created so many ill-informed and ill-mannered people in the first place. Soul-sucking Facebook in particular is giving us a scary look into who’s out there (no wonder younger people are abandoning it in droves). The same person spouting vitriol on Facebook probably doesn’t do so in public, however, so the anonymity offered by social media fans those angry flames, mostly again because we aren’t collectively bright enough to avoid giving trolls the limelight they were justifiably denied when responsible people ran media outlets and thus controlled the podium. Those news outlets even make Facebook and Twitter the sources of their stories and then turn the comments of anonymous posters into follow-up stories, which is cheaper than hiring actual reporters to track down facts, especially when readers would rather be entertained than informed.

HIStalk Announcements and Requests

Only around one-third of poll respondents sent or received information by fax in the past year, with just one-third of those who did so saying that it was only for healthcare purposes. I’ll summarize as this – while most of us don’t use fax any more, it’s not just healthcare still using it. Respondent Foxy Faxxer is a clinician who gets faxes – often because nobody can figure out how to use Direct messaging – and has few alternatives since his or her university employer won’t pay for scanners.

That leads me to conclude that faxing is a reliable, free, no-training-required interoperability standard that everyone has agreed on, making it hard to create a business case for replacing it (especially for the sender, who doesn’t really care what happens on the other end). You would be impressed if you took away the “faxing is so 1990s” stigma away and envision a technology in which anyone, anywhere can send you documents of any size, at no cost to anyone, with next to zero work on either end, that can be triggered to automatically create documents from inside even proprietary systems such as EHRs, that arrive immediately and print themselves out into a common workplace in-basket, and that support asynchronous communication. Still, I can’t think of any cases in which I’ve used fax other than in healthcare, where the whole “print, sign, scan, and attach to an email” suggestion raises a contempt-filled “we don’t do that” from the person on the other end who clearly doesn’t care what customers think.

New poll to your right or here: What primary interoperability role should the federal government play?

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

Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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

Sales

• Houston Methodist Hospital joins TriNetX’s global health research network for evaluating study feasibility, facilitating academic discussion, and increasing participation in clinical trials.

Announcements and Implementations

Microsoft will shut down Microsoft Band and Microsoft Health Dashboard apps and services on May 31, following discontinuation of its Band fitness tracker two years ago. The company is offering active users of the service a partial refund of the cost of their Band 1 and Band 2 devices.

Other

A Charlotte, NC man complains to the local TV station after a Novant Health nurse asks him puzzling questions about his huge weight loss, heroin addiction, and suicidal tendencies, after which started receiving large bills for services he hadn’t received. He finally discovered that his identity is tied to four patient profiles in Novant’s EHR, some of them bearing names such as “zzz test z chart correction,” suggesting that someone did their IT testing in the production environment.

BCBS Michigan paid its CEO $19.2 million last year, with the insurer adding that “we are keeping health care affordable to the best of our ability here in Michigan.”

In Australia, a hospital’s internal review concludes that “disjointed information flow” in its Cerner EHR, along with other factors, contributed to a newborn baby’s brain damage. A midwife entered a test result in the EHR that suggested pre-eclampsia, but the obstetrician didn’t see it because OBs use a different EHR view and the catch-all “results view” function wasn’t working correctly. The review also found that clinicians monitored the mother’s symptoms using the wrong assessment tools and that the regional clinic where she was first seen should have given her a paper copy of her record to hand-carry to the hospital. EHealth Queensland had previously issued a patient safety alert that warned obstetricians that the EHR’s labor progression monitoring module wasn’t working correctly and Cerner could not fix the problem, requiring the entire module to be turned off.

