EPtalk by Dr. Jayne 2/9/17

Several readers asked whether I saw this article about Obamacare vs. the Affordable Care Act, so I feel compelled to respond. I don’t know about the exact statistics, but we’re having lots of conversations with patients in the office about their coverage and their concerns about what will be changing. Usually it’s in the context of their being grateful for our transparent pricing and low costs, but a lot of people are genuinely worried about pre-existing conditions and whether their insurance will still cover preventive services.

When patients complain about rising premiums or changes to insurance plan offerings, I typically mention that while the laws regulate doctors and hospitals, there hasn’t been much done in the way of insurance regulation. Whether or not you think enormous bonuses for insurance company CEOs are warranted, the sheer economics dictate that the money has to come from somewhere.

On the payer front, Centene’s recent report showed quarterly revenue and profit ahead of expectations, helped by growth in the individual coverage market and by Medicaid expansion. Net earnings for Centene were $261 million for the fourth quarter of 2016. Based on 11.4 million patients covered, it’s a small margin, but when you couple it with the administrative costs of running a health plan, it represents a tremendous amount of premium and tax dollars that are not being spent on patient care.

I’ve been inundated by requests from HIMSS for their corporate member focus groups. Some of the sessions are pretty drab sounding and others don’t work with my schedule, so I probably won’t make it to any this year. I was a little aggravated, though, that they can’t figure out how to blind copy the invitation – seems like a basic email skill.

Some of the sessions are vendor-specific and it’s obvious who you will be talking to or about, but others are a bit more vague. I was tempted by one that advertised discussion of precision medicine solutions, but I figured it would just irritate me. As a preventive and public health curmudgeon, I have a hard time talking about spending millions of dollars on focused gene-based therapy when we can’t fund the basics of health promotion and disease prevention.

I attended a service launch webinar for another consulting company this week. They’re not in the same space as me, but they’re a fun bunch of people, so I wanted to see what they’re up to. They’ve partnered with a third-party vendor for the tool, although they didn’t say it. If it’s not totally white labeled, I think it’s better to say you’re at least “powered by X vendor” rather than having prospects or vendors see “copyright X vendor” at the bottom of the screen and wonder what’s going on. The presenter also seemed nervous. Even if you’re a presentation pro, I’d definitely recommend a dry run when you’re launching something new or presenting in a new format.

For weird news fans: I stumbled across an article about a patient who lived for six days without lungs. She had been waiting for a transplant but developed influenza and sepsis along with organ therapy. After concluding that death was likely imminent unless there was intervention, physicians removed the source of infection – her lungs. She was placed on an external oxygenation device (Novalung) with rapid improvement and received donor lungs several days later. Four months later, she’s breathing normally on room air, although she does still have to have dialysis following kidney failure. Hearing about physicians pushing the boundaries and having success reminds me of the excitement of medical school, when it seemed like our faculty was making history on a weekly basis.

CMS has extended the submission deadline for 2016 clinical quality measure reporting required by eligible hospitals and critical access hospitals participating in the Medicare EHR Incentive Program or the Hospital Inpatient Quality Reporting program. Electronic clinical quality measures are now due March 13 rather than February 28. For 2017 reporting, CMS plans to start a rule-making process looking at modifications to the final rule. It’s always fun to wait for the rules to be finalized after you’re already playing the game.

The AMIA Mentor Match program is looking for informaticists willing to spend an hour a month for the next 11 months working with mentees. I’m thinking about signing up, but struggle with how to describe my experience and areas of expertise. Somehow I don’t think “Sassy former CMIO turned consultant seeks idealistic mentee to remind me how idealistic I used to be, before corporate healthcare and chaotic vendors drove me over the edge” is what they’re looking for. Some days I wish I had a mentor of my own to give me perspective on the bizarre work situations in which I often find myself.

I’m spending some extended time in the patient care trenches due to a colleague’s medical leave. We’ve started seeing some EHR performance issues during the times of peak patient volume. It’s bad enough when you’re overwhelmed with patients, but having your system fail you makes it intolerable. At times, the system is at a crawl.

I was spoiled when I was a CMIO because our EHR vendor had a SWAT team they would send out for issues like this. Even if you had strong resources in house, you could leverage the team to review performance and monitoring tools and make recommendations. My current vendor is on the smaller side and not terribly helpful when it comes to helping us manage the issues.

We use a third party to manage desktop and wireless solutions, so as you can imagine, there is a bit of finger-pointing between the access crowd and the application support folks. It always unnerves the IT team when you have a physician who starts asking about latency and Citrix load balancing, but I’m happy to give everyone a nudge to stop the blame game and get about the business of finding solutions.

The HIMSS mailings have started rolling in. Every year it seems like the marketing themes and giveaways get a little goofier. Physicians have long been scrutinized for regarding gifts from industry, but there’s no reporting for the majority of healthcare IT professionals. I hope the Open Payments system has fields available for tracking giveaways such as virtual reality goggles, scooters, art pieces, and more.

What’s the best trade show giveaway you’ve ever seen? Email me.

Email Dr. Jayne.

Morning Headlines 2/9/17

VA ‘confident we’re going to commercial’ for EHR, scheduling fixes

During a House Committee on Veterans Affairs hearing Tuesday, Acting VA CIO Robert Thomas reported that he was confident the agency would eventually migrate to an off-the-shelf EHR system.

DOD plugs in new electronic health record system

DoD goes live with its first Cerner site at Fairchild Air Force Base in Washington.

Data breach at Verity Health could have affected 10,000 patients

Verity Health reports that the website of one of its hospitals was hacked between October 2015 and January 2017, potentially exposing the records of 10,000 patients.

Fitbit Faces Criminal Probe Into Jawbone Trade Secret Theft

Jawbone’s ongoing lawsuit against rival Fitbit intensifies as new court filings suggest that Fitbit is also under a criminal investigation for trade secret theft.

HIStalk Interviews Tom White, CEO, Phynd

Thomas White is co-founder and CEO of Phynd Technologies of Kearney, NE.

Tell me about yourself and the company.

Phynd is the third company I’ve co-founded. Two of those were in healthcare IT and one in the 1990s was in Internet real-time news search. All of the businesses that we’ve started have been focused on new categories of software that simplify and improve search, profiling, and content. The second addressed diagnostic results. Now it’s provider data for this third company.

We see an intersection of provider data being important. Historically, there have been patient systems, EMR systems, payer systems, and rev cycle systems. But there’s really never been a provider data system. We see the elevated issue of provider data being an opportunity in the marketplace.

What problems do health systems have with provider management?

Hospitals have 10, 15, or maybe 20 IT systems that silo provider data. Each system has a specific function, whether it’s radiology, lab, EMR, or credentialing. Each has a specific core function with a provider database embedded inside.

Our clients tell us they have a hard time harvesting the data across all those systems and managing the data. There’s good data in all of those core systems that impacts clinical outcomes, rev cycle, and marketing. It is buried in these systems. Our clients have problems exposing the provider data into one platform where it can be curated and managed by the organization versus being buried in these silos.

What benefits do they expect from implementing a provider management system?

On the business side, inaccurate provider data creates a significant delay in the billing cycle. The reality of healthcare is that providers from all over the country are in the databases of hospitals. A hospital in New York is going to have referring physicians from Dallas, Los Angeles, and Chicago. When they discharge the patient and invoice for that claim, they need accurate provider data to process the bill. If they don’t, it will get kicked back. We’ve seen a delay of a month to two months for up to 10 to 20 percent of our clients’ invoices because of inaccurate provider data.

On the clinical side, as hospitals have grown their physical footprint, they have added clinics in the field. They have large referring bases. They’ve created clinically integrated networks. As they have to communicate more and more — whether it’s by fax, phone, or Direct address – maintaining the data elements on the providers in the field has become difficult. We impact the clinical care process from the communications side by having accurate, good information that is curated by the client themselves.

