Morning Headlines 5/12/17

Genevieve Morris

ONC names Genevieve Morris, MA Principal Deputy National Coordinator for Health Information Technology. Morris has no clinical background, but worked on HIEs and Meaningful Use prior to taking on her new role.

NantHealth Reports 16% Increase in 2017 First Quarter Total Net Revenue; SaaS Revenue Rose 11% and GPS Adoption Continues to Climb

NantHealth reports Q1 results: revenue up 16 percent to 22.5 million, adjusted EPS –$0.24 vs. –$0.18, missing expectations for both.

Microsoft bets big on AI data with new developer, user features

Cerner is reportedly interested in working with Microsoft’s AI-powered Custom Vision Service, which allows applications to learn the names of items in images users upload. Joe Quint, an director over app development at Cerner, commented “That was very interesting. Being able to use this broadly across a hospital and being able to do image extraction of videos would be very cool.”

Outbreaks, Evolution, and Rock ‘n’ Roll: Topol Talks to Pardis Sabeti

Eric Topol, MD interviews Pardis Sabeti, MD, Dphil, a professor with the Broad Institute of Harvard and MIT, where she develops algorithms investigating evolution in the genomes of deadly diseases.

News 5/12/17

Top News

HHS appoints Genevieve Morris, MA as ONC’s principal deputy national coordinator. She was previously senior director of HIT policy with Audacious Inquiry.

Unlike her predecessor Vindell Washington, MD, Morris has no clinical education or experience (her master’s is in political science), having spent her nine-year career working on HIEs and Meaningful Use.

Reader Comments

From Significant Other: “Re: Partners HealthCare. I worked at Partners for many years and attended a February conference  featuring CEO David Torchiana, MD (who had an insightful presentation, btw.) I asked the last question, which was ‘Can you talk a bit about Partners 2.0?’ His answer was quite candid — since its formation 23 years ago, little has been done to consolidate within the now $10+ billion organization. He expects to see a $500 million reduction over the next few years as the network reinvents itself. The Brigham and Women’s Hospital early retirement offering has nothing to do with Epic and that cost.” 

From Hospital Personality: “Re: Epic. Announced that they are developing a fetal monitoring solution so that customers don’t need to turn to a third party such as Perigen, GE, or Obix.” Unverified.

From Diego: “Re: hospital MU3 attestation for Athenahealth users. For the Athenahealth spokesperson, how many of the company’s stated 35 live hospitals are using the complete inpatient solution, including clinicals? How many have actually attested with the inpatient product? How many users have fully implemented the inpatient product, including clinicals, within a 12-month timeline with the past two years?” 

Epic’s App Orchard

I received more reader comments about working with Epic’s App Orchard.

#1

The experience with App Orchard thus far has been very disappointing. After paying the hefty fee for the Silver tier, we expected to receive all of the perks of the tier as discussed in the App Orchard documentation. Unfortunately, upon receiving access to the App Orchard program, it became readily apparent that much of what was promised was either not available or, in some cases, not yet built. Additionally, we were informed by App Orchard personnel that our "Sandbox" access would only be for a testing Sandbox and not an environment that we could use to demonstrate our solution to clients. The original documentation was highly misleading on this point.

The documentation also suggested that any press releases were to be submitted to the App Orchard team for review. After we went through a lot of effort constructing a press release with our PR firm and submitting it to App Orchard personnel for review, we were told that Epic would be providing developers with a standard press package.

All of this inconsistency is making us very uneasy. While we appreciate that we are one of the first few companies to join the App Orchard, and that we will be helping define the process for other companies in the future, we expected the process to be far more robust and established.

On the plus side, the App Orchard personnel have been very responsive and have provided as much help as they could given the under-developed state of the Orchard at the moment.

#2

We applied to the Epic App Orchard right when it was opened to vendors. Our initial interaction with Epic required us needing some detailed information on the different levels that App Orchard offered. I was pleasantly surprised to see how quickly they replied and how helpful they were as we worked through this decision.

Our application was processed timely and we got the access that we needed to start working on the technical integration. We are currently working on the technical integration and will soon be planning the marketing efforts. So far, so good.

#3

The team has been very responsive and the APIs are robust. We wish there were a bit more clarity on the pricing model for the live application (transactions vs. revenue share structures are a bit hard to follow). We also wish we had a clear sense of the timing / duration of the approval process for an application, as well as acceptance / rejection criteria.

HIStalk Announcements and Requests

Mrs. G’s DonorsChoose grant request was for STEM and engineering kits for her elementary school’s Robotic Rumblings program, noting that the city-wide STEM science fair includes few minorities and females. She reports, “The materials obtained through DonorsChoose are having quite an impact on my students. They are giving my students the opportunity to grow in the area of robotics. Their creative juices are definitely starting to soar. They are thinking and developing deeper thought processes on how to manipulate the materials. They are also learning how to better work together cooperatively. The students like working in small group settings. They appear to be quite focused when using the materials and do not want to leave when the session ends. We thank you from the bottom of our hearts. There are definitely some rumblings going on around here!!!!!!”

Webinars

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

Acquisitions, Funding, Business, and Stock

NantHealth reports Q1 results: revenue up 16 percent, adjusted EPS –$0.24 vs. –$0.18, missing expectations for both. NH shares continued their slide on the news, now down 83 percent since last year’s IPO.

Specialty EHR vendor Modernizing Medicine raises $231 million in a private equity investment, increasing its total to $322 million. 

People

New York-Presbyterian promotes Peter M. Fleischut, MD to SVP/chief transformation officer. 

Ivenix promotes Jesse Ambrosina to COO,  George Gray to CTO/VP of R&D, Janice Clements-Skelton to VP of HR, Carolyn Malleck to VP of finance, and Ben Powers to VP of infusion systems.

Announcements and Implementations

PokitDok will build its healthcare transaction recording platform on the Linux Foundation’s open source Hyperledger Sawtooth blockchain project along with Intel Software Guard Extensions. 

Vermont Information Technology Leaders and Medicity connect the Vermont HIE to the Veterans Health Information Exchange, allowing clinicians in the VA and the HIE members to view each other’s records for a veteran patient. 

MModal announces enhancements to its computer-assisted physician documentation technology.

WellSpan Health brings its initial sites live on Epic.

Government and Politics

Officers in West Virginia’s state capitol arrest a veteran journalist who was attempting to ask HHS Secretary Tom Price if domestic violence would be considered a pre-existing condition under the House’s American Health Care Act. Dan Heyman was taken away in handcuffs and charged with “willful disruption of state government processes,” with the Secret Service agents who were protecting Price and White House Special Counsel Kellyanne Conway claiming they had warned Heyman that he was interfering with their work by shouting questions that Price was ignoring.

HIMSS reports that while Congress’s spending bill still won’t allow HHS to spend money to develop a national patient identifier, it encourages HHS and ONC to provide technical assistance to non-governmental organizations trying to address the patient identification issue.

President Trump threatens to withhold $7 billion per year in ACA cost-sharing reduction payments to insurance companies, which would likely drive more insurers out of the exchange market or raise premiums. The President said in an interview, “There is no Obamacare. It’s dead. Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will, anytime I want.”

Privacy and Security

Memorial Hermann Health System (TX) pays $2.4 million to settle HIPAA charges following a 2015 incident in which it issued a press release that named an illegal immigrant who was arrested after using a phony Social Security card at one of its clinics. The hospital said it called police because of concerns about fraud, not immigration status. The woman’s husband was also in the country illegally, but had insurance through his employer.  

Hackers breach two old data servers of a Memphis, TN family medicine practice using valid login credentials and demand a $10,000 ransom after encrypting its files, which the practice declined to pay since they switched EHRs 18 months ago and only those older records were involved.

Innovation and Research

Cerner says it’s interested in just-announced Microsoft technology that can identify, name, and index objects depicted in photos or video, saying it could be useful for alerting hospital nurses of patient actions that require their attention. 

Other

Healthcare Growth Partners analyzes the valuation differences for enterprise vs. healthcare software as a service companies, concluding,

If the set of health IT companies were able to grow more quickly, it is likely that their valuations would become more in line with general enterprise SaaS companies. The reason for health IT’s slow growth rate is no doubt a complex combination of factors including longer sales cycles, heavy regulation, and slow adoption rates. Potentially it may be due to the relative immaturity of the healthcare software market and a different mix of publicly traded comps in health IT as compared to the larger and more mature enterprise SaaS market.

Sonar studies at University of Mississippi Medical Center (MS) reveal that up to 7,000 human bodies are buried on the hospital’s grounds, believed to be those of patients who died in the state’s mental hospital from 1855 to 1935 when it was located on what is now hospital property. Construction work turned up 2,000 bodies three years ago. The medical center, faced with a $21 million estimate to relocate the remains, is proposing to exhume a few of them for research and then just build a memorial.

A scientific editor trolls one of the many predatory medical journals with lofty-sounding titles that will run articles from publication-desperate researchers in return for cash. He submits an article built entirely around “Seinfeld” episodes as researched at the prestigious Arthur Vandelay Urological Research Institute, listing himself as the primary investigator under the name Dr. Martin van Nostrand. The Urology & Nephrology Open Access Journal accepted the article about a made-up condition nearly verbatim, billing him for its $799 fee (a mistake on their part since he declined to pay).  

Eric Topol interviews the fascinating Pardis Sabeti, MD, PhD: member of a family who emigrated from Iran just before its 1978 revolution, Rhodes scholar, physician, scientist (computational biology and medical genetics), host of an education TV series about statistics, and singer/songwriter for Thousand Days, a decent alt-rock band.

Sponsor Updates

• Advisory Board Chief Medical Officer Dennis Weaver, MD, MBA presented “Pragmatic Approaches to Succeed at Value-Based Payment and Care” at the World Health Care Congress Hospital and Health System Summit in Washington, DC last week.
• EClinicalWorks will exhibit at the Ohio Association of Health Plans Annual Convention May 16-17 in Columbus.
• GE Healthcare will supply over 200 Egyptian hospitals with 700 units of its advanced healthcare technologies.
• Healthwise will exhibit at the Cerner Collaboration Forum May 16-18 in Kansas City, MO.
• Huntzinger Management Group’s William Reed is named a Life Fellow Member of HIMSS.
• Consulting Magazine names Impact Advisors VP Lydon Neumann one of the Top 25 Consultants of 2017.
• Imprivata will exhibit at VA Healthcare 2017 2017 May 15-18 in Arlington, VA.
• Entrepreneur Magazine features LogicWorks CEO Kenneth Ziegler.
• Healthgrades recognizes Meditech hospitals for patient safety.
• National Decision Support Company will exhibit at WEDI 2017 May 15-18 in Los Angeles.
• Navicure and PatientKeeper will exhibit at Centricity Live 2017 May 17-20 in Boston.
• Shane McCarran joins Orchestrate Healthcare as senior recruiter.
• Experian Health will exhibit at HFMA WV May 17-19 in Roanoke.
• InterSystems will exhibit at the NEHIMSS Annual Spring Conference May 11 in Foxboro, MA.
• The US Patent Office awards Intelligent Medical Objects a patent for its medical terminology solution.

