Morning Headlines 5/2/17

How science fares in the US budget deal

Congress passes a bi-partisan budge that will fund the government through the end of the fiscal year on September 30, including a 6 percent bump in NIH funding, and additional funding earmarked to establish a telehealth center of excellence.

Vanderbilt is a case study for the dreaded EHR conversion

Modern Healthcare profiles Epic’s $214 million implementation at Vanderbilt University Medical Center as it prepares for its November go-live.

VA partners with Department of Energy on big-data initiative to improve health care for Veterans

The VA is partnering with the Department of Energy to develop supercomputing capabilities that will analyze health and genomic data to help the VA improve its suicide prevention programs.

Cleveland Clinic CEO Toby Cosgrove talks about his decision to step down, time at the helm: Q&A

Cleveland Clinic CEO Toby Cosgrove announces that he will retire from his position by the end of the year.

Curbside Consult with Dr. Jayne 5/1/17

I’m doing some work with a health system that is migrating multiple hospital and ambulatory systems to a single instance of Epic. They have contracted with a number of third-party vendors to keep the proverbial lights on with their legacy applications while the core teams are incorporated into the Epic team.

At times, it’s been heartbreaking to watch. The Epic project team forced longstanding qualified employees to go through rounds of personality testing and interviewing, only to be denied an opportunity to join the Epic project. I’m personally happy to have these so-called “rejected employees” as part of the team that’s keeping things running because they have extensive experience and knowledge as well as being good people. It’s a shame that the health system has some mold they’re trying to fill for the Epic team because they’ve missed out on some talent.

I’m handling some clinical and regulatory work for the ambulatory applications, but another third party is handling any development work that is needed. There’s more development than I would have expected this close to a migration. The health system continues to purchase independent practices and wants to bring them live on EHR for reporting reasons. They are developing specialty-specific documentation templates that I’m pretty sure are never going to get used because they are for high-dollar subspecialists who prefer to dictate their documentation and aren’t going to sit and do a bunch of clicking just because an administrator asks them to. I’m confident their acquisition contracts didn’t include data entry, so the template development is a bit of a wasted enterprise to begin with.

The third-party development partner uses offshore resources and availability for meetings is an issue. I’m watching the stateside analysts pull their hair out because they’re being asked to get on calls at 10 p.m. local time to accommodate the offshore analysts, who have contractual limitations regarding calls during non-working hours. The US managers are aggravated because the most expensive resources are being stressed out by the hours. The analysts fear for their jobs if they don’t comply since they’ve already been passed over for slots on the Epic team and are likely to be candidates for a layoff after the go-live.

Apparently no one thought about these factors when they signed the agreement with the development partner, but I bet they will think about it next time. It’s just particularly sad because, again, they’re spending a lot of resources on templates that aren’t going to be used (and even if they are used, it will only be for a few months). They’re also burning out dedicated workers who have served the healthcare system for years and have a lot to offer.

I’ve made the suggestion that they should halt the development project, create a stripped down data entry template, and then hire a couple of medical students or nursing students to do the data entry from the providers’ dictated notes each day. It would be more cost effective and create better goodwill for everyone involved, but of course no one is listening to the person who is best positioned to understand provider psychology, habits, and workflows.

I have to say that one of the more frustrating aspects of being a consultant is being expendable. If I was the CMIO or a medical director, my opinions might have more impact. But when you have two consultants contradicting each other, there’s some cognitive effort required to untangle the issues, which it seems some health systems aren’t eager to do.

I find this situation particularly ironic. Where I’m trying to save them money, aggravation, and employee morale, the other consultant is trying to sell them something that’s going to cost money, time, and frustration. It should be an easy decision, but healthcare decision-making is often less than straightforward. It seems to be an easier decision to do what has already been started rather than raise questions.

This situation also illustrates something I’m seeing more often, which is organizations that have so many consultants in the mix that they need resources just to manage the consultants and their activities. Different parts of the organization may have their own consultants doing the same work, or it may be contradictory. I’ve watched the office equivalent of a steel cage match when consultants hired by the finance team face off against those hired by the clinical team. One of the combatants will inevitably tag out to the IT team, which may be allying itself with one or both of the other teams depending on which way the organizational winds are blowing.

There is a lot of time, money, and energy wasted in these non-coordinated approaches, but I’ve seen multiple situations where no one is willing to step in and stop the madness. I try to do my best (within the confines of my engagement and the personal relationships I’ve built at the organization, of course) to calm things down where I think I can make a difference, but it’s definitely challenging.

When I see these situations, it generally points to a larger problem with organizational leadership and a lack of executive sponsorship at the appropriate level. When organizations are having functional leadership meetings and various teams have a common understanding of organizational goals and budgetary and time constraints, the situations are much more productive. Teams with potentially competing initiatives can actually talk to each other and work together for a solution that creates common ground rather than succumbing to an “us vs. them” mentality.

With my current client, I’m hoping that while doing engagements to support their legacy software, I’ll be able to build relationships and the political capital needed to approach them with an engagement around the change leadership and management challenges that are the root of many of their struggles.

Unfortunately, it feels like they see the move to Epic as the be-all, end-all that is going to solve their problems. It may solve some problems, but it’s going to create new ones that they’re not expecting, or exacerbate underlying issues that they may have overlooked. History tends to repeat itself in these situations and I would love to see greater information sharing among those in the trenches so that they can avoid the pitfalls that I see over and over. There’s only so much I can do from the consulting perspective, but I’m going to keep trying.

How many consultants are involved at your organization? Email me.

Email Dr. Jayne.

Morning Headlines 5/1/17

Athenahealth (ATHN) Q1 2017 Results – Earnings Call Transcript

Athenahealth shares fall 20 percent in trading Friday following its report of Q1 results. In its earnings call, CFO Karl Stubelis said that lower than anticipated claims and collections volumes, more aggressive sales promotions, and slower on boarding of clients were the primary drivers of revenue falling below expectation.

Meditech 10-Q

Meditech reports Q1 results: revenue remained flat at $117 million, EPS $0. vs. $0.51. Net income has dropped 23 percent compared to the same period last year, while dividends paid  per share has remained level.

Cerner (CERN) Q1 2017 Results – Earnings Call Transcript

On Cerner’s Q1 earnings call, CFO Marc Naughton reports that strong software license sales and technology resale drove its quarterly revenue up 11 percent to $1.26 billion.

U. Health Care CEO Vivian Lee resigns after cancer institute controversy

University of Utah Health Care System CEO Vivan Lee resigns following an incident in which she fired the director of the health system’s cancer institute via email. Lee has also been caught in the fallout from a recent STAT news investigation on NantHealth exposing questionable donations coming from Patrick Soon-Shiong, MD, passing through University of Utah Health Care System, and then almost entirely returning to NantHealth.

Monday Morning Update 5/1/17

Top News

From the Athenahealth investor call, which follows disappointing revenue and earnings quarterly results that sent shares down 19 percent Friday:

• CFO Karl Stubelis blamed the miss on lower-than-expected claims. lower collection volumes, and slow onboarding of new customers.
• The company lowered revenue, earnings, and bookings guidance for the fiscal year and expects a lower operating margin for 2017.
• Jonathan Bush says office visits and payment per visit are both down for the first time, bucking the trend caused by hospitals buying practices and increasing their prices. He attributes the drop to consumer uncertainty around the Affordable Care Act and higher deductibles that consumers are unwilling or unable to pay.
• Bush said, “When we get into a meeting with a prospect and that prospect decides to do something, 80 percent of the time they go with Athenahealth. That doesn’t suck. That does not suggest retrenching, going to cash flow, ceasing the entry of the hospital market. It suggests breathing into the beating until things get better, which we believe they will.”
• Bush says the company had planned for doubled customer attrition for the year after its rollout of the Streamlined clinical product, but Net Promoter Scores have since rebounded.
• The company was not considered in some deals due to its lack of a viable inpatient product, but Bush expects that to change as it expands its inpatient EHR, which he describes as, “For a one-year-old product, kicking ass” that more than pays for itself with elimination of capital expenditures and an improvement in collections.
• Future drivers of what Bush says will be a restored higher growth rate are improved scalability of the inpatient product implementation, a cost guarantee for doctors, and automating practice tasks beyond previous government-mandated functionality.
• Bush disagreed with an analyst’s slightly combative observation that the company’s guidance is aspirational and often at odds with actual results, thereby reducing investor confidence, saying, “While our goals remain ambitious, our guidance is something that we think is a balanced handicapping of what we think will actually happen on the field. My goals, my team, the guys who are out there in the field still think they can get this number, but they’re not prepared to reassure you in that regard … One thing we all took for granted is that Athena would know its revenue a year out … The one place that we all need to get our confidence back is understanding the activity in the practice. And believe me, we’re studying it.”
• Bush concluded the call with, “Metamorphosis hurts. We’re feeling the crunch of several coming-of-age moments all at once here at Athenahealth. Attrition hangover from last year’s Streamlined rollout and the customer service issues, adjustments to Trumphealth from Obamahealth, a totally new guard at our senior management team, a tale of employee disruption from the change to it. Adjusting guidance hurts us, but it’s mostly the shame of coming to grips with that hurt. Our strategy is right, our traction against our challenges is better than ever, and optimism at the senior-most levels of this company is at an all-time 20-year high. Hence we enter execution mode.”

Reader Comments

From Carrot Bottom: “Re: MUMPS. Curious, you mentioned a blog post about developers complaining about MUMPS. It wasn’t very long after your post that you changed the link from Hacker News to some academic professor’s personal wiki on MUMPS. Now when I go to the original Hacker News link, it also has been taken down. Were you pressured to remove this information by an unknown legal team from Wisconsin?” I didn’t change the link in my original post from Hacker News and that link still works. However, in trying to figure out what you are referring to, I noticed that Lt. Dan (who writes the daily headlines) inadvertently used a different link in his headline. I actually didn’t get any private feedback on that post.

From Harry Angstrom: “Re: Jonathan Bush’s Instagram. This was quickly removed a few minutes later.” Unverified. The screenshot shows JB’s comment to Friday’s huge ATHN share price drop as, “K Thanks Bye.” Regardless, his other photos provide a glimpse into what life is like being raised rich and living hyperactively smart and quirky (like being one of a tiny number of trust fund kids to commendably serve in the Army).

From Causative Agent: “Re: charity for sale. Given your stance on charities, I thought you would find this highly offensive and in-your-face advertisement interesting.” An unnamed Dallas charity offers itself for sale for $2.4 million, urging prospects to “do the math” since they can “legally keep $200,000 as a salaried director.” Beyond enriching the new owner, the charity sends handicapped children to Orlando theme parks “and helps other charities as well,” with the owner helpfully suggesting expansion via new fundraising offices, telethons, squeezing business for donations, and running galas. I couldn’t figure out which charity it is, but I’d be curious about its reviews on Charity Navigator, Guidestar, and CharityWatch. Most surprising to me is that somebody can just “sell” a charity to whomever ponies up the cash, although I supposed the owner can simply install the buyer as board director and then resign even though the assets can’t be transferred short of a merger with another non-profit. For that reason, paying $2.4 million to buy a $200K job seems like bad financial planning, and hopefully the new owner will reap what they sow. 