Is it harder for hospitals to track their provider relationships under new care delivery models?

A hospital has to track 10 to 15 times as many providers as they have credentialed. If they have 1,000 providers, they’re going to need to manage 10,000 to 15,000 referring providers.

As they shift into clinically integrated networks, ACOs, narrow health networks, and narrow health plans, the provider base is going to shift. It’s not just their historical credentialed base. It’s everyone within a certain geography or target market segment they’re going after. They need to know who is in the clinically integrated network and then the specific data around their referral patterns, communication preferences, and rev cycle information.

Does having that self-curated information accessible enterprise-wide provide a competitive advantage?

It does. The end user can look at our client’s data  through their native systems, whether it’s their EMR, credentialing, radiology, lab, cardiology, or pathology systems or into their marketing platform. Also being able to expose that data on internal and external websites for provider search. Then using the UI to curate and manage the data. It’s available wherever the end user is. We think that’s a competitive advantage.

Are hospitals getting more interested in marketing the physicians that work with them via provider search?

Yes. Our philosophy is that you have to get the provider data right first. That’s the core Phynd platform. Once you have the provider data in a format that’s accurate, then you can expose that data across multiple systems, such as provider search.

Provider search matters because it helps with referral patterns. It helps with customer satisfaction. But it also grows the top line. It’s good for healthcare organizations to provide the best search algorithm environment for consumers to find the right doctor the first time.

Are physicians finding that the marketing clout of their local health system benefits their practices, such as in a hospital website’s provider search function?

Yes. The world of search is a complicated world. How healthcare organizations are creating large franchises on the web is important. That drives traffic into their clinically integrated network providers, people in their ACO, and the different organizations that they’ve created.

What business advice would you offer someone thinking about starting a company?

The first thing is that startups are really hard. In general, they’re very difficult to go do, from concept all the way to customer acquisition. They require a lot of patience and a long-term view of solving the core problem that you’re going after. That’s the first bit of advice.

The second bit is that building happy customers is a long-term approach that requires an all-in mentality. To be at the customer site, to see how they use the product, to hear the conversations they’re having with their peers. Then to communicate with them routinely thereafter. It’s about being a part of the customer conversation long term.

You need the idea to start the business, but the reality is that you pivot. Part of being a startup is you’re pivoting based on conversations you have with your clients. Finding clients that are willing to work with you and to pay you is the hardest part. Once you get those folks, you can pivot the product ideas around what their needs are.

You need the core, basic idea. Ours is that we want to simplify provider data management across the healthcare industry. How we do that is dependent on a number of factors, including our partners, our customers, and then our long-term vision as well.

Where do you see the company in the next five years?

Healthcare organizations are going through significant change. They’re driven by the opportunities to attract new patients across new locations. Their physical footprint is growing. They’re building alliances and clinically integrated networks. They’re participating in narrow health plans.

We see Phynd as a gathering point of provider data that can be used to improve clinical communications, revenue operations, provider, consumer, and web touch points across all these really big businesses that are being formed right now across healthcare. We see ourselves growing with that marketplace.

I’m not sure where the healthcare organization ends. Is it payers? Is it vendors? We’re focused on the hospital space right now. Long term, healthcare is  the biggest industry in the country. We see ourselves growing with it.

Morning Headlines 2/8/17

Multifunctional, inexpensive, and reusable nanoparticle-printed biochip for cell manipulation and diagnosis

An NIH-funded research project yields a reusable lab-on-a-chip that can be printed with a standard inkjet printer and costs just $0.01 to produce. The chip “can perform complex, minimally invasive analyses of single cells without specialized equipment and personnel.”

FDB and Translational Software Announce Collaboration to Deliver Pharmacogenomic Drug Knowledge

First Databank will incorporate pharmacogenomic data from Translational Software, Inc. into its drug formulary so that genetics data can be integrated into clinical decision support systems powered by First Databank.

Is Your Doctor Listening?

Danielle Ofri, MD, provider at Bellevue Hospital (NY), author of several books, and regular op-ed contributor to the New York Times publishes a piece for Slate describing an incident in which she lost a note she had written about a patient because she accidently closed the chart without saving it.

News 2/8/17

Top News

A National Academy of Sciences article describes a reusable, inkjet-printable lab-on-a-chip for point-of-care diagnostics that costs just $0.01.

Heading the NIH-funded project is Stanford Genome Technology Center’s Rahim Esfandyarpour, PhD, an engineering associate who says inexpensive diagnostics could improve low survival rates in developing countries of conditions such as breast cancer, malaria, tuberculosis, and HIV.

Esfandyarpour summarizes, “Maybe $1 in the US doesn’t count that much, but somewhere in the developing world, it’s a lot of money.”

Reader Comments

From Guacamole Greg: “Re: EHR. This doctor’s article says she inadvertently closed the wrong EHR tab and lost the note she was writing without warning. It fascinates me to what extent my colleagues view things like this as anything less than criminally negligent design errors. Still, I’m also amazed to the extent to which medical people don’t grasp the difference between structured data entry and word processing.” The doctor-author practices at Bellevue Hospital. She doesn’t mention the EHR she was using, although I assume QuadraMed since I don’t think they’re live on Epic yet. She bemoans the “special circle of hell created by cocksure computer programmers whose systems can incinerate hours of work” and wonders why EHRs don’t have a Word-like auto-save feature. Perhaps those who know common EHRs can answer the question – do the systems you know allow closing an entry screen without warning the user that they will lose their work? I think expecting auto-save is a bit much, but it’s reasonable to warn a user that their action is going to trash whatever they’ve entered but haven’t saved. The author had previously complained in a New York Times article that the EHR has a limit of 1,000 characters and she struggles to squeeze in lengthy notes.

From Chris: “Re: VitalWare’s website. It’s been hacked again, with comments suggesting a different hacker. Any concern with PHI or customer data?” Not likely. Their public-facing website is running WordPress v. 4.7, which is getting hacked all over the place due to a REST API vulnerability. They really need to apply the 4.7.2 upgrade, which takes maybe 30 seconds and is unlikely to cause problems. Auto-updating of the WordPress core is enabled by default, I think, so perhaps they made the mistake of turning that off. In any case, it’s probably only WordPress that was hacked and that platform isn’t connected to anything sensitive on the back end – it’s just a website content management system.

From Cabin Boy: “Re: Stanford. I can confirm the changes reported by Silicon Valley Geek in your late January post. At least some parts of the Epic rollout have been cut back after the organization failed to fund parts of its project plan and a lot of executives and contractors were replaced.”  

HIStalkapalooza Sponsor Profile

Healthcare’s most trusted data integration and compliant hosting company has a new name — Datica. Same trusted expertise; new and exciting moniker. The rebranded name better reflects the company’s emphasis on healthcare’s great challenge — a deluge of data to be integrated, exchanged, shared, and protected. Datica provides the ways and means for connecting healthcare. Check out the rebranded website www.datica.com, the new Twitter page @daticahealth, and make sure you stop by HIMSS booth #8152 for coffee or check this HIStalkapalooza sponsor out at their Datica cabana on the dance floor.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Ms. L in Texas, who asked for books and a storage cart for her elementary school class. She says students are now able to choose books at their own reading level, where they “pick spots on the floor where they are able to stretch out and read.”

Stopping by our HIMSS booth (#4845) on Tuesday, February 21 will be Industry long-timer and WebPT CEO Nancy Ham, who will offer career advice to women from 4:00 until 5:00 p.m. Saying hello to visitors from our microscopic booth on Monday from 1:00 to 2:00 will be Regina Benjamin, MD, MBA, the 18th US Surgeon General.

Thanks to new HIStalkapalooza sponsors Clearsense (healthcare data science) and Hedgeye (financial and research media). I’ll have more about them later. 