Everything that’s screwy about US healthcare, part 59. For-profit mental health and addictions provider Sovereign Health (which shut down last year over fraud accusations) sues insurer Anthem for sending checks for services received by patients to the patients themselves instead of to Sovereign, with many of those patients predictably pocketing the cash like it was lottery winnings instead of forwarding it on to Sovereign. Critics, which include the AMA, say insurers do that to punish out-of-network providers, while insurers say they have no contract with the out-of-network providers and therefore the checks represent true reimbursement to the patient and it’s the patient’s job to make good. A medical ethics professor concludes, “Only in our crazy, market-driven, bureaucratic mess of a system would we think about this kind of a solution … You’re going to be giving out these sums of money that a lot of people never see in a year and tell them their duty is to shift it over to the out-of-network service provider? You can’t be serious.” An attorney representing Sovereign said that sending piles of cash to people who are addicted, some of them who receive the check while still in rehab, is an invitation to disaster, not to mention that insurers don’t tell the providers that they’ve paid the patient. One patient received a check for $240,000 following a surgery.

Sponsor Updates

• Lightbeam Health Solutions team members attend the Dallas Area Habitat for Humanity dedication ceremony for the home they worked on last October.
• Meditech releases the latest episode in its Thought Leader Podcast series, “Addressing the Opioid Crisis.”
• NextGate raised $3,000 for St. Jude’s Children Research hospital during HIMSS19.
• Black Book recognizes Nordic for top EHR implementation consulting, and Epic consulting and advisory services.
• OmniSys will exhibit at the APCI Annual Convention and Stockholders’ Meeting March 7-10 in Nashville.
• Securance Consulting awards CloudWave’s OpSus Live cloud hosting solution a “Best Practice” rating after completing the Meditech Infrastructure and Supporting IT Process Audit.
• Experian Health will exhibit at the MGMA Financial Conference March 3-5 in Las Vegas.
• Visitors to Bluetree’s HIMSS19 booth allowed the Epic consulting firm to donate 624 trees that will be planted by the National Forest Foundation.
• PerfectServe discusses product and bolsters client relationships at its fifth annual customer advisory board meeting.
• PreparedHealth will exhibit at the 2019 AMDA Annual Conference March 7-10 in Atlanta.
• Sansoro Health releases a new 4×4 Health Podcast, “Air-Traffic Control for Patient Care.”
• Surescripts will exhibit at the 2019 PBMI National Conference March 4-6 in Palm Springs, CA.
• SymphonyRM publishes a new e-book, “Competing in an Amazon World: Four-Step Action Plan For Health Systems.”
• The MedTalk Podcast features Wolters Kluwer Health Senior Manager of Clinical Effectiveness Lisa Kean.

Blog Posts

• CMS Emergency Preparedness Self-Assessment Quiz (LiveProcess)
• What we learned at HIMSS19 (Waystar)
• Clinician Satisfaction for Overall Success (Netsmart)
• Charge Reconciliation: Process, Roles, and Reporting (CereCore)
• How Boys Town Hospital overcame its revenue management problems (Experian Health)
• Proof that Psychographic Segmentation Reduces Hospital Readmissions and Cardiac Events (PatientBond)
• Does Your Healthcare Payment Technology Give You the Reports You Need? (Patientco)
• Digital health done right: Murj (Redox)
• I Heard It Through the Go-Live: Episode II (Visage Imaging)
• Consolidating services and extending reach with central patient monitoring. (Voalte)
• The Intersection of Technology and Humanity (Vocera)
• 4 Weird Ways Patients are Finding Your Practice (WebPT)
• Health Information Exchange Accelerated by Rapidly Growing Integration as a Service (IaaS) Solution (Zen Healthcare IT)

Contacts

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

Weekender 3/1/19

Weekly News Recap

• Medsphere acquires Wellsoft
• WellSky acquires HCS
• House VA committee Chairman Mark Takano (D-CA) chastises VA Secretary Robert Wilkie for failing to turn over documents related to the Mar-A-Lago trio’s influence on VA software purchasing decisions
• Crossover Health acquires Sherpaa Health’s technology platform
• More than half of surveyed home care clinicians say they can’t access the hospital EHR records of their patients to reconcile patient medications
• Cedars-Sinai pilots the use of Alexa-powered devices in patient rooms to route their verbal requests and to control their TVs

