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EPtalk by Dr. Jayne 2/8/18

February 8, 2018 Dr. Jayne 3 Comments

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We’ve heard a lot of stories lately about people behaving badly (not to mention criminally), and frankly there are too many stories of harassment to count. The AMIA Board of Directors released a new anti-harassment policy that applies to future meetings. I was pleased to see that they called out the unacceptable behavior of “real or implied threat of professional or personal damage.” Fear of retaliation or professional retribution are powerful forces that keep people from reporting harassing and unprofessional behavior. Simply having a policy isn’t going to stop abusers, but it may make them think twice about their actions. Regardless, I’ve seen too many institutions sweep inappropriate behavior under the proverbial rug, so kudos to AMIA for providing leadership.

In the current climate, organizations need to get serious about educating their employees about problematic behaviors and reducing situations where harassment and abuse can occur. HIMSS is coming and it will be interesting to see if the parties are any less alcohol-fueled than in previous years. I was harassed by a vendor sales rep the last time HIMSS was in Las Vegas and didn’t say anything because I just wanted to get away from the situation and forget about it. Thinking back, I’m still disheartened that the other sales folk that witnessed it didn’t say anything either, because they were people I had known for many years. I’m hoping that both victims and witnesses are increasingly empowered to say something and make sure that abusers know their behavior is not OK.

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Speaking of HIMSS, if you’re planning your wardrobe, too bad you can’t get a pair of Intel’s new Vaunt smart glasses yet. A worthy successor to Google Glass, they don’t look too different from typical spectacles. The main feature is retinal projection, which makes you feel like you’re looking at information on a screen. The glasses don’t have a speaker or a microphone, which saves on weight and adds more normalcy. An early access program will launch for developers later in the year. If they’re looking for any sassy physicians to give it a try, I’m definitely game.

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I was beyond disappointed to hear of Jamie Dimon’s comments that walked back the Amazon, Berkshire Hathaway, and JPMorgan Chase healthcare venture. Apparently now it’s only going to be targeted to benefit employees of the three companies, and are sounding more like a group purchasing arrangement than the lofty endeavor we heard about last week. We need someone to shake up healthcare, but to do it in a way that includes a rational business plan rather than hype. I had hoped that these companies would be the real deal, but they’re already sounding like a fizzle.

In actual news that might help patients deal with the high cost of care, the FDA reports that 2017 was a record year for approval of generic drugs, with 843 medications receiving full approval. I haven’t seen any statistics on “formerly generic drugs that we let manufacturers re-brand and drive up the cost” such as Colcrys, but I’d like to see what that category looks like over the last several years. Despite a generic being available again after the three-year period of exclusivity for Colcrys, prices haven’t dropped anywhere near the historical price of generic colchicine. It was around 10 cents a pill prior to Colcrys, then went to $5 per pill, and even the generic still sits near $4 per pill ($2.50 if you can find a really good coupon). I get that it’s capitalism at its finest, but for patients, it’s terrible.

Even though we’re seeing a spike in flu cases, we have many patients coming in with severe illness because they’re trying to avoid medical costs. Patient deductibles reset on January 1, and with many more patients using high-deductible plans, cost of care is right in front of them rather than months later when the explanation of benefits arrives.

My practice’s cost of care is higher than it might be at a primary physician, but still significantly less than the emergency department, so patients are often pleasantly surprised at the end of their visit, especially if we’ve had to do a significant procedure such as a laceration repair or a CT scan. Our physicians are very conscious of our charges and how we fit into the overall healthcare expenditure scheme, so we can educate our patients as they make choices.

I wonder how many physicians truly understand how much the care they’re delivering costs and what value it does (or does not) bring. Every day I meet physicians who are having quality metrics data entered on their behalf and reported behind the scenes so they can check a box to avoid payment penalties. They have no idea what their actual numbers look like and aren’t using them to change how they deliver care. Now that is truly a waste of time, money, and effort.

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The best thing I did this week was rearrange a meeting to be able to watch the Falcon Heavy live stream on Tuesday. Many kids dream of being an astronaut, but I took it one step farther and wanted to be the first doctor on a permanent space station. I figured by the time I finished medical school and residency, certainly we’d have civilians living and working in Earth’s orbit. That dream wasn’t to be, but I still find the idea of space travel fascinating. In some ways, my generation became somewhat spoiled by the seemingly “routine” nature of the Space Shuttle program even with its tragic accidents. Movies like “Apollo 13” and “Hidden Figures” gave us a new appreciation of what it took from a STEM perspective to make space travel possible. I still can’t believe we put people into orbit and later went to the moon with human computers and slide rules making it possible behind the scenes.

Hopefully a new generation of kids will be inspired by what they saw this week and will do some deeper digging. The Tesla may have been the first midnight-cherry roadster launched into space, but three other electric cars went before it on Apollo 15, 16, and 17. The story of our journey up to this point, both manned and unmanned, is inspiring. We need many more young people to be as fascinated by science and engineering as they are by pop culture and social media if we’re going to solve some of the biggest problems we’ll face in the next hundred years. If you didn’t have a chance to watch the launch, I highly recommend viewing the video, especially when the side boosters re-enter and land, starting around seven minutes into the flight.

Email Dr. Jayne.

Morning Headlines 2/8/18

February 7, 2018 Headlines No Comments

Immelt’s Life After GE Leads to Health Firm Targeted by Activist

Athenahealth continues its leadership restructuring with the appointment of Jeff Immelt as chairman – a position previously held by CEO Jonathan Bush.

US Judge Dismisses Whistleblower Claim Against Epic

A US District Court Judge tosses out a 2015 lawsuit claiming Epic’s anesthesia module enabled hospitals to overbill Medicare and Medicaid.

Cerner will boost Kansas City workforce by 600

Cerner will use reinvested tax break money to hire 600 workers at its headquarters in Kansas City, MO.

Morning Headlines 2/7/18

February 6, 2018 Headlines 4 Comments

Strange Bedfellows? Group Unites Old Foes in Hunt for Health Fix

Former CMS Acting Administrator Andy Slavitt joins several luminaries to launch a nonprofit, nonpartisan group that will push for federal healthcare policies its members believe are nearly universally supported despite political differences.

Cerner posts record bookings of new business after stumbling three months ago

Cerner’s Q4 results in a mixed bag of record bookings and disappointing profits.

Computer problems in the NHS could be blamed for hundreds of deaths, experts say

British academics call for a public inquiry into the state of NHS hospital software after combing through clinical negligence claims related to old, low-quality computers.

News 2/7/18

February 6, 2018 News 5 Comments

Top News

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Former CMS Acting Administrator Andy Slavitt joins several luminaries to launch the non-profit United States of Care, a non-partisan group that will push for federal healthcare policies that it believes are nearly universally supported despite political differences.

Among its members are health system executives, actors, Mark Cuban, Atul Gawande, former US CTO Todd Park, and former Republican Senate Majority Leader Bill Frist.

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Slavitt describes the group’s goals in a Health Affairs blog post.


Reader Comments

From Orbiter: “Re: HISsies awards. I got my ballot, but how are you presenting the results without an HIStalkapalooza?” I could do some kind of Web extravaganza via GoToWebinar with celebrity participants and live reaction from the winners (perhaps including a virtual pie in the face), with the cost underwritten by the “worst vendor” winner. Or, maybe I’ll just run the PowerPoint results sometime before, during, or after the HIMSS conference. Guess which?