From Soiled Skivvies: “Re: suck-up writers. This writer lost objectivity and it’s obvious they were star-struck.” Much of the health IT content out there is written by newbies, underachievers, and raging introverts who are way too easily influenced by the phony, smarmy charm of some Type A industry bigwigs who turn it on knowing they’ll get uncritically positive PR as a result. It’s kind of like being that cubicle-bound programmer who mistakes minor casual exposure to the boss as newfound social acceptance. The inhabitants of mahogany row did not ascend to the throne being unaware of the org chart caste system and they are not like you. Which is probably OK since someone has to have the swagger, however misplaced, to get everybody else to follow orders.

HIStalk Announcements and Requests

Poll respondents predict that the VA’s biggest problem if it decides to implement Cerner or Epic will be budget overruns, with lack of internal resources being another potential problem. Red Tape goes with “none of the above” in predicting that governance and bureaucratic decision-making will create an impossible struggle to stay on track. Daddio62 warns Cerner clients that if the company wins the deal, it will pull their experienced consultants off to the VA and replace them with greenhorns. Art Vandelay (welcome back, Art) says VistA was built around requirements that have no equal in the rest of the healthcare world and says user acceptance of a COTS will be a problem, possibly requiring a wrapper solution around the core product to support the VA’s unique needs. Cerner User also warns of the limited availability of skilled Cerner consultants and the pressure on the VA to increase productivity that will conflict with clunky software workarounds that reduce productivity.

New poll to your right or here, based on a reader’s comment: Have you ever bypassed your insurance and paid cash to choose a better ongoing PCP? It’s often depressing to have to settle when choosing a new PCP from your insurance company’s provider list (which is usually not only outdated, but fails to note that most of the docs listed aren’t taking new patients for their particular low-paying plan). You are often out of luck if you want a doctor who’s been out of school long enough to not be dangerous yet who isn’t past normal retirement age; one who attended a decent US medical school and residency; or a PCP whose Healthgrades reviews are better than appalling. In other words, you might not want to join a club that would accept you as an insurance-wielding member, while plopping down cash opens up endless (but expensive) possibilities. I suspect most of us just grit our teeth and choose the best-sounding of the substandard choices who will accept our insurance.

We funded the DonorsChoose grant request of Mrs. R in California, who asked for egg shakers and a rhythm set so her elementary school students can have fun with music as a break between tough subjects. She reports, “We have Fun Friday every week and I have been able to give a small music and rhythm class using the instruments and shakers. It is a hit! The students love it! Sometimes we make our own music and sometimes we follow along to child-friendly versions of today’s radio hits. Other teachers have noticed the fun and have borrowed the instruments and shakers to enjoy with their students. It has been a true blessing to have the instruments and shakers as a stress reliever for both the students and myself!”

This Week in Health IT History

One year ago:

• Nokia announces plans to acquire consumer health device vendor Withings to create Nokia Digital Health.
• CMS releases the warning letter it sent to Theranos in which it stated that, “The laboratory’s allegation of compliance is not credible.”
• Verks Analytics agrees to sell its Verisk Health business to Veritas Capital for $820 million.
• Caradigm quietly announces that Microsoft has sold its 50 percent stake in the company to JV partner GE Healthcare.
• A science publication questions the privacy and exclusivity terms contained in the agreement between NHS and Google’s DeepMind.
• Quintiles merges with IMS Health.
• Joint Commission gives its OK (later reversed) to send orders via text messaging.

Five years ago:

• Allscripts shares lose more than one-third of their value following announcements of poor quarterly results, the departure of its CFO, the firing of board chair Phil Pead, the resignation of three board members who supported firing Glen Tullman, Tullman’s erratic defense of his performance in the investor call, and the company’s loss to Epic in two UK decisions.
• Merge Healthcare shares shed 36 percent on poor quarterly results, with the company announcing that it will divide itself into two operating divisions, the traditional Merge imaging business led by Jeff Surges and a consumer kiosk and clinical trials division under Justin Dearborn.
• Chicago Mayor Rahm Emmanuel pressures the state’s attorney general to back off its investigation of Accretive Health’s strong-arm patient collection tactics.
• New health system CIO hires include Jocelyn DeWitt (University of Wisconsin Health) and Pamela Banchy (Summa Western Reserve Hospital).

Weekly Anonymous Reader Question

I asked readers to who have either considering quitting HIMSS or who have actually done so what motivated them:

• Almost useless organization. What Epic has done to hospital IT cost should never have happened. HIMSS needs to be more than a vendor show.
• Simply cost vs. benefit. HIMSS motives are suspect anyway.
• Annual conference was my main involvement. It’s gotten too big to be useful. One cannot do anything of substance on the exhibit floor. Classes have been good, but it’s just too much. I’d rather be involved in a more focused group, like ATA (telemedicine) or something like that. Cramming it all into one show dilutes things.
• I have been an individual member for over 20 years. No longer! Not continuing membership or attendance at national events. HIMSS is just about money, vendors, and more money. But the main reason is association with Federal government and DOD has taken over focus. Government nerds are not technological leaders. They have nothing to offer healthcare technology … boring bunk. Finally just bored with the agenda.
• Increasing irrelevance ever since HIMSS changed from a member-driven org to a "mission"-driven one. Individual members have little impact or recognition, even those who donate numerous hours on committees. Smaller specialty associations provide more return on the membership fee. Also hard to justify the annual conference cost when the only value is networking.
• Retirement.
• I considered quitting until I changed my expectations from education and knowledge acquisition to it being a huge shopping mall. It fits that bill, not the other. It’s a reasonable way to keep in touch with product domains.
• It has become such a racket. It has become nothing more than a vendor forum, which is very disappointing.
• I left HIMSS about 15 years ago because: (a) the organization became exceedingly political with no requests for input from members, and (b) the focus shifted from users to vendors and thus had little value to me.
• I did not renew in 2017 because of the increasing power of the vendor. The last straw was that the head of my state chapter was a vendor who behaved very badly in my organization (e.g. contacted board members when he didn’t get what he wanted from me). I prefer CHIME over HIMSS because I don’t feel like I’m a sales target every time I am on a phone call or in a meeting.
• Haven’t quit yet, but working at an HMO presently, I don’t see a lot of value in HIMSS other than interacting with members from the provider side. While that is of great value to me, over half of the new people I meet are consultants or contractors.
• The cost outweighs the benefit.
• HIMSS educational and networking offerings had value for me early in my career. Now, I have experience in the field and am not a decision-maker in IT investments. HIMSS repeats the same "Informatics 101" and "Learn about TIGER!" webinars every quarter and they seem to be efforts to market products rather than educate members. I don’t know if this is a change from past years, if I was less aware of the context in early days, or if I’ve just grown old and jaded. Now I only renew membership in years in which my employer sends me to the annual conference, since registration + membership is more affordable than registration as a non-member. Otherwise, I see no return on the investment. I’d rather pay membership dues to AMIA.
• Former HIMSS member here. I quit because as an IS analyst supporting the revenue cycle side of operations, the HIMSS focus is clinical. I wasn’t seeing the value.
• Too much focus on vendor revenue.
• Worthlessness of HIMSS CPHIMS certification. They sell it relentlessly but don’t even support it with networking at the annual conference or advertising to employers.

This week’s question: What’s the best career advice you’ve received that goes beyond the usual platitudes? In other words, not just “work hard, learn, market yourself” and other obvious recommendations.

Last Week’s Most Interesting News

• Greenway Health is hit with a ransomware attack that affects customers of its hosted Intergy systems.
• Cerner announces good quarterly results., while Athenahealth shares drop sharply on missed earnings and revenue expectations.
• Leapfrog Group’s hospital patient safety participants report nearly universally available bar code medication administration scanning systems, but with inconsistent usage.
• The Coast Guard issues an RFI for an EHR following its failed attempt to implement Epic.
• Ambulatory EKG monitoring services vendor CardioNet pays $2.5 million to settle HIPAA charges following the 2012 theft of an employee’s laptop.
• The Trump administration dismisses US Surgeon General Vivek Murthy, replacing him in interim with Deputy Surgeon General Rear Admiral Sylvia Trent-Adams, who is a nurse.

Webinars

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

Acquisitions, Funding, Business, and Stock

Meditech announces Q1 results: revenue flat, EPS $0.39 vs. $0.51. Product and service revenue were both basically unchanged over Q1 2016.

From the earnings call of Cerner, whose Q1 results beat expectations for both revenue and earnings and sent shares up 8 percent Friday:

• Domestic revenue increased 13 percent, while non-US revenue was basically flat excluding currency fluctuations.
• The company noted several wins over Epic, which it says is in a defensive stance following more coverage of its client cost overruns.
• Cerner says its advantages over Epic are predictable total cost of ownership, more modern architecture, better ability to demonstrate value, and strong population health management capabilities.
• The company says its Department of Defense work “is making Cerner better” in ways that will benefit all of its customers, adding that the remaining three DoD pilots are on track .
• President Zane Burke says IT is the best way to drive down cost, which hasn’t been addressed by either party’s healthcare platforms that focus instead on access and insurance reform.
• The company sold no new ITWorks IT management contracts in the quarter, but expects record sales of that product in 2017 as larger health systems conclude that some aspects of IT aren’t their core business.
• Burke declined to specifically say if Cerner is taking ambulatory business from Athenahealth, saying only that, “We’re taking share from all competitors.”
• Burke also declined to provide an update to previous comments that Cerner is seeking a CRM partner.

Sales

In the UK, Burton Hospitals NHS Foundation Trust expands its agreement with Summit Healthcare following its Meditech 6.1 go-live to include continued management of interface strategy, education, modifications testing, and developing additional interfaces as needed.

Decisions

• OhioHealth Mansfield Health (OH) switched from Infor to Oracle PeopleSoft supply chain management in December 2016.
• Franklin Memorial Hospital (ME) will replace Meditech with Epic in 2018.

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

People

Nordic promotes Vivek Swaminathan to president of its managed services division; Katherine Sager to EVP of consulting services; and Matt Schaefer to EVP of strategic services. 

Other

In Canada, 15 internists at Nanaimo Regional General Hospital go back to paper medication ordering in defiance of Island Health’s mandated use of its Cerner system dubbed IHealth. Doctors have long complained that the system causes medication errors. One of the internists was given a one-day suspension and another faces disciplinary action. The hospital says it can’t support paper orders and therefore has assigned other doctors to enter their paper orders into the EHR. Island Health previously tried bribing doctors to use IHealth, while the hospital’s ICU and ED doctors had gone back to paper in May 2016 — nine weeks after rollout — because of patient safety concerns. Island Health shut the CPOE system down in February 2017 following a 75 percent no-confidence vote by the medical staff, but restarted it a month later in saying it is too connected to other systems remain offline.