Best Reader Comments

Over the past month, I’ve been seen several times a week at different specialists within Emory. Every time I’ve checked in, I’ve been handed a printed medication list, asked to make any edits or changes on the paper, these are then confirmed verbally by both nurse and clinician in the exam, and by the next visit (sometimes two hours later, sometimes five days), the new printed list is always accurate. The changes are reflected in the patient portal too (which is to be expected, but God knows that doesn’t always happen…). They’re also the first healthcare org I’ve visited where *every* person who comes into the exam room confirms my name, DOB, and why I’m there. They even squirt on hand sanitizer as they’re walking in the room. Those are seemingly small things, but it’s been one of the most cohesive patient experiences I’ve ever had the pleasure of being involved in, especially considering my case is pretty complex and I’m bouncing around different offices all the time. (AtlantaPatient)

Every time I visit a provider (many different EHR systems), I bring a “yours truly”-generated, printed copy of my current meds (generic name, brand name, dosage, type, instruction; e.g., ALENDRONATE SODIUM (FOSAMAX) 70 MG TABLETS, 1 tablet by mouth weekly) because many of my meds are ordered by different providers. In addition, I take the time to explain the differences between the list they are viewing on their screens and my list. Last, I personally ask the provider to make sure they update their information exactly as I have noted in my list, which typically includes some additions, deletions, dose changes, etc. When I later recheck via my portal to see if the updates occurred (often having to wait until the next provider visit), I notice the same, damn, original list! When I later inquire as to why my requested updates have not been entered in their system, typically the response has been, “Our system doesn’t accept the information in the manner you provided.” (Woodstock Generation)

I wonder/wish if there was a way to quantify how much of Epic’s perennial higher ratings comes from the fact that they made extensive training with proven methods a mandatory part of their contract and implementation? (Smartfood 99)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. I in California, who asked for take-home science projects for her dual-immersion (English and Spanish) fourth grade class whose families are mostly farm workers. She reports, “With your donation, my students were able to work on science projects we normally would not be able to do in fourth grade. Many of my students were so excited at having the ability to look at things under the microscope and would run out to the yard to find things to bring back in to look at. My students particularly liked the bubble science project and looking at different books about projects to do at home with their parents. Any project that allows a student time to spend with their parents is more beneficial than you would imagine.”

I’m not finding much I like among the Oscars “Best Picture” nominees. I though “Bohemian Rhapsody” was toe-tapping, formulaic fiction and “Roma” was beautifully filmed and directed but never really went anywhere. I rented “Green Book” and surely it’s the worst movie to ever win, full of clichés, filmmaking mistakes, and an eye-rollingly sappy story that first presents just a tiny bit of racial unjustice to make us privileged white people feel shame, then let us off the hook with a heavy-handed, feel-good message that we’re all decent people who just need to understand each other better to get along (ample evidence, much of it contemporary, to the contrary). I’m seeing “BlacKkKlansman” next, but it has tough competition from “A Star Is Born,” which ranks above the best movies I’ve seen (I’ve watched it at least four times and will happily do so again). “Green Book” is a middling movie at best, joining other embarrassing Best Picture winners like “The Artist,” “Shakespeare in Love,” and “Chariots of Fire.”

NPR reports that the car problem diagnostic process used by the Magliozzi brothers in its former “Car Talk” program is being used to teach medical students how to solve patient problems by collecting data, defining the problem, and choosing from several possible solutions.

The newly launched Onward offers a “post-breakup concierge service” for outsourcing-comfortable millennials who are “leaving cohabitation” and don’t have friends or family nearby to help. Customers pay $99 to have their housing and moving managed and can buy extra services such as therapist matching, weekly check-ins, and personalized neighborhood guides. It even manages to work in the meaningless millennial word magnet of “curated.”

This might be more dramatic than a Steve Jobs “one more thing” reveal. A surgeon in Barcelona, Spain directs a remote surgery via 5G-powered, high-definition video from the stage of the Mobile World Congress conference. 

Cleveland Clinic confiscated 30,000 weapons from patients and visitors in 2018, which might be a gauntlet throw-down to inner city trauma centers that surely see more weapons (and the result of them) in their EDs.