From Integumentary Film: “Re: HIMSS. What are you looking forward to most?” Two things: (a) not having to deal with HIStalkapalooza headaches, and (b) checking out vendors undercover in the exhibit hall. I have planned nothing for the entire week – no events, no meetings, no must-see educational sessions – so I’ll just be letting the HIMSS breeze (including the inevitable hot air) carry me.


HIStalk Announcements and Requests

Does it seem that there’s less industry news to read today? It’s that time of year when vendors start creating their backlog of self-serving announcements, mistakenly thinking that they’ll get more exposure and booth traffic if they hold off announcements until Tuesday, March 6. HIMSS is just 25 days away and the smart companies are building the PR momentum now instead of after it’s too late to take advantage of it.


Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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


Acquisitions, Funding, Business, and Stock

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Cerner announces Q4 results: revenue up 4 percent, adjusted EPS $0.58 vs. $0.61, missing Wall Street expectations for both. President Zane Burke describes the company’s FY2017 as, “We finished the year on a mostly positive note, with record bookings and all other key metrics except for earnings in line with our expectations,” which glosses over the significant point that the company’s all-important profit number disappointed everyone, including Cerner itself.

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Varian acquires radiation oncology QA software vendor Mobius Medical Systems for undisclosed terms.

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JPMorgan billionaire CEO Jamie Dimon had to soothe the ruffled feathers of the company’s healthcare clients after the announcement that his company — along with Amazon and Berkshire Hathaway – will work together to reduce the healthcare costs of their 1.2 million employees. The company’s healthcare bankers – who drive $682 million in annual revenue – reassured their customers that the partnership won’t really be as disruptive as people are wildly speculating, but instead will be more like a group purchasing organization that will help the companies negotiate better prices for services their employees consume. Insiders say that more-disruptive activities that were discussed, especially with Amazon’s involvement — such as offering health insurance, starting a pharmacy benefits management company, and distributing drugs – are now off the table.

NantHealth CEO Patrick Soon-Shiong is rumored to be close to acquiring the Los Angeles Times and San Diego Union-Tribune for $500 million. Declining business and a series of missteps at the LA Times by owner Tronc – the former Tribune Publishing, in which Soon-Shiong is a major shareholder – have resulted in a two-thirds cut in reporting staff, heavy-handed management intervention into editorial issues to appease advertisers, and a vote by newsroom employees to join the union.


Sales

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UCSF Health (CA) selects Voalte for enterprise communications across six hospitals.

Pickens County Medical Center (AL) chooses Cerner Millennium, delivered via the CommunityWorks hosted model.


Announcements and Implementations

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Michigan Medicine offers virtual visits for minor illnesses such as adult flu, offering a same-day response to symptom questionnaires submitted by noon or within 24 hours if completed later in the day. The seven-day-per-week service costs $25 and is accessed through the health system’s Epic MyChart patient portal.

LifeImage launches Clinical Connector, a vendor-neutral, standards-based platform by which clinicians and patients can access medical images and information from PACS and EHRs across sites. The project began as the LifeImage-powered RSNA Image Share pilot that winds down in March.

DrFirst announces that its real-time prescription benefit checking service has been used 6 million times, saving patients an average of $11 for a 30-day prescription.


Government and Politics

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This isn’t directly health IT related, but it’s important for healthcare journalism, of which I’m the fringest of players. CMS threatens to ban Modern Healthcare Washington bureau chief Virgil Dickson from its news conferences after he wrote a story blaming the resignation of a high-ranking Medicaid official on that official’s clashes with CMS Administrator Seema Verma. I Googled the name of the spokesperson who told Dickson’s editor that he would be banned unless he rewrote his story — Brett O’Donnell is working under a private contract with CMS after (or during) his career as a political communications consultant (nicknamed “Tea Party Whisperer”), during which he pleaded guilty in 2015 to lying to House ethics investigators.


Privacy and Security

In England, Department of Health officials admit that every one of 200 NHS trusts have failed new, tougher cybersecurity requirements, many of them because of delays in system patching.


Other

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Google’s DeepMind reports “promising signs” from its research project with NHS Moorfields Eye Hospital to analyze retinal scans with AI to detect eye disease. Its report has been submitted to a peer-reviewed medical journal.

In Ireland, a review of last year’s incident in which the country’s national imaging system was found to ignore the “less than” symbol finds that no patients were harmed as a result. The Health and Safety Executive says Change Healthcare did not tell it about a software update that fixed the problem, so it didn’t apply that update.

Lancaster County, PA’s Coalition to End Homelessness creates a social services data system that allows people to sign up for multiple programs with a single, universal electronic form that sends information to 40 participating organizations and then allows the groups to coordinate their efforts. The local health system CEO says she has HIPAA concerns with such a project and the hospital won’t participate because it doesn’t have the resources. The cloud-based system vendor is CaseWorthy, which says its system meets HIPAA requirements. It is apparently working on integrating its system with Epic.

In Australia, a coroner finds that an inpatient’s death after routine knee surgery was due to a drug overdose that was caused by an anesthesiologist entering the wrong product in Macquarie University Hospital’s just-implemented InterSystems TrakCare system. The doctor admitted that he wasn’t trained on the system and didn’t follow up when he noticed his patient wearing a pain patch that he didn’t intentionally prescribe.

Vince takes a look back 30 years, when magazine ads featured decisive hospital executives wearing three-piece suits and clinicians literally dancing with EHR delight, which might make you think the hospital IT wars had been fought and won to the musical backdrop provided by chart-toppers Tiffany and the manufactured Latin-influenced band Exposé.

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This tweet is brilliant.


Sponsor Updates

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  • DocuTap employees restock The Teddy Bear Den, an incentive and education program for limited-income pregnant women and their children.
  • PerfectServe publishes a new customer success story, “Chicago-based ACO and managed care organization Advocate Medical Group (AMG) strengthens continuity of care for patients.”
  • AdvancedMD will exhibit at the Association of Dermatology Administrators & Managers February 12-14 in San Diego.
  • Besler releases a new podcast, “The impact of 340B changes on providers and beneficiaries.”
  • CarePort Health will exhibit and present at the California Hospital Association’s Post-Acute Care Conference February 15-16 in Redondo Beach, CA.
  • Healthx teams with Change Healthcare to provide cost transparency tools.
  • CompuGroup Medical encourages support for health center funding via the Red Alert campaign.
  • Cumberland Consulting Group will sponsor Model N Rainmaker 2018 February 12-14 in Carlsbad, CA.
  • Dimensional Insight will host a regional user meeting February 8-9 in Amelia Island, FL.
  • Divurgent publishes a new success story, “Cybersecurity Transformation Program.”

Blog Posts


Contacts

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

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Morning Headlines 2/6/18

February 5, 2018 Headlines 4 Comments

Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model

Three months after cancelling its Shared Decision-Making Model, CMS scraps the Direct Decision Support Model, which would have encouraged non-provider organizations to involve beneficiaries in care decision making using tools like digital health apps. 

Malware incident discovered in May, 2017 affected 2,600 patients: Partners HealthCare System

Partners HealthCare (MA) reveals a May 2017 data breach that may have exposed the information of 2,600 patients.

Agility Health Announces Definitive Agreement to sell US-Based Operations

Alliance Physical Therapy Management will acquire outpatient rehab and PM software company Agility Health’s US operations for $45 million.

International Olympic Committee and GE Healthcare Launch Analytics Tool to Help Drive Precision Health at the Olympic Winter Games

GE Healthcare develops an Athlete Management Solution for the upcoming Olympic Winter and Summer Games that will offer athletes personalized medicine using aggregated data, dashboards, and analytics.

Embrace by Empatica is the world’s first smart watch to be cleared by FDA for use in Neurology

MIT Media Lab spin-off Empatica receives FDA clearance for its smart watch that has been shown to detect the onset of seizures in patients 100 percent of the time.