Welcome to new HIStalk Gold Sponsor AssessURhealth. The company helps clinicians assess a patient’s health risk in several mental and behavioral health categories using a five-minute iPad survey that can be completed in the waiting room, after which the results are securely delivered directly to the EHR so they can be reviewed with the patient. Providers increase their revenue while screening patients for depression, anxiety, opioid risk, PTSD, and other conditions in raising awareness of mental and behavioral health. Thanks to AssessURhealth for supporting HIStalk.

I found this AssessURhealth intro video on YouTube.

Dear HIMSS-owned publication, sorry to be on your case again, but it’s really embarrassing that a publication dispensing health IT information can’t spell HIPAA correctly. Not that it matters since the JPP case had nothing to do with HIPAA despite your headline – ESPN is not a covered entity. Searching your site even turned up examples where you’ve spelled your own organization’s name incorrectly. Fake news! Sad!

Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

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

Acquisitions, Funding, Business, and Stock

HIPAA-compliant hosting and integration services vendor Catalyze renames itself to Datica. I’m sometimes skeptical of a seemingly gratuitous rebranding, but co-founder Travis Good, MD explained that quite a few healthcare-related companies, incubators, and venture funds have used the name Catalyst as their service mark, observing that the Internet has made it hard to find a name that is securable and unique. There’s a good lesson there for newly formed companies – choose a name that is memorable, Google-able, and not already in use in healthcare, which is harder than it sounds (which is why new companies often prefer making up a word).

Cloud-based patient matching system vendor Verato raises $12.5 million in a Series B funding round, increasing its total to $25 million.

A Connecticut investment bank loses its bid to avoid paying $1.25 million to two elderly retirees to whom its broker sold shares of Nashville-based EHR implementation vendor iPractice Group in 2012. The Nashville startup shut down the following year.

Physician staffing company TeamHealth will pay $60 million to settle charges that its hospitalists up-coded to create inflated bills as pressured by the company.

People

Rich Walsh (Philips Wellcentive) joins Continuum Health Alliance as VP of business development.

Sales

Novant Health (NC) chooses Glytec’s eGlycemic Management System for personalized glucose control in its 14 hospitals.

Oregon Advanced Imaging (OR) selects McKesson for revenue cycle management.

Saint Francis Healthcare Partners (CT) will implement Orion Health’s Amadeus precision medicine platform.

Announcements and Implementations

First Databank and Translational Software, Inc. will collaborate to develop pharmacogenomics-based drug knowledge that will provide clinicians with genomic-related risk information when prescribing drugs.

BloodCenter of Wisconsin and Fresenius Kabi launch a pilot program at Children’s Hospital of Wisconsin that will use RFID to track and inventory blood products.

InstaMed releases a secure token that allows providers and payers to accept online credit card payments without storing or accessing cardholder data directly.

Other

A USA Today article by the CEO of The Permanente Medical Group questions why the US isn’t paying more attention to India’s 20-hospital Narayana Health, where state-of-the-art heart surgery costs $1,800 vs. $90,000 in the US with outcomes that are among the best in the world. He observed the procedures first hand:

In surgery, the experience of the surgeon and the team are the best predictors of superior clinical outcomes. As you might imagine, given the huge volume of procedures his team performs each day, his hospital’s results are exceptional … clinicians use a sophisticated electronic health record they developed, with the information stored on an iPad. Unlike nearly all US EHR systems, the application is so intuitive that minimal physician or nurse training is required. The operating rooms themselves have huge windows leading to protected gardens designed to allow natural sunlight to enter and spur creativity. The bedside monitoring equipment links with a central computer system, allowing clinical leaders like Devi to measure each day how long it took a physician to intervene for a potentially urgent medical problem. In the United States this often exceeds an hour at night and on the weekend. In India it was eight minutes. The disruptive innovation he has implemented isn’t just lower cost, it’s also higher quality. The hospital’s focus on people was widely evident. Embroidered on the white coats of doctors, nurses and staff was the question, "How can I help you?"

Weird News Andy titles this story “Roach Nosetel,” where roaches check in but don’t check out – they get evicted. Doctors in India investigate a woman’s “wiggling” sensation in her nose following her unsuccessful visits to three other hospitals, finally identifying the problem as a full-grown, live cockroach that had made its way high into her nasal passages. They removed it, adding it to their list of successful nasal extractions in previous patients that includes beads, batteries, chalk, and a leech.

Sponsor Updates

• The Sequoia Project appoints Medicity’s Brian Ahier to its board.
• Florida Governor Rick Scott honors Voalte Founder and President Trey Lauderdale for creating jobs in the state.
• ZeOmega’s Jiva 6.1 achieves ONC Health IT 2014 edition modular EHR certification from ICSDA Labs.
• ZirMed will exhibit at the Healthpac Users Meeting February 9-11 in Savannah, GA.
• Meditech posts a case study titled “It’s in Their DNA – Avera Health Drives Precision Medicine at the Point of Care”
• Agfa HealthCare and Telemedicine Technologies Company sign a memorandum of understanding at Arab Health.
• The South Florida Business Journal profiles Aprima Medical Software’s acquisition of Healthcare Data Solutions.
• Bernoulli publishes a new booklet, “Medical Device Connectivity & Informatics.”
• Besler Consulting releases a new podcast, “What is Revenue Integrity?”
• CoverMyMeds COO Michelle Brown will speak at the Columbus Women in Technology event February 15 in Columbus, OH.
• HCI Group releases a new podcast, “MACRA: Preparation, Benefits, and Third-Party Assistance.”

Blog Posts

• Applying Agile Principles to Epic System Maintenance (Ellis  & Adams)
• Bridging Communication in the Multi-Generational Workplace (TierPoint)
• Will Blockchain solve healthcare’s interoperability challenges? (Infor)
• At HIMSS17, unlock the power of your data (Medicity)
• KLAS Recognizes Impact Advisors as Clinical Optimization Leader (Impact Advisors)
• CEO Bruce Cerullo shares a few things you might not know about Nordic (Nordic)
• Zynx Health Named KLAS Category Leader for CDS – Order Sets for Second Consecutive Year (Zynx Health)
• 5 Things We’re Looking Forward to at HIMSS17 (Dimensional Insight)
• Verscend Receives 2017 Best in KLAS Award for Payer Quality Analytics and Reporting Solutions (Verscend Technologies)
• Transitioning to MACRA & MIPS in 2017 – Have You Picked Your Pace? (Optimum Healthcare IT)
• From a “Wait-and-React” to a “Detect-and-Prevent” Healthcare Model (Validic)
• How population health analytics can help identify and address opioid abuse (Verscend)
• More perspectives on healthcare’s future (Conduent Health)
• Value for the Patient (Arcadia Healthcare Solutions)
• 2017 Healthcare Trends Part 3: The Rise and Fall of the EHR (Datica)
• Healthcare Supply Chains Face Cost Issues and Data Hurdles (Black Book Market Research)
• Competency-Based Training Program (Culbert Healthcare Solutions)
• How to Succeed with CPC+: Three Areas of Focus for Primary Care Practices (ECG Management Consultants)
• 4 medical innovations to watch for in the next 100 years (Elsevier Clinical Solutions)
• 4 Pillars to a 360-Degree Physician View (Evariant)
• How Analytics can Benefit 4 Key Members of the Compliance Team (Hayes Management Consulting)

Contacts

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

Morning Headlines 2/7/17

Examining the ‘Copy and Paste’ Function in the Use of Electronic Health Records

NIST publishes findings and safety recommendations from its review of “copy and paste” practices within EHR clinical documentation tools.

Trump, Congressional GOP Back Off From Immediate Obamacare Repeal

In an interview with Bill O’Reilly, President Trump dials back the timeline to develop an ACA replacement plan, saying “I would like to say by the end of the year, at least the rudiments.”