A baby whose entire life of 572 days was spent in Oishei Children’s Hospital (NY) goes home for the first time, saved by “countless” surgeries after being born weighing just over one pound. He was cleared for discharge months ago after 10 months in the NICU and five in the PICU, but the family couldn’t find homecare nurses who could care for his ventilator. A GoFundMe project has raised $3,700, which will probably cover a few hours of his 19-month hospitalization and none of lifetime expenses afterward (the family needs 16-20 hours of nursing help each day). Meanwhile in Japan, a baby born at just 9.45 ounces leaves the hospital after five months.

A hospital in Jamaica, where pollution makes tap water unsafe to drink, installs hydropanels from Zero Mass Water that absorb water vapor from the air to create 800 gallons of drinking water each month.

A study finds that crematorium workers are exposed to radiation when processing the bodies of people who have undergone radiation therapy or PET scans, with the urine of the single employee tested showing radioactivity that apparently came from inhaling volatilized radiopharmaceuticals. An expert but suggests that crematory workers wear masks and gloves, which seems like an excellent idea.

Illinois health officials warn anyone who flew through Chicago’s Midway Airport last week that they may have been exposed to measles, courtesy of an unvaccinated passenger who flew while infectious. A second warning was issued to anyone who visited Delnor Hospital, where he sought treatment.

Officers from police, fire, and emergency medical departments in Arkansas mobilize via a fellow officer’s Facebook request to line the highways leading to Arkansas Children’s Hospital, where a nine-year-old boy with a terminal illness was making what is expected to be his final journey.

In Case You Missed It

• News 3/1/19
• EPtalk by Dr. Jayne 2/28/19
• HIMSS Financial Highlights
• News 2/27/19
• Curbside Consult with Dr. Jayne 2/25/19
• HIMSS19 Reader Impressions
• Monday Morning Update 2/25/19

Get Involved

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

Morning Headlines 3/1/19

Teladoc Health Reports Fourth-Quarter and Full-Year 2018 Results

Teladoc reports Q4 results: revenue up 59 percent, EPS –$0.35 vs. –$0.76, meeting earnings expectations and beating on revenue.

Bad Actors Getting Your Health Data Is the FBI’s Latest Worry

The FBI believes foreign hackers will soon use medical data gleaned from precision medicine efforts in the US to engage in biological and cyberwarfare, or exploit individuals

Statement from FDA Commissioner Scott Gottlieb, M.D. as prepared for oral testimony before the U.S. House Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies, Committee on Appropriations

The FDA is working to link claims data in its Sentinel medical product safety system to EHRs to more quickly spot potential drug safety issues.

News 3/1/19

Top News

Medsphere acquires Wellsoft and will integrate its emergency department software into a new health IT offering for urgent care centers.

Wellsoft founder and CEO John Santmann, MD will join Medsphere as CMIO.

Reader Comments

From Bjorn To Be Wilde: “Re: Inova. EVP/CIO/CISO Connie Pilot has left, with Bert Reese hired as acting CIO as a national search is launched.” Unverified, but the reader forwarded an internal email announcing the change. Connie Pilot had been on the job just 3.5 years. Former Sentara SVP/CIO Bert Reese has worked for Divurgent since early 2016.

From Oldie Goodie: “Re: oldest healthcare-related blog. I’ve seen at least two that claim they were first, before HIStalk?” Beats me, but I started HIStalk in June 2003, so that’s the bar to clear.

HIStalk Announcements and Requests

Thanks to HIMSS for providing its most recent federal tax forms, which I’ve reviewed here. Takeaways aren’t surprising:

• It pays its CEO a lot (Steve Lieber made $1.26 million last fiscal year)
• It’s a large organization, with 364 employees
• Member dues make up just 13 percent of revenue, with the annual conference and publishing being its biggest revenue generators

Welcome to new HIStalk Gold Sponsor SyTrue. The Chico, CA-based company uses artificial intelligence through natural language processing and machine learning to unlock insights within medical records for health plans and health systems. The company’s technology reads and understands medical terminology similar to the way a healthcare expert does, regardless of medical record format, in less than a second. Find out in less than a second which ICD-10, CPT, LOINC, SNOMED, and HCC codes are present in the same record; identify allergies or meds; and deep dive into personal history or medical necessity to turn medical records into actionable insight. Enterprise-wide semantic search allows quickly finding records with “MI without aspirin,” for example. The company asks, what’s in your medical records? Thanks to SyTrue for supporting HIStalk.