Readers Write: Healthcare CIO Tenure Trends

February 5, 2018 Readers Write No Comments

Healthcare CIO Tenure Trends
By Ranae Rousse

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Ranae Rousse is VP of sales for Direct Consulting Associates of Solon, OH.

Last year while supporting one of the many local HIMSS chapter events, a keynote speaker presented a statistic that caught my attention. The speaker was presenting on the rise of cybersecurity threats to healthcare. The first slide in his well-constructed PowerPoint presentation had a bolded “17 months” with a font size of about 200. The gentleman then shared with the attendees, most of whom were CIOs, that 17 months is now the average tenure for a chief information officer.

I asked for the source of the 17-month statistic and found that it was for CISOs rather than CIOs and it was also not specific to healthcare. I decided to do my own research with an independent survey of 1,500 healthcare CIOs. The results:

  • The average tenure for a healthcare CIO is 5.5 years, with the range from five months to 23 years.
  • 37 percent of respondents were not healthcare CIOs in their previous jobs. Those who were tended to have longer tenure in their previous CIO positions.
  • 44 percent of the respondents said they don’t have a succession plan. Those respondents also did not have a requirement to appoint a successor.
  • 69 percent intend to retire as a healthcare CIO, although 11 percent say they would purse a COO/CEO role and the remaining 20 percent were split equally between moving to a consulting job or leaving healthcare.

Increases in mergers, acquisitions, and hospital closures between 2008 and 2017 reflect a loss of roughly 280 hospitals, so the number of CIO positions is decreasing. The perception of the CIO role itself has changed from being a senior IT leader to becoming a higher-level healthcare executive, opening the door for the role of the associate CIO in many large health systems.

Considering this ever-changing landscape; what trends can we anticipate for the future?

Readers Write: The Secret to Engaged Physicians at Go-Live: Personalize the EHR

February 5, 2018 Readers Write 1 Comment

The Secret to Engaged Physicians at Go-Live: Personalize the EHR
By Dan Clark, RN

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Dan Clark RN, MBA is senior vice-president of consulting at Advisory Board.

I often compare an EHR implementation and go-live to getting a new smart phone. Out of the box, it’s a powerful tool, but it doesn’t truly become effective until you start to download applications, add your email and contacts, and pick a personal picture as your background.

Just like your new smart phone, EHRs aren’t ready to perform at their best out of the box and always require some degree of personalization. EHR personalization may sound like one more step in a long, multi-staged implementation and go-live, but it can often be the difference between adoption and rejection.

New technology will always be a disruption, but personalization can minimize a new EHR’s negative impact on patient care by matching new tech to existing clinical workflow, not vice versa. While it’s important to focus on “speed to value” with a new EHR, health systems that take the time to personalize workflows for specialties and individual providers typically see a much higher rate of adoption and a quicker return to pre-go-live productivity.

Health systems should consider a multi-layered approach to personalization. At the very least, health systems should design technology that aligns the EHR to serve high-level strategic goals, such as quality reporting and provider productivity expectations.

When it comes to the individual user level, almost every health system starts with didactic classroom trainings that may combine users from a variety of different clinical and administrative areas. While this is a good baseline, it’s challenging to teach a course that applies to doctors and nurses, front office staff, and revenue cycle alike. Physicians, specifically, report that these sessions take time away from their patients and don’t always provide the value they are hoping they will.

Because of this, one-on-one opportunities for personalization are most efficient and have the biggest impact. I typically see health systems tackle one-on-one personalization support in a couple of ways. The first is setting up a personalization lab. Prior to go-live, we set up a 24/7 personalization lab right in the physician’s office or hospital. This gives clinicians the opportunity to stop in with ad hoc questions, or better yet, make a formal appointment with a clinical EHR expert. These sessions are guided by an extensive checklist of EHR personalization options, fine-tuning everything to the clinician’s preference and specialty.

One orthopedic surgeon came back to the personalization lab four times, and that was after she had already completed the classroom training. We worked with her to personalize specific workflows, order sets, and even simple things like page setup in the EHR.

Personalization serves as just-in-time training and is usually well received by the clinicians. Sometimes this training takes the form of a mobile workstation in the hallways that caters to clinicians’ in-the-moment questions during their breaks and doesn’t pull them away from patients. This kind of assistance is also usually well received by clinicians since it gives them a chance to ask a question about a real patient scenario.

The trick to getting EHR and go-live training right, in any scenario, is to provide the right support—other clinicians who will stand at the elbow with the providers as they navigate real scenarios and issues. And staffing your personalization lab with clinicians will give you the best bang for your buck, providing your staff with clinical and technical expertise. Trainers that combine EHR acumen with clinical expertise and knowledge of appropriate workflows can help clinicians hard code best practices into the technology in a way a technical expert may not.

EHR go-live is an anxiety-ridden time for all health system staff, clinicians and non-clinicians alike. It’s important that all staff feel they have the support, training, and preparation to use the EHR to its fullest potential to impact patient care.

Curbside Consult with Dr. Jayne 2/5/18

February 5, 2018 Dr. Jayne No Comments

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I receive quite a few requests from readers wanting to pick my brain about various topics. This week brought questions about Apple’s new Health Records. There are concerns that patients can change or hide information, which makes them less reliable should patients want to show them to physicians. A reader asked what I thought about it.

Frankly, hiding or changing information is nothing new. Patient-provided medical records of the past (mostly from memory) can have dramatically variable reliability. Sometimes people don’t remember a procedure or lab they’ve had done or don’t think a piece of their history is relevant. Other times patients intentionally alter the facts, leaving out details that they think might negatively impact their interaction with the physician or that might make it into records for potential release.

One of the best examples of this is asking patients about their alcohol intake. In medical school, we often joked about the rule that whatever the patient says should be doubled. The advent of EHR documentation has forced our questions to be much more detailed, so it’s difficult to tell whether that still holds true.

Does asking for more detailed information make the data more reliable? Do patients just round down because they’re tired of answering so many detailed questions? I would be interesting to study, although I don’t see such an exercise being funded any time soon. Patients also tend to intentionally leave out other confidential information such as sexual history, drug use, incarceration, and more. This happened in the paper world, and whether it’s worse in the digital world or not remains to be seen.

Then there are situations where patients might want to remove information because it’s inaccurate. I’ve had it happen to me, where an erroneous diagnosis was entered into my chart. Once that happens, it becomes nearly impossible to remove it. I’m surprised by how many ambulatory organizations don’t have good records correction policies. As long as an audit trail exists, erroneous information that hasn’t been acted upon should be able to be removed from the chart in a way that it doesn’t continue to haunt the patient. Of course, it’s a different story of the erroneous information has been acted upon, and it might need to remain in the chart in a modified fashion to document a decision process or an adverse event.

In many instances, a patient-curated chart might be more accurate than some of what we inherit from other physicians, especially if the patient is engaged and has a high degree of health literacy.

In short, I don’t think the fact that Apple will let people edit their records is a big deal. I personally don’t see the app getting a huge amount of traction, but we’ll have to see what the coming months bring once people start downloading and using it.

Another reader wanted to pick my brain about why I still attend HIMSS. As the cost of attending continues to rise, it’s something I weigh each year. So far, the benefits continue to outweigh negatives, and as long as they do, I’ll likely attend. What do I find beneficial?