University of Utah Health Care CEO Vivian Lee, MD, MBA resigns after she fired its cancer center director by email and following her acceptance of questionably motivated donations from NantHealth’s Patrick Soon-Shiong. Billionaire donor and cancer survivor Jon Huntsman’s threat to withhold his planned $250 million donation to the cancer center named after him forced the university to reinstate the fired director and to rearrange the org chart so that she reports directly to the university’s president. Huntsman called Lee a “one-person wrecking crew” and “the least ethical, least disciplined woman in the world.” Meanwhile, Utah House Speaker Greg Hughes has asked state auditors to review Soon-Shiong’s $12 million donation – which a STAT report suggested came with strings attached in requiring the university to buy products from his various companies – to determine whether a formal state audit is warranted.

NBC News covers the often expensive consumer confusion between doc-in-the-box urgent care centers and freestanding emergency rooms, highlighting the case of a mother who pulled in what looked like a retail clinic in getting antibiotics for her daughter’s chest infection that ended up costing her $1,700 (later reduced to $1,000). She was flabbergasted when her insurer told her that PrimeCare Emergency Center is actually an ED, replying, “It was next to a nail place!” The report says 35 states allow freestanding ERs, most of them as off-campus hospital locations, but some are operated by for-profit companies. A class action lawsuit claims that now-bankrupt Adeptus Health, which runs 99 freestanding ERs, intentionally tricks patients into thinking they’ve entered a cost-effective urgent care center. A couple who took their child to an Adeptus ER racked up a $7,700 bill for an X-ray and pain reliever for what turned out to be constipation. 

Here’s Vince and Elise with their HIS-tory of the top 10 physician practice EHR vendors. 

Sponsor Updates

• QuadraMed, a division of Harris Healthcare, will exhibit at the CHIMA Annual Meeting May 4-5 in Westminster, CO.
• The SSI Group will exhibit at LA HFMA Annual Institute April 29 in Lafayette, LA.
• SK&A publishes the “2017 Guide to Effective Email Marketing.”
• GE Healthcare partners with Partnerships for Affordable Health Access and Longevity to address the healthcare needs of underserved communities in India.
• Sunquest Information Systems releases a video celebrating Medical Laboratory Professionals Week.
• Surescripts will exhibit at the annual Health Plan and Payer Summit April 30-May 4 in Washington, DC.
• Wellsoft will exhibit at Emergency Medicine Update May 3-5 in Toronto.
• ZeOmega will host its annual client conference May 2-4 in Plano, TX.
• ZirMed will exhibit at ASCA 2017 May 3-6 in Washington, DC.

Blog Posts

• The VA Healthcare System: A Broken System with Superior Quality (Definitive Healthcare)
• How to Make an Impact in the First 100 Days as a New CIO (Culbert Healthcare Solutions)
• 3 Keys to Establishing an Authentic Conversation with Your Audience (Salesforce)
• Healthcare Payers Uncertainty Lingers Following Demise of AHCA (The SSI Group)
• How virtual reality is changing patient care (Advisory Board)
• MEDITECH’s Global Digital Exemplar Customers Leading UK’s Healthcare Revolution (Meditech)
• Do You Know How Your Patients Really Feel? (Solutionreach)
• Alerts & Notification Platforms in the Future of Patient Communications (Sphere3)
• Industry Collaboration is Key to Improving Patient Safety (Surescripts)
• UltraLinq and the Great Ape Heart Project (UltraLinq)
• How does data analytics curb healthcare spending? (Verscend Technologies)
• A decade makes the difference (Voalte)
• More Evidence That Evidence-Based Care Works: North York General Hospital (Zynx Health)

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 4/28/17

Medication Safety

Leapfrog Group publishes safety results on electronic bedside medication administration, finding that while 98 percent of hospitals have software in place to support electronic medication administration, only 30 percent fully utilize the technology.

Greenway Health Reports Criminal Cyber Attack Affecting Certain Customers

Greenway Health is hit with a ransomware attack impacting users of its cloud-hosted Intergy platform. The company says it plans to restore client data from backups.

Cerner Reports First Quarter 2017 Results

Cerner reports Q1 results: revenue climbed 11 percent to $1.26 billion, adjusted EPS $0.59 vs. $0.53, beating analyst expectations for both.

Wanted: Feedback on Ways to Measure the Implementation and Use of Interoperability Standards

ONC solicits feedback on its proposed interoperability standards.

News 4/28/17

Top News

A Leapfrog Group report finds that while 98 percent of hospitals have bar code medication administration scanning technology connected to their EHR, only 30 percent of those hospitals are meet ingLeapfrog’s BCMA standard.

The most common reasons for falling short are (a) not having all seven decision support elements available (most often missing were vital signs and allergies), and (b) not using the BCMA system in at least 95 percent of total bedside administrations.

Reader Comments

From Dad’s Tie: “Re: David Butler’s article. That guy is terrific. What he describes is exactly what my hospital organization needs.” Agreed. Dave’s article on marketing IT, written from his health system CMIO perspective, is a breath of fresh air. I hope he contributes regularly.

From Industry Watcher: “Re: Caradigm. Another huge round of layoffs last week with nearly the entire senior leadership team included other than the CEO.” Unverified. The cached version of its leadership page from three weeks ago suggests that seven of the 13 executives have departed, including four of five SVPs. I don’t assume that executive turnover under a new CEO is necessarily a bad thing, though (except obviously it often is for the people who are gone). Companies usually bring in new blood to make changes, not to preserve the status quo.

From Unimpressed: “Re: Greenway Health. Working with the FBI after being hit by ransomware. Hosted customers on one of their platforms are still down, possibly until Monday. The company has had a long period of bad news and execs jumping ship.” Greenway says the attack affects its Internet-hosted Intergy customers, but adds that it expects to restore all their data from backups. The company was also involved in 2016 breach in which it misconfigured the patient portal of Florida Medical Clinic so that some patients could view the balance due statement of other patients. With regard to executives, the year-ago cached version of Greenway’s leadership page suggests that five executives remain of the 12 listed then. Greenway Health was formed in 2013 when Greenway Medical Technologies was taken private by Vista Equity Partners and combined with Vitera (the former Sage Software, previously Medical Manager) and SuccessEHS. Greenway’s HIMSS17 booth was noticeably downsized.

From Expired Mallow Cup: “Re: IT history. Forty years ago today, I started my first IT (data processing in those days) job at a hospital. I am showing people a 1977 photo of my desk with no PC in sight – I started with a mainframe with punched cards. Today I am working at a hospital converting from Soarian to Cerner Millennium. I’ve decided to stick around to support Soarian, but no Millennium for me. When they insist that we take our 390+ order sets that I have built on Soarian and duplicate those on spreadsheets for some young just-out-of-college person at Cerner to then transfer using the nice build tool in Millennium (that we’re not allowed to touch until August), I was out of here. Having to tell a physician that their problem entering medication orders is a known bug and they have to hand-write the order because it won’t be fixed for a few months — I’ve had enough of getting yelled at over the phone. Read your posts every day when I can. Thanks for letting me vent.”

From Dangling Participle: “Re: County of San Bernardino, CA. Has posted an RFP for a new EHR to replace Meditech C/S after halting efforts to connect to a neighboring hospital’s Epic system last year.” Looks right — I found this RFP for Arrowhead Regional Medical Center that also includes possible expansion throughout the county’s entities.  

HIStalk Announcements and Requests

One day after whining about the paucity of good Readers Write submissions, I received two excellent ones from David Butler and Joe Petro. I’ll use those a springboard to urge readers (especially non-vendors) to write pieces of their own. The process is good for organizing and presenting thoughts, the content is more important than writing perfectly, and the audience is substantial.

We funded the DonorsChoose grant request of Ms. S in Missouri, who asked for an Osmo coding set, a pencil sharpener, and five sets of headphones for her second grade class. She reports, “My class is able to stay engaged in their learning without distractions from those around them now that we have enough headphones for everyone. They are learning so much from the coding Osmo. They are becoming deep thinkers and problem solvers with this interactive tool. These skills will be lifelong necessities for them as our world becomes more and more digital. Thank you for being a part of creating an equipped tomorrow. We are extremely appreciative of people like you.”

The mental and physical decline of my four-year-old iPhone 5 was accelerating, with puzzling call failures, poor LTE connectivity, and sluggish performance. Since I don’t use my phone broadly (mostly just browsing, checking email, and GPSing while away from home), I just couldn’t get excited about spending $800 or more on an iPhone or Samsung Galaxy. I did a lot of research and concluded that beyond fanboy upgrades, the smartphone market has matured, with little innovation and sales that are propped up by user ego rather than added value. My solution: Motorola’s Moto G Plus from Amazon Prime for an astounding $240 (partially subsidized by Amazon lockscreen ads that I don’t find intrusive, plus I’m always using Amazon services anyway). Features:

• It’s unlocked, so you can easily swap out the SIM at any time when traveling overseas or changing carriers. I popped my own AT&T SIM in without incident.
• The Moto G has 4 GB of RAM and 64 GB of storage, plus it accepts a standard Micro SD card that allows adding up to 128 GB more storage for around $50.
• It comes with a nearly stock version of Nougat, the latest version of Android (Google, thank you again for creating a competitive market in developing Android). The learning curve in moving from iOS is nearly zero.
• Battery life is long and the TurboPower charging adds six hours of use after just 15 minutes of plugged-in time.
• Content that’s connected to your Google account (Gmail, Maps, YouTube, Drive, Photos, etc.) is instantly available on the phone.
• The fingerprint sensor works great to lock/unlock and is placed on the front of the phone where it belongs.
• The camera is 12 MP and the front one offers a wide-angle selfie cam that I’ll probably never use (since as a curmudgeon, I find selfie-takers to be irritatingly vain and self-congratulatory).
• It fits in my pocket even though the display is much larger, sharper, and brighter than that of the iPhone 5.
• It’s so cheap that phone insurance or delayed future upgrades are unnecessary.
• The only items I’ve missed: FaceTime (use Google Duo, Skype, or my choice, WhatsApp, instead) and “unread items” counter badges aren’t displayed on individual app icons – use a third-party app like Nova Launcher to add them or just pay attention to the notification bar and lock screen messages.

This week on HIStalk Practice: Prime Healthcare ACO (CA) implements population health analytics and benchmarking from Persivia. DiagnosisAI develops new Alexa medical advice skill. Salus Telehealth adds urgent care consult capabilities. Portland healthcare darling Zoom gets exits the health insurance business. Consumers keep their enthusiasm for AI-powered healthcare to a minimum. SimonMed Imaging signs with Zotec Partners. Oncology Consultants selects Navigating Cancer technology. US Oncology Network physicians discuss carrots versus sticks when it comes to VBC compensation.