“AP Stylebook” and millions of people have illogically declared the Oxford comma (the one before the “and” in a list) as unnecessary, despite the fact that omitting it saves negligible author time and space while significantly reducing readability and clarity. Quite a few laws and legal judgments in which it was missing have been interpreted in ways that their authors probably didn’t intend, most recently when a dairy lost a $10 million lawsuit because its omission made the law’s intention unclear. Lesson learned: including the Oxford comma never has negative consequences, but it will always prevent readers from stumbling or failing to interpret the author’s meaning. Eats, shoots and leaves.

Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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

Acquisitions, Funding, Business, and Stock

Healthcare software and services company WellSky (the former Mediware) acquires long-term and post-acute care health IT vendor HCS.

Teladoc reports Q4 results: revenue up 59 percent, EPS –$0.35 vs. –$0.76, meeting earnings expectations and beating on revenue. Shares dropped 7 percent Thursday on the news as shareholders were spooked by Q1 guidance.

People

Navicent Health (GA) promotes Omer Awan, MBA to chief information and digital officer.

Mark Roche, MD (Avanti IHealth) joins CMS as its first chief health informatics officer.

Sales

• Sturdy Memorial Hospital (MA) will implement Cerner Millennium.
• The Louisiana Health Care Quality Forum selects API software from Secure Exchange Solutions to enhance its HIE services.
• Health information network EHealth Exchange will integrate its FHIR Healthcare Directory with InterSystems solutions.
• Valley Regional Hospital (NH) switches back to Medhost’s EHR.

Announcements and Implementations

Phoebe Putney Memorial Hospital (GA) rolls out Vocera’s new Smartbadge, which offers hands-free communications.

LifeBridge Health and CareFirst will hold a “Shark Tank”-like pitch challenge for digital health startups in Baltimore on June 5, featuring a prize pool of up to $50,000.

Government and Politics

FDA Commissioner Scott Gottlieb, MD tells House lawmakers that the agency is working to link claims data in its Sentinel medical product safety system to EHRs to more quickly spot potential safety issues and study drug effectiveness using real-world data.

Despite a tech-heavy, long-term strategy and plans to get rid of fax machines and pagers, a new analysis reveals that 42 percent of surveyed NHS providers plan to quit or reduce their hours within the next five years. Topping their list of complaints is the NHS decision to offer virtual visits to every citizen within the next two years, a situation they believe will increase their workload.

Privacy and Security

This article digs into the increasing likelihood that foreign bad actors will use medical data gleaned from precision medicine efforts here in the US to engage in biological and cyberwarfare, or exploit individuals. “If a foreign source, especially a criminal one, has your biological information, then they might have some particular insights into what your future medical needs might be and exploit that,” says Edward You, a supervisory special agent in the FBI’s Weapons of Mass Destruction Directorate, Biological Countermeasures Unit. “What happens if you have a singular medical condition and an outside entity says they have a treatment for your condition? You could get talked into paying a huge sum of money for a treatment that ends up being bogus.”

Other

The University of California won’t renew its journal subscriptions contract with Elsevier after the world’s largest scholarly publisher declined to make UC-contributed research articles available at no charge globally, with Elsevier instead proposing that UC authors pay publishing fees on top of its multi-million dollar subscription. UC says publishing research articles behind paywalls prevents the public from seeing the results of the work they paid for, adding that scientific journals are so expensive that no single university can afford to subscribe to them all.

Large groups of anti-vaccination Facebook users are waging coordinated online harassment attacks against medical experts who recommend vaccination, driving down their online ratings in hopes of hurting them financially. The coordination occurs in closed Facebook groups, such as the one run by a full-time antivaxxer who urged his several hundred thousand followers to take action against a naturopath who testified in favor of vaccination to Washington’s senate. The result was predictably insulting, profane, and science-free.

ProPublica points out the absurdity of pay-to-play professional recognitions like that offered by “Top Doctor” with a tale of how one of its journalists received an unsolicited offer to accept the honor based on bogus peer nominations and patient reviews. He claimed the prize, which came with a plaque with his chosen specialty, for a reduced rate of $289.