  • It’s an easy way to pick up 20 of the magical LLSA Credits that those of us who are board certified in clinical informatics need. Many of the sessions are actually relevant to what we do as informaticists, unlike some of the other LLSA-eligible coursework out there such as undersea / hyperbaric medicine and occupational health. Even though some of the sessions can be stale, there is often lively discussion and I’ve met a good number of people with similar interests in sessions that I correspond with.
  • Meeting people face-to-face is valuable and HIMSS is an easy place to do it. Many companies don’t send people to the conference and don’t exhibit, but they know that there is going to be a critical mass of people wherever the conference is held. Last year, I had at least a handful of vendor meetings with people who weren’t registered for HIMSS but came to town to do business. I was able to use the opportunity to make decisions on products and strategy for my clients.
  • Some of the less-flashy parts of the meeting are good opportunities to talk to people in the trenches. I spent a fair amount of time in the Interoperability Showcase over the last couple of years, talking with the people who actually build the solutions that are in the field. Once you get past the demos (which can range from engaging to lackluster), people are eager to talk about the work they’re doing and how it’s behaving in the real world. Presenters seem willing to talk about what they’ve seen go wrong as well as what has gone well, and that’s where real learning happens.
  • The exhibit hall, in its own crazed, deranged, over-the-top way. It’s interesting to see what companies decide to put front and center. Sometimes it’s something truly interesting, and sometimes it’s just a smokescreen for the fact that they really don’t have anything new to talk about. It’s a decent way to check out comparable products from different vendors without having to schedule people to come to the office, and to be able to go back and forth and make purchasing decisions. I did this a couple of years ago with workstation carts. The time it would have taken to try to do real comparisons while meeting with vendors in the hospital would have been untenable, but having all the competitors on the same show floor was a timesaver.

I have to admit, I have a love/hate relationship with the exhibit hall, though. The excess makes me nauseated, as do the reps that can’t engage and the companies that think prospects aren’t smart enough to figure out that they’re showing vaporware. I’m tired of the luxury cars, jet skis, and Vespas, yet I’m entertained by the magician. For someone who spends most of their day being cool, collected, and logical, the fact that it’s so overwhelmingly overdone makes me think in a different way. And then there’s the scones — can’t forget those for putting a smile on your face.

I also have a bit of a love/hate relationship with the parties and social activities, of course with the exception of the late HIStalkapalooza. I enjoy the networking and meeting new people and learning what’s going on elsewhere in the industry, but attending both as me and as my alter ego can be tricky. I think the kind of event that a company throws says a lot about their strategy and how they see themselves, as well as how they’re trying to position their products. Are they the wild and crazy party guys? Are they the quiet trip to the symphony? Are they the people that invite you and then un-invite you? If the latter happens, that’s a huge red flag for a company you do not want to do business with.

I do love some of the social media meet-ups, even though I attend incognito. It’s good to talk with people who face some of the same challenges that I face in writing every week and trying to keep things fresh in an industry that sometimes feels like it has a deadly undertow. There’s no one in my real life that I can talk to about blogging or how to navigate the industry.

Last but not least, HIMSS is the one time of year I get to see my HIStalk family. What we do is usually a solitary activity, so it’s great to be able to spend time together and get to know each other as people rather than just lobbing columns and articles and “hey, did you see this?” messages back and forth.

I’d like to see HIMSS dial it down a little and work on providing a better value proposition for more attendees, but I’m not too hopeful that they’re going to change the recipe (or the venues, for that matter, since we’re likely permanently locked into the Las Vegas-to-Orlando death march).

Now that my brain has been thoroughly picked, let’s hear from some readers. Why do you attend or not attend HIMSS? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

February 5, 2018 Interviews 1 Comment

Rob Culbert is founder and CEO of Culbert Healthcare Solutions of Woburn, MA.

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Tell me about yourself and the company.

I started my career in the mid-1980s with a company called IDX. I had the pleasure of watching IDX grow by leaps and bounds over a nine-year career. I’ve been in the consulting world for over 20 years, starting Culbert Healthcare Solutions in 2006. We are just entering our 13th year, having a blast, and trying hard to help customers through all these crazy times of healthcare.

How is consolidation in health systems, software vendors, and consulting firms affecting your company and the industry as a whole?

We’ve seen it as well. It’s hard to avoid it. In some ways, it’s positive because it’s an opportunity to gain efficiencies through economies of scale.

The areas where we have seen it the most have been around organizations coming together and either consolidating billing operations or creating centralized billing functions. Also with IT opportunities. In many cases, organizations are able to make better IT decisions when they can spread the cost over a larger population to pick the technology that makes the most sense for the newer organization. It’s a win for the patient, obviously, the more centralized an electronic health record. From a billing and efficiency standpoint, organizations have great opportunities to do their job easier.

What is the impact of Epic and Cerner offering systems appropriate to smaller hospitals?

It helps the vendors get a customer that they might not otherwise get. The need and the interest in being able to outsource IT for organizations that don’t have the bandwidth to hire the technical talent in-house — it makes it a tougher decision if they have to own that responsibility. If they can leverage a larger organization that can provide security and disaster planning, then it’s the difference between selecting a system vendor and not selecting a system vendor.

People have always said that it’s hard to sell small hospitals pre-packaged software that was designed to meet the more complex needs of larger hospitals. Do you get calls now from some of those small hospitals that are implementing Epic and Cerner who need help with implementation, maintenance, and optimization?

We do. You’re right, it is amazing that smaller hospitals that you wouldn’t have thought of as being a traditional Epic or Cerner customer can now take advantage of that technology like the big boys. We see it quite a bit, whether it’s through an affiliation with a larger organization or becoming part of a larger organization. It really does help them to be able to get access to a system.

The content that has been provided by the vendors, in addition to the software, helps organizations make the right install decisions. There’s a whole lot more tools to help them through that process than there used to be. The timetable of how it takes to implement a hospital on these systems has narrowed quite a bit to make it a win-win.

Are hospitals with less-certain margins questioning the ongoing cost of maintaining these systems?

I would say it’s the number one worry that they have. Trying to balance the user’s need for functionality and technology to do the job and the costs associated with providing that technology and supporting that technology. There’s always a balance.

The challenge in looking at it compared to earlier times is that systems are more integrated now. Typically when we were involved in a practice management implementation or a hospital billing system implementation, you didn’t get involved with people outside of those departments. That can’t be the case now because so much of what clinicians do, in terms of entering medical data for electronic health systems, is going to ultimately feed the billing side of the house. There has to be a whole lot more coordination.

If you look at total cost of ownership and take out the non-pure IT costs that can be eliminated if you set up the systems correctly, the cost of expensive systems comes significantly down.

Are hospitals looking back at the cost and effort of implementation to decide if they got their money’s worth?

A number of customers that have asked us to help them take a look at what they’ve already spent. Many times it’s because they have board members or C- level folks who are reading the newspaper and find a horror story that talks about costs of implementing a system, the challenges that came out of the early days of that system going live, and the disruption it caused to the physicians and to the organization.

What we have found is that typically when you let the dust settle — because everybody starts out all thumbs on a brand new system regardless of the system — and you get to the point where they’re using it the intended way, the costs settle down. In many cases, we’ve been able to show customers that their investment turned out to be a very good one. That helped justify their willingness to move forward to a Phase 2 or Phase 3.

We typically don’t see a ton of big-bang implementations of every application across the board. We’ve seen an awful lot of cases where it’s been staged. There’s been nervousness around, did we spend too much? Did we get the value? Is the system doing what we want it to do? We’ve found that often that investment has proven to be invaluable and helped make the decision to move forward to completing the enterprise-wide system. It’s made it a “go” decision more often than not.