Webinars

April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

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

Acquisitions, Funding, Business, and Stock

Health system supply chain technology vendor Jump Technologies raises $3.5 million in a venture funding round.

Urgent care PM/EHR vendor DocuTap acquires Atlanta-based Clockwise.MD, which offers patient queue management and survey systems.

Athenahealth reports Q1 results: revenue up 11 percent, adjusted EPS $0.32 vs. $0.34, missing expectations for both. Shares were pounded in early after-market trading following the announcement, down 16 percent.

Cerner reports Q1 results: revenue up 11 percent, adjusted EPS $0.59 vs. $0.53, beating expectations for both. Shares were up 4 percent in early after-hours trading.

Sales

University of Michigan Health System chooses Phynd for managing the information of its 67,000 providers across its clinical systems.

People

Dana Moore (Centura Health) will join Children’s Hospital Colorado (CO) as CIO.

Precision medicine technology vendor GNS Healthcare hires Ben Bielak, MS, MBA (Harvard University) as CIO.

Point of Care Decision Support names Jay Syverson, MBA (Coherent Solutions) as president.

Solutions vendor Formativ Health hires David Harvey  (Health Healthcare) as CTO.

Datica promotes Kevin Lindbergh to chief revenue officer.

Announcements and Implementations

MedData launches MyMedicalMe, a mobile app that allows users to manage their medical bills.

Partners HealthCare’s Connected Health expands its Online Second Opinion Service to allow collecting medical records, radiology, and pathology results through West’s HealthAdvocate Solutions.

A Kyruus study of 40 health system call centers finds that three-quarters of them can’t match callers with an available appointment within the following three weeks, 60 percent are unable to meet gender-specific provider requests, and half are incapable of matching a patient with providers in their desired location.

Government and Politics

ONC seeks feedback on a proposed measurement framework for interoperability.

Privacy and Security

Microsoft ends support of Windows Vista, which doesn’t necessarily mean that PHI-containing systems running on it constitute a HIPAA violation, but HHS says the resulting lack of security patches in unsupported operating systems warrants risk analysis (translation: you’re screwed if your old OS’s lack of security patches allows a breach). Windows 7 is the next to cross the rainbow bridge in early 2020 and then it’s Windows 8 in 2023.

In England, a 20-year-old man who had made $300,000 from selling a distributed denial-of-service attack tool that he built when he was 15 is sentenced to two years in prison.

A former Army sergeant pleads guilty to filing fraudulent tax returns using UPMC patient data that be bought from an online hacker marketplace.

Other

Brigham and Women’s Hospital (MA) offers voluntary buyouts to 1,600 employees, warning that a lack of takers will require layoffs.

Moody’s affirms Vanderbilt University Medical Center’s bond rating, but observes that its financial performance will temporarily moderate with its November 2018 implementation of Epic.

A NEJM opinion piece takes a mixed view from the “what problem are we trying to solve” perspective of requiring investigators who are running clinical trials to share their data with other researchers. It notes that data sharing increases clinical trial cost, assumes that whoever consumes the published data can really understand it since they weren’t involved in collecting it, and devalues the “currency of academic achievement” in giving investigators less opportunity to publish career-enhancing journal articles. The author also notes that participation in such sharing has been minimal and research benefits are uncertain despite the theoretical advantages.

Sponsor Updates

• Eye Care Leaders, which offers an EHR for optometry and ophthalmology practices, will integrate DrFirst’s medication management and e-prescribing into its products.
• Phynd is exhibiting at NAHAM in Dallas, TX this week.
• LogicWorks achieves AWS Service Delivery Partner status.
• MedData will exhibit at the Advanced Institute for Anesthesia Practice Management April 29-May 1 in Las Vegas.
• CloudWave’s OpSus Live infrastructure as a service earns its third annual Best Practice rating in the Meditech Infrastructure and Supporting IT Process Audit.
• Meditech will exhibit during HIMSS UK e-Health Week May 3-4 in London.
• ROI Healthcare Solutions will sponsor the Inforum Conference July 10-12 in New York City.
• Zynx Health customer North York General Hospital wins the 2016 HIMSS Enterprise Nicholas E. Davies Award of Excellence.
• Navicure will exhibit at the Oregon/Washington MGMA meeting April 30-May 2 in Spokane, WA.
• Health Data Specialists sponsors the Cerner Southeast Regional User Group May 3-5 in Jacksonville, FL.
• Netsmart will exhibit at the Care Coordination Summit May 1 in Baltimore.
• Revenue recovery software vendor Ontario Systems adds the ReconBot claims automation from Recondo Technology. 
• Obix Perinatal Data System will exhibit at the AWHONN Michigan Annual Conference May 5 in Frankenmuth.
• CloudWave achieves a best practice rating for OpSus Live.
• PatientKeeper will exhibit at Hospital Medicine 2017 May 1-4 in Las Vegas.

Blog Posts

• What is HIPAA? Complying and Reducing the Burden (Liaison Technologies)
• Enterprise Imaging in Cardiology (LifeImage)
• Policies and Procedures for Continuity: CMS Rules (LiveProcess)
• Cinco de savings – 5 simple steps to spice up your revenue cycle (Navicure)
• Electronic Patient Signatures and First Impressions (Access)
• Saving Money and Lives Through Value-based Care (Netsmart)
• Wise Up to Hidden Healthcare Fees (NTT Data Services)
• VCISO Meets the Needs of Healthcare in an Ever-Intensifying Threat Environment (Orchestrate Healthcare)
• Meditech 6.1x Implementation Phases Part 3: Design (Parallon Technology Solutions)
• #JoinTheConversation with Experian Health’s Nicole Rogas at #HIMSS17 (Experian Health)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

EPtalk by Dr. Jayne 4/27/17

I attended the Physician Compare Benchmark and 5-Star Rating webinar this week. The team shared information about their new ABC Benchmark methodology and asked for physician feedback on the proposed approach.

Frankly, after attending the webinar, I’m disheartened. What they are proposing is complex and there is debate about whether a cluster method or equal-ranges method should be used to assign the ratings. There is also debate on what to do when providers are so high performing they can’t determine how to allocate fewer than five stars. For those measures, they’re discussing only displaying those providers who had five stars vs. not displaying those measures at all. It seems counterintuitive to not report something that people are good at. Not to mention, if it’s this complicated, it’s going to be less meaningful for patients.

At the beginning of the webinar, the speaker specifically stated that sometimes when they use a five-point scale, that people see it like school grades: A, B, C, D, F. But that’s not what they’re trying to do here, etc. I challenge the people involved in this to understand that most of the public is still going to see this like school grades. Regardless of footnotes or explanations on the website, people see three stars and think you’re a C performer.

These ratings become even more complex for measures where everyone is doing well. So how about this proposal: set benchmarks related to a grade scale and let patients truly compare not only from physician to physician, but across measures. Say we want 100 percent of diabetic patients to have a foot exam. Ninety percent is five stars, 80 percent is four, 70 percent is three, etc. Or heck, just use letter grades to make it easier. Maybe your physician gets As and Bs on everything relevant to your needs and you’re good to go. Maybe they get Bs and Cs and you need to look for someone else. Maybe all physicians get a C on some measures, which helps you understand that it’s difficult to achieve. It certainly would save the millions of dollars they’re spending to put this together and would create a system that fits into an already accepted cultural schema rather than creating something new that takes a statistician to explain.

The slides are available here if you want to check them out yourself, and if you want to share feedback, it can be sent to PhysicianCompare@westat.com with a subject line of “5-Star Rating Feedback” prior to May 10.

NCQA announced a new Oncology Medical Home recognition program, following the Patient-Centered Medical Home and Patient-Centered Specialty Practice models already available. They’ll host a webinar on May 5 to discuss the new program and how to achieve recognition. I’ve assisted several organizations through the NCQA recognition process and it’s not for the faint of heart (or the light of pocketbook).

Regenstrief Institute, along with the American Medical Association, has launched a mock EHR tool for use by medical students. It contains simulated patient data and allows students to practice documentation along with processing information in a typical EHR format. These kinds of tools are increasingly needed as hospitals institute fragmented policies around whether students are allowed to document in the EHR, and if they are, what kind of user rights and training they receive. My hospital allowed students to use the EHR, but didn’t give them full rights for ordering, writing scripts, or many of the other functions they had in the paper world.

The Regenstrief EHR Clinical Learning Platform tool was co-developed with Indiana University School of Medicine and is also in use at the University of Connecticut School of Medicine and the University of Southern Indiana College of Nursing and Health Professions. AMA will assist in its distribution.

Given the expansion of patient-generated health data through home monitors, fitness trackers, and more, ONC has created a challenge to find solutions to the problem of capturing data provenance. I know many physicians who are reluctant to allow patient-generated data into the EHR due to concerns about reliability as well as quantity. Anyone who has been faced with home blood pressure logs documenting five or six readings a day for three months knows what a burden this data can be. ONC recognizes that reliability and trustworthiness of data are issues.

The $180,000 challenge is in two phases, the first involving submission of white papers describing current methods with the second phase requiring winners to develop and test their solutions. Information about the challenge can be found here and phase 1 submissions are due May 22.

I’m enjoying reading Mr. H’s coverage of Missouri’s ongoing failed attempts to create a Prescription Drug Monitoring Program. Hopefully they’ll eventually arrive at a workable solution. Opioid addiction continues to be a national issue and CDC recently launched an online training series around opioid prescribing. The first of eight modules is now available. Future modules include patient communication, non-opioid pain management options, dosing/titration, and risk reduction. I’m still slogging through a bunch of online CME, so let me know if you’ve test driven the module and what you thought.

I subscribe to dozens of communications from various governmental organizations in an attempt to keep up with all the warnings, alerts, proposed rules, and dictates that impact physician practices. Every once in a while I see an email subject line that truly catches my attention, as did this one about “Mixing Kentucky Spirits with Food Safety.” We think about the FDA as regulating medications and foods, but it also has jurisdiction over veterinary issues. Grain byproducts of brewing and distilling are often used as livestock feed. The 20-member FDA team found their visits to various production facilities (including Woodford Reserve, Wild Turkey, and Jim Beam) to be “extremely productive” with there being “no substitute for actually seeing how these beverages are produced.” I can say that I felt the same after a recent pilgrimage to the distillery responsible for my favorite adult beverage. However, I wonder if the FDA tour ended with a complimentary drink and a souvenir glass, as mine did? I also wonder if the FDA sends as large of a contingent to less-exciting venues such as sunscreen manufacturers.

Email Dr. Jayne.

Morning Headlines 4/27/17

The MacArthur Amendment Language, Race In The Federal Exchange, And Risk Adjustment Coefficients

Health Affair’s Tim Jost, JD reviews the new AHCA amendment proposed that has won the support of the GOP Freedom Caucus, substantially improving its chance of passing both chambers of Congress.