Blog Posts

• Redefining School of Medicine Resource Allocation Strategies (ECG Management Consultants)
• Arming the Marketer: Understanding Healthcare Marketing Financials (Evariant)
• Data Governance is a Process, Not a Project (Optimum Healthcare IT)
• What’s the Key to an Effective IT Transition? Governance and Strategy (Hayes Management Consultants)
• Committing to our communities, a Nordic consultant’s viewpoint (Nordic)
• The New Hospital Marketing Department and What it Means for Consumers (Healthgrades)
• The Bands, Bikes, and Buttons of Emerging Strategies (Iatric Systems)
• A Litany Against Complexity in Healthcare Technology (Influence Health)
• #JoinTheConversation with Experian Health’s Jason Wallis at #HIMSS17 (Experian Health)
• 8 Tips for Severe Weather Emergency Planning for Hospitals (LiveProcess)
• Lessons Learned: General Ledger Revenue Mapping (Impact Advisors)
• May is Mental Health Month (Netsmart)
• What to Expect from MACRA: The Early Years (PerfectServe)
• Meditech 6.1x Implementation Phases Part 5: Test (Parallon Technology Solutions)
• Star Wars and Cultural Shifts in Society and Technology (CloudWave)
• #JoinTheConversation with Experian Health’s Crista Harwood at #HIMSS17 (Experian Health)
• National Nurses Week: A Look Back and The Way Forward (PatientSafe Solutions)
• “When Times Get Tough, Get Creative” & Other Pointers for Leaders of Clinically Integrated Networks (Kyruus)
• Computer-Guided Insulin Titration Helps Hospitals Meet Basal Bolus Standard, Study Finds (Glytec)

Contacts

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

EPtalk by Dr. Jayne 5/11/17

The CMS Quality Payment Program website has been updated with an “Am I included in MIPS?” feature. Providers and organizations can search by NPI (sorry, no bulk search feature for groups yet) to determine if they are included. The site also doesn’t flag whether you’re participating in an ACO, but rather tells you to talk to the leaders managing your participation.

Forbes posts an article about the Internet making us lose trust in our doctors. I think many of us agree (at least anecdotally) that things have changed over the last decade, and exponentially so after the rise of the smart phone. The piece details a study looking at whether screenshot content can prime a pediatric patient’s parents to be biased towards a particular diagnosis. When the physician diagnosis didn’t match the Internet diagnosis, parents were less likely to trust the physician diagnosis and were more likely to say they would seek a second opinion. The researchers’ conclusions note that “conflicting online information could in some cases delay necessary medical treatment. Physicians must be aware of the influence the internet may have on parents and ensure adequate parental education to address any possible concerns.”

Physicians in the patient care trenches have known this for a while, that it can take a significant amount of counseling and discussion to counteract what “Dr. Google” or a number of other websites may have said. When it’s the occasional patient arguing with you about your clinical expertise, it can be managed, but when it feels like every patient is coming in the door with a preconceived notion about what is going on, it is a direct contributor to physician burnout. I don’t believe physicians are omniscient or that our opinions should be absolute, but sometimes you just wish your patients would trust your decades of experience and the many dollars and hours you’ve expended to arrive at your level of clinical judgment. Even a seemingly straightforward diagnosis like “contact dermatitis due to plants” can suck time out of your day when you have to engage around smart phone photos of poison oak, ivy, and sumac. Bottom line is, it doesn’t matter what plant got you, we’re going to treat you the same way regardless of botanical factors and you need to avoid coming into contact again with whatever it was.

Sometimes it’s hard for people to understand what it’s like to be a physician and the pressures we’re under outside of dealing with payers, metrics, regulations, etc. I’m talking about the actual clinical pressure to be 100 percent accurate. If you’re a good physician, it weighs on you and it’s hard to keep in balance. I recently had a situation where a patient perceived a poor outcome based on my diagnosis. She had come to the urgent care on a Saturday with back pain, which had some distinct muscular features and no acute findings on an x-ray, and was diagnosed accordingly. Our practice always has a second reader for films, and my colleague agreed with my reading. The patient was instructed to follow up with an orthopedic specialist on Monday (two days from the visit) if she was not improving. She followed up, and the orthopedist sent her for advanced imaging and diagnosed a vertebral compression fracture, then performed an expensive procedure. She came back to us demanding compensation for our missed diagnosis.

Our standard practice in this case is to convene a peer review and to also have the films re-read by a radiologist, who also failed to appreciate the compression fracture. Peer review found my treatment to be appropriate given the history and exam and the setting (urgent care). The patient was given appropriate follow-up instructions and her pain was managed adequately. Of course, we don’t have access to the advanced imaging results showing the fracture, so it’s hard to tell whether the specialist is taking advantage of a marginal finding or whether something was really there. The patient’s treatment wasn’t even delayed by my supposed misdiagnosis since she would not have been able to have advanced imaging until Monday anyway due to her insurance and its requirements. Getting a pre-certification for a non-emergent ambulatory procedure on a Saturday just doesn’t happen in our world. Assuming you agree there was a fracture, she received definitive care in a timely fashion that was more impacted by the fact that she came to care on a weekend than it was by a potential misdiagnosis.

One also has to consider the role of the urgent care, which is to rule-out any life-threatening conditions and to provide treatment for illnesses and injuries that require immediate care. Sometimes we’re also just there for convenience, for patients who don’t want to wait to see their primary care physician or whose schedules don’t mesh with their primary physician’s office hours for refills on maintenance medications. There are numerous situations in which we do not provide definitive care. Most fractures are merely stabilized and then the patient is referred for orthopedic management. For most urgent care centers, anything requiring imaging that is more than a plan film x-ray has to be referred back to a primary physician to coordinate authorization, scheduling, and follow up. We’re not in the position to order complex studies and follow up on them, and most of the time we do strive to get you back to your primary care physician for follow up.

Even when a physician feels he or she has done the right thing, and their care has been validated by a peer review and supplemental evaluation of diagnostics, it still weighs on us. There is the nagging sensation that we should have done something different, and that the patient thinks we’re bad doctors. It’s hard for people outside our world to understand what that does to a person, and culturally it’s difficult for us to find people to talk with about our experiences. It’s also legally difficult, sometimes, when you think the patient is going to sue. We end up stuck with only the risk management team to talk with and they’re not exactly caring nurturers who want to help you work through the psychological ramifications of a poor outcome and subsequent lawsuit.

Keep this in mind next time you encounter a physician who seems aggravated and preoccupied. Or any health care providers, for that matter. We’re all walking around with some baggage, and sometimes a malfunctioning EHR or one more regulatory hurdle is all it takes to break us.

Email Dr. Jayne.

Morning Headlines 5/11/17

Modernizing Medicine Announces $231 Million Equity Investment from Warburg Pincus

Specialty EHR vendor Modernizing Medicine takes on a $231 million investment from PE firm Warburg Pincus.

Senate Confirms Scott Gottlieb to Head FDA

The Senate voted 57 to 42 on Tuesday to confirm Scott Gottlieb, MD as commissioner of the FDA.

Aetna fully exits Obamacare exchanges with pull-out in two states

Aetna announces that it will exit the Nebraska and Delaware public exchange markets for the 2018 open enrollment period, the two remaining states where it had still offered plans.

Kaiser raises record $4.4 billion in white-hot hospital bond market

Kaiser Permanente (CA) secures $4.4 billion in funding through three bond offerings. CFO Kathy Lancaster reports that the proceeds will be used to fund expansion.

Readers Write: The Value Proposition of Optimizing Clinical Communication

The Value Proposition of Optimizing Clinical Communication
By James Jones and Wayne Manuel

James Jones, BSN, MBA, MSN, NEA-BC is VP of patient care services and nursing operations at University of Washington Medicine’s Valley Medical Center. Wayne Manuel is senior VP of strategic services at University of Washington Medicine’s Valley Medical Center.

A few years ago, Wayne was on an airplane when he came across a magazine article about how Texas Children’s Hospital switched to Apple iPhones to improve clinical communication and reduce noise. With some due diligence, he found that Cedars-Sinai Medical Center and several other hospitals had also switched from old ways of communicating to iPhones, and they experienced similar positive results. As our senior VP of strategic services, Wayne recognized the opportunity for UW Medicine’s Valley Medical Center to replace our old, noisy phones with smartphones.

Around the same time, James attended a dinner event for chief nursing officers in Seattle. Again, smartphones were a main topic of the discussion, representing a solution to some common clinical communication challenges.

With both of us having technical backgrounds, we started sharing ideas on how to transition from our disparate communication systems to a more modern solution. We approached our CNO and CMO with research on the value proposition of implementing a mobile communication strategy. It was easy to see how a new way of communicating would bring us additional value. Some of the improvements we hoped to achieve included:

• Improving the clinician and patient experience.
• Reducing interruptions.
• Gaining workflow efficiencies.
• Saving time for clinicians.
• Improving communication between interdisciplinary teams.
• Meeting The Joint Commission’s National Patient Safety Goals for alarm management.

At that time, we had recently deployed a new electronic health record (EHR), which gave us the opportunity to improve many other systems and workflows. Our senior leadership team felt that to get the most out of our EHR, we needed a mobile app to close the gap and provide real-time access to clinical information, allow for mobile documentation, and offer an easy way for nurses and other staff to communicate.

Our staff were already using smartphones in their personal lives and were frustrated with the multiple communication devices they were juggling (two-way radios, legacy phones, pagers, and overhead paging). We met with many of our nurses to get their input, and one said, “Anything you can do to lighten the load would be greatly appreciated.”

We started with a phased approach, rolling out iPhones to one pilot unit, then to all inpatient units and several ancillary departments for calling; secure text messaging; and notification of alarms and alerts from patient monitoring, patient elopement, and the nurse call system. This was done via Voalte and Connexall applications.

We conducted before and after analysis so we could measure the outcomes from the new clinical workflows. One area we looked at was hospital-acquired pressure ulcers and skin integrity events. Using the iPhones, our wound care nurses saw an immediate improvement in workflow by using the Epic Rover application to take a photo of the wound, which uploads the photo for documentation into the patient medical record. The physician or wound care nurses can see it immediately and even show it to the patient and their family when rounding with a physician.

With only two dedicated wound care nurses on our team, their time is extremely limited. Rather than spending time walking around looking for a physician or nurse to discuss a patient, they can now find the appropriate physician in the smartphone directory, send a photo via Rover, and ask the physician to call when he or she is available to discuss treatment. The result has been better communication among our interdisciplinary teams, more efficient use of time for our wound care team, real-time documentation to the medical record, and improved communication with patients and families.