A lot of what passes for interoperability involves entities within a given health system connecting their respective systems. How much interest do unaffiliated health systems or practices have in exchanging information with those potential competitors?

The reason we typically see the challenges of trying to share all of the patient data within the multiple systems that one organization might have has more to do with the business need to grow faster, add more physicians, or help hospitals into the fold so that they can do their job better of managing costs and helping patients across a wider spectrum. The business decisions around needing to implement those acquisitions quickly happen far faster than the IT systems can keep up with changing them over. That business need is what has driven some of the system integration pieces to lag behind, where everybody would prefer to start right off the bat with a clean system that is fully integrated across the various entities that have come together over time.

After that, in terms of sharing with others outside of the particular organization, the interest is there and the need is there, but we see a mixed bag of success in that happening. It is dependent on what each of those organizations use for technology as to whether or not they have the mutual interest and the ability to afford the resources to put into sharing that data.

What factors should health systems check before hiring a firm to do major implementation work?

What is the goal at the start and the end of an implementation? In some cases, if an organization has a system software license that’s going to expire in 12 months and they have no interest or ability to extend that license, then they might be under the gun to do an implementation in that time frame, regardless of whether the organization is ready and able to handle all the change management that goes into making that implementation successful and do the change management and the re-engineering of work flow to best change advantage of what the software can help you with.

That’s where we see the missed opportunities — if there are pressures above and beyond just doing the ideal implementation. Some of those organizations, whether they like it or not, are making the strategic decision that they have to move forward, get the system up and running, and then do a wave of optimization after the fact in order to make sure that they round out all of the bells and whistles and the features that could go in place.

Any time you do a big bang implementation of this size, you are hitting people over the head in terms of the amount of change that they are going to have to absorb in a short period of time. You typically try to push out your training until the very end for almost any of your users, because whatever gap in time between the training and the go-live point is going to hurt their ability to remember what they learned in training and take advantage of all the tips and tricks that they’ve been taught.

Once users get used to the system, in some cases finding themselves to be using their thumbs more than they want to, optimization waves provide a great opportunity to reinforce best practices that may have been taught in the beginning but that were forgotten. In other cases, the organization has the ability to turn on features that didn’t go on in the beginning, or maybe they turn them on because they see challenges, opportunities for improvement, or the chance to make users’ lives easier. That never changes. Constant, ongoing training to help users take full advantage of the technology. It doesn’t happen overnight. Sometimes system implementations get blamed for being a bad implementation or a poor implementation when it’s really just the start of the journey.

What is the single biggest trend you saw in health IT in 2017?

The number of organizations that were looking for a partner or an affiliate to leverage their need for IT. Their need for knowledge of the IT in order to get the biggest bang for the buck for their IT dollars and spend. Why reinvent the wheel if someone has already done it very well and you can take advantage of their best practices to get you to the end game faster?

Do you have any final thoughts?

I’ve been in this business for over 30 years. I’ve watched providers come together, go apart, and come back together for lots of reasons. The most exciting part is that there’s an opportunity to use data to make the provider world so much better, allowing them to do their job for patients in new ways. We are only seeing a fraction of the benefit of EHR installs today because we’ve been so busy getting people to take advantage of structured notes and following a structure that can now turn into data that we can use to do great things.

It’s scary and it’s frustrating because it’s a much bigger pie than we’re used to when focusing on clinicals, financials, hospitals, or ambulatory business, but all of that now has the ability to come together. We’ve never had access to that information. We will have better ways to help the patient and run an organization more efficiently than we’ve ever seen.

Morning Headlines 2/5/18

February 4, 2018 Headlines No Comments

A new sort of health app can do the job of drugs

The Economist reviews the number of prescription-only digital health apps that have earned FDA approval or could so more quickly under FDA’s new pre-certification program.

RCMP backlogged with access-to-information requests from its own staff

Canada’s Royal Canadian Mounted Police reverses its decision to require officers to file an Access to Information Act to get copies of their own medical records after being overwhelmed by requests and complaints about delays.

Nation’s first Virtual Living Room Telehealth Center brings unique care to Appalachian veterans

The VA Hospital (KY) embarks on a pilot project with the local telephone company to create a living room-like space at the public library for telemedicine services geared towards veterans.

JPMorgan plays down health care company to clients

JPMorgan reassures nervous clients that the healthcare company it will form with Berkshire Hathaway and Amazon will be more of a group purchasing organization than a competitive industry disruptor.

Monday Morning Update 2/5/18

February 4, 2018 News 8 Comments

Top News

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The Economist reviews the number of prescription-only digital health apps that have earned FDA approval or could so more quickly under FDA’s new pre-certification program.

Apps are being approved to actually treat conditions – either alone or in combination with a drug – but investors are watching to see how companies fare since the “who pays” question hasn’t been answered and nobody’s sure how a patients will react to being given an app instead of a pill.

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Pear Therapeutics won FDA approval in September 2017 for its ReSet app for substance abuse treatment. Its pipeline includes apps for schizophrenia and post-traumatic stress disorder. The Boston-based company, founded by neuroscientist Corey McCann, MD, PhD, raised $50 million in a Series B funding round last month that increased its total to $70 million.


Reader Comments

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From Eloquent Rascal: “Re: Apple Health Records. Does it display any information that patients can’t already see in their EHR portal? Can patients change the information?” A source tells me that, so far anyway, the patient’s phone will show consumers nothing that they can’t already see on the patient portal. Patients can apparently change or hide information, which makes their phone-stored information of limited use to clinicians who may not trust it.


HIStalk Announcements and Requests

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My poll tool doesn’t calculate percentages like you might expect when allowing multiple choices, but it’s safe to say that most respondents use their phones for health-related activities. Relatively few, however, use the information contained on it during their provider visit, view their progress notes via OpenNotes (although that obviously requires their hospital to participate), or seek out a video visit.

New poll to your right or here: if you’re going to the HIMSS conference, why?

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I received a few responses to What I Wish I’d Known Before … Bringing an Ambulatory EHR Live. Let’s hear what you have to say about the reader-recommended topic of taking a software sales job.

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

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Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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


Acquisitions, Funding, Business, and Stock

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From the Athenahealth earnings call following positive quarterly results that sent shares up 14 percent Friday:

  • CEO Jonathan Bush says the company is seeing a post-HITECH “sugar low” as overall buying demand slacks off. Bookings for the fiscal year didn’t meet the company’s goal.
  • The company will change its software release schedule to three times per year following disappointing customer retention numbers.
  • 62 hospitals are fully live on its inpatient system.
  • 40 percent of customers are exchanging patient records via CommonWell and Carequality. Bush says the they can see hospital CCD information on an application tab, but the next steps involve extracting the most useful information and then developing APIs to allow users to interact directly with a hospital’s EHR.
  • The company’s main strategy will be to deepen the number of services offered to mitigate the “micro aggressions against the practice of medicine” and to emphasize its network’s capabilities rather than assuming that offering the best EHR or PM will create demand.
  • Bush says the previously “clunky” single, integrated view of inpatient and outpatient patient records view is improving as the company hopes to avoid being “boxed out” in being replaced by a single integrated system such as Epic or Cerner.
  • Epocrates continues to turn in poor numbers, although it’s no longer being positioned as a standalone product but instead as a dashboard for other Athenahealth offerings.
  • The company spent a lot of money and annoyed doctors as it fought to get a significant share of HITECH-driven business, but now it is transitioning to more thoughtful product offerings.  
  • Bush says MACRA and MIPS won’t drive sales since practices “get the check something like two years after you make the move and the check is smaller than cable bill.”
  • Bush says high-deductible insurance has pushed patients to defer services until later in the year when they’ve met their deductible, with providers and their vendors facing lean first quarters as the new normal.