Uncertainty, Headwinds Hurt Final Marketplace Enrollment Total

Tim Jost provides commentary on Healthcare.gov’s final enrollment figures: 9.2 million individual enrollments, of which three million were new consumers.

A tale of two accountable care organizations

Modern Healthcare covers the experiences and associated financial results of two ACOs delivering value-based care to Medicare and private payer beneficiaries simultaneously.

Curbside Consult with Dr. Jayne 2/6/17

I’m playing cleanup for one of my clients this week. They’re dealing with one of the most common management challenges I see – lack of redundancy for key positions or functions.

Due to some leadership personality issues, individual contributors were allowed to become “experts” on a variety of topics without any thought to backup, collaboration, or shared responsibility. When issues came up, it placed the experts in a position of being able to swoop in and solve the problem using their sacred knowledge, further solidifying the idea that only the rescuer had full command of the information. Instead of raising appropriate red flags about why only one person could solve a problem, previous leadership continued to groom these expert resources.

In reality, what some of the experts were doing was front line customer support, but because no one else had visibility into what they were doing, it appeared that they were doing a lot more than was actually going on. Now that a couple of them have left the organization, it has become apparent that some of them were doing very little, and others were doing work that could have been handled by appropriately training the practice call center employees who interact with the internal customers on a daily basis.

When I came into the situation, the organization was in a tailspin trying to figure out how they could possibly replace these people. The reality was that we were able to outsource it pretty quickly, along with selling them some consulting services to document the process, educate others, and prevent this from happening in the future.

In looking at the broader structure of the organization, however, there are much larger cultural factors at play that allowed this behavior to continue. There is a history of promoting individual contributors to management positions because there was no other career path for them. When you take people with no management experience and plop them into a management role, it often feels very uncomfortable. That can lead to the new manager withdrawing from those responsibilities and instead to try to create new individual responsibilities that are more in their comfort zones. Couple that with upper management that is too crisis-oriented and doesn’t budget adequate time to develop these new managers and you have a recipe for a mess.

My task with these folks now is to evaluate the depth and breadth of the experts and figure out what they were actually doing. Some of them have been doing obscenely little given their titles and pay grade. Others were trying to do more than anyone could possibly do well because of wheel-spinning and inefficiency. Once we identify the core body of knowledge and the tasks that need to be completed, I assign an external resource to first cover the acute needs, but second, to document everything and create a training plan to build out multiple resources to cover the needs moving forward. I’m unfortunately seeing a lot of resistance as members of the organization figure out that the emperor has no clothes and begin to worry that they might be next in being exposed.

This fear of being exposed leads to all kinds of bad behavior: information hoarding, siloing, manipulation, maneuvering, and more. People feel threatened when they’re worried others will figure out they have been operating outside accepted boundaries and will do anything to protect themselves.

My favorite strategy is blaming the consultant, who has clearly been brought in by the leadership to fix something that has been identified as a problem. There’s a certain level of trust (and money on the line) when you bring in an outsider and give them carte blanche to realign resources and shift roles and responsibilities. Complaining about it or pitching a fit only makes you look bad and potentially tees you up to be “realigned” outside the company if you are uncooperative enough. Couple that with the fact that the consultant was able to replicate your job duties at a fraction of your cost, and it might just be better to keep your head down and cooperate.

I’m on site this week doing stakeholder interviews, trying to sort out what people think about their role in the project and how the project is going overall, vs. what others have to say and what the leadership thinks is going on. It’s not looking good for some members of the management team who are behaving like cornered animals. Although downsizing was not an original goal of this consulting engagement, how they’re handling it is making it seem like losing a few people might be a good idea.

I enjoy doing stakeholder interviews and organizational assessments. Sometimes they can be enlightening, but often they’re fascinating journeys into the underlying psychological baggage that people carry around with them. Some of my standard interview questions involve the team, its goals, what people think about their participation, the overall health of the project, and how they think they’re contributing.

I conducted one interview this morning where the participant raved on and on about a colleague and how helpful she is, how much of an asset to the team, how she enjoyed working with her, etc. A few hours later, I met with the subject of the glowing commentary, who went on and on about how she thinks my previous interview subject hates her and is trying to undermine her within the company. This client has a fair number of “you can’t make this up” scenarios that I have to figure out how to deal with. I’m thinking I need to bring in a therapist in addition to subject matter expert consultants.

The leadership is not without blame here. Although they’re relatively new and inherited the bulk of the mess, they’ve been complicit in allowing some of the craziness to continue without stepping in earlier. They’ve allowed the process of making people managers because there’s no way to promote people in various job classes, which has compromised people’s effectiveness and weakened the organization.

Members of the leadership also project the air of being too busy to help the little people sort it out, which is going to be a long-term issue. They’d be much better served by at least appearing that they’re willing to roll up their sleeves and dig in to build the organization rather than making it clear that their main goal is to continue acquiring physician practices and everything else is secondary. Adding more practices (many of which are distressed when they’re acquired) when they’re struggling to support their existing practices doesn’t seem like the best strategy, so I’ll continue to work on that piece as well.

What’s your current project? Does it make you want to crawl back in bed every morning? Email me.

Email Dr. Jayne.

Health IT Changes the Game for Workplace Wellness

From next-generation wearables to predictive analytics, healthcare technology is helping employers gain greater ROI from workplace wellness programs.
By @JennHIStalk

The month of January has come and gone, no doubt leaving a plethora of abandoned New Year’s resolutions in its wake. Personal goals related to weight loss, healthier eating, better sleep, and less stress – to name a few – have fallen by the wayside for some, as regular routines (and familiar bad habits) kick back in after the holidays. This month’s Super Bowl parties, Valentine’s treats, and even HIMSS exhibit hall fare threaten to trip up even the most dedicated of goal-keepers.

Employers of all sizes have, over the last several years, recognized they have a part to play in the resolution game – one that extends beyond pounds shed and muscle gained to fewer sick days, increased productivity, and lower overall healthcare costs for employee and employer alike. Nearly 20 percent of all employers offered comprehensive wellness programs in 2015 and 2016, according to a 2016 United Benefit Advisors survey, which also found that such programs are the most prevalent among education, government, and utilities employers.

These programs have typically consisted of health risk assessments, biometric screenings or physical exams, coaching for high-risk employees, seminars or workshops, and, of course, incentives for participation. Technology’s role in these programs has become increasingly sophisticated,  evolving from basic clip-on pedometers to BYOD programs that serve up tailored employee offerings based on claims and clinical data. Some may see that level of sophistication as being in direct correlation to the out-of-pocket healthcare costs increasingly shouldered by consumers.

“In the past, employee wellness programs have mostly been built around physical health,” explains Michelle Snyder, chief marketing officer at Welltok, which has developed a wellness technology platform that uses predictive analytics to offer employees custom programs and incentives. “But now that consumers are having to take on more of the cost burden for healthcare, they’re beginning to want their employers to help them manage not only their physical health, but also their financial health, emotional health, and social connectedness.”

Employers, in turn, are looking to better control their healthcare costs and improve employee productivity, satisfaction, and morale. Snyder adds that employers are also eager to find ways to better engage employees in wellness programs already up and running. “The two main reasons we’ve found that employees aren’t engaging have to do with the fact that they didn’t know the programs existed and the programs aren’t relevant to the individual employee.”

From Pedometers to Predictive Analytics

As employers have begun to focus on more than just the physical health of their employees, their need for more tailored technologies has grown. “I think wearables sometimes get a bad rap,” Snyder says. “People will wear them and some employers think of that as the centerpiece. That’s the answer to their corporate wellness program. That’s great, but those devices should be just a piece of the bigger picture. The real-time data you can get from wearables is important, but its importance is tied to all of the other data streams that are a part of that wellness program. Those step counts, for example, have to be tied to other data sets to make it really rich and valuable for the employer, and for the employer to figure out how to better target and engage with employees.”