CMS notifying clinicians of MIPS participation status

CMS announces that by the end of May it will send letters to practices to notify them that they are required to participate in MIPS in 2017.

Sepsis Solutions Are Saving Lives and Enabling Better Care, According to New KLAS Report

In a small survey, KLAS reviews sepsis surveillance solutions marketed by major EHR vendors and niche surveillance vendors. 69 percent of respondents reported improved outcomes, with some reporting up to a 50 percent drop in mortality.

Prize-Winning DxtER “Tricorder” Makes a Public Appearance With Tech Legend Steve Wozniak

Basil Harris, MD, the team leader of Qualcomm Tricorder X-Prize first place winner Final Frontier Medical Devices, demonstrates his team’s Tricorder design to Steve Wozniak at the 2nd annual Silicon Valley Comic Con.

Readers Write: A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing

A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing
By David Butler, MD

David Butler, MD is associate CMIO of the Epic/GO project of NYC Health + Hospitals of New York, NY. 

My first lesson in healthcare marketing came in the spring semester of my junior year at Texas A&M University, when I accepted a prestigious internship with a little company called Merck Pharmaceuticals. Believe it or not, I hadn’t even heard of this company, but I soon found out one of the many reasons for their meteoric rise.

That summer, Merck was releasing a new prostate drug. They posed the question to their young crop of interns: where should we market this drug? Field & Stream! Men’s Health! Cigar Aficionado! We shouted rapid-fire.

Wrong, wrong, and wrong again. Our instructor basked in our ignorance for a moment before he uttered the answer: Good Housekeeping. Targeting the significant others of the drug’s target audience was actually the smarter way to go. They were more likely to notice changes in their partner’s behavior and push them to go to the doctor.

Fast-forward 25 years later and healthcare is approaching physicians and nurses with the non-WIIFM, non-behavioral economics approaches similar to what my intern class suggested.

We spend hundreds of millions of dollars to implement technology for our best and brightest to leverage to care for patients, yet we continue to allow these transformative changes to the software to enter into their workflows without rollout efforts that match the investment and the desired results.

Healthcare needs to stop communicating and start marketing new health IT projects and improvements to existing provider-facing solutions. Too many initiatives fail not on the merit of the technology, but because the organization failed to successfully relay the value to the end users.

Here are five ways to help launch a full-fledged marketing campaign to capture your end users’ attention and effectively roll out new technology and important updates to current systems:

Change the mindset.

Health IT project teams need to think of their communication differently. It should not only inform, it should persuade. If you were going to sell something to physicians to get them to actually buy it, how would you change your communication? That should be a question asked during the creation of every piece of project collateral. How do you find the wife or the Good Housekeeping marketing equivalent from my opening example?

Get docs and nurses to want to do your desired action, or even better in some cases, understand why it would hurt not to do it.

Spotlight the value.

Too often healthcare organizations spend a bunch of R&D resources creating or improving something really cool, and then communicate that in an email with a laundry list of other changes that aren’t as meaningful. If you’ve added technology that will help save lives or otherwise have a profound impact on clinician efficiency, give it the spotlight it deserves.

For example, it used to be a policy at Sutter Health (my former organization) that if a nurse gave a patient insulin, a second nurse had to log in to double-check the dose. The organization finally changed the policy so that second nurse and verification was no longer needed. Some genius asked how much nursing clicks, time, or dollars would this save. We actually took the time to figure it out.

After calculating the size of organization and the insulin doses given each day, we figured that policy change resulted in $400,000 in savings of nurses’ time—and that’s the value we marketed. Not only to the nurses, but also to the board. We told the nurses how much of their time we were giving back to them and told the board about the significant cost savings for the organization.

Once you find the value to spotlight, think about what that value means to different parties and market that ROI.

Devise a catchphrase.

If you want end user attention, you’re going to have to earn it. There are too many competing priorities for a busy physician’s or nurse’s attention. Have some fun and get some eyeballs by devising a catchphrase for your campaign.

For example, when I was helping roll out a secure messaging solution to thousands of physicians, we could have promoted it with “New! Secure Messaging” or even “Pagers to Smartphones” messaging. Instead, we used “Safe Text.” It was fun and catchy—there were plenty of good-natured jokes and buzz around the campaign—and it also tapped into their own motivation to protect PHI. Make your catchphrase not only descriptive, but also memorable. That’s marketing.

Include a call to action.

What do you want your audience—physicians, nurses, or whichever group it may be—to actually do after they’ve read your communication? Good marketing always includes a call to action, or CTA. After you create marketing for the group, ask yourself what the CTA should be. Do you want them to download an app or an update? Submit their feedback? Add an event to their calendar? Always make the CTA big, bold, and if possible, frictionless.

For example, include a link that can automatically add the event to their calendar, or seamlessly forward it to a friend or colleague. You can also think about the tools you already have and how you might get innovative with them to drive follow-through.

One prominent health system in the Pacific Northwest used their EHR alerts to creatively capture clinician attention at various workflow points within the EHR. They were greeted by a respected physician leader — their CMO — whose image and quote reminded them to complete certain crucial activities within the EHR. Having his face staring at the clinicians alongside that CTA made it much more influential.

Rinse and repeat.

If a company you already like and engage with introduces a new product, they’re going to be marketing that to you on every channel they can: Direct mail, email, TV commercials, social media ads, display ads. Follow a similar approach for internal projects: Emails, flyers, reader boards, table tents in the cafeteria, digital banners on internal websites, announcements at town halls, free tchotchkes—anything you can think of where your end users might see it.

Physicians rarely understood why drug companies would provide free prescription pads, pens, and other items. They stated, “It doesn’t affect my prescribing patterns.” However, after many years of research on this, it actually does. So let’s wise up and follow other marketing examples from other verticals to keep the messaging in front of them. It may take several exposures for the message to resonate, but you can keep it fresh by switching up the format, colors, and graphics.

Finally, don’t forget to ask for help if you need it. Most healthcare organizations have talented marketing teams that are consumer-facing, but may be willing to help out with internal initiatives. They’re just not always asked.

With these five strategies, you can help your organization’s IT team pivot from communicating new technologies from boring emails to full-fledged campaigns that truly market the value to doctors and nurses and successfully bring them on board.

Readers Write: Deep Neural Networks: The Black Box That’s Changing Healthcare Decision Support

Deep Neural Networks: The Black Box That’s Changing Healthcare Decision Support
By Joe Petro

Joe Petro is SVP of research and development with Nuance Communications.

Don’t look now, but artificial intelligence (AI) is quietly transforming healthcare decision-making. From improving the accuracy and quality of clinical documentation to helping radiologists find the needle in the imaging haystack, AI is freeing clinicians to focus more of their brain cycles on delivering effective patient care. Many experts believe that the application of AI and machine learning to healthcare is reaching a crucial tipping point, thanks to the impact of deep neural networks (DNN).

What is a Neural Network?

Neural networks are designed to work in much the same way the human brain works. An array of simple algorithmic nodes—like the neurons in a human brain—analyze snippets of information and make connections, assembling complex data puzzles to arrive at an answer.

The “deep” part refers to the way deep neural networks are organized in many layers, with the intermediate (or “hidden”) layers focused on identifying elemental pieces (or “features”) of the puzzle and then passing what they have learned to deeper layers in the network to develop a more complete understanding of the input, which ultimately produces a valid answer. For example, a diagnostic image is submitted to the network and the output may be a prioritized worklist and the identification of a possible anomaly.

Like us humans, the network is not born with any real knowledge of a problem or a solution; it must be trained. Also known as “machine learning,” this is achieved by feeding the network large amounts of input data with known answers, effectively teaching the network how to interpret and understand various inputs or signals. Just like showing your child, “This is a car, this is a truck, this is a horse,” the network needs to be trained to interpret an input and convert it to an output.

For example, training a DNN for medical transcription might involve feeding it billions of lines of spoken narrative. The resulting textual output forms a truth set consisting of spoken words connected with transcribed text. This truth set expands over time as the DNN is subjected to more and more inputs. Over time, errors are corrected and the network’s ability to deliver the correct answer becomes more robust.

A key feature of a neural network is that when it gets something wrong, it is corrected, Just like a child, it becomes smarter over time.

The Black Box

Here’s where it gets interesting. Once the DNN has that baseline training and it begins to analyze problems correctly, its neural processes become a kind of black box. The DNN takes over the sophisticated, multi-step intelligence process and figures out how the inputs are connected or related to the outputs. This is a very powerful concept because we may not fully understand exactly how the network is making every little decision to arrive at an output, but we know it is getting it right.

This black box effect frees us from having to contemplate—and generate code for—all the complex intermediate variables and countless analytical steps required to get to a result. Instead, the DNN figures out all intermediate steps within the network, freeing the technologist from having to worry about every single one. And with every new problem we give it, we provide additional truth sets and the neural network gets a little bit smarter as it trains itself, just like a child learning its way in the world.

How smart is smart? One of the biggest challenges with speech recognition is accommodating language and acoustic models, the specific and very individual aspects of the way a person speaks—including accent, dialects, and personal speech anomalies. Traditionally, this has required creating many different language and acoustic models to cover a diverse range of speakers to ensure accurate speech recognition and improve the user experience across a large population of speakers.

When we started using special purpose neural networks for speech recognition, we discovered something surprising. We didn’t need as many models as before. A single neural network proved robust enough to handle a wider range of speech patterns. The network essentially leveraged what it learned from the massive amounts to speech data we used as a training set to improve its accuracy and understand people across the entire speaker population, reducing the word error rate by nearly 30 percent.

Anecdotally, I’ve heard from people seated across from a physician dictating with such a thick accent at such high speed that they could not comprehend what was said, yet DNN-driven speech recognition technology understood and got it right the first time.

It’s important to note that neural networks are not magic. DNNs require problems that have clear answers. If a team of trained humans agrees with no ambiguity and they can repeat the agreement across a large set of inputs, this is the kind of problem that neural nets may help to solve. However, if the truth set has grey areas or ambiguity, the DNN will struggle to produce consistent results. The problems we choose and the availability of strong training data is key to the successful applications of this technology.

Putting DNNs to Work in Healthcare

So how are DNNs changing the way healthcare is practiced? Neural networks have been used in advanced speech recognition technology for years, and that’s just the beginning. The potential applications are nearly endless, but let’s look at two: clinical documentation improvement (CDI) and diagnostic image detection.

Clinical documentation includes a wide range of inputs, from speech-generated or typed physician notes to labs, medications, and other patient data. Traditionally, CDI involves having people who are domain experts reviewing the documentation to ensure an accurate representation of a patient’s condition and diagnosis. This second set of eyes helps ensure patients receive the appropriate treatment and that conditions are properly coded so the hospital receives appropriate reimbursement. The CDI process requires time and resources and can be disruptive to physicians’ workflow since the questions coming from CDI specialists are generally asynchronous with the documentation input.