Sales

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In England, Plymouth Hospitals NHS Trust joins the global health research network of TriNetX.


Decisions

  • Adirondack Medical Center Saranac Lake (NY) went live with Meditech in November 2017.
  • St. Luke’s Gnaden Huetten campus (PA) will switch from Cerner to Epic in June 2018.
  • St. Vincent Hospital (PA) will replace McKesson with Epic in February 2018.

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


People

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Investment syndicate AngelMD hires industry long-timer Michael Raymer (Perspectum Diagnostics) as chief strategy officer.


Government and Politics

A GAO report finds that federal and state governments are spending $10 billion for assisted living services for Medicaid beneficiaries without much oversight or quality monitoring. It concludes that CMS has provided unclear guidance, Congress has not established standards, and states haven’t tracked cases involving neglect or abuse.


Other

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Hospitals are being overwhelmed with record-breaking numbers of flu-related ED visits and admissions, to the point that Lehigh Valley Hospital-Cedar Crest (PA) erected a MASH-style “surge tent” in its ED parking lot to hold overflows. Patients housed there who didn’t get a flu shot told the New York Times reporter some bizarre theories that “heard” (meaning that they cluelessly read on Facebook):

  • When offered a Tamiflu prescription, “No, I heard it causes hallucinations. I heard about a lady whose daughter got Tamiflu and tried to kill her.”
  • “I hear the [flu] shot gives you flu.”
  • “I heard you can get Alzheimer’s from it — that there’s mercury in it, and it goes to your brain.”
  • “I heard it’s a government plot for population control.”
  • “As a family, we don’t get it,” an apt description from a man convinced that he got the flu more often in years when he got a flu shot.

Canada’s Royal Canadian Mounted Police reverses its decision to require officers to file an Access to Information Act to get copies of their own medical records after being overwhelmed by requests and complaints about delays. The 30,000-employee RCMP has 65 people working in its access-to-information and privacy office, which scanned 1.2 million pages of documents last year. Documents requested under the Access to Information Act have to be printed from their electronic original and shipped to the access and privacy office in Ottawa, where they are then scanned back in. 

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An NHS surgeon who claimed in a job interview to have performed over 50 solo keyhole surgeries vs. his real-life total of six says he didn’t understand the question and instead gave a “guesstimate.” He got the job after submitted a fraudulently completed surgery logbook, but was investigated after a high incidence of post-surgical complications and death. He’s been found guilty of fraud.


Sponsor Updates

  • T-System will provide its T-Sheets flu templates to EDs and urgent care centers at no charge.
  • Santa Rosa Consulting adds e-learning capabilities to its Meditech offerings.
  • Surescripts will exhibit at the NACDS Regional Chain Conference February 4-7 in Fort Lauderdale, FL.

Blog Posts


Contacts

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

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What I Wish I’d Known Before … Bringing an Ambulatory EHR Live

That technical dress rehearsal issues would get ignored or not addressed before the go-live. Wasn’t that the point of the TDR?


I wish I knew ahead of time that the EHR vendor outsourced their support to a third party. This arrangement created speed bumps to getting real support answers relayed from the EHR vendor through the support vendor.


I wish I knew how effective running a mock clinic was for training providers, especially physicians. An EHR analysts plays the role of a mock patient and gets checked in, roomed by the MA or nurse, seen by the doctor, and checks out. Ideally, the provider completes common orders, does a note, and charges. Any system problems can be caught by the analyst and a trainer can be at the elbow of each users. It is a little labor intense, but the clinics come back up to full speed much sooner. We had one ophthalmologist seeing 87 patients a day within one week of go live. His partners that didn’t do the mock clinic took weeks to get back up to full speed.


To what degree provider productivity would be negatively impacted and how that would impact the productivity-based comp plans of physicians and administrators. There’s a reason CIOs have a hard time surviving an EHR implementation, first among them messing with peoples’ pay checks.


How to generate sincere engagement for the implementation with the clinicians and staff as beneficial to their patients and care delivery. And helping all to make the project not just about the billing.


We learned after the CIOs and people allowed in the room had chosen Epic just because, that all non-Epic apps that were to integrate into the EMR had to have a test environment, or else integration was denied. Even apps with fewer than five users. Go-live was pushed back months, there no budget for this, and rebuilding non-Epic apps took time away from learning and building the actual future EMR and getting certified.


Focusing on optimizing physician workflows and making them as efficient as possible is absolutely important, but the same amount of effort must be made for the other roles on the ambulatory clinical care team: nurses (especially nurse triage), medical assistants, in-house laboratory and radiology, as well as all other ancillary services provided by the practice. Ensuring that the physicians are happy should not come at the expense of everyone else in the practice.


Weekender 2/2/18

February 2, 2018 Weekender No Comments

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Weekly News Recap

  • Advocate Health Care announces that it will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care.
  • A Nextgov review finds that the VA wasted $2 billion on three failed EHR projects from 2011-2016, adding the cost of the abandoned HealthVet effort to the GAO’s estimate of $1.1 billion.
  • Epic issues a rare press release to tout “One Virtual System Worldwide,” which allow Epic-using sites to communicate electronically, perform patient data searches, and schedule patient appointments with other Epic sites.
  • Amazon, Berkshire Hathaway, and JPMorgan Chase create an independent company to reduce their employee healthcare costs in unspecified ways.
  • A GAO report urges the Coast Guard to make an EHR decision following its failed $60 million attempt to go live on Epic that left it working with paper records, with some members of Congress questioning why the USCG doesn’t follow the lead of the DoD and VA and implement Cerner.
  • Digital advertising vendor Outcome Health announces that its two co-founders will leave their executive roles and will take board positions as part of the company’s settlement with investors who say they were defrauded by inflated advertising performance claims .
  • Allscripts restores access to its hosted systems more than a week after a ransomware attack.
  • The Best in KLAS 2018 report is released.

Best Reader Comments

Syntactic structure and semantic context: MHS Genesis has both. They also have the  largest HIT project budget in history and the full attention of the world’s largest HIT vendor. And yet, they have no connection to any of that vendor’s other sites. No connection to CommonWell. No connection to Carequality. What they do have – after coming a year late out of the gate – is a read-only viewer connection to the VA that you have to open in a separate app. Why does every five-doc clinic on Athena go live connected to Carequality, but the $5b flagship goes live with NOTHING? Vaporware. (Vaporware?)

Does Epic get to define the word “Interoperability?” It seems like the only thing they have an interest in doing is “INTRA-operability,” which is why they were passed over by DoD. It seems to be a roadblock ahead in innovation for them and I think some folks are really starting to notice. (Cheez Whiz Liz)

Would you rather but all those rolls of digital duct tape and the people to string it together, or have it done for you with no special effort? They [Epic] have been working on this stuff for years, since before I left. I don’t think any other vendor has put in that effort. Back then, it was also free. Not sure whether that’s still true. (Ex Epic)

Sequoia: passing CCDAs in a point-to-point manner does not seem to me to very disruptive approach. (Bobby)

Touting same-vender interoperability seems spectacularly uninteresting … We already have the complete syntactic structure for healthcare data and we have the full range of semantic context determined to give it appropriate meaning. What we need are the vendors to stop making the use of these well thought out and excellent protocols too costly to utilize, which they only do to continue to enforce their monopoly over patient and other clinical and revenue cycle data. (Bill)

Epic doing all of this work to connect between Epic customers is a lot more easy to accomplish since you can build in the functionality, control requirements, and control the message process / processing. If they were to try to do this for the industry, it’d be damn near impossible without buy in from all of the EMR vendors, let alone take multiple times longer. Epic communicating with Epic is a great first start and certainly leads the way in actually accomplishing something. Someone needs to pull the Band-Aid. (Johnny B)

I’ll take leadership by DOING SOMETHING over leadership-by-PowerPoint any day (I’m looking at you, CommonWell). My observation is that industries advance by someone going first and executing better, not by everybody agreeing on a lowest common denominator. (Vaporware?)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. A in Texas, who is rebuilding her relocated classroom following Hurricane Harvey and asked for lap desks for her fifth graders. She reports, “Now students can choose where they work, and they become more interested and invested in the learning happening in our classroom. I firmly believe my students have a greater impact of learning when they feel in control and have a voice in how they learn.”