The State of Colorado has realized the need to think beyond pedometers in the years since it launched its wellness program. “When we launched our program in mid-2013, we secured funds to distribute 1,000 digital pedometers on a first-come, first-serve basis,” says Statewide Wellness Coordinator Nate Sassano. “Those pedometers connected automatically to a customized activity in our program. Since then, we have expanded that activity, and Welltok, which provides our platform, has expanded its digital connections. Today, employees who own just about any device can connect it to our physical activity programs on the CafeWell platform.”

Sassano has steered the state beyond pedometers to include CafeWell Concierge, an IBM Watson-powered app that offers up personalized recommendations to help employees achieve optimal health and get the most out of their state health plan benefits. “I believe that having one hub, as we do with CafeWell — where employees can go to access all of our wellness programming as well as become educated about their benefits — has greatly enhanced our program and increased participation.”

Sassano isn’t stopping there. He is in the process of expanding the offerings in the CafeWell platform to include other wellness vendors that deal with weight and stress management. He adds that, “This connection between vendors will allow our employees to participate in activities seamlessly and help them easily earn incentives for their participation.”

Turnkey Benefits

Smaller companies tend to look for similar wellness program benefits, albeit in a more turnkey fashion. Sanford, FL-based beverage distribution company Wayne Densch, for example, is somewhat new to the world of wellness programs, but is already aware of the role health technology can play in making them a success.

The company, which launched its wellness program in 2015 with biometric screenings, began using activity trackers when it adopted UnitedHealthcare’s Motion program in January 2016. The program enables employees and their covered spouses to earn up to $1,500 per year in deductible credits by meeting daily walking goals related to frequency, intensity, and tenacity. Deposits are made on a quarterly basis and help employees and their dependents offset covered medical expenses.

“As a relatively small company, it was important to find a wellness program that was largely turnkey and easy to implement, while still effective in driving engagement,” says Thomas Williams, director of accounting. “We use the program’s proprietary Trio device, which was developed to track the program’s specific walking goals. Employees are able to keep tabs on their progress using the program’s mobile app or website. By using technology that is intuitive and engaging, our employees have become more invested in maintaining and improving their well-being.”

Fine-Tuning for Better Engagement

UnitedHealthcare initially rolled out its Motion program early last year as a pilot across 12 states and has since expanded it to 40 states. That initial trial helped the company realize what employees liked and disliked about the program. “Interest in the program has been very broad, with companies across all industries and sizes adopting it,” says Craig Hankins, VP of digital products. “After introducing the program as a pilot, we identified several lessons that we applied to the broader expansion. First, to help people get going with the program, we added a registration credit. By providing a $40 credit for signing up, we created an incentive to get people started, which helped drive higher adoption rates. Second, we recognized people are interested in accessing additional devices. That’s why we worked with Qualcomm Life to introduce a BYOD model, which enables the addition of activity trackers from some of the nation’s leading technology companies.”

“Ultimately,” he adds, “the motivation for implementing Motion was simple: Help create happier and healthier employees. We know wearable devices represent a new way to encourage employees to become more active, helping people walk their way to improved health and earn financial incentives in the process.”

Understanding Employer ROI

Healthier, happier employees are surely good for a company’s bottom line, but how do employers translate happiness into lower overall costs and greater productivity? Where does the pilot phase end and true ROI begin?

Sassano seems optimistic about the State of Colorado’s expected return. “Participation in our first year was 50 percent, which I think speaks to the excitement of our employees and their interest in the program,” he says. “Of the 32,000 benefit-eligible employees we have today, we have around 52 percent participation today. While it is still early to effectively measure effects on health outcomes and productivity, we are starting to see evidence that participating employees have a lower cost in our health plans.”

Williams sings a similar tune, noting that Wayne Densch’s initial results have been positive for both employees and employer. “With participation rates exceeding 90 percent, the response from employees has been overwhelmingly positive. We are seeing walking and wellness become a bigger priority among our employees, with daily walking groups helping to keep people motivated. We have seen employees shed pounds and improve their fitness levels.”

Gaining in Importance

Employers of all sizes look to corporate wellness programs to help them trim costs and attract and retain talent. As the healthcare industry remains on high alert for impending changes to the Affordable Care Act (which may result in higher out-of-pocket costs for all), wellness programs and the technologies they use will have a greater role to play in keeping costly, preventable conditions at bay.

Morning Headlines 2/6/17

Advisory Board Said to Interview Banks About Possible Sale

The Advisory Board Company is considering strategic options, including a sale of the company, after disclosing that an activist investor has secured an 8.3 percent stake in the company.

Athenahealth (ATHN) Q4 2016 Results – Earnings Call Transcript

During its earnings call, Athenahealth CFO Karl Stubelis addressed the Q4 revenue miss that led to a 14 percent drop in share prices on Friday, and reported that the company closed 52 deals with hospitals and health systems in 2016.

What’s a serial entrepreneur to do when the world is topsy-turvy?

Crain’s Chicago Business profiles Glen Tullman.

ESPN’s Jason Pierre-Paul Statement

ESPN settles a lawsuit brought by New York Giants defensive end Jason Pierre-Paul after ESPN published images from his medical record confirming that he lost his finger after a fireworks accident.

Monday Morning Update 2/6/17

Top News

Bloomberg reports that The Advisory Board Company is considering strategic options – potentially including a sale of the company — following last month’s acquisition of 8.3 percent of its shares by an activist investor.

ABCO shares have climbed nearly 50 percent since mid-December 2016, although their one-year performance of 9.6 percent and five-year increase of 29 percent trails the Nasdaq’s 30 percent and 95 percent, respectively. Above is the one-year chart of ABCO (green) vs. the Nasdaq (blue). The company’s valuation is nearly $2 billion.

The Advisory Board announced a six percent workforce reduction last month along with its exit of some business lines and the closing of four offices. The company says it will honor its commitment to add 1,000 jobs as required by a $60 million, 10-year tax break offered by Washington, DC to consolidate its offices at a new location in Mount Vernon Square.

Reader Comments

From Flash in the Pan: “Re: Verscend Technologies, formerly Verisk Health. Restructuring since the Veritas acquisition resulted in 185 layoffs and the elimination of solutions this week.” CEO Emad RIzk, MD provided this response: “Verscend Technologies reorganized this week, resulting in a small workforce reduction. Verscend is a high-performing organization positioned for growth and will continue to invest in its people, technology, solutions, and customers. We reorganized to improve efficiency, reduce redundancies, and position us for significant growth. We are not eliminating any products, and no Verscend offices are closing as a result.”

From Ruby Claret: “Re: APIs. This article says APIs are like the industrial age, when adoption of interchangeable parts changed everything.” I’m not sure that’s an apt analogy. Interchangeable parts were devised to allow a specific company to move from the work of individual craftsmen to mass producing products on an assembly line at a lower cost. Those early companies weren’t standardizing parts to be used by their competitors. Interchangeable parts are more like proprietary code libraries used by vendors across multiple products. As an alternative theory of how interoperability might be supported and incented, I offer a 20-year-old article about Visa founder Dee Hock:

Hock designed the organization according to his philosophy: highly decentralized and highly collaborative. Authority, initiative, decision making, wealth — everything possible is pushed out to the periphery of the organization, to the members … On the one hand, the member financial institutions are fierce competitors … On the other hand, the members also have to cooperate with each other: for the system to work, participating merchants must be able to take any Visa card issued by any bank, anywhere. That means that the banks abide by certain standards on issues such as card layout. Even more important, they participate in a common clearinghouse operation, the system that reconciles all the accounts and makes sure merchants get paid for each purchase, the transactions are cleared between banks, and customers get billed … No one way of doing business, dictated from headquarters, could possibly have worked. "It was beyond the power of reason to design an organization to deal with such complexity," says Hock.