Technology is used to augment the CDI process. Applications exist that capture and digitize CDI processes and domain expertise, creating a CDI knowledge base at the core. This involves processing clinical documentation, applying natural language processing (NLP) technology to extract key facts and evidence, and then running these artifacts through the knowledge base. The output of this complicated process is a context-specific query that fires for the physician in real time as she is entering patient documentation, linking, say, a relevant lab value with key facts and evidence from the case to indicate the possibility of an undocumented infection, for example. This approach to addressing a common documentation gap is a technically arduous and complex processing task.

What if we applied neural networks to change the paradigm? Many institutions have been doing CDI manually for years and we can leverage not only the existing clinical documentation (the input), but also the queries generated (the output) from those physician notes to create a truth set for training the neural network with a repeatable, deterministic process. The application of neural networks allows us to skip over complexity of digitizing domain expertise and processing the inputs through a multi-step process. Remember the black box concept? The DNN essentially determines the intermediate steps, based on what it learned from the historical truth set. In the end, this helps improve documentation by having AI figure out the missing pieces or connections to advise physicians in real time while they’re still charting.

The applications of neural networks are not limited to speech or language processing. DNNs are also changing the game for evaluating visual data, including radiological images. Reading the subtle variations in signal strength associated with identification of an anomaly requires a highly-trained eye in a given specialty. With neural networks, we can leverage this deep experience by training the network with thousands of radiological images with known diagnoses. This enables the network to detect the subtle differences between a positive finding and a negative finding. The more images we feed through it, the more experienced and accurate the DNN becomes. This technology will streamline the busy workflow of the radiologist and truly amplify their knowledge and productivity.

Augmenting, Not Replacing

While the possibilities for neural networks are incredibly exciting, it’s important to note that they should be viewed as powerful tools for augmenting human expertise rather than replacing it. In the case of diagnostic image detection, for example, a DNN can serve as a first line review of films, helping prioritize them so radiologists focus first on those that are most critical. Or it might serve as an automated second opinion, possibly spotting something that might have been overlooked.

Today, AI in healthcare decision support is still in its infancy. But with the exciting possibilities created by DNNs, that infant is poised to transition from crawling to walking and even running in the foreseeable future. That’s good news for providers and patients alike.

CIO Unplugged 4/26/17

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

The Disintermediation of the CIO

The role of the CIO has reached its zenith. Over the next several years, we will see the title deconstruct. Just as the baby boomers held on to “Data Processing Director” concepts as long as they could, a few of us diehard GenXers will grasp on to the CIO title until our retirement. Millenials and Gen Z will jump on the chance to blaze new trails and transform our profession to reflect the rapidly changing world we live in. There will be less concern with title and more focus on the depth of impact on business and on remaining relevant.

The transition began the day the CIO title was adopted. Moore’s Law became the norm and change a constant. As a profession, we metamorphosized through a variety of stages ranging from pure technical manager to today’s C-level executive. The changes ahead are not for lack of skill or talent, but are at best reflective — at worst reactive — to cultural and technological changes.

What makes this transition more profound is that the majority of CIOs never made it to the C-suite. They allowed themselves to get stuck someplace in between. The opportunity for them to close the gap is gone..

Empowered internal and external consumers and the ubiquitous nature of technology are key drivers for the change. We are seeing the democratization of data, information, and knowledge. CIOs can no longer control technology proliferation nor cap or meter its utilization. Service desks are becoming a relic of the past. Millennials grew up in a self-service age and have expectation of the same. The average consumer has 30+ applications on their smartphone and few if any come with call center support. Think cloud, blockchain, mobile, big data, consumerization, and social supported by disruptors. There is diminishing need for traditional IT.

Granted, there will always be a need for technical expertise. IT will revert back to pure technical play. IT divisions will become cost centers again and will fade into the background. IT will be focused on providing safe networks and connections and can be summed up as “interoperability and security.” Staff size and budgets will shrink and investment cut by 50 percent or more. Data centers will go lights-out and most companies will either convert the space for document storage or sell them outright. The data center is a financial albatross ripe for partnering. “Shadow IT” will become partners, not adversaries. It is not the old centralization versus decentralization, but pure and simple disintermediation.

So where are today’s CIOs headed? We are already seeing some directional signs. I was contacted twice this year by recruiters who were trolling for chief digital officers (CDO). In both cases, the existing CIOs were bypassed and would report to the CDO. While I think CDO has legs and will stick, it is not the final destination, but perhaps an intermediate layover. Just as Uber disrupted transformation, IT is being disrupted. Uber is an intermediate step for the next wave in transportation. We are beginning to see self-driving vehicles and the proliferation of drones for transport.

I don’t have a savvy prediction on how you spell the CIO title five years from now. What I am confident in is that we need to change and adapt or report to those that do. We must evolve and continuously retool ourselves and focus heavily on innovation, entrepreneurship, and value creation. We must be able to see the future and collaborate with partners, developing strategic solutions grounded in the practical realities of taking the best care of our patients. We must be the one trusted advisor who can see across the business enterprise and facilitate change at 10 times the speed of Moore’s Law.

Finally, we can’t forget that our primary talent must remain focused on being experts in the people business. When consultants say people, process, and technology, it is really people (85 percent), process (10 percent), and technology (5 percent). This is how we add value and remain relevant. Retool, yet never forget that we are in the people business and always keep the patient in the center of all we do. This is not the age of the stodgy hotel; this is the age of AirBnB.

If we don’t shape the future, others will change it for us and leave us behind.

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.

Morning Headlines 4/26/17

USCG Electronic Health Record Acquisition RFI

The Coast Guard issues an RFP soliciting bids for an EHR that will integrate with both the DoD and the VA. The Coast Guard abandoned its 2015 Leidos-run Epic installation without going live anywhere.

Mayo Clinic Health Information Offered Through Epic Patient Apps

Epic partners with Mayo Clinic to offer patient’s health information within its MyChart and MyChart Bedside apps.

Erlanger reports solid earnings for third quarter

Erlanger Health System reports strong Q3 results, but warns that the $100 million Epic implementation, which begins May 1, will impact future revenues.

Former NFL Player, Myron Rolle, To Start Neurosurgery Residency at Harvard

Former Tennessee Titans defensive back Myron Rolle has earned a medical degree from Florida State University College of Medicine following and recently announced that he has been matched to Harvard medical School, where he will start his neurosurgery residency program.

News 4/26/17

Top News

The Coast Guard posts an RFI for an EHR that can achieve interoperability with the EHRs of the Department of Defense and VA.

USCG gave up on its Epic implementation in 2015 without going live anywhere and finally elected not to renew its Epic contract that expired in early 2016, citing unspecified risks. It had spent five years and several dozen million dollars, also deciding along the way to add the US State Department to its ultimately failed rollout.

After the Epic project was halted, the Coast Guard determined that it could not revert back to its previous CHCS/AHLTA system and went back to paper instead.

The lead contractor in USCG’s Epic project was Leidos, which later won the DoD $4.3 billion bid in offering Cerner.

SAIC, which spun itself off in 2013 as its parent company renamed itself to Leidos, originally developed the DoD’s CHCS system (interestingly, as a customization of the VA’s VistA) in a billion-dollar 1988 initial contract. The DoD is rumored to have spent at least $20 billion on CHCS and its add-on AHLTA, which was not interoperable with the VA’s VistA. Defense contractor Northrop Grumman was paid at least $5 billion to develop AHLTA, rated in a 2016 physician survey as the worst EHR in the country. The DoD keeps giving Leidos and Northrop Grumman high-dollar contracts to keep the old systems running.

Cerner should have a slam dunk here unless a well-connected defense contractor takes the Coast Guard down a puzzling path or if the DoD’s project isn’t faring as well as they’ve announced. Leidos might have taken a black eye in the Coast Guard’s failed Epic project, but I still assume they’re the frontrunner as long as Cerner is game to partner with them again, which surely they are given their strong bidding position after their DoD win. Or maybe the Coast Guard will figure out how to participate in the DoD’s Cerner contract instead of mounting a separate project, given that it’s a uniformed service just like the Army, Marines, Navy, and Air Force.

Reader Comments

From Indigenous Species: “Re: Orion Health. Laid off 20 people last week – I have the list of those affected if you want it. My position was eliminated two weeks ago. Share price is way down from last year.” The New Zealand-traded shares of the company have shed 66 percent in the past year, valuing it at $223 million. The stock was pounded earlier this month on the company’s announcement of expected lower annual revenue and continuing (but improving) annual operating losses. CEO Ian McCrae said in that announcement that Orion will launch a cost reduction program and will evaluate partnership or minority investment interest.

From Dense Matters: “Re: Readers Write articles. Some of them are pretty lame. Do you run all of those submitted?” I actually reject most of them. Folks with creative ideas and insightful opinion apparently aren’t writing articles since most of those I receive are PR-polished vendor fluff pieces. I justifiably rejected one of those this week by randomly choosing five sentences from it and defying the PR person who sent it to me to find a single original or interesting thought in any of them (example: “Payers and providers recognize that future survival in the fee-for- value world depends on having the right systems in place.”) Restating dull, obvious facts isn’t a good way to draw the interest of my readers and yet people keep proudly sending me that crap like it’s wonderful. If you don’t like what I’ve run, imagine how bad the articles were that I rejected.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Ms. B in Arizona, who asked for a document camera for her second grade class. She provides this update: “Since I teach math, we use it almost every day and now I wonder how we survived without it before! My students love it because they get to see what I and their peers are doing from the document camera to the projector. It arrived at the perfect time — the week before our measurement unit. I put the ruler under the camera, and when it appeared huge, detailed, and gigantic on the screen, the class was in awe. I know that thank you letters were not requested but my students seriously thank you. They feel lucky that there are people out there who care about their educations that they spent their time and money donating an expensive tool to their classroom to benefit their learning. It is so, so helpful. You really helped out a great group of second graders immensely.”

I needed to get my medical records from an old, distant provider today and called the office. They need me to sign a release form, which is fine, but the only way they can send me this generic, blank form is via fax or mail. The conversation went like this:

Office person: We can send that form to you. Do you have a fax machine?
Me: No, this is actually the 21st century, where the only fax machines left running are in hospitals and doctors’ offices. I don’t even have a landline even if I wanted to set up my multifunction printer to fax. It’s just a blank form. Can you email it to me?
Office person: No. If you don’t have a fax machine, we will have to mail it to you and you can fill it out and mail it back.

My only secret weapon is those online fax services that allow you to send an ad-supported free fax, where I can at least scan and send the completed form back to them quickly. I am baffled why no doctor’s office I’ve ever asked can (or will) send email attachments for routine, non-PHI containing forms like this. Probably because nobody’s willing to pay them to change their ways.