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Nashville Public Radio profiles the open source HIV care app developed for the Kenyan Ministry of Health by Martin C. Were, MD, MS, assistant professor of biomedical informatics at Vanderbilt University. Were, who is originally from Kenya, says there’s lessons learned there that make sense for the US, which like Kenya has areas that are isolated or that have low educational levels.

In England, a group led by physicist Stephen Hawkings wins a judicial review of Health Secretary Jeremy Hunt’s proposal to reform NHS by putting all of an area’s NHS bodies under an ACO with a single budget, which Hawkings calls “back-door privatization.”

India’s government announces a plan to offer free healthcare to half a billion of its poorest residents. The government, which made the announcement in advance of next year’s elections, says the program will create hundreds of thousands of jobs. The coverage would allow patients to seek care in private hospitals instead of in poorly-run government ones. Public health experts question spending so much on hospitals instead of preventive care, noting that poor people are mostly dying of conditions caused by water and air pollution, malnutrition, poor sanitation, and substandard housing.

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The Onion weighs in on Amazon’s healthcare ambitions.


In Case You Missed It


Get Involved


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Morning Headlines 2/2/18

February 1, 2018 Headlines No Comments

Five breaches add up to millions in settlement costs for entity that failed to heed HIPAA’s risk analysis and risk management rules

Fresenius Medical Care North America will pay $3.5 million to settle HIPAA violations related to five separate breach incidents that happened in early 2012.

Advocate Health Care replaces Cerner and Allscripts with Epic

Advocate Health Care (IL) will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care, a move that will create the country’s 10th-largest health system.

Yale New Haven Hospital launches new Capacity Command Center

Yale New Haven Hospital (CT) works with Epic to design a Capacity Command Center that uses dashboards to display real-time insight into patient volume, staffing, and environmental services.

CDC director denies she resigned due to tobacco stock buy

Former CDC Director Brenda Fitzgerald, MD denies that she resigned because of newly uncovered tobacco stock sales and instead attributes her resignation to a tangled web of financial conflicts — including investments in Greenway Health – that she couldn’t get out of easily.

News 2/2/18

February 1, 2018 News 1 Comment

Top News

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Advocate Health Care will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care, as speculated here ever since the merger – which will create the country’s 10th-largest health system — was announced in December 2017.

Advocate SVP/CIO Bobbie Byrne, MD, MBA said in a statement, “This transition will allow for better interoperability throughout our entire geographic region, benefiting patients through a seamless, integrated approach. We are confident this single-platform EHR will be a nimble, long-term solution that can be continually adapted and developed as technology advances to keep us on the leading edge.”


Webinars

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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


Acquisitions, Funding, Business, and Stock

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Athenahealth reports Q4 results: revenue up 14 percent, EPS $1.11 vs. $0.62, beating expectations for both. Shares rose moderately in after-hours trading following the announcement.

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McKesson announces Q3 results: revenue up 7 percent, adjusted EPS $3.41 vs. $3.04, beating expectations for both.

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Meditech announces Q4 results: revenue up 11 percent, EPS $0.83 vs. $0.33. For the fiscal year, revenue increased 4 percent and net income rose 6 percent, although the December 2017 tax law changes reduced the company’s fiscal year taxes from $29 million to $19 million and thus heavily contributed to the increased earnings. Both numbers reverse a two-year downward trend. Product revenue jumped 21 percent year-over-year as service revenue dropped slightly.

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Voalte gains $15 million in new capital from Silicon Valley Bank, bringing the 10 year-old company’s funding to just under $70 million.

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Navicure and Zirmed name their newly merged companies Waystar.


Sales

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Mineral Community Hospital (MT) replaces its four year-old NextGen system with Athenahealth.

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Marshall Browning Hospital (IL) selects CloudWave’s OpSus Backup service.

Martin County Hospital District (TX) chooses Cerner, delivered via the company’s CommunityWorks hosted model.

North Carolina will become the 45th state to implement Appriss Health’s PMP InterConnect platform to share prescription drug monitoring program data across state lines.

In UAE, VPS Healthcare will implement the Tasy EMR from Philips. I’ve never heard of it, but Googling suggests that Philips acquired the Latin American-focused EHR in 2010 and started rolling it out in Europe last year.


People

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William Gish (Cerner) joins Voalte as COO.

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DocuTap names Robert Rueckl (Edementum) CFO and Jared Linsby (PointClear Solutions) SVP of sales.

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Vibrent Health names James Wade, MD (Inova Schar Cancer Institute) CMIO.

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Allscripts promotes interim CFO Dennis Olis to the permanent position.

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PatientPoint hires Dan Owens (EVerifile) as CTO, Scott Schemmel (Ciner Resources) a EVP of IT, and promotes Kimberly Thiess to COO.


Announcements and Implementations

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In Saudi Arabia, Johns Hopkins Aramco Healthcare goes live on Epic.


Government and Politics

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Former CDC Director Brenda Fitzgerald, MD denies that she resigned because of newly uncovered tobacco stock sales and instead attributes her resignation to a tangled web of financial conflicts — including investments in Greenway Health – that she couldn’t get out of easily.


Technology

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Yale New Haven Hospital (CT) works with Epic to design a Capacity Command Center that uses dashboards to display real-time insight into patient volume, staffing, and environmental services.


Privacy and Security

Fresenius Medical Care North America will pay $3.5 million to settle HIPAA violations related to five separate breach incidents that happened in early 2012. HHS OCR found problems that include failure to conduct a risk assessment, improperly disclosing PHI, failing to develop policies to address security incidents, and improper movement of PHI-containing hardware and media.


Other

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Analysis verifies that 5 percent people who are commercially insured account for 53 percent of healthcare spending, but it’s not the same people year after year – 61 percent of them moved off the top spender list from 2014 to 2015. The takeaway: consumers who buy crappy health insurance (or none at all) because they think they’re healthy might get a big financial surprise, especially as ACA changes allow policies to be sold without pre-existing condition coverage or with newly reinstated lifetime caps.

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CHIME decides to pick up the federal government’s slack and create an opioid task force that will attempt to come up with solutions to the opioid epidemic using the expertise of its members and their access to data. Some  might wonder if this is a PR push similar to its National Patient ID Challenge, which CHIME decided to shut down last year for lack of viable entries.

Pediatrician Bryan Vartabedian, MD says even Silicon Valley couldn’t create an EHR that doctors wouldn’t hate because “it’s less about design and more of what’s required of doctors.”