Sponsor Updates

• EClinicalWorks will exhibit at the 2019 AAD Annual Meeting March 1-3 in Washington, DC.
• EPSi offers early-bird registration for the Visis:2019 EPSi Summit October 22-24 in Austin, TX.
• Hyland Healthcare demonstrates successful interoperability at IHE Connectathon and HIMSS19. (Hyland)
• Kyruus reports monumental market share gains in 2018 with more than 225,000 providers at nearly 500 hospitals nationwide now on its platform.
• The Chartis Group publishes a new paper, “The New World of Healthcare Partnerships: Technology Companies.”
• Nordic moves to expanded office space in its hometown of Madison, WI.

Blog Posts

• For Best Results, Engage Your Patients! (EClinicalWorks)
• Looking Back on HIMSS19 – Looking Forward to an Exciting Year in Health IT (FormFast)
• The Importance of User Experience for Interoperable Adoption (The HCI Group)
• 3 Reasons You’re Still Receiving Faxed Refill Requests & How You Can Reduce Them (Healthfinch)
• HIMSS19 Was All About Data (Healthwise)
• Huntzinger Recognizes Hospital for Special Surgery – Winner of the HIMSS Davies Award of Excellence (Huntzinger Management Group)
• 2019, The Year of Telemedicine? (Optimum Healthcare IT)
• What We Learned at HIMSS19: EHR 2.0, AI, Interoperability, and More (Spok)

Contacts

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

EPtalk by Dr. Jayne 2/28/19

I’ve been rationing my fun socks post-HIMSS. Today was the day to show off these polka dot doozies from the amazing CoverMyMeds sock machine. I have to give them props for the best swag-dispensing system on the show floor. If you were willing to hit Twitter and follow some basic instructions, you got a great pair of socks.

I checked in on the company’s statistics. They have helped complete 128 million medication prior authorizations. More than 700,000 providers have used it and they are connected to 96 percent of pharmacies. The service remains free for providers and partners, with health plans, PBMs, and drug companies footing the bill. I don’t run across many prior authorizations for medications in the urgent care space, but if I was back in traditional practice, I think it would be a must-have.

I needed my great socks to boost my mood since I’ve been having adventures in collaborative software this week following an organization rollout of Microsoft Teams. It seems like nothing lasts for more than a year or two here and we’ve been through an entire progression of applications, from Windows Live Messenger to Skype to Slack to Yammer and now to Teams. At one point we also had HipChat in the mix, which created confusion since people were expected to collaborate on multiple platforms depending on who we were working with.

Although use of the actual Teams platform has been seamless, I’ve been struggling because since we went live I can’t use my OneDrive documents offline and no one can explain why it’s not working. I discovered this not-so-little issue when I was on a flight with no Wi-Fi service and couldn’t even edit documents, despite them being stored “on” my laptop within OneDrive. There’s a ticket open on my behalf with Microsoft, but it’s already been a couple of days and I’m not hopeful about a resolution. If anyone has seen this and has any ideas, let me know.

I was pleased to see that the HIMSS Electronic Health Record Association (EHRA) is working to make it easier for physicians to effectively use data to avoid opioid misuse. The US has a patchwork of Prescription Drug Monitoring Program (PDMP) systems by state (except for Missouri, which still can’t seem to get its act together). The systems function differently depending on state laws, which can be challenging for providers practicing on state borders. It’s also challenging for EHR developers who have to try to figure out how to create solutions that work across the country.

EHRA has put together a compendium of state-specific policies and standards, including what data is being collected and who can access it. EHRA’s Opioid Crisis Task Force has also created an “ideal minimum data set” detailing the information needed to best support clinicians who are making decisions around opioid prescriptions. The ultimate goal is to be able to create a standard for PDMP data that would be consumable by EHRs and useful to clinicians. EHRA notes that they’d like to work with ONC and other stakeholders in this effort. I agree it would give the effort some teeth since it’s often hard to herd the states in a common direction.