Another area where we have made great headway with the iPhones is in reducing medication errors. Using our new workflow, a nurse changes his or her status in the directory from “available” to “busy” and types in a status message, such as “administering meds.” This lets the rest of the care team know not to interrupt that nurse until their status changes back to “available.” New workflows escalate alerts to a backup while that nurse is busy.

Today, we are using iPhones for communication on all clinical inpatient units for nurses, physicians, respiratory therapists, discharge planners, environmental services managers, and administration. We are communicating more efficiently, with about 70 percent of all communication now taking place via text message versus 30 percent via voice calls. Our very tech-savvy staff loves the new solution and has adapted well to the workflow changes. One nurse said her unit is much quieter and that the hospital “feels like a hotel, so patients can get some rest.”

In our first year using smartphones, we are still learning where we can make adjustments in our workflows to make the most of our new way of communication. Going forward, we will be analyzing workflow efficiencies, adjusting alarm settings, and managing notifications from nurse call, physiological monitors, and the EHR.

The authors presented an HIStalk webinar titled “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.”

Readers Write: An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back

An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back
By Crystal Ewing

Crystal Ewing is manager of data integrity at ZirMed.

In a video message from last year that he surely never intended for public and regulatory scrutiny, Mayo Clinic CEO John Noseworthy, MD appeared to advise employees to prioritize patients with commercial insurance in order for the famed hospital to remain financially strong.

Months later, Mayo is still explaining exactly what Dr. Noseworthy meant. Many healthcare leaders need no further explanation, even if they personally dislike any suggestion of favoring the commercially insured over Medicare and Medicaid patients. With government reimbursement continuing its decline, most hospitals are straining to hold on to their profitability.

Still, placing hope in commercial insurance to make up the difference is misguided, especially with the rising dominance of health plans that are not only high deductible, but also require high co-payments and high co-insurance. Touted as a means of covering more Americans, these plans often put more of the financial burden on patients than simply paying for healthcare in cash at a discount.

As such, many patients with these plans may claim they have no coverage when it comes time to pay for a procedure or service. It’s hard not to empathize with their motivation for doing so, but it’s a practice that can put the hospital in a precarious position.

With self-pay patients, things become more complicated, especially since there can be a lag of 30 or more days between the time that they are treated and the time the invoice comes due. When faced with a choice between paying for housing, utilities, food for their families, auto repairs, etc. – all of which affect the present and future – or paying a hospital bill for an event that occurred in the past, the decision is easy.

When this thinking is spread across a large patient population, bad debt accumulates quickly. Additionally, patients are unlikely to pay medical bills that are greater than 5 percent of household income, according to the Advisory Board, a consulting firm for hospitals. Median household income in the U.S. is at about $53,000, suggesting that when out-of-pocket charges exceed $2,600 hospitals can forget about collecting, according to Spencer Perlman, an analyst with Height Securities in Washington.

Given the above realities, more hospitals are using automated coverage detection technology, which also finds insurance coverage that patients legitimately aren’t aware of or are unable to communicate. When patients are brought to the hospital in the grips of a heart attack, for example, or while unconscious, they’re hardly able to convey their levels of coverage. Some fully conscious patients even may forget they have coverage, or provide information on secondary rather than primary coverage, or become confused about which carrier covers them. This isn’t uncommon with elderly patients.

No matter the reason it is problematic , it is imperative that coverage verification becomes a more streamlined process at our nation’s hospitals. It can be done in a way that respects the patient and in a timely fashion to protect the hospital’s finances. The most feasible method is to pair automated coverage detection with automated eligibility verification, the latter of which is already in place at many hospitals. However, coverage detection can also be an independent, standalone process. Either way, it makes quick work of checking with thousands of healthcare payers to determine if any are the primary or secondary insurer for a given patient.

Often, as much as 15 percent more instances of billable insurance are uncovered with superior processes and technology. Even just some quick mental calculation can see how this would recoup millions of dollars for many large hospital systems. It’s also significantly over the 1 to 5 percent rate achieved by manual and legacy coverage detection.

Much of this improvement is due to the huge data sets that now power some business intelligence engines, encompassing billions of historical health insurance transactions for millions of Americans. As these insights are tested against a pre-identified set of payers, algorithms can match the key data attributes that confirm coverage and the information needed to file the claim.

What has yet to be quantified but surely exists is the reduction in future collections activity with patients. Despite jargon that describes these patients as “empowered consumers,” the reality is they are struggling to pay their bills and rely on hospitals to help them navigate this uncertain terrain. In turn, hospitals must be fully informed about all of a patient’s sources of payment, including if commercial insurance coverage exists.

There is nothing unethical about seeking such information, only for using it to prioritize patients who it turns out are commercially covered. Clearly hospitals should be setting their sights on treating all patients, regardless of source of payment. The ability to do so is greatly enhanced when hospitals can identify all sources.

Morning Headlines 5/10/17

Confidential medical records from Bronx-Lebanon Hospital exposed online by vendor’s error

Bronx-Lebanon Hospital exposes “tens of thousands or even millions” of patient records after a contractor misconfigures its rsync backup.

Teladoc Announces First Quarter 2017 Results

Teladoc reports Q1 results: revenue climbed 60 percent to $43 million, while net losses remained flat. EPS –$0.30 vs. –$0.40, beating analyst expectations on both. Share prices jumped 25 percent on the news.

Intelligent Medical Objects Awarded Patent for Industry-leading Medical Terminology Solution

IMO receives a patent for its “concept-based” terminology management solution.

Cambridge trust set for IT services market test decision this summer

In England, Cambridge University Hospitals NHS Trust announces that it will make a decision on its IT outsourcing contract by the end of summer.

News 5/10/17

Top News

A DataBreaches.net investigation finds that up to several million records of Bronx-Lebanon Hospital Center (NY) were exposed after its revenue cycle contractor, iHealth Innovations, apparently misconfigured an rsync backup

Reader Comments

From Dr. Evil: “Re: EviCore. The specialty benefits manager is considering a sale or IPO, valuing itself at $4 billion. It pays to build a business around denying care.” The company describes its services as “comprehensive care management solutions,” although the emphasis seems to be on reducing cost via evidence-based solutions. It’s a good approach, although it fails to address out-of-control provider, drug, and device costs and instead focuses on restricting what is ordered. It’s an often-missed point that all of the political wrangling over health insurance would be much less necessary if costs were made reasonable, an even more daunting and therefore unlikely legislative accomplishment since the folks making fortunes on the backs of sick people also employ lobbyists.

Epic’s App Orchard

I received these unverified reader comments when I asked for first-person experience with Epic’s App Orchard.

• I have worked extensively with Epic Corp over the past two years with their iterations of the App Orchard. The rules of the road require that an app developer permit Epic to take whatever IP they choose, if Epic believes it makes sense to include in future releases of Epic software. Epic will reject apps that directly compete with Epic functionality, as determined by Epic’s current and future roadmap. Further, the 30 percent fee they charge is too broad in scope for the app revenue (if there is any). Most importantly, originally, only Epic clients could submit apps to the Orchard, effectively locking out the global collective genius of non-Epic entrepreneurs (I am not sure if such a restriction remains). Based on the approach to their App Orchard, Epic seems to be trying to respond to the market demand for "open" as heavily advertised by Cerner as their competitive differentiator. However, Epic also seems to want to control the Epic app environment and has absolutely no motivation to loosen their model to the wild, as Judy mentioned several times that such a move would be the end of Epic.
• We have started working with Epic to build out an API integration under the App Orchard. For us, the biggest concern are the revenue sharing terms. For a software vendor that is operating under tight margins in a competitive market, having to factor in up to a 25 percent gross revenue share is an impossible burden. From our perspective, the App Orchard is a blatant money grab from companies trying to innovate on the edges of the Epic ecosystem.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Softek Solutions. The Prairie Village, KS-based company’s OnTrack software and consulting services optimize revenue integrity and system performance for Cerner Millennium hospitals (and those preparing to move to Millennium). Its Charge Integrity Control provides visibility into revenue management by correlating patient orders and charges throughout the transaction process –one customer found a lab charge error that lost them $3 million in appropriate billing over four months before they found it instantly with Charge Integrity Control. Revenue Conversion Services allows correction of application, workflow, and configuration problems that otherwise would cause millions of dollars in lost revenue right after a Cerner go-live — a single hospital called Softek three months after go-live and avoided $20 million in annualized lost charges due to orders that weren’t charging, a location-specific workflow problem with ordering, and ED batch charges that weren’t actually charging. The company also provides Millennium system performance optimization software and services as well as conversion and purge maintenance assistance using proprietary diagnostics. Thanks to Softek Solutions for supporting HIStalk. 

I finally pulled the trigger on replacing of my years-old, $300 laptop that I use for everything. I chose an Acer Aspire E15, which has pretty decent specs for $621: an AMD FX 9800p CPU with 2 MB L2 cache, 16 GB of DDR 4 SDRAM, a 128 GB solid state drive running Windows 10, a 1-terabyte hard drive for data, a 15.6-inch display powered by a Radeon R8 dual graphics video card with 2 GB of dedicated VRAM, and thankfully nearly zero pre-installed bloatware. I’ve had no problems so far getting it loaded up.

HIStalk readers funded the DonorsChoose grant request of Mrs. S in California, who asked for a 3Doodler child-safe 3-D printing system (it was actually inexpensive at just $113 for everything, plus our donation was matched). She reports, “I would like to thank you from 22 very excited third grade students that have really been enjoying and benefiting from your generous donation! We have been using our 3Doodler pen each Friday afternoon during our STEAM centers time and I have truly observed some fantastic skill building. Some of the benefits that are very noticeable to me are an increased attention to detail, improved direction following within a detailed task, increased patience for a task, increased observation of the steps necessary for a positive outcome, and an increased motivation to try something new! You have made a difference!”

Webinars

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

Acquisitions, Funding, Business, and Stock

Video visit provider Teladoc reports Q1 results: revenue up 60 percent, EPS –$0.30 vs. –$0.40, beating analyst expectations for both.

People

Reed Liggin (Athenahealth) joins electronic prescribing system vendor EazyScripts as CEO. He was president and CEO of the small-hospital information system vendor RazorInsights that was acquired by Athenahealth in January 2015.

Telehealth solution provider Avizia hires Joe Quinn (ComScore) as CFO.

Health Symmetric hires Bob Teague, MD (Quorum Health Resources) as chief medical officer. The company’s website uses a lot of vague gibberish in not saying exactly what it is they’re selling other than a “healthcare platform” that uses APIs.