Sponsor Updates

  • Medicomp Systems will host Medicomp U 2018 May 21-24 in Reston, VA.
  • NCQA certifies ZeOmega’s Jiva population health management solution for 10 HEDIS 2018 measures.
  • Premier awards Agfa Healthcare an enterprise imaging agreement.
  • Forrester cites Liaison Technologies as a “Strong Performer” in operational intelligence for B2B integration.
  • Nordic will exhibit at the HIMSS Wisconsin Dairyland Event February 8 in Madison, WI.
  • PatientSafe Solutions exhibits at the San Diego Health IT Summit February 1-2 in San Diego.
  • The American Heart Association/American Stroke Association and Nordic help University of Colorado Health and Saint Francis Hospital – both Epic sites –  optimize quality measure reporting for stroke patients using the ASA’s Get with Guidelines-Stroke program.
  • Spok publishes a case study describing how Woman’s Hospital (LA) overcame logistical and communications challenges caused by record flooding to manage a 27 percent increase in call volume and to track physicians down using secure messaging.
  • Bernoulli Health profiles company highlights in 2017.
  • InterSystems announces GA of its Iris Data Platform for transaction processing and analytics.

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EPtalk by Dr. Jayne 2/1/18

February 1, 2018 Dr. Jayne 1 Comment

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Lots of chatter among my clinical colleagues about two main topics: Amazon getting deeper into the health space and the State of the Union address.

The Amazon topic definitely got a lot more traction, namely because of comments that the Amazon, Berkshire Hathaway, and JPMorgan Chase venture would be “free from profit-making incentives and constraints.” Many physicians blame the current healthcare crisis not only on hospitals trying to make a buck, but on payer executives focused on shareholder profits and their own career advancement. Healthcare industry stocks declined, including Express Scripts, CVS Health, and UnitedHealth Group.

The new company was also quoted as planning to center on “technology solutions that will provide US employees and their families with simplified, high-quality, and transparent healthcare at a reasonable cost.” There is an incredible amount of waste in our healthcare system, with estimates of up to 35 percent lost through several categories. Don Berwick broke the categories down in his 2012 piece on “Eliminating Waste in US Health Care” and I don’t know that they’ve changed significantly since then:

  • Clinical waste (14 percent). Could be improved with high-quality care, use of cost-effective treatments, or standardization of best practices.
  • Administrative complexity (9 percent). Could be improved through standardization of billing and collections, credentialing, and compliance.
  • Fraud and abuse (7 percent). Payments for services not provided or billed by deception.
  • Excessive prices (5 percent). Could be improved by tying prices to efficiency, outcomes, or fair profit.

There are some interesting findings in those numbers. Many of the laypeople I encounter assume that the entire problem with healthcare is with excessive prices, because they see the prices that hospitals and healthcare providers charge and the dramatic reductions through allowable charges and other adjustments. The higher “list” prices are often billed directly to patients without insurance if they don’t know to specifically request a cash price or adjustment.

Health-related businesses should be able to earn a fair profit, I don’t dispute that, but then there are the stories of price gouging, particularly in the drug industry. There are games that manufacturers play, such as purchasing a generic and finding a way to get a new patent so they can raise prices and control the market. Then there are unconscionable acts, such as grossly inflating the prices of medications that cost modest amounts to produce.

Those sources of waste, even coupled with the nefarious category of fraud and abuse, still pale in comparison to the losses via administrative complexity and clinical waste. I spent a good chunk of my clinical day trying to talk patients out of treatments they don’t need even though they think they do because they heard about them on TV or read about them in an article about “things your doctor doesn’t want you to know.” I also watch patients pay urgent care prices for treatments that should be performed in the primary care office, where they can’t get an appointment because we have a serious shortage of primary physicians in our community. I watch our practice spend incredible amounts of money on the billing and collections process, dealing with rejections, denials, and other attempts by payers not to actually pay. We experience these things on a daily basis while we work with patients who lack the resources to get the care they need. I can’t help but think the disconnect between waste and need contributes to the burnout that many of us feel.

When we hear that someone as upright as Warren Buffett wants to get into the fray, we can’t help but be hopeful. And despite what one may think about Amazon and their takeover of the marketplace, the company does seem to get things done and provide excellent service, which people crave. And when it sounds like they’re going to try to take down payers, which many of us find cocky and distasteful, that makes it even better.

The devil is in the details with an endeavor like this one, and it remains to be seen if they can make a difference where others have not been successful, or where they have failed to appreciate the complexity of healthcare economics.

Failure to grasp the complexity of healthcare leads us to the State of the Union address, where much was promised. Addressing drug prices will be a priority, with lowered costs and improved access to breakthrough drugs. Anytime someone talks about breakthrough drugs, many of us are skeptical – precision medicine sounds sexy, but the costs are substantial. The real savings may lie in figuring out to incent manufacturers of generic drugs and reducing the need for drugs through prevention and lifestyle change.

The State of the Union address also covered “right-to-try” legislation that would expand access for patients with terminal conditions so they can try experimental drugs that have not been approved by the FDA. It’s dramatic to talk about patients going “from country to country to seek a cure,” but in reality, the number of patients impacted by this would be much smaller than the number of patients who could benefit from basic, affordable healthcare. In some circles, right-to-try”is spoken of as cruel since treatments themselves may cause suffering with little promise of improvement. I’ve seen my colleagues in hospice care in tears while they care for patients and their families who have been given false hope.

The speech also touched on the need to address widespread opioid misuse. Since my practice just began a groundbreaking partnership with our local sheriff’s office to try to better support opioid addicts as they attempt rehab, I’m all for efforts to stop this serious epidemic. I don’t see big increases in government funding in the future, however. That’s one reason why our practice started this new protocol – addicts in our area have a high risk of relapsing before they can even make it to rehab because there are so few rehab beds available, and those that are open come with a great cost. We help bridge patients through opioid withdrawal while they try to stop using during their wait. The strategy has worked in other communities and we’re happy to bring our resources to bear.

There’s a lot going on in the industry today and frankly it’s been refreshing to hear providers talk about something other than how much they hate their EHRs and how much they think they’ve been meaningfully abused. I’m interested to hear what non-providers think about these recent developments.

Ready for Amazon to get in our business? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/1/18

January 31, 2018 Headlines No Comments

Veterans Affairs Wasted Closer to $2 Billion On Failed IT Projects

Public and private audits reveal that the VA spent nearly $2 billion on three failed EHR projects between 2001 and 2016 – a sobering statistic in light of the department’s impending contract with Cerner, valued at $10 billion.

US public health chief quits over financial conflicts

CDC Director Brenda Fitzgerald, MD resigns after reports surface she purchased stocks in a Japanese tobacco company after taking the helm.

CHIME Kicks Off Opioid Task Force with Inaugural Meeting in DC

CHIME creates an opioid task force that will leverage the expertise of its members and their access to data to identify best practices and develop protocols to prevent, identify, and treat opioid abuse.

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Reader Comments

  • Sam Lawrence: Except in this case, coding = medical billing, not development. Though the same warning may be true...
  • BeenThere: Partners will find the savings from their cuts of coders as fools gold. There are a lot of hidden costs running an outs...
  • JC: If there is not there can be. VistA has a reference lab interface that can create the manifests/labeling and such as we...
  • Tom Cornwell: Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be 'who's' not 'w...
  • HIT Observer: What I find most interesting here, is people defending their common practices rather than truly taking this as invaluabl...
  • Bob: There's no incentive for the provider to spend time doing a price comparison for the patient. Nor is it a good use of th...
  • Peppermint Patty: Veteran - can you clarify what was "fake "? Was something made up (definition of fake) or did you disagree with Vapo...
  • Pat Wolfram: Such a refreshing article. Thanks -- there really can be a simpler version of an acute HIT implementation. But I do ...
  • Woodstock Generation: Bravo to HIStalk's Weekender recaps and other news/opinions. I read it first thing on Monday mornings..................
  • Veteran: #fakenews...

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