From Banshee: “Re: VitalWare. Site hacked?” Apparently. Most horrifying is that hacker MuhmadEmad, who apparently hit a bunch of sites over the weekend as evidenced by Googling the text above, changed the font to Comic Sans. The good news is that his hack seems to consist of just posting an anti-ISIS messages as a WordPress post while leaving the site otherwise intact, which should make recovery uneventful.

HIStalkapalooza Sponsor Profile

Since its founding in 2010, Nordic has evolved from its roots as a leader in EHR staffing to not only the world’s largest Epic consulting firm, but a firm with a broad set of KLAS-proven healthcare IT solutions. Featuring nearly 700 consultants, Nordic has organized those experts to solve healthcare organizations’ most challenging health IT problems with carefully crafted solutions. These solutions were developed and refined over the last few years to meet the evolving needs of Nordic’s client partners, including the shift to value-based care, mergers and acquisitions, Community Connect, upgrades, optimization, revenue cycle transformation, analytics, a suite of managed service offerings (including tier 2 application support), and more. At HIMSS17, visit Nordic at booth 903 and RSVP for Nordic’s reception. To learn more, visit nordicwi.com.

Meet Your HIStalkapalooza Hosts

Allow your hosts to introduce themselves:

Bonny Roberts slid down the rabbit hole in 2013 when her “Ode to Mr. H” earned her the preeminent title (and sash) as Mr. H’s Secret Crush. Since then she has contributed a bit to the publication and much to the fervor that is HIStalkapalooza. In preparation for role as greeter on the red carpet, Bonny admits to using her Frontier Airline miles to purchase People, Us, and Star magazine subscriptions. She has also studied Melissa Rivers technique and is diligently practicing the complete opposite. Bonny has worked in the healthcare information technology industry for the past 19 years and is the VP of customer experience for Aventura Software in Denver, CO.

First things first – Barry Wightman published his first novel, Pepperland, a revolutionary, technology, rock ‘n’ roll love story in 2013. The book received a starred review on Booklist, won a Silver IPPY for best fiction from the Independent Publishers Book Awards. His day job – he’s creative director for Forward Health Group, Inc., a maker of population health measurement platforms and data strategies that drive success in the move to value. Rest of the time – he can still be found with a guitar in hand figuring out the riffs to old Kinks records.

Ever since she was a little girl, Julie Yoo‘s lifelong dream has been to emcee the HISsies at HIStalkapalooza. In between grueling rehearsals, Julie oversees the product and business development teams at Kyruus. After February 20, with lifelong aspirations fulfilled, she will shift her focus back to improving patient access one patient-provider match at a time.

HIStalk Announcements and Requests

Poll respondents say they’re going to the HIMSS conference primarily to socialize and spend time in the exhibit hall, which should shock only that handful of people who thought the educational track was the big draw. Mobile Man provides the unsolicited but satisfying response: “One word … HIStalkapalooza!”

New poll to your right or here, as suggested by a reader: if you aren’t going to the HIMSS conference, why not? I’m sure I omitted some good reasons in my list of presumptive choices, so I’ve added a space for providing your own answer.

Ms. F from Arizona reports on the Chromebooks we provided in funding her DonorsChoose teacher grant request, saying that most of her students wouldn’t have access to technology otherwise. She is assigning them work on school-approved math programs that can be completed without leaving the classroom. 

Thanks to the following companies for their recent support of HIStalk. Click a logo for more information.

Last Week’s Most Interesting News

• Children’s Health (TX) is fined $3.2 million for repeated non-compliance with HIPAA security standards, including loss of two unencrypted devices.
• Meditech’s FY2016 financial report shows significant declines in product and overall revenue, as net income has dropped 41 percent since FY2014.
• OxyContin manufacturer Purdue Pharma gives the State of Virginia a $3.1 million grant to integrate its prescription drug monitoring database with provider EHRs.
• The source of President Trump’s claim that illegally cast votes cost him a popular vote win is discovered to be Gregg Phillips, chairman of Medicaid eligibility decision support tool vendor AutoGov.
• Global Health Exchange and Vyne are reported to be exploring selling the companies.
• A JAMA article finds that providers continue to overcharge patients for copies of their medical records despite specific HHS OCR guidance that addresses allowable costs that can be passed on.

Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

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

Acquisitions, Funding, Business, and Stock

From the Athenahealth earnings call following a revenue miss that sent shares down 14 percent Friday:

• Collection volumes were down in Q4 and clients pushed some professional services work back.
• The company expects to gain business as provider focus shifts away from government-mandated functionality.
• The company’s Q4 Net Promoter Score of 23.9 fell far short of its target of 44.
• The company closed 52 AthenaOne for Hospitals and Health Systems deals in 2016, says it is building momentum with under-50 bed hospitals, and will double its hospital base in 2017 as customers look for “one throat to choke.”
• Jonathan Bush says whatever form repeal-and-replace takes will help the company sell to under-50 bed hospitals that are short on capital.
• Bush said of the revenue miss compared to previous guidance, “We were very surprised and upset with the revenue guidance thing,” as CFO Karl Stubelis added, “We should have had a better handle on this.”
• Bush said the company “did very badly” in the group segment because Athenahealth’s fees sometimes exceed user cost savings.
• The company reported increased integration with Epic and expects that to increase sales to health systems using Epic, Cerner, and Meditech, noting that population health management requires a “fabric that crosses across systems” since most of the doctors involved will never use Epic.
• Bush says that under HITECH, the company only had to be better than other vendors, while today they have to be “better than doing nothing” since providers won’t buy new systems unless they increase cash. He says the company will be issuing a net patient market share guarantee.

Canada-based long-term care software vendor PointClickCare Technologies raises an $85 million round of funding.

People

Talent management solution vendor HealthcareSource hires Bob Zurek (Scribe Software) as SVP/CTO.

Doctor waiting room advertising company Outcome Health, recently renamed from ContextMedia, hires former US CIO Vivek Kundra (Salesforce) as EVP/chief growth officer.

Privacy and Security

ESPN settles the lawsuit brought against it by pro football player Jason Pierre-Paul, who objected to the network’s tweeting out photos of his medical records indicating that he had blown off a finger while playing with fireworks on July 4, 2015. ESPN maintains that running an illicitly obtained photo of an on-screen surgery schedule describing Pierre-Paul’s amputation – for which two Jackson Memorial Hospital employees were later fired — was “both newsworthy and journalistically appropriate,” calling into question its understanding of both principles.

Other

A Los Angeles TV station uncovers the lucrative side business run by a medical marijuana doctor who, for $150 and a quick Skype chat, will sign a letter proclaiming that his customer needs an “emotional support animal.” Airlines are then required to accept the precious pooch (or in some cases, pigs and monkeys) as a main cabin passenger for free. I Googled “emotional support animal” and came up with many examples of people buying such certification to do what they want instead of what is allowed or reasonable.

A fired surgical resident is caught participating in medical rounds, attending lectures, and observing surgeries in several Boston hospitals by “tailgating” — entering restricted areas without an ID badge by tagging along with people who helpfully hold the door open for someone who seems to be a co-worker. Hospitals worry that such inherent politeness renders their electronic card systems and security cameras less useful, but are reluctant to install subway-style turnstiles, station guards outside ORs, or implement biometric ID. IT people know that anyone can enter card-protected spaces by simply wearing UPS-like brown shorts and a shirt and walking up to a secure door while holding large packages.

Crain’s Chicago Business runs a lengthy (and a obviously homer-written) profile of Glen Tullman (Allscripts, Livongo), including his political thoughts, investments, and investment style. Apparently he sleeps just four hours per night and bolts down meals to move on to something more interesting than eating with his family.