Announcements and Implementations

Intelligent Medical Objects is awarded a patent for its concept-based terminology management system that allows rapid distribution of terminology changes to the company’s EHR vendor partners. Clinician-entered terms are matched with appropriate billing and reference codes that capture clinical intent.

Hybrid IT vendor TierPoint will expand its Hawthorne, NY data center campus for the third time, adding 38,000 square feet of raised floor to the existing facility that includes 52,000 square feet of raised floor plus a 70,000 square foot recovery and business continuity center.

PeriGen releases PeriWatch, a perinatal analytics system that integrates WatchChild fetal monitoring with PeriCALM decision support and adds a maternal dashboard.

­­­­­­­­­­­­­­­Penn Medicine Center for Health Care Innovation (PA wins ECRI Institute’s health device award for its app development platform that extracts clinical information from the EHR and other sources. 

Government and Politics

In England, the Cambridge University Hospitals trust will decide this summer whether to outsource commodity IT services that include enterprise infrastructure, service desk, and end-user computing in a tender expected to total $180 million over seven years. The trust says its increasing Epic use has created a need to expand its services. 

The White House appoints Gopal Khanna (Illinois Department of Innovation and Technology) as director of AHRQ.

Innovation and Research

University of Illinois at Urbana-Champaign is working on a virtual physician agent that can describe lab test results to patients via a patient portal, targeting older adults with conversational speaking, context-appropriate facial features, and other body cues that can help with retention.

Other

St. Mary’s Hospital (NJ) celebrates Nursing Week by laying off seven nurses and 13 med techs.

Sponsor Updates

• The local paper profiles Ability Network CEO Mark Pulido.
• Black Book identifies 10 top MACRA trends challenging providers with value-based care and quality metrics.
• Agfa Healthcare launches a new version of its Integrated Care Suite.
• Besler Consulting releases a new podcast, “Healthcare in the first 100 days of the Trump presidency.”
• Washingtonian names The Advisory Board Company CEO Robert Musslewhite as one of its biennial Tech Titans.
• Casenet announces its Connect 2017 speaker lineup, led by client executives from Cigna and Healthfirst.
• CoverMyMeds will exhibit at the American Academy of Ambulatory Care Nursing Annual Conference May 10-13 in New Orleans.
• Boston Software posts a white paper titled “Eliminate the Pain of EMR Upgrade Testing” that describes use of its Cognauto system to validate and set appropriate expectations for each department regarding
  the added benefits of the EMR upgrade.
• The Hartford Business Journal interviews Diameter Health CEO Eric Rosow.
• Health Professional Radio interviews Docent Health co-founder Paul Roscoe.

Blog Posts

• 10 Fun Facts About Nurses for National Nurses Week (Spok)
• Using Evidence-based Medicine (CareSync)
• Waiting for Godot: My first experience with virtual care (Advisory Board)
• Consultants as Mentors? (Culbert Healthcare Solutions)
• Deposits and Withdraws (Direct Consulting Associates)
• 6 resources to maximize wellness during National Nurses Week (Meditech)
• How to Access Dimensional Insight Online Help (Dimensional Insight)
• An RN moves from the bedside to the conference room (Infor)

Contacts

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

Morning Headlines 5/9/17

FBI Director Invites Hospitals to Reach Out to His Agency

Addressing hospital executives at the annual AHA meeting, FBI Director James Comey calls on executives to report all instances of cyberattacks, explaining, “we have to convince you to talk to us. We will treat you as what you are — as victims. We will explain to you what will happen to any information you give us; we will be open and honest with you.”

GOP Sen. Susan Collins Says Senate Will ‘Start From Scratch’ on Health Care Bill

Senator Susan Collins (R-ME) says that the Senate will not take up a vote on the House passed AHCA, and will instead start from scratch and write its own legislation.

Mental health leader Thomas Insel is leaving Alphabet’s Verily

Former director of the National Institute of Mental Health, Thomas Insel, MD announces that he is leaving Verily, Alphabet’s life science business. Insel was developing technology that could be used to combat anxiety and depression.

The Internet Is Making Us Lose Trust In Our Doctors

A recent study links exposure to online symptom checker data with a decreased  confidence in a physician’s diagnosis, concluding that “prior exposure to information can ‘prime’ a parent to have a unique bias,” which can damage the doctor patient relationship and alter the care pathway.

Curbside Consult with Dr. Jayne 5/8/17

Readers who have followed Curbside Consult for a while might remember that I teach at an outdoor classroom program a couple of times a year. It’s a lot of fun, because you get people out of their normal environments and challenge them in different ways. It’s also great working with people from different industries and segments of the working world rather than the usual healthcare and IT people I encounter on a daily basis. One of my fellow instructors is a preschool teacher and we often commiserate around the fact that there are quite a few “everything I needed to know, I learned in kindergarten” nuggets that we inevitably have to address during the weekend.

This session, we had around 40 students organized into six teams. Each team is challenged to come up with a name and motto, then elect leadership and assign roles and responsibilities. They are then tasked to not only make it through the weekend (some of them have never been camping), but also to attend a rigorous educational program. Team-building, project planning, cooperative learning, feedback, and continuous improvement are woven into the curriculum along with camp cooking, knots and lashings, and more.

We had some extra challenges this weekend, with torrential rains in the week leading up to the course and a boil order being in effect for our facility throughout the weekend. We also had a couple of instructors unable to make it for the weekend due to flooding near their homes, which led to some scrambling to cover presentations. Fortunately, most of us have been doing this for a while and can teach the content without too much trouble. We’re lucky that we’re not teaching for mastery, but trying to give the participants an overview of various outdoorsy topics. It’s not like we’re going to drop them in uncharted lands when they’re done and expect them to survive.

This particular session, we had an exceptional group of students. Usually there is at least one team that has some level of dysfunction ranging from mild to severe. This time, however, the teams had their acts together. Any forgotten equipment was remediated by sharing with other teams, everyone had plenty of drinkable water, and the percentage of people wearing knee high rain boots was high. (Nothing spoils a weekend outdoors like wet feet, so that was a particularly good sign.) We talk about the stages of team development and it seemed like most of them went straight through forming and storming and on to norming and performing.

What we did have this weekend, however, was some breakdowns on the instructor team. I took a new role with the program this year, and in the middle of the first day, was informed by another staffer that I wasn’t fulfilling my duties despite the fact that no one had told me those duties belonged to me. The person telling me this wasn’t even in my chain of command, so that was another problem. She had done something similar during the prep work for the course, which I quickly took care of with my supervisor, but this time things were a little trickier.

I approached the colleague who previously held my position and he said he had the same issue and confusion when he held the role. Yet, nothing was resolved, and it was just handed off to the next person as a ticking time bomb. I also mentioned some frustration with the documentation for the role and how I had to redo a lot of it to align with our updated curriculum. He mentioned that he had done all the updates before handing the documentation back to leadership, so there was no reason why I should have had to do the updates again. Apparently our course director sent me the same documentation that he had sent to my predecessor without incorporating or acknowledging the updates.

Needless to say, that was pretty frustrating. When you’re used to being part of a high-performing team and it starts breaking down, one of the first things people tend to do is to doubt themselves. I went through that a bit and had to keep running my mental checklist making sure I had done everything I was asked to do to as well as I could. I also kept thinking of whether there was anything I should have done differently. Should I have asked more questions? I couldn’t come up with much I would have changed since I was essentially emulating what the previous person in the role had done to the best of my knowledge and ability.

Another thing that tends to happen when you’re being impacted by a leadership breakdown is that you want to withdraw. People don’t want to confront others. I know I didn’t want to go to the person accusing me of non-performance and have a focused conversation about why she felt I wasn’t getting it done and what we were going to do about the situation. That’s how I ended up talking to my predecessor rather than addressing the issue directly.

Although seeking expert guidance is a valid strategy, one has to be sure we’re not doing it as an avoidance mechanism. Having those difficult conversations is also hard when you’re in a high pressure situation, or when schedules don’t align. It was rare that both of us had more than two minutes of free time at the same time, and trying to slip in that kind of conversation wouldn’t have been the right thing to do.

There were some other leadership breakdowns this weekend, with the course director not following through on a couple of agreed-upon actions. It’s never fun when your boss slacks off, particularly when you’re left holding the bag. Coupled with a schedule that ran late, very little sleep, and being cold overnight (planning fail!) I wasn’t in a good place on Saturday morning. Fortunately, some attention from a camp cook staff that worked around my food allergy was enough to start boosting my mood. It’s amazing how the little things can make a difference when people are struggling, and a nice reminder that what might seem like no big deal to you might make a difference for someone else out there.

Once the program moved into full swing and we started interacting with the students, I was in a much better mood. Their enthusiasm was contagious and their willingness to tackle the challenges they were given was impressive. Several of the teams went above and beyond in ways I hadn’t seen before, with a couple writing songs or poems for the staff. Not everyone loves a kiss-up, but this weekend we certainly did. It was also good to see that regardless of what was going on behind the scenes, it didn’t trickle down to our students and they were able to get the most out of the weekend. They say you’ve never really mastered material until you can teach it, and that’s often true. It’s also true that even those of us that teach are constantly learning and there will always be something our students teach us.

By Saturday afternoon, I was back on my game with a plan to make up for my packing failure and stay warm overnight. I threw myself into cast iron cooking and slinging the best “pigs in a blanket” out of my homemade box oven the staff had seen in recent memory. I clapped when people were able to start “one-match” fires, giggled at campfire skits, and watched our students grow in their knowledge and appreciation of the outdoors as well as their readiness to be leaders back at their home organizations.

I came home Sunday exhausted but gratified, which will help get me through the difficult conversations I still have to have with some of the staff. There have already been some post-session emails that have been less than productive, so the discussions need to happen sooner than later. We’ve got another course in the fall and things need to be hashed out so we can move on. Good principles to live by regardless of whether you’re at work or in these situations elsewhere.

Have a favorite cast iron recipe? Email me.

Email Dr. Jayne.

High Hopes for HHS Cybersecurity Center

Stakeholders react to news that HHS will launch a healthcare cybersecurity center this summer.
By @JennHIStalk

While administrations may change and legislation come and go, the need for cybersecurity across healthcare’s many verticals seems to be a constant that will remain with the industry for the foreseeable future. News that HHS will create a Healthcare Cybersecurity Communications and Integration Center this summer highlights the federal government’s commitment to helping providers, payers, vendors, and (hopefully) patients prevent data breaches that could impact patient safety.

Modeled after the Department of Homeland Security’s National Cybersecurity and Communications Integration Center, the new HHS center helps to fulfill the Cybersecurity Information Sharing Act of 2015, part of a broad initiative under the Obama administration to bolster the government’s offensive and defensive cybersecurity capabilities.