Listening: Kiefer Sutherland (yes, Donald’s boy Jack Bauer). Movie stars obviously get a fast track for crossover music deals (especially when they own the record label as Kiefer does), but his 2016 album is really good with his gruff, whiskey-sounding voice, which is probably appropriate given his string of DUI arrests and prison time. The album has been characterized as country, but despite an occasional on-stage cowboy hat, it sounds more like blues-rock tinged Americana to me. Here’s a healthcare connection – Keifer’s grandfather created North America’s first universal healthcare program in Saskatchewan, Canada as the father of Canada’s Medicare program. If you’re instead feeling proggish, there’s a new album by former Genesis guitarist Steve Hackett, who provides an alternate ending to Phil Collins turning the shockingly talented prog rockers into the Archies.

Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

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

Acquisitions, Funding, Business, and Stock

Specialty drug prescribing software vendor ZappRX raises $25 million in a Series B funding round, increasing its total to $33 million.

Mpirica, which publishes surgery quality scores for hospitals and surgeons using claims data, receives a $4.6 million crowdfunding investment. 

Clinical communication system vendor Doc Halo receives $11 million in a Series A funding round. 

Care management company Lumeris acquires analytics vendor Forecast Health.

HealthVerity, which sells drug companies de-identified healthcare research data that it assembles from 30 suppliers, raises $10 million in a Series B round.

UK-based video- and chat-based virtual visit provider Babylon Health raises $60 million in funding, valuing it at $200 million. The company is also working on an AI-powered chatbot for NHS’s 111 non-emergency line and plans to further develop AI-powered diagnosis.

Surgical Information System acquires SourceMed, which sells ambulatory surgery center software. SourceMed’s president, CEO, and board chair since December 2014 is Jamie Coffin, PhD, who was VP/GM for Dell’s healthcare and life sciences business from 2007 to 2013.

Announcements and Implementations

Epic will offer patients health information from Mayo Clinic in its MyChart and MyChart Bedside tablet apps, available by clicking an Infobutton or on a keyword.

Apache Software Foundation releases v4.0 of its open source cTakes natural language processing engine for healthcare-related free text.

Smartphone clinical study participation vendor Medable will use API services from Redox to integrate EHR data into their system.

PolicyMedical announces GA of Integrity Manager, which automates the electronic review of vendors, business associates, and employees to meet the compliance requirements of OIG and OCR.

Cerner will integrate concussion management software from NeuroLogix Technologies into its HealtheAthlete health management system. I’ll be honest in admitting that I’ve never heard of HealtheAthlete.

This seems bizarre: Klick Labs releases a “tele-empathy” device that allows Parkinson’s Disease patients to transmit their tremors to a Bluetooth-connected muscle stimulation armband, allowing whoever is wearing it to feel their tremors and understand their effect on activities of daily living. The company says future versions will transmit symptoms to remote doctors for diagnosis. It’s also working on “symptom transference” for diabetes and COPD and hopes to use virtual reality to “virtually put other people in that patient’s shoes.”

Partners HealthCare will work with Persistent Systems to create an open source, SMART/FHIR-powered platform that will allow providers to exchange best practices knowledge.

Medsphere releases a patient scheduling tool for its OpenVista inpatient and ChartLogic ambulatory EHR.

QuintilesIMS will develop Salesforce solutions for managing clinical trials, recruitment, and marketing that will be marketed to life sciences companies.

Government and Politics

Former President Barack Obama will speak at the healthcare conference of Wall Street investment banker Cantor Fitzgerald in September for a rumored $400,000 fee. I bet someone at HIMSS is talking to his people about opening HIMSS18, which would certainly represent an improvement in the string of vendor CEOs to which HIMSS has recently bestowed the prime time speaking slot, although maybe the former President is too expensive (HIMSS paid Hillary Clinton $225,500 for her HIMSS14 speech). You’ve likely heard the Cantor Fitzgerald name – 658 of its 960 New York-based employees died in the World Trade Center attacks of 2001.

Privacy and Security

Ambulatory EKG monitoring services vendor CardioNet pays $2.5 million to settle HIPAA charges following the 2012 theft of an employee’s laptop that contained the PHI of 1,400 people. HHS OCR found that the company didn’t perform adequate risk analysis and risk management and hadn’t implemented its draft security policies. My conclusions from this:

• CardioNet would have had no HIPAA responsibilities if it were simply a technology vendor, but the company provides services to Medicare patients and thus is a covered entity subject to HIPAA.
• It would seem true in most cases that a breached covered entity could be accused of failing to provide adequate risk analysis and management.
• The company will begin encrypting laptops, flash drives, SD cards, and other portable media.
• I’m not sure what this means, but HHS will require the company to implement training that includes “out of-office transmissions.”

Other

A Nemours Children’s Health System survey finds that while only 15 percent of parents have used telemedicine services for their children, 64 percent plan to do so within the next year, the unlikely massive uptick in projected usage recalling that consumer responses to surveys often differ vastly from their actual behavior. It was also an online survey, which doesn’t necessarily draw a representative sample of all patients. I couldn’t find the 2014 version of the Nemours survey, which I expect contained rosy telemedicine projections that didn’t pan out. Respondents said they favor using telemedicine for their own convenience (acute conditions such cold and flu) but have little interest in having the chronic conditions of their children managed remotely.

Erlanger Medical Center (TN) posts improved quarterly revenue, but the CEO warns the board that its $100 million Epic rollout that starts May 1 will temporarily cause reduced revenue due to loss of productivity until staff become comfortable with it.

This is not sustainable in a globally competitive environment: healthcare employs one in nine Americans as communities embrace expanding health systems whose swollen headcount replaces jobs lost from dying industries. More than half of the $3.4 trillion spent annually on healthcare is made up of labor costs, with each physician being outnumbered by 16 other workers, half of whom function in non-clinical roles.

A Warren Buffett-backed insurer offers life insurance for poorly controlled diabetics in the UK using a process called “robo-underwriting” in which the insurer uses technology-powered medical data analysis to set premiums based on user behavior such as medication adherence and having their blood glucose levels tested regularly. Customers are required to comply with the company’s diabetic control policies, with their annual monitoring results sent directly to the company for premium adjustments that can range from a 4.5 percent discount to a 7.5 percent penalty.

Kaiser Health News notes the proliferation of breast milk banks, some of which are run by for-profit companies that pay new moms $1 per ounce for milk that they then resell to other mothers and even hospital NICUs for up to $300 for a one-day supply or to drug companies who use the milk in manufacturing. The facilities are not overseen by the FDA and studies have found that a significant amount of the product being sold is either contaminated with bacteria or has been diluted with plain old supermarket milk. 

I missed this great story from last month. Myron Rolle — a former NFL player and a Rhodes Scholar from Florida State University – has not only earned a master’s in medical anthropology at Oxford, but has also graduated from FSU’s medical school and has matched to Mass General’s neurosurgery residency program. He says he had football playing years left, but was anxious to avoid the potential concussions and hand injuries that could have ended his dreams of becoming a neurosurgeon.

Police use home network and fitness tracker data to charge a Connecticut man with murdering his wife. Home network logs showed that the husband logged into Outlook at the time he claimed to have been at work, the couple’s home security system log showed doors opening at times that didn’t agree with his story, and the wife posted to Facebook and recorded her Fitbit steps after he claimed to have found her dead.

Sponsor Updates

• Impact Advisors publishes a new white paper titled “Ensuring Effective Physician Engagement.”
• Besler Consulting releases a new podcast, “A look at the United Healthcare orthopedic bundled payment program.”
• The Advisory Board includes CareVive Systems in its Cancer Care Transformation Playbook.
• Casenet will deliver evidence-based content from XG Health Solutions via its care management platform.
• Crossings Healthcare Soutions GM Justin Monnig is featured in a Goliath Technologies case study.
• Health Catalyst wins the Gallup Great Workplace Award for the second year in a row.
• Cumberland Consulting Group will exhibit at the Asembia Specialty Pharmacy Summit 2017 April 30-May 3 in Las Vegas.
• Direct Consulting Associates will exhibit at the iHealth 2017 clinical informatics conference May 2-4 in Philadelphia.
• ECG Management Consultants will present and exhibit at the 2017 ASCA Annual Meeting May 3-6 in Oxford Hill, MD.
• EClinicalWorks will exhibit at the CAMGMA 2017 Annual Conference April 27-29 in San Diego.
• Evariant will exhibit at the Healthcare Communications Conference May 1-3 in Baltimore.
• Healthwise will exhibit at ZeOmega’s client conference May 2-4 in Plano, TX.
• Imprivata and Intelligent Medical Objects will exhibit during the HIMSS UK eHealth Week May 3-4 in London.
• Ingenious Med will exhibit at the Society of Hospital Medicine’s 2017 annual meeting May 1-4 in Las Vegas.
• InstaMed will present at the World Health Care Congress May 3 in Washington DC.
• InterSystems will exhibit at the HL7 international meeting May 6-12 in Madrid.

Blog Posts

• #JoinTheConversation with Jason Kressel of MyHealthDirect (Experian Health)
• Planning for an EHR Implementation? Don’t Overlook Communication (Optimum Healthcare IT)
• The General Ledger is dead, long live the Global Ledger! (Infor)
• How remote support can free you for more important go-live and upgrade tasks (Nordic)
• How to keep patients healthy with your patient portal (Meditech)
• 7 Traits Every Doctor Should Have (CareSync)
• The Experience Economy is Here: Healthcare Will Never be the Same (Docent Health)
• From Boardrooms to Exam Rooms: 4 Strategies to Enhance Frontline Engagement in Continuous Improvement (Hayes Management Consulting)
• Four Cyber Security Threats to Healthcare that You Can’t Ignore (HCI Group)
• The Exceptional Patient Experience at University of Utah Health (Spok)
• Health Happens Between Doctor Visits (Healthgrades)
• Unlock Healthcare Consumer Experience with Data (Influence Health)
• Enterprise-Wide Visibility into Provider Availability: A Patient Access Imperative (Kyruus)

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 4/25/17

$2.5 million settlement shows that not understanding HIPAA requirements creates risk

OCR announces a $2.5 million HIPAA settlement with remote mobile monitoring vendor CardioNet after a stolen laptop exposed 1,391 patient records. During its investigation, OCR found that CardioNet never implemented finalized policies on safeguarding ePHI.

AHIMA Letter to Congress

AHIMA sends a letter to ranking members of the Appropriations Subcommittee on Labor, Health and Human Services, Education lobbying for sufficient ONC funding to allow the office to meet expanded obligations established under the 21st Century Cures Act.

HHS to stand up its own version of the NCCIC for health

HHS announces that it will form the Health Cybersecurity and Communications Integration Center, which will work to educate healthcare organizations and consumers about cyber threats and data security.

Prescription monitoring program stalls in Legislature

The future of Missouri’s prescription drug monitoring program is once again uncertain after the Missouri House rejects the most recent version of the bill after several new amendments were added, one limiting the type of drugs monitored and another defining how long patient records would be kept. Missouri’s bill is now at a standstill, leaving it the only state without a PDMP.