CMS is holding a listening session on March 5 covering the Interoperability and Patient Access Proposed Rule. Registration is open for the session, which will include opening comments by CMS Administrator Seema Verma followed by an overview of the proposed rule. Participants will also be able to submit questions and get clarifications that are needed prior to submitting formal comments to CMS.

Many physicians have concerns about the impact of patient satisfaction scores on their overall performance including how they play into compensation and insurance rating issues. An article published this week gives credence to some of those concerns. The investigators set out to specifically investigate whether Asian physicians received lower patient satisfaction scores compared to non-Hispanic white physicians. Researchers surveyed nearly 150,000 patients and found that those who self-identified as Asian were less likely than other patients to give their physicians the highest ratings for patient satisfaction. Overall, Asian physicians had lower patient satisfaction scores due to the higher proportion of Asian patients treated by those physicians.

There were other subtle differences in the data depending on the characteristics of the patient and physician populations. The authors encourage organizations that use patient satisfaction scores to drive provider compensation to look at the possible need to adjust their numbers based on patient race and ethnicity.

As physicians try to be more responsive to the cultural preferences and practices of patients, this type of research is going to be more important and brings up many questions. What defines a particular race or ethnicity? What if you are Asian but were raised by a Midwestern Caucasian family with no connection to your birth culture? What if you are Caucasian but grew up deeply immersed in the Latino community? How do you grade a physician based on true cultural competency vs. their ancestry or genetics?

The study looked at data gathered from 2010 to 2014 from a community health clinic in northern California. What would the data look like if it were gathered from a practice in another part of the country or with a different socioeconomic makeup? What about a more recent timeframe given the speed of change regarding cultural practices?

These are important factors to consider, but they aid in exposing how difficult it is to measure patient satisfaction and the various factors that might go into it. How do you control for compassion and communication when looking at clinician behavior? I’ve heard some interesting physician comments on the study, but would be curious to hear what others in the healthcare community think and also what people think as patients.

I’m waiting for the HIMSS session recordings to come out so I can finish “attending” sessions and claiming continuing medical education (CME) credits. It seemed like many of the sessions I wanted to attend were at the same time, so I’ve got some catching up to do. Despite the availability of on-demand recordings, we’re still limited to only claiming credit for one session per real-world time slot. In the age of electronic media, it would make more sense to allow participants to claim the credits that best meet their professional development needs rather than limiting them by their inability to be two places at once (which used to be reality before recordings).

I’d be fine with still capping the overall number of hours if granting too many hours is part of the concern, but I think this is one of those situations where we’ve simply added technology to an old-school process without revisiting how it might best serve the end users. For the hours to count for the CME needed for Clinical Informatics you have to also complete questions on the learning objectives so it’s not like a bunch of us are trying to game the system.

Email Dr. Jayne.

HIMSS Financial Highlights

HIMSS sent me a copy of their most recent Form 990 tax filing for the fiscal year ending June 30, 2017. These are the highlights.

Yearly Accomplishments

• The strategic business unit completed 96 percent of its tactics
• The organization supported 68,000 members
• It published 750 tangible resources
• It established relationships with CMS, FDA, and the White House

Revenue

• Total revenue was $88.5 million
• Expenses were $87.6 million
• Revenue less expenses was $925,000

Revenue Contribution

• Annual conference $29.9 million (35 percent of the total)
• Publishing $13.9 million (16 percent)
• Dues $11.7 million (14 percent)
• Corporate sponsorship $9.9 million (11 percent)
• Global conferences $9.4 million (10 percent)
• Other $11.6 million (13 percent)

Salaries

• The total compensation of then-President and CEO Steve Lieber was $1.26 million
• EVP Carla Smith earned $685,000
• Most of the other six VPs earned in the $300,000 range
• HIMSS Media EVP John Whelan was paid $421,000 and two of its media salespeople earned in the $300,000 range (much of that as incentive pay)
• HIMSS paid 364 employees a total of $42 million

Expense Notes

• HIMSS spent $14.7 million to operate the annual conference
• The largest outside expense was the $5.6 million paid to event management vendor Freeman
• It paid a marketing software company $1 million for a HIMSS Analytics tool that allows customers who are in sales to prospect