“HCCIC establishes the mechanism to provide proactive and anticipatory analysis of cyber threats to both HHS and the healthcare and public health sector,” says an HHS spokesperson. (The department declined a formal interview.) “The HCCIC will act as a clearinghouse to drive healthcare-relevant cyber indicators, briefings, and actionable intelligence to and from a wide variety of stakeholders – both public and private. HHS aims to begin initial operations this summer.”

The timing is apropos given the impending release of a report authored by the Health Care Industry Cybersecurity Task Force, a CISA-mandated group put together last spring tasked with:

• Analyzing how other industries have addressed cybersecurity threats.
• Reviewing the security challenges associated with networked medical devices and software connected to EHRs.
• Developing and circulating cybersecurity best practices.
• Establishing a plan the government can use to freely share real-time intel regarding healthcare cybersecurity threats.

While HHS would not confirm the HCCIC will help to implement the task force’s recommendations, one can only assume that the two resources will converge to some degree. Industry stakeholders are of course eager to collaborate and benefit from the new center’s deliverables, which are yet to be fully determined.

“We are anxious to begin to see actionable data coming out of the HCCIC, including threat and vulnerability,” says Marc Probst, CIO of Intermountain Healthcare (UT), which formed a cybersecurity center last year with the University of Utah and several other partners. “The HHS goals around information sharing and analysis align perfectly with our organization and several that we are working with,” he adds. “We are anxious to contribute and develop automated feeds for the HCCIC.”

While emphasizing that long-overdue federal cybersecurity risk assessment and risk management efforts will provide good implementation guidance, Probst and his colleagues are reluctant to see cybersecurity become a compliance effort or a certification program. “Many of those currently participating are vendors or people with a product to sell,” Probst explains. “We hope the committees and chairs will seek more payer and provider participants.”

While selling a product to providers in need would surely be seen as a positive outcome for any vendor involved, Divurgent CISO Stephen Watkins sees the benefit of an HHS-sponsored cybersecurity center as one of cohesive collaboration. “For advisory and consulting services organizations like ours,” he says, “these centers allow us to share and contribute our strategic, operational, and tactical insight from the field as well as act as both sounding boards and feedback loops for best-practice implementation guidance from the HCCIC, especially for small providers that may not have in-house IT security staff.”

Real-time cybersecurity guidance to the healthcare community will surely be welcome in light of today’s constant stream of data breach announcements, which have become so banal as to no longer incite the media hysteria it first engendered a year or two ago. While it may be too much to hope the center and its collaborators can help providers, payers, and vendors stay ahead of constantly evolving cyber threats, stakeholders no doubt hope HCCIC resources will become some of the strongest defenses in their cybersecurity arsenal.

Morning Headlines 5/8/17

Warren Buffett, at Berkshire Meeting, Condemns Republican Health Care Bill

Warren Buffet comments on the recent House passage of AHCA, saying the bill amounted to “a huge tax cut for guys like me.” He also said rising health care costs, rather than high taxes, were the biggest drag on American businesses.

VA chief talks commercial Vista

Describing longstanding VA and DoD EHR interoperability issues, Rep. Thomas Rooney (R-Fla.) tells VA Secretary David Shulkin “You could be the best VA secretary of all time if you solve this one problem,” to which Shulkin agreed and affirmed that he would either replace VistA with a COTS EHR or hand development work over to a private firm, explaining "VA has to get out of the business of being a software developer. This is not our core competency, and I don’t see how it serves veterans.

Big Mega HIT Purchasing Report

A Reaction Data health IT purchasing report notes that inpatient and ambulatory EHR systems sit at the top of the shopping list for healthcare executives, followed by telemedicine solutions, patient engagement solutions, and MACRA implementation services.

Allscripts Healthcare Solutions (MDRX) Q1 2017 Results – Earnings Call Transcript

Allscripts Q1 earnings call affirms its positive Q1 results, noting a 13 percent increase in quarterly bookings, and announcing that it anticipates being accepted into the UK’s London Procurement Program, a sign of potential growth overseas.

Monday Morning Update 5/8/17

Top News

Billionaire investor Warren Buffett says in the annual Berkshire Hathaway shareholders’ meeting that the American Health Care Act would be “a huge tax cut for guys like me,” adding that, “Medical costs are the tapeworm of American economic competitiveness.”

Buffett also complained that private equity firms load their acquired companies with debt, announced that the company has sold one-third of the IBM shares it holds, and joked in answering a question about how much his successor will be paid (Buffett is 86) that, “If the board hires a compensation consultant, I’m coming back.”

Reader Comments

From Chiming In on CHIME: “Re: CHIME. You asked why people are quitting HIMSS. I’d like to see the same anonymous question about why people are quitting CHIME. I’m considering it since it has changed from a CIO networking organization to a vendor-driven one, where companies pay for CIO time.” I created a rather awkwardly worded survey here and will report the results next week. 

From 300-Buck Gyp: “Re: radiology report. A friend’s pelvic CT scan had this radiologist comment in the report: ‘CT pelvis. Reproductive organs – the uterus and ovaries are normal. I guess the fee includes copy/paste issues since the patient is a male.” Perhaps “normal” could be loosely construed as meaning that the lady parts are “absent” in male patients, thus streamlining the radiologist’s report template even more.

From Privy Pathway: “Re: Brigham and Women’s. Any thoughts on the offering voluntary buyouts as a cost-cutting measure? It used to be that Epic only got the C-suite fired, but Brigham, MD Anderson, and Southcoast are proving a trend. I’ve also heard that a notable health system is cutting annual compensation increases for the rank and file given capital and operating constraints associated with their Epic go-live.” My cheap-seats view would be this. Epic is fanatical about forcing customers to budget the entire project’s expense. My survey of C-level execs of health systems that use Epic (which got pretty big participation) found that 75 percent of projects came in at or under budget, with just 15 percent saying they spent a lot more than they expected. Therefore, I’ll postulate that it’s probably simplistic to assume that Epic is guilty just because it was present at the crime scene:

• Health systems that choose Epic should not be surprised by its upfront and ongoing costs. That would seem to be the case with most of its customers since few have had disastrous, permanent financial challenges purely because of Epic, especially those that have been live for a few years.
• Leaders of financially challenged hospitals typically find a scapegoat, whether it’s unions, government payments, IT, or regulatory compliance costs. They haven’t blamed Epic all that often, but even when they did, the reality might not be quite so simple, especially if the executives are looking to justify unpopular decisions.
• The type of health systems that choose Epic (large, aggressive, market-leading health systems) are those most likely to have had their bottom line hit by government, payment, and marketing challenges as the emphasis shifts away from heads in the bed and the extraordinarily high cost of hospital-provided care, especially in those with massive market clout that drives negotiation with insurers.
• Timing is everything. Epic gained a lot of customers in the past 3-4 years and financial conditions have changed considerably since then, so those significant upfront costs may be hitting at an inopportune time for some health systems.
• Having poor financial performance after Epic doesn’t necessarily mean Epic was the problem. Some hospitals screwed up their implementations with bad decisions, while others were poorly managed both before and after Epic. Sometimes you read about a high-profit health system choking on Epic and think to yourself, based on what I know about them, I’m not too surprised they managed to mess it up. Software ROI is usually more related to the client than the vendor.
• Some of the hospitals are cutting back because of future expectations, not necessarily due to concerns about their current bottom lines.
• It’s going to get a lot worse of the ACA is repealed and many millions of hospital patients go back to being charitable write-offs, shrinking health system profits.

HIStalk Announcements and Requests

Nearly 80 percent of poll respondents haven’t bypassed insurance to pay cash for a better ongoing PCP. Stephen pays an $149 annual fee to belong to One Medical even though the actual visits are still covered by insurance. Nonsequitur took the concierge route for his father since few decent doctors in his area accept Medicare, adding that the new practice provides nearly 24/7 secure communications via Twistle. Amy says she hasn’t done it for a PCP, but does so for other services because some providers offer a cash price that’s cheaper than paying her high-dollar insurance deductible. Rose goes out of network to keep a particular PCP even as insurance contracts change frequently, although she’s cautious to get orders for expensive lab and rad tests ordered by an in-network provider since some plans won’t pay for them otherwise.

New poll to your right or here: what was your reaction to the House’s passage of the American Health Care Act last week? Feel free to elaborate further by clicking the poll’s “Comments” link after voting.

HIStalk readers provided an Amazon Fire TV and accessories for Ms. D’s California elementary school class in funding her DonorsChoose grant request. She reports, “Technology is always changing, so my teaching strategies need to accommodate the needs of my students. Most of them are visual learners, so I play YouTube clips and videos all the time when I am teaching science. In addition, the Amazon Fire TV has allowed my students to visually see the concept as they are watching science videos on TV. Now, my students are extremely excited about science! On behalf of my students, thank you for supporting them as they continue to reach for their goals!”

This Week in Health IT History

One year ago:

• Theranos announces a reorganization that includes the retirement of President and COO Sunny Balwani.
• HHS spells out details of its proposed MACRA program.
• NextGen ceases development of its NextGen Now cloud-based PM/EHR as it moves focus to its acquired HealthFusion product.
• The FDA rejects the application of the “digital pill” that uses technology from Proteus Digital Health.
• Apple releases the CareKit developer’s framework.
• Internal documents from University of Texas indicate that MD Anderson Cancer Center blames its Epic implementation for a nearly 60 percent year-over-year income decrease, although noting that it had already assumed some negative impact.
• Siemens changes the name of Siemens Healthcare to Siemens Healthineers.

Five years ago:

• Partners HealthCare chooses Epic to replace Siemens Soarian.
• ONC launches its Health IT Dashboard.
• The Nashville Medical Trade Center names six companies that will join HIMSS as tenants.
• Medseek announces plans to conduct a management buyout of the company.