Curbside Consult with Dr. Jayne 4/24/17

I’ve been working with several challenging clients over the last several weeks. All of them have been playing various versions of the blame game: clinical blames IT, IT blames operations, operations blames clinical, some blame the consultant, most blame the government and payers, and everyone blames the vendor.

I think I’ve finally put my finger on the underlying problem: learned helplessness. Essentially, learned helplessness happens when a subject undergoes repeated painful stimuli and loses the ability to employ escape or avoidance behaviors. The subject feels they have lost control and ultimately stops trying.

In the case of healthcare IT, the repeated painful stimuli have taken the form of multiple rounds of governmental regulations, reduced physician payments, increasing numbers of risk-bearing arrangements, and shrinking organizational pocketbooks in response to greater uncertainty. The complexity of the environment in which healthcare organizations are asked to work makes it difficult to manage all the details unless one has full-time teams dedicated to doing so. Most smaller organizations simply can’t afford that kind of infrastructure, so they try to cobble together resources from local and state medical societies, professional organizations, and their IT vendors to try to make sense of all of it.

Many of these organizations are struggling to make sense of it themselves, depending on their size and level of funding. Based on my clients’ experiences, the amount of information put forth by EHR vendors ranges from comprehensive to zero. One vendor was even worse than zero, putting out information that was incorrect and therefore placed their clients at risk. Clients who use web-based platforms where the vendor upgrades them automatically have one set of issues, where they have to keep up with the vendor’s plans and be ready to roll out workflows over which they have little control. At the other end of the spectrum are clients who can choose when to upgrade and which features to enable, which can lead to analysis paralysis.

Provider organizations are understandably worried about the certification status of their vendors. A recent surfing of the Certified Health IT Product List shows a shrinking number of vendors who have completed the most current certification. Those organizations that need 2015 Edition software installed before January 1, 2018 are understandably nervous, especially those that are large or complex. These are the kinds of organizations that are finding their way into my client pool, trying to completely avoid the pain of an upgrade by outsourcing the entire thing.

I’m not sure what other consulting organizations do, but the first thing I explain to these potential clients is that it’s very difficult to entirely outsource an upgrade (or a go live, or many other IT processes). There will always be parts of the project plan that require ownership and involvement by the client for best results. These steps may include decision-making around new features; training schedules; whether or not demonstration of mastery will be required; and user acceptance testing.

Regarding the latter, I’ve found that no matter how good your test scripts might be, there are always undocumented (and often aberrant) workflows that no one will know to test that will cause you heartburn on go-live day. The best way to avoid issues is to have actual end users perform user acceptance testing, rather than analysts or contractors.

Clients also need to have active involvement if there are decisions to be made around customizations. Whether to retire or retain customizations depends on whether the vendor’s workflows are equivalent to the customization or will create issues. Although a third party can make an objective analysis of the pros and cons, we sometimes don’t have the understanding of organizational culture that is needed to make the ultimate decision. I’m not saying we can’t do the majority of the heavy lifting for our clients, but we’re not going to allow them to completely abdicate all responsibility.

Another critical piece of upgrades that often involves organizational culture is the training plan. Clients need to take ownership of whether providers and end users will be pulled out of clinic for training, whether they will be compensated for training, whether it will be mandatory, etc. Although we as consultants can execute on whatever is decided, we can’t force an organization to mandate training for providers and ensure they actually show up. Sure, we can beg, plead, cajole, and even put monetary incentives around getting a client to perform one way or another, but ultimately the client has to participate in the process.

I went through the discovery process with a potential client last week, who has some major barriers between them and an upgrade. They’ve had near total staff turnover during the last two years and are three versions behind on their vendor’s software. They can’t find any previous project plans, testing plans, test scripts, or training plans from previous upgrades. They want to hire someone to “just take care of it,” but are reluctant to pay for the time it would take to document their existing workflows, create a testing strategy, determine a training plan, etc.

They keep mentioning that they are a community health center with limited budget, but don’t seem to appreciate that third-party vendors can’t give away their services for free. It makes for a very challenging business relationship, and with this particular prospective client, I’m not sure we’re ever going to have a relationship.

I’ve also run into some passive-aggressive clients who expect EHR vendors to spoon feed them information on various governmental programs while taking no accountability themselves. Although vendors can be good sources of information, clients still have to create their own policies and procedures and operationalize them to ensure compliance with regulatory programs. Your vendor isn’t going to stand behind your staff and make them perform medication reconciliation. Ultimately, provider organizations have to ensure that their staff members do their jobs and meet expectations.

My team provides first-line support for a handful of small practices. Sometimes there are basic workflow questions, such as, “How do I document XYZ?” Other times they’re outside of scope of EHR support.

One of those came in this week from a provider. He wanted to know how to document in the EHR that he disagreed with the nurse practitioner’s assessment and plan, and how to reject it and send it back to her. My team escalated it to me since it had medico-legal ramifications, so I got on the phone with the provider. I asked how he would have documented it in the paper chart and his answer confirmed what I suspected: he wouldn’t have documented it in the paper chart — he would have had a conversation with the NP, asked her to adjust the treatment plan, and then documented his review after the patient had been notified, etc.

I asked him why he would now want to have that liability-rich conversation in the electronic record rather than verbally. It took a few beats but he finally got my point, that there are certain things that just need to be done outside the EHR. But in some ways, he had become unable to think it through on his own, instead relying on the EHR’s workflows to direct him what to do.

I’m not sure what the answer is in these situations, but it’s good for those of us in the trenches to be able to commiserate.

What examples of learned helplessness are you seeing? Email me.

Email Dr. Jayne.

EHR Design Talk with Dr. Rick: Keep or Replace VistA? An Open Letter to the VA 4/24/17

Mr. Rob C. Thomas II
Acting Assistant Secretary & Chief Information Officer
US Department of Veterans Affairs

Dear Mr. Thomas:

The decision whether to bring state-of-the-art innovations to the VistA electronic health record (EHR) system or to replace it with a commercial EHR such as Cerner, Allscripts, or Epic will have far-reaching and long-term repercussions, not just for the VA, but for the entire country’s healthcare system.

Several years ago, when Farzad Mostashari was head of ONC, I attended a conference (see post) where he stated that when talking with clinicians across the country, the number one issue he heard was that their EHR was unusable, that "the system is driving me nuts." After his presentation, we had the opportunity to talk. I asked him, given the dominant market share (nearly monopolistic for hospital-based EHRs) that a handful of EHR vendors were in the process of acquiring, where would innovations in usability come from? His answer was that they would come from new “front ends” for existing systems.

In your deliberations, I would urge you to consider how innovative front end EHR user interfaces, based on the science of Information Visualization, could improve our country’s healthcare system. The field of Information Visualization systematically designs interactive software based on our knowledge of how our high-bandwidth, parallel-processing visual system best perceives, processes, and stores information. Stephen Few describes the process as translating “abstract information [e.g., EHR data] into visual representations [color, length, size, shape, etc.] that can be easily, efficiently, accurately, and meaningfully decoded.”

Sadly, while EHR technology has almost totally replaced paper charting over the past decade, not much has changed in EHR user interface design. For a number of reasons, the major EHR vendors have not made it a priority to develop better front ends based on principles of Information Visualization. The adverse consequences for physicians and other healthcare providers, for patients, and for our entire healthcare system are immeasurable. An Institute of Medicine Report found that current EHR implementations “provide little support for the cognitive tasks of clinicians . . .[and] do not take advantage of human-computer interaction principles, leading to poor designs that can increase the chance of error, add to rather than reduce workflow, and compound the frustrations of doing the required tasks.”

A well-known example of an EHR user interface design contributing to a medical error is the 2014 case of Mr. Thomas Eric Duncan at Texas Health Presbyterian Hospital, where there was a critical delay in the diagnosis and management of Ebola Virus. No doubt, this case is just the tip of a very large iceberg because most major EHRs use similar design paradigms (and because many medical errors are never reported or even recognized, and even when reported, are rarely available to the public). In the most comprehensive study to date of EHR-related errors, the most common type of error was due the user interface design: there was a poor fit between the information needs and tasks of the user and the way the information was displayed.

Furthermore, current EHR user interfaces add to physician workflow. A recent study found that nearly half of the physicians surveyed spent at least one extra hour beyond each scheduled half-day clinic completing EHR documentation. In addition, current EHR user interfaces frequently fail to provide cognitive support to the physician.

Innovative EHR user interfaces, based on principles of Information Visualization, are the last free lunch in our country’s healthcare. EHR usability issues are becoming increasingly recognized as a major barrier to achieving the Triple Aim of enhancing patient experience (including quality and satisfaction), improving the health of populations, and reducing per capita costs. Well-constructed EHR user interfaces have the potential to improve the quality and decrease the cost of healthcare while improving the day-to-day lives of physicians. In my opinion, a well-designed EHR user interface would easily increase physician productivity by more than 10 percent, probably by much more, while reducing physician stress and burnout.

On the design front, innovative EHR front end designs, based on principles of Information Visualization, are already being created by a number of research groups, including Jeff Belden’s team at the University of Missouri (Inspired EHRs). See also my design for presenting the patient’s medical record chronologically using a dynamic, interactive timeline.

In addition, technological advances in computer processing speed and programming language paradigms now support the development of a comprehensive, open source library of interactive, dynamic Information Visualization tools. In this regard, see the work of Georges Grinstein and colleagues at the Institute for Visualization and Perception Research at UMass Lowell.

The beauty of building new front ends on top of existing EHR data bases is that the underlying data structure remains the same. This makes the design much easier to implement than if the underlying data base structure and software code had to be rewritten. Fortunately, all of the EHR systems being considered by the VA, including VistA, have excellent and robust underlying data base structure and organization.

The question then becomes, which EHR system is most likely to embrace intuitive visually-based user interface designs and make these designs widely available? In my view, the clear winner is VistA, for the following reasons:

• VistA, unlike the other for-profit vendors, is government owned. Its goal can be to improve the VA’s and the country’s healthcare system.
• VistA became a world-class EHR through its now famous open source model of distributed development, incremental improvement, and rapid development cycles. Using this same model, visually-based cognitive tools for the EHR could be rapidly created, developed, tested, and implemented. Commercial EHRs do not use the same development model and their development cycles are typically much longer.
• VistA is the only EHR in contention which is open source. Any innovative user interface designs developed in VistA would be freely available to commercial EHR vendors and third-party developers and would thereby benefit our entire healthcare system.
• A major federal health IT goal is for EHRs to “be person-centered,” permitting patients to aggregate, organize, and control their own medical records, regardless of the sources. Innovative user interface designs developed in VistA could, with modification, serve as the basis for an intuitive, open source patient-centered medical record.

If the VA’s goal in selecting an EHR, both for the VA and for the country as a whole, is to improve health outcomes, reduce costs and errors, and improve physician satisfaction, then VistA is the clear choice. Any other choice will set our country’s healthcare system back decades.

Rick Weinhaus, MD practiced clinical ophthalmology in the Boston Area until 2016. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

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