An interesting article explains why the level of fear people have about something (like being killed by a terrorist) is often in disproportion to the likelihood of that happening. It blames the “bleeds it leads” media, click-seeking news reports, and violent movies and TV shows as part of the Mean World Theory, which has led Americans to misperceive that crime rates are high when they aren’t and to ignore known significant but unsexy threats like gun violence and climate change (and as CIO Sean Gilliland notes in his retweet, they are more scared of terrorists than their much more likely but partially preventable executioners, cancer and heart disease). 

The president of Pakistan’s medical association says that 10 percent of the country’s medical schools are “fleecing the public,” offering low-quality education strictly for profit by owners whose other holdings include sugar mills and textile plants.

Sponsor Updates

• Fortified Health Security is approved as a HITRUST CSF Assessor.

Contacts

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

Morning Headlines 2/3/17

Lack of timely action risks security and costs money

HHS announces a $3.2 million penalty against Children’s Medical Center of Dallas (TX) following two separate PHI breaches, one stemming from a stolen laptop and another stemming from a lost blackberry, both were unencrypted.

Jupiter Medical Center Implements Revolutionary Watson for Oncology to Help Oncologists Make Data-Driven Cancer Treatment Decisions

Jupiter Medical Center (FL) becomes the first community hospital to implement IBM Watson’s oncology clinical decision support software.

Meditech: Form 10-K

Meditech reports Q4 and FY16 results: revenue dropped 2.8 percent to $462 million. Net income climbed four percent to $73 million, EPS $0.62 vs. $0.52.

Athenahealth, Inc. Profit Advances 40% In Q4

Athenahealth reports Q4 results: revenue up 12 percent to $288 million, adjusted EPS $0.62 vs. $0.45, a 40 percent year-over-year earnings growth.

News 2/3/17

Top News

Children’s Medical Center of Dallas (TX) will pay $3.2 million to settle HIPAA charges related to the loss of an unencrypted BlackBerry in 2010 and theft of an unencrypted laptop in 2013.

The organization failed to encrypt all PHI-containing devices as recommended by two consulting firms that had performed security gap and vulnerability analyses. It had also allowed its biomedical department to inventory its own IT equipment, causing the IT department to miss those devices in enforcing its security policies.

HHS OCR says Children’s practiced “non-compliance over many years with multiple standards of the HIPAA Security Rule.”

Pam Arora, SVP/CIO of Children’s Health since January 2007, was named last month by CHIME and HIMSS as their John E. Gall CIO of the Year.

Reader Comments

From Deranged Bunny: “Re: mistakes in the HIMSS-owned publication. Here’s one from the first sentence in their lead story today.” Re-wording a press release into a “story” should have been easy for their writer since all the words were right there. For the record, “Purdue” pushes OxyContin, while “Perdue” sells chicken.

HIStalkapalooza Sponsor Profile

InstaMed, healthcare’s most trusted payments network, delivers secure and fully integrated patient payment solutions to the largest health systems, children’s hospitals, and provider organizations across the US, processing billions of dollars in healthcare payments per month. Connect with InstaMed during HIMSS17 at booth 609 to chat about the healthcare payments experience your patients are demanding, the need for integration of patient payments into EHR/PMS, and the increasing pressure on security and compliance, including PCI scope. Plus, we are hosting an evening of conversation, food, and drinks on February 19 after the HIMSS17 opening reception. Learn more.

HIStalk Announcements and Requests

I still have seats available for our CMIO lunch at the HIMSS conference, Tuesday, February 21 at noon, conveniently located just off the exhibit hall and paid for by me. CMIOs can sign up here. Our 20 or so CMIO attendees will enjoy a great buffet lunch and casual peer-to-peer conversations – the only non-CMIO attendee will be Lorre, who is hosting. Everybody has to eat even with all the conference hustle and bustle, so a relaxing lunch with peers is a nice way to escape the neon jungle.

We funded the DonorsChoose grant request of Mrs. W from Arizona, whose elementary school class is using the document camera we provided for reading and phonics skills along with their sections in science, math, and social studies.

This week on HIStalk Practice: Family Choice Urgent Care implements Practice Velocity software. ATA asks for comments on pediatric, mental health, stroke guidelines. MediSys adds Alpha II PQRS capabilities. PatientClick launches telepsychiatry service. DrFirst acquires VisibilityRx. Das Health develops online mental health assessment tools. Greenwood Genetic Center’s Michael Lyons, MD discusses GGC’s decision to add telemedicine capabilities.

Welcome to new HIStalk Platinum Sponsor Siemens Healthineers. The company’s product lines include medical imaging, laboratory diagnostics, and point-of-care testing. Imaging and IT offerings include PACS, RIS, image sharing, clinical data management, software for multi-modality reading, cardiovascular care software, and enterprise imaging, workflow, visualization, and archiving. Diagnostic products include data and workflow management systems, diagnostics system remote monitoring, and laboratory inventory management. Nine out of 10 US hospitals depend on the company’s solutions, including every hospital listed on the US News & World Report Honor Roll. Siemens Healthineers and IBM Watson Health are working together to develop and deploy new population health management products and services to help providers transition to value-based care with analytics and patient engagement. It will offer IBM Watson Care Manager, a cognitive solution that supports nurses and other care managers as they monitor and counsel people with chronic conditions. See them in HIMSS Booth # 2323. Thanks to Siemens Healthineers for supporting HIStalk.

Here’s a Siemens Healthineers intro video I found on YouTube. It’s from May 2016, when the company announced its name change from Siemens Healthcare.

Listening: new from Horisont, fantastic 1970s-sound prog rock that’s actually from a fairly new band from Sweden (think Kansas meets Deep Purple in Uriah Heep’s basement). Speaking of which, RIP John Wetton, whose long career as a prog-band bassist, singer, and songwriter included stints with King Crimson, UK, Uriah Heep, and most notably Asia. Asia’s tour starts on March 15, but Wetton had already bowed out due to his chemotherapy treatments, replaced by Yes’s Billy Sherwood, who previously replaced another deceased legendary prog bassist, Chris Squire of Yes.

Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

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

Acquisitions, Funding, Business, and Stock

Meditech announces Q4 results: revenue down nine percent, EPS $0.62 vs. $0.52. For the year, revenue was down 2.8 percent as product revenue slipped 15 percent, having declined by 38 percent since 2014. The privately held company’s net income was $73 million in 2016, up 4 percent from last year but down 41 percent vs. 2014’s total.

DrFirst acquires VisibilityRx, which identifies and recruits patients for clinical trials.

Athenahealth reports Q4 results: revenue up 12 percent, adjusted EPS $0.62 vs. $0.45, beating earnings expectations but falling short on revenue.

Sales

George Washington University (DC) chooses Castlight Health’s employee health benefits management platform.

Announcements and Implementations

Catholic Health Services (NY) rolls out Uniphy Health’s mobile collaboration app to its providers.

Jupiter Medical Center (FL) will go live in March 2017 on IBM Watson for Oncology, the first community hospital to do so following the system’s “training” at Memorial Sloan Kettering Cancer Center. It presents individualized, evidence-based treatment options to oncologists in drawing information from 15 million pages of text from medical journals and textbooks.

UCHealth (CO) announces technology-related developments that include virtual visits, online scheduling, a new app, and adoption of the OpenNotes standard.

Government and Politics

A Florida urologist will pay $3.8 million to settle False Claims Act charges that he ordered medically unnecessary lab tests. Meir Daller, MD ordered 13,000 FISH bladder cancer tests of questionable medical value on Medicare patients who were steered to a lab owned by his employer, who then paid the doctor $2 million in bonuses. The assistant US attorney says the doctor would look at paper-based urinalysis results but then throw them away so he could enter whatever he wanted into the EHR, often falsely recording that blood was found in the patient’s urine to justify ordering the test. The practice’s owner, 21st Century Oncology, previously paid $20 million for its role in over-ordering the $1,000 tests for Medicare patients. The company, which operates 180 cancer treatment centers, also reported an October 2015 breach of its systems that exposed the information of 2.2 million patients.