Weekly Anonymous Reader Question

I asked readers to describe the best career advice they have received:

• You can do better without working more hours.
• From Ben Franklin: ask people for help in order to make them like you.
• From my first professional manager who that had been employed for our then-current employer for the previous 30 years, "Don’t make the same mistake as me and think that you need to stay with the same company your whole career."  Knowing what I know now, and having held various positions with several different employers over the course of 25 years, I would have loved the opportunity to have been given the option to stay put.
• Perception is reality. It doesn’t matter what you think — if people perceive X, then X is true.
• Always put yourself in the other person’s shoes — most people have good intentions, so if they don’t behave in a good way, understand why from their point of view.
• When I was thinking of starting my own independent, HIT consultancy in 1985 — terrified every step of the way, but more terrified not to do it — my mentor at the HIT company where I was employed advised me that, so far, my track record for getting through rough days is 100 percent and that’s pretty good.
• Be nice to the administrative assistants.
• When you walk somewhere, go fast so you look like you’re actually on your way to do something.
• Realize when it’s time to recalibrate. Your vision of your life when you were 18 is probably different than it has turned out to be when you reach 40, so focus on the accomplishments rather than regrets.
• Being told that I was not a good writer, and as such would never be published in one of the B2B magazines owned by the publishing company I worked for. While not your typical piece of advice, I took it as a challenge to prove the naysayers wrong. I believe my ensuing track record of published pieces for a variety of media outlets speaks for itself.
• My daughter just became an RN and has started working at our local hospital. In her first week or so, she was introduced in passing to an OB/GYN who happens to be my wife’s and also happened to be the doctor who delivered my daughter. She says "Hello, Dr. A," to which he replies "Get out of healthcare, kid."
• People will always remember how you’ve made them feel. Don’t be a jerk.
• Don’t listen to your parents. They really think they know you, but they can’t because you only become you by following your nose and that takes time, experimentation, trial and error, and the occasionally do-over. In fact, don’t listen to anyone. Do something that is new every day, and when it stops being new at least a little every week, then move on.
• Listen. You may be the smartest person in the room. Listen anyway. You’ll learn something.
• If it’s not going to matter in five years, it doesn’t matter now. Pull back and reconsider your response to the situation.
• You need to read HIStalk.
• When the horse has died, dismount. (Ross Perot)
• Your boss cares about results, not the path you took to get there.
• If you are young and take a travel job for the higher pay, have an exit plan. Otherwise, you’ll find yourself still on a plane traveling every week when you are 65 years old, having missed so many family and friends moments because you were always on the road.
• You can love your job, but it will never love you back. No job — no matter how rewarding either financially or emotionally — is worth destroying your peace or sanity for.
• Do not let one person ruin your job. (Advice I should have taken.) I left a job after 6.5 years because I could not stand my boss. Other people just ignored or tolerated him. Many of them are still there today, 15 years later. He has since retired.
• Back in the early 1980s:  learn to type. Sounds dated now, but as my mother said, you can always fall back on being a secretary if needed. Thankfully I took four years of typing in high school, and went onto college to get my bachelors. I type for a living now in IT.
• Earlier in my career, I was really ambitious and wanted a promotion after my direct manager left. I wasn’t ready to be the department manager but i met with the VP making the decision anyway. He learned more about my background and experience and said to me, "You have to ask for the job you want, otherwise no one will know you want it." It was a revelation to me. A plain spoken truth and something so simple would be the best career advice I ever received.
• My first CIO taught me not to ever say “no” to my business partners. Say “how long” what they want will take to acquire and/or develop, and “how much” it might cost. This is our obligation as IT professionals serving an organization.
• Taking the path of integrity and good character will not always result in promotion within an organization. You must be willing to stick to your professional values and be ready to move on to new adventures if your superiors do not like your answers.
• You hold yourself back more than anyone or anything. You are good at what you do. Have faith in yourself, be heard, make a difference.
• Spend more personal time with your team. Show your human side. Both will build more trust, which will make the team closer and stronger.
• Never talk to a reporter. Your response should always be "no comment."
• Don’t do anything rash.
• When you have an issue with the way the organization is being run, address it by tying it to core values or customers, not by calling out the way a specific person does things.
• You should spend 10 percent of your time looking for your next gig.
• Do what you say you’re going to do, when you say you’re going to do it. Return the call or email promptly even if you don’t have the answer. In other words, be there. If colleagues and customers know they can count on you, you’ll be given more opportunities (and responsibilities) to grow your career and, at the same time, build a network that will be increasingly valuable.
• Arrive at a meeting at least five minutes early, and if you are leading, a meeting ensure that it ends on time or earlier.
• I was having trouble getting what I needed professionally from a boss. The advice I received from a mentor was, "She will never be the kind of boss you need. So how do you make the most of what she has to offer and get your other needs met elsewhere?"
• Live on what you currently make so your employer will never "own" you. I stayed in positions because I wanted to be there, not to get a paycheck.
• Worry about the sale. The margin will take care of itself.
• Advice to a just promoted CIO: "Remember that you are a VP of the organization, not just of IT."
• Don’t apologize if you have not done anything wrong. Said to me by the late great Steve Macaleer, of the Macaleer/SMS family, who died way too young at 49.
• Every five years or so, change jobs. You have probably developed bad habits that are best discarded. You can do this within your current employer or by getting a new employer.
• Ninety-five percent of the time you are right, but 95 percent of the time your delivery sucks. You need to work on your delivery AND timing.

This week’s question: what specific event crystallized your decision to leave your last job? (or another previous job if you’ve got a good story from there).

Welcome to new HIStalk Platinum Sponsor CSI Healthcare IT. The Jacksonville, FL-based company, which has offered services nationally for 20 years, provides training and implementation solutions for EHR and coding as well as IT staff augmentation, legacy system support, and infrastructure staffing. Case studies: Houston Methodist (CPOE activation), Norton Healthcare (a 300-contractor Epic go-live), Sutter Health (Epic training), and Grady (big-bang Epic go-lives). The company’s consultants voted it to Inavero’s Best of Staffing Talent List, which recognizes fewer than 1 percent of staffing agencies in North America. The company provides customized consulting and staffing solutions that provide unmatched results at a fraction of the cost. Thanks to CSI Healthcare IT for supporting HIStalk.

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

Last Week’s Most Interesting News

• The House passes the American Health Care Act that would repeal most of the Affordable Care Act, sending the bill to the Senate.
• Thoma Bravo buys Lexmark’s Perceptive Software business and moves it under its Hyland Software portfolio company.
• Computer systems at University Hospitals (OH) go down for several days due to unspecified causes.
• ONC launches a patient matching algorithm challenge.
• Meditech announces Q1 earnings per share of $0.39 vs. $0.51 in the same quarter last year.
• Internal medicine physicians at Canada’s Nanaimo General Hospital are disciplined for going back to paper orders in declaring patient safety concerns with Island Health’s Cerner system.

Webinars

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

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call, following the quarterly report in which the company beat expectations on earnings and met on revenue:

• A strong segment was Payer and Life Science.
• The company expects its acceptance into the UK’s NHS London Procurement Partnership to help it maintain UK momentum.
• The Netsmart acquisition contributed around $50 million of the quarter’s bookings.
• Paul Black says the company is watching the market evaluation being performed by the VA and Coast Guard, noting that the Allscripts loss in the DoD bid wasn’t due to technology, applications, workflow, security, or company background – it didn’t make it to the final round because of price.
• The company is not seeing the decline in claims volume as reported by Athenahealth, although it notes that Athenahealth has greater exposure than Allscripts because of its business model.
• Allscripts will focus on increasing the client base’s adoption of Sunrise Financial Manager rather than trying to roll out outsourced inpatient revenue cycle management services.

Decisions

• Central Montana Medical Center (MT) will switch from Evident to Infor supply chain management in 2017.
• Children’s Hospital Of New Orleans will go live with Epic in 2018.
• New Orleans East Hospital (LA) will switch from Cerner/Siemens Soarian to Epic in 2018.
• Thomas Memorial Hospital (OH) replaced Siemens with Meditech on March 1, 2017.

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

People

New York-Presbyterian Hospital (NY) promotes Rosemary Ventura, MA, RN, DNP to the newly created position of CNIO.

Announcements and Implementations

Reaction Data publishes its “Big Mega HIT Purchasing Report,” which finds that the top spending item of health systems and standalone hospitals in the next 12 months will be inpatient and ambulatory EHRs (Epic was #1 in mindshare for both, followed Cerner and Meditech that were nearly equal in score). Hospital-owned physician groups will focus on information security, while independent practices place telehealth as #1 with equal interest in four vendors.

Definitive Healthcare adds quarterly inpatient and outpatient Medicare claims data for hospitals, clinics, and long-term care providers to its provider data, intelligence, and analytics product line.

Government and Politics

VA Secretary David Shulkin reiterates that he will announce the VA’s plans for VistA in July, choosing to either replace it with a commercial system or turn VistA over to a private company to convert it into a single, cloud-based, externally managed instance. When asked about the historic lack of technology cooperation between the VA and the Department of Defense, Shulkin promised better, saying, “We’ve always found ways not to do that.”

Privacy and Security

Hacker The Dark Overlord posts records of 180,000 patients online from medical practice hacks last year, most likely because those facilities declined to pay the extortion demanded.

Other

A Utah-based orthopedic surgeon is ordered to turn over 10 website domains to Intermountain Health Care, which complained that the doctor had no legitimate reason to have purchased domains related to Intermountain’s Cedar City Hospital and was instead was trying to use them to convince an insurance company to add him as an in-network provider.

Here’s the finale of Vince and Elise’s series on physician practice vendors, this time looking at the “other” ones.

Sponsor Updates

Blog Posts

• #JoinTheConversation with Phillip Scott of NCPDP (Experian Health)
• Value-Based Purchasing: A Bad Deal for Safety-Net Hospitals? (Definitive Healthcare)
• Reduce Paper Fat with a Health Check (Access)

Contacts

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

Morning Headlines 5/5/17

What’s in the AHCA: The Major Provisions of the Republican Health Bill

The House passes the American Health Care Act in a 217-213 vote. The ACA replacement bill will now head to the Senate for debate.

Allscripts Healthcare Solutions, Inc. (MDRX)

Allscripts reports Q1 results: revenue climbed 20 percent to $413 million, adjusted EPS $0.13 vs. $0.13.

Doctor On Demand Announces Lab Testing Services to Provide Patients Better Everyday Care

Direct-to-consumer telehealth vendor Doctor On Demand partners with both LabCorp and Quest Diagnostic. The partnership will give Doctor On Demand providers a way of ordering diagnostic tests that consumers can have run locally.

The world’s most valuable resource is no longer oil, but data

The Economist argues that data has surpassed oil as the world’s most valuable resource, and calls for antitrust actions against the technology giants that control the vast majority of data flow.

News 5/5/17

Top News

The House votes 217 to 213 to repeal the Affordable Care Act, sending the American Health Care Act to the Senate. President Trump said afterward in a White House victory celebration, “We’re going to get this passed through the Senate. I feel so confident,” adding a promise that premiums and deductibles will go down.

No Democrats voted “yes,” while 20 Republications voted “no.” Two more “no” votes would have killed the bill. The House allocated 40 minutes for discussion before the vote.

The voting was held just before the House leaves for an 11-day recess. Congressional Budget Office scoring of cost and the change in the number of uninsured has not been completed.

Just about every medical and consumer group urged rejecting the American Health Care Act, which would:

• End Medicaid as an open-ended entitlement.
• Give the wealthiest Americans a $300 billion tax break over 10 years.
• Allow insurers to charge older citizens five times the premium rate of younger ones (increasing it from three times).
• Allow states to eliminate the requirement that insurance companies issue policies without considering pre-existing conditions.
• Eliminate the requirement that individuals buy insurance.
• Remove the penalties for large employers who don’t want to provide insurance to their employees.
• A change added to the bill in a last-minute amendment would allow states to remove the out-of-pocket maximums now required of employer-provided insurance.

The expected millions of people who would lose insurance under the proposal would leave hospitals at risk for providing their emergency care without payment since the Affordable Care Act reduced hospital Medicare payments on the assumption that more of their patients would be insured.

The Senate’s debate on the bill will begin in June.

Reader Comments

From LongInTheTooth: “Re: Australia’s Telstra Health. You mentioned them as being shortlisted for an EMR tender in Northern Territory. After making over a dozen health IT acquisitions in the last few years, they have decided to trim down and focus solely on the Australian market. New Managing Director Mary Foley is trying to turn around a larger-than-required health vertical without a coherent strategy and has just announced a massive reorg which includes layoffs. Last week they sold their Arcus EMR business in Asia to private buyers. Their CTO Roy Shubhabrata (ex-Epic, GE Healthcare, Microsoft) couldn’t save the sinking ship. Another acquisition, Dr. Foster in the UK, is up for sale as well.” Telstra Health is a business unit of Telstra, the biggest telecommunications and media company in Australia.

From Polite Patrician: “Re: Epic’s App Orchard. The site seems to be free of legal disclaimers. I’m wondering how the submission and approval process works.” I’ve heard concerns that Epic asks a lot of questions about submitted apps and could theoretically use that information to guide its own product development. Epic could also reject apps in claiming without proof that they encroach upon planned future Epic functionality. It seems farfetched to me that Epic would use App Orchard submissions to glean product enhancement ideas or that it would deny applications without a good reason, but at least some small companies seem to worry about that possibility. I’m interested in hearing (anonymously) from anyone who has experience in working with Epic on App Orchard since we’re otherwise just sitting around wringing our hands without facts.

From Old Relay Dev: “Re: McKesson. Sweeping layoffs in NewCo/Change starting last night.” Unverified. An anonymous post on TheLayoff.com quotes a claimed internal email indicating that 394 employees were let go along and 89 open positions were closed, predicting that another RIF will follow in June.

HIStalk Announcements and Requests

HIStalk readers funded the DonorsChoose project of Mrs. F in Virginia, who asked for headphones for her kindergarten class. She reports, “During our group rotations, when students are not working with one of the teachers, then they are on the computer using a program that they sign into so that reading, word recognition, and spelling are at the student’s level. The headphones allow only the student who is on the computer to hear the program without distracting the groups the teachers are working with. The students on the computer are also not distracted by what the teacher is teaching. These headphones allow my classroom to run smoothly. The donors who help make my room complete are angels.”

This week on HIStalk Practice: Compulink develops all-in-one HIS solution for ASCs. MDLive CEO hints at the important role telepsychiatry will play in its future business model. NCQA develops Oncology Medical Home recognition program. Charlotte Eye Ear Nose & Throat rolls out Epic. Practice Velocity announces ownership changes. Change Healthcare helps Saltzer Medical Group transition to independence. Kerri Wing, RN of IHealth Innovations outlines the IPPS proposed rule’s peace offering to physicians.

Webinars

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

Acquisitions, Funding, Business, and Stock

Private equity firm Thoma Bravo will buy Lexmark’s enterprise software business — which includes Kofax, ReadSoft, and Perceptive Software – and will then sell the Perceptive business (image capture, vendor-neutral archive, and a universal viewer) to its portfolio company Hyland Software. The Kofax and ReadSoft businesses will be rolled into a new Thoma Bravo company under the Kofax name. Lexmark acquired Perceptive Software for $280 million in 2010, bought competitor Kofax in 2015, and then sold itself to a China-based investor consortium for $3.6 billion in 2016.

Allscripts announces Q1 results: revenue up 20 percent, adjusted EPS $0.13 vs. $0.13 as GAAP earnings swung to a loss, meeting earnings and revenue expectations. Shares were unchanged early in after-hours trading and are down 9 percent in the past year.

Germany-based CompuGroup Medical reports Q1 results: revenue up 5 percent, EPS $0.27 vs. $0.22. Share price has risen 20 percent in the past three months.

Analytics vendor Inovalon reports Q1 results: revenue up 5 percent, adjusted EPS $0.07 vs. $0.05. Share price is down 22 percent in the past year, valuing the company at $1.8 billion.

EHR prescription drug coupon vendor OptimizeRX reports Q1 results: revenue up 22 percent, EPS -$0.03 vs. –$0.01. OTC-listed shares are down 29 percent in the past year, valuing the company at $22 million.

Analytics vendor Koan Health buys ZirMed’s value-based care analytics business.

China-based insurer Ping An launches a $1 billion investment fund that will focus on overseas financial and healthcare technology. The company’s health Internet subsidiary, which offers free online doctor consultations, raised $500 million in a Series A round last year,valuing it at $3 billion.

People

Patient engagement technology vendor Conversa Health hires Chris Edwards (Validic) as chief marketing and experience officer and Becky James (WebMD Health Services) as VP of operations.

Phil Spinelli (Visiant Health) joins Ingenious Med as SVP/chief revenue officer.

Kyruus hires Scott Andrews (Athenahealth) as SVP of delivery.

AdvancedMD hires Greg Ayers (inContact) as CFO.

Announcements and Implementations

Video visit vendor Doctor On Demand integrates its system with those of lab companies Quest and LabCorp, allowing its doctors to order lab tests and for its patients to choose a lab based on insurance coverage, availability, and location. The company — co-founded by TV psychologist Dr. Phil and his TV producer son – has raised $87 million in three funding rounds, although the largest and most recent was nearly two years ago. Among its investors are Athenahealth’s Jonathan Bush and Virgin’s Sir Richard Branson. It offers medical sessions for $49 along with ongoing psychology and psychiatry counseling.

In Australia, Pulse+IT reports that a Victoria-wide implementation of Epic did not receive funding in the state’s new budget.

Surescripts extends its real-time medication history service to long-term and post-acute care facilities.

Government and Politics

The CEO of insurer Molina Healthcare – the son of the company’s founder who, along with his CFO brother, was fired Tuesday despite improved quarterly results – says his criticism of the Republican repeal-and-replace movement may have cost him his job. He says, “People are afraid of the administration. Why take an aggressive stance if you think you have nothing to gain, or if you think you have something to lose?” He adds, “The most troubling development has been the attempt to get votes from the Freedom Caucus by allowing states to get rid of the ban on pre-existing conditions … The Trump administration is destabilizing [the marketplaces]. Health plans need to plan ahead. He can pull the rug out from the health plans at any minute.” Molina shares rose 25 percent on the news as investors speculated that the company is now an acquisition target, having jumped 41 percent in the past year and 152 percent in five years.

Privacy and Security

DataBreaches.net reports that an anonymous hacker is running a “summer sale” on his or her inventory of 500,000 recently stolen patient records from pediatric practices, offered at $3 per child. The site verified the validity of a sample of the records even though no cumulative breaches of that magnitude have been reported. The hacker, “Skyscraper,” says he or she simply searches for “patients,” adding that, “For some stupid reason, entire databases show up” and clarifying that the searches don’t involve the known weaknesses of IoT-connected devices or FTP servers. Asked what practices should do to protect themselves, the hacker says they need to pay for their software: “You wouldn’t believe how many of those offices run on cracked / downloaded software and outdated 2015 versions.” 

University of California regents sue several doctors and pharmacies, claiming that they defrauded the student health insurance of $12 million over six months by running Facebook ads offering students $550 to participate in phony clinical trials for a pain cream and recruited other students as sales reps for a drug “startup” at a campus job fair. The 500 respondents to both solicitations were required to provide their student health plan numbers, which the lawsuit claims were used to bill prescriptions for custom compounded, Ben Gay-like creams that cost the student health insurance up to $5,300 per tube. The prescribers did not examine the students, who were unaware that they were being billed for the creams. One podiatrist wrote 600 prescriptions for the creams in a single day, costing the system $1.7 million.

Other

Ever-increasing patient cost-sharing has hurt the collection rates of medical practices, according to a Health Affairs article co-authored by Athenahealth’s Jonathan Bush that studied the company’s practice data. Patients paid around 90 percent of balances that were less than $200, but once they owed more than that amount, the figure dropped to 67 percent. The article also notes that collection rates are lower for specialists (because they charge more) and that practices must wait weeks to receive an EOB from the insurance carrier to find out what the patient owes, greatly reducing the chances of getting paid once the patient has left the office.

An article in The Economist says that data rather than oil is the world’s most valuable resource, suggesting an antitrust evaluation of the companies that are profiting massively from it (Google, Amazon, Apple, Facebook, and Microsoft). It notes that access to consumer data gives those big companies an early warning (“a God’s eye view”) of potentially competitive upstarts that they can either copy or buy, highlighting Facebook’s $22 billion acquisition of 60-employee, zero-revenue WhatsApp in 2014. The article suggests that antitrust regulators look not only at company size when evaluating the consumer impact on a proposed merger, but also the extent of the data assets of the companies. It also proposes that companies be forced to let consumers know what information about them they hold and how much money they make from it; that governments open up their own data vaults; and that countries require at least some industries (as is being done with banks in Europe) to share their customer data with third parties.

A Wall Street Journal article examines whether public outcry over a company’s $89,000 drug (previously sold for $1,200) forced that company to sell the drug to yet another company and effectively put itself out of business. Marathon Pharmaceuticals bought a old UK muscular dystrophy drug, paid $370,000 to buy study data from universities, researchers, and the Muscular Dystrophy Association that it used to earn FDA approval, then set an $89,000 per year US price. The CEO’s previous company bought another rare disease drug and upped the price from $289 per vial to $1,950, a formula it repeated in buying “under priced” drugs from big companies and increasing US prices by an average of 500 percent. He made $60 million when he sold the company for $900 million. He expected to sell the current company, Marathon Pharmaceuticals, for several billion dollars before the pricing backlash, but even though he fell short, the company received $140 million in cash and stock, 20 percent of future sales revenue, and a potential $50 million payout, all  thanks to 20,000 young boys afflicted with Duchenne muscular dystrophy.

A survey of 800+ health IT workers (two-thirds of them consultants, most of them working on Epic) finds that 86 percent of them feel optimistic about their career opportunities and nearly half say they make $100,000 or more per year. The most important factors in deciding whether to accept a contract are pay, company reputation, and the expense reimbursement model, with the least-important factor being the ability to work from home. Interestingly, two-thirds of consultants would consider a full-time role, which represents a huge jump over surveys from previous years, although salary expectations seem to be a barrier given the tiny number of respondents who say they’re willing to take a pay cut.

Wilkes Regional Medical Center (NC) will convert from McKesson Paragon to Epic as its lease is turned over to Wake Forest Baptist Medical Center on July 2, when it will be renamed to a name that will surely almost never be used in its entirety, Wake Forest Baptist Health – Wilkes Medical Center.