USA Today reports that shares of McKesson were among the healthcare-related investments made by HHS Secretary nominee Rep. Tom Price (R-GA) since 2012 that appear to be improper. Price bought MCK shares in March 2016, McKesson warned investors in early May that Medicare’s reduction in medical equipment payments could hurt its bottom line, and Price introduced legislation to cancel the cuts on May 12.

Privacy and Security

In England, an analysis of the four-day October downtime of three-hospital Northern Lincolnshire and Goole NHS Foundation Trust finds that it was caused by a misconfigured firewall that allowed ransomware to penetrate its systems.

President Trump’s long-time doctor Harold Bornstein, MD lists the president’s medical conditions and prescriptions in a New York Times interview, raising the question of whether he violated HIPAA in doing so.

Other

HRH Princess Haya of Jordan, the junior wife of UAE’s prime minister (she’s the second of his five wives), addresses the Arab Health Exhibition and Congress in Dubai:

I have already alluded to the difficulty faced in embracing new technology in healthcare. To ensure successful adoption, we need to equip the physician, the patient, and the system with the right tools and knowledge. We also need to improve medical training to ensure future generations of doctors are proficient in the use of technology, social media, and digital platforms. This is my point. This is where the balance lies. We have seen all kinds of machines and technologies that have created the architecture, but in the end, it was for the benefit of the people, to give them a home for the future. This same balance needs to be struck between innovation and medicine.

An interesting article lists the biometric measurements that will soon allow police to identity suspects in ways that go far beyond fingerprints. They include signature recognition, typing pattern recognition, recognizing patterns used in reading predefined passages aloud, eye movement tracking, gait analysis, and identifying people by their body odor. Facial recognition systems are already in place, with the FBI having stored the images of half of Americans in its databases. The article notes that President Trump’s executive order on immigration calls for expediting the use of biometric screening at the US border.

Sponsor Updates

• Kyruus will present at the Harvard Healthcare Business Conference February 4 in Boston.
• ZeOmega’s Jiva 6.1 earns ONC Health IT 2014 Edition Modular EHR certification.
• Learn on Demand Systems releases details about its invite-only Launch event in March for customers and partners.
• LiveProcess releases a new case study, “Communication During a Cyberattack.”
• MedData will exhibit at the HFMA NENY Women in Leadership Conference February 9 in Clifton Park, NY.
• Medecision releases a new video, “Aerial Powering Population Health Success.”
• Meditech will exhibit at the AHA’s Rural Healthcare Leadership Conference February 5-8 in Phoenix.
• Navicure will exhibit at the 2017 Healthpac Annual Users Meeting February 10-12 in Savannah.
• Nordic will sponsor the inaugural Epic North Carolina Users Group Meeting February 8-9 in Greensboro.

Blog Posts

• Strata Ranked #1 in KLAS for Business Decision Support for Third Consecutive Year (Strata Decision Technology)
• Sentri7 from Wolters Kluwer Earns Category Leader Designation for Clinical Decision Support-Surveillance in the 2017 Best in KLAS Report (Wolters Kluwer)
• It’s Time to Grade Data Breach Responses (ID Experts)
• DNS – The Essential Hidden Server (Impact Advisors)
• The Case for Email Personalization (Influence Health)
• Why Not All Hospitals Would Suffer Under a Full ACA Repeal (Definitive Healthcare)
• Agfa HealthCare’s XERO Viewer Captures 2017 KLAS Category Leader Award (Agfa Healthcare)
• 5 Things to Do Now for a Successful 2017 (InstaMed)
• AI technology spreads its wings in healthcare sector (Intelligent Medical Objects)
• Useful, Usable, Desirable: The Importance of UX in Healthcare (Spok)
• “Best in KLAS” Report Names Iatric Systems No. 1 for Patient Privacy Monitoring for Third Consecutive Year (Iatric Systems)
• Meditech Wraps Up 2016 with Strong Q4 Sales (Meditech)
• Three Elements Your Find-a-Doc Needs to Drive Patient Conversion (Kyruus)
• When 1+1+1+1 Does Not Equal 4: How Revenue Cycle Management Components Work Together to Yield True Performance Improvement (Navicure)
• Integrating Care: Moving Beyond Interoperability to True Collaboration, Part IV (Netsmart)
• Precision Medicine (Part 1) Exploring the Role We Need to Play (Orion Health)
• When Will Interoperability Be a “Given” in Health IT? (PatientKeeper)
• It Takes Two to Tango! (Optimum Healthcare IT)
• Why Beanbag Chairs Don’t Make You a Cool Place to Work (PokitDok)
• Why Accurate Provider Data is Critical to Cost Control and Revenue Cycle Improvements (Phynd Technologies)
• 4 Things to Check out at HIMSS17 (Protenus)
• The Importance of a Strong Compendium (Summit Healthcare)
• Can Manual Prior Authorizations Damage Patient/Provider Relationships? One Doc’s Word of Caution (Surescripts)

Contacts

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EPtalk by Dr. Jayne 2/2/17

It’s increasingly difficult to keep up with the literature when there is so much coming out and the pace of change is so rapid. This article in PLOS One regarding influenza vaccination for healthcare workers caught my eye. It looked at vaccination statistics in long-term care facilities and whether the “number needed to vaccinate” in order to prevent patient death was in alignment with what had been predicted based on previous data. Rather than the previously predicted number of eight vaccinations needed to prevent a single patient death, the number was calculated at somewhere between 6,000 and 32,000. Authors concluded that the four studies supporting enforced vaccination for healthcare workers “attribute implausibly large reductions in patient risk to healthcare worker vaccination, casting serious doubts on their validity.”

This is a great lesson in small data vs. big data and the need to keep questioning and keep researching as the healthcare knowledge base continues to expand. Through the magic of eBay, I once purchased a set of medical student notebooks from the 1920s. They’re half-legal sized bound notebooks that flip at the top, and it’s amazing to see what is written and what we knew then. My favorite page starts with the statement, “There is so much we still do not know about the thyroid.” I wonder what that medical student would think of our current knowledge base? Those notebooks also make me wonder what physicians will think of us 80 years in the future, especially given the current wrangling over whether we as a nation are committed to ensuring medical care for all.

I recently posed the question to my readers about what would their ideal jobs would look like.

From Sunshine State: “An optimal role would be leading several business units from a COO or similar position, with a focus on solving problems in our industry in a fast-paced and dynamic environment. A level of risk is attractive — as John Paul Jones stated, he who will not risk cannot win. How do we shrink an industry and not put people out of work while advancing care? With a generalist background, a greater contribution is possible with coordinating resources and goals across groups rather than leading a specific business unit or department requiring specialized skills.” I agree that the idea of having more than one business unit at your disposal might make it easier to solve problems creatively without the distraction or bottlenecks that occurs with more siloed organizations. There’s a temptation for leaders to protect their own rather than stepping out of their comfort zones in an effort to solve the bigger problem. Certainly figuring out how to reduce cost, increase quality, and maintain jobs is a challenge, even more so when you have limited financial or personnel resources.

From At Bat: “Funny you should ask about the perfect job because I happened into it several years ago. I worked at a large hospital for 30+ years in direct patient care, managed care, the physician organization, the health plan, patient safety, and at the last part of my career in evidence-based medicine. I’m not technical, but was involved system-wide in various projects. I was contacted by the executive for our data warehouse asking if I would speak at a conference on a particular topic. I replied, ‘No problem, any opportunities?’ and after a whirlwind of phone interviews and a quick meet-up at HIMSS, I was offered my dream job helping health systems with analytics initiatives. I