An interesting study finds that parents who Google the symptoms of their child are much more likely to question their pediatrician and seek a second opinion because they don’t understand the differential diagnosis process the doctor used. The author suggests that physicians explain how they arrived at their diagnosis during the office visit to avoid treatment delays caused by patient second guessing.

Vending machines are offering $4 HIV test kits as part of a government pilot project in China, where people often don’t undergo testing because homosexuality — and with it, HIV and AIDS — are taboo subjects and hospitals reportedly regularly turn away HIV/AIDS patients even though the law forbids such discrimination.

Weird News Andy says 50-times-faster brain surgery is fine as long as it isn’t done half-fast. University of Utah develops a robotic, CT-mapped surgical drill that may reduce surgery time from two hours to 2.5 minutes, although it hasn’t actually been tested on humans.

Sponsor Updates

• Impact Advisors delivers 200 backpacks filled with craft supplies and games to patients of Florida Hospital for Children.
• EClinicalWorks will exhibit at the 2017 ASCA Annual Meeting May 3-6 in Oxon Hill, MD.
• Nuance recaps recent hospital sales of its computer-assisted physician document system and publishes a new report titled “CAPD 2017: Improve physician documentation at the point of care.”
• Evariant will host its third annual Converge User Conference May 7 in Austin.
• ECG Management Consultants will present at the 2017 ASCA Annual Meeting May 4 in Oxon Hill, MD.
• An Emory University research study finds cost savings for CABG surgery, supported by Glytec’s Glucommander for personalized insulin dosing.
• The HCI Group publishes “Selecting the Right Interface Engine – Top 5 Considerations.”
• Healthcare Growth Partners supports the sale of Clockwise.MD to DocuTap.
• Imprivata will exhibit at the Canada Collaboration Forum May 8-10 in Whistler, British Columbia.
• Influence Health releases a new whitepaper, “Healthcare Consumer Experience in 2017.”
• InterSystems will exhibit at the Blue Cross Blue Shield National Summit May 9-12 in Orlando.
• Kyruus publishes “Health System Call Center Experience Report: Are Top Health Systems & Hospitals Answering the Call to Provide a Better Patient Experience?”
• Liaison Technologies begins accepting applications for its new Data-Inspired Future Scholarship.
• NVoq will exhibit at the MGMA NE conference May 10-12 in North Falmouth, MA.
• Experian Health will present at HFMA Eastern Michigan May 12 in Livonia.
• Wellsoft will exhibit at the Rural Health Conference May 9-12 in San Diego.

Blog Posts

• How to Increase Your Revenue by Closing Care Gaps (ECG Management Consultants)
• Beyond Clinical Care – How to Define “Customer Experience” (Evariant)
• Are You Maximizing Your Clinical Documentation Improvement? (Optimum Healthcare IT)
• Implementing a New Compensation Plan: 5 Ways to Get Physician Buy-In (Hayes Management Consulting)
• Why Sugar Isn’t Sweet for the Healthcare Industry (Healthgrades)
• PHI and Meditech’s Data Repository (Iatric Systems)
• MEDITECH Solutions Bring Real Results to Southern Africa Healthcare (Meditech)
• How Gundersen Health System is securing its EMR without impacting clinical access (Imprivata)
• A Healthcare Marketer’s Consumer Experience Wish List (Influence Health)
• I Know it When I See It: Coordinated Care (InterSystems)
• The Evolving Role of Digitization in Healthcare (Conduent Health)
• Solving the Problem of Dirty Orders (Liaison Technologies)
• Landing Top Information Security Talent: How Healthcare Organizations Can Stand Out to CISOs (Fortified Health Security)
• Rethinking healthcare data: it is a technology ecosystem (LifeImage)
• Meditech Solutions Bring Real Results to Southern Africa Healthcare (Meditech)
• The Power of 3: From the Three Musketeers to Our 2017 Patient Payment Check-Up Survey (Navicure)
• Meditech 6.1x Implementation Phases Part 4: Build (Parallon Technology)
• My nursing path to Infor (Infor)
• Healthcare Security Roundtable: An Interview with CloudWave and Fortified Health Security Experts (CloudWave)
• Who Let the Trump Out? (Reaction Data)
• No Logo: When Your Brand Gets in the Way of Your Vision (Salesforce)
• Will Ambulatory Surgery Centers Become More “Hospital-Like?” (The SSI Group)
• The Difference Indifference Can Make (Solutionreach)
• Thank You, Lab Professionals, For All You Do! (Sunquest Information Systems)
• Spring Fever Hits IT – Disaster Recovery to the Rescue (TierPoint)
• From Meaningful Use to Meaningful Insight. (Voalte)
• Leverage SMS Messaging for Fiesta-Worthy Communication (West Corp.)

Contacts

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

EPtalk by Dr. Jayne 5/4/17

A recent ONC blog post mentioned efforts to “demystify patient matching algorithms.” Patient matching continues to be challenging to many interoperability projects. The blog post makes the point that although matching is critical, there isn’t much transparency around how well current algorithms perform. There’s been a lot of debate about a universal patient identifier, and despite the restrictions around any federal initiatives to move towards such an identifier, many of us would like to see one move forward. Even if it’s voluntary, I’d rather take my chances with ID theft than risk misidentification. I’ve had recent issues with someone else’s data in my chart, so maybe that adds to my bias.

To aid in finding a solution for matching issues, ONC launched the Patient Matching Algorithm Challenge, which aims to develop new algorithms, benchmark the current state, and help organizations find common metrics. There will be six prize winners with a total payout of $75,000. There are several webinars upcoming and registration for the challenge opens next week, for those that are interested.

My pet peeve of the week is meetings that start late. I’ve been on multiple conference calls where I’ve heard phrases like, “Let’s just wait a few more minutes, there might have been some people with meetings before this who have not yet arrived.” It’s extremely disrespectful to those of us who adjusted our schedules to be on time, who get to sit there and wait. During several of the offending meetings, the latecomers never materialized, so it truly was a waste of time.

I’ve said it multiple times, but organizations that want to be high-performing need to look at how they schedule meetings and make adjustments if people are constantly late or double booked. Condemning people to daily runs of back-to-back meetings is not only inhumane, but non-productive. The best organizations I’ve worked in have policies in place to limit meetings to 25 or 55 minutes so that participants can transition to another meeting if needed. They also have active agenda management within their meetings to ensure that time is used well and that they don’t run over. I preach this constantly during my consulting engagements and can usually get my clients to make progress. Lately I’m involved in projects, though, where I’m just a small piece of the puzzle, so I’ve been feeling the pain of poorly managed meeting schedules.

US prescription drug spending continues to rise, potentially crossing the $600 billion mark in the next four years, according to a Reuters article. The annual increase of 4-7 percent is less than the 6-9 percent increase in spending growth that was originally forecast, partially due to fewer approvals of new medications and pharmaceutical companies facing pricing pressures. The piece mentions that “several drug makers have pledged to limit annual price hikes to under 10 percent.”

I understand price increases have to keep up with inflation and manufacturing costs, etc. but it seems most manufacturers are going to keep increasing prices as much as the market (and public opinion) will bear. I continue to cringe when I review patient medication lists during patient care shifts. It’s increasingly rare to see patients on fewer than 10 medications unless they are pediatric patients. I see people on the “latest and greatest” branded medications when generics are available that have virtually identical side effect and risk profiles.

It takes a lot of work and effort to have conversations with patients around whether switching from medication X to generic Y is a good idea and what the cost savings could be over the course of a lifetime of chronic treatment. Patients with low health literacy aren’t going to understand relative risk reductions and how a medication being 1-2 percent more or less effective is going to make a difference for them. Physicians often don’t have the time to have those conversations, either.

The best resources I’ve seen for these conversations are pharmacists who are embedded in the clinical practice, but we don’t see a lot of those in the workforce. We also need to get past the cultural idea that being on the latest and greatest medication is best. How many drugs have we seen that have serious issues that aren’t found until they are on the market for a year or two? More than I care to remember.

It’s also more of a challenge to have the conversations and interventions around lifestyle modification than it is to just give another medication, especially when physicians are being graded on their outcomes. I’d like to see insurers or pharmacy benefits managers providing these kinds of direct-to-patient interventions. They could keep a share of the savings from the lower-cost interventions to motivate them. Of course, it would cut into the overall profit margin, but it would be better from a societal standpoint because polypharmacy is a real issue. It’s easier though to push the work to the physicians and other front-line providers, who I guarantee aren’t getting payment increases that are hovering under 10 percent.

Lots of people were impacted this week by a Google Docs phishing scam. When I saw identical emails come through from almost a dozen unrelated people in the course of a few minutes, I knew something was up. It quickly made its way through several local school systems that use the Google Classroom applications, and from there to their parents and out into the community. It’s a good lesson for the younger set, that there are bad actors out there and they have to be suspicious.

The things that kids have to worry about in this day and age are sad, however. My local school district just announced a program starting in the fall where every middle school student will be issued a personal Chromebook for use at school and at home. Although it might keep family computers from being impacted by scams accepted by unsuspecting children, it increases the burden for tech support for the schools.

The rapid growth of technology is also a bit of an experiment on our society as a whole. Social media creates stress for adults and youth alike, and the social media-related suicides and bullying are truly tragic. I was fortunate to grow up in a location and as part of a generation that could run around the neighborhood until the street lights came on, and most of our worries were around flat tires on our bikes. Even in middle school, the pace of bullying was limited by the passing of folded pieces of notepaper and whispering in the hallways between classes, where now hundreds of people can be involved in negative interactions at the touch of a button. Add in the recent boom in murders, suicides, and assaults broadcast live for the world to watch and it makes you wonder where we’re headed. Maybe patient matching challenges aren’t such a big deal after all.

Email Dr. Jayne.

Morning Headlines 5/4/17

US Hospital EMR Market Share 2017

KLAS publishes its 2017 report on EMR market share finding, not surprisingly, that Epic and Cerner lead, with a fairly even split of 25.8 percent and 24.6 percent respectively, followed by Meditech with 16.6 percent.

Statement of the Honorable David J. Shulkin, Secretary of Veterans Affairs

VA Secretary David Shulkin testifies before members of the House Appropriations Committee noting that the agency will make a decision on whether to implement a commercial EHR or continue with VistA by July 2017.

Growing Insurance Coverage Did Not Reduce Access To Care For The Continuously Insured

A Health Affairs study concludes that the increased insurance coverage brought about by ACA did not impact access to care for those that were already insured.

Genomic Testing and Precision Medicine in Cancer Care

A Medscape survey of 132 medical oncologists and hematologists finds that most patients do not benefit from genetic testing because results rarely point to evidence-based, clinically actionable changes to a treatment plan. Despite this, 61 percent of respondents still believe the tests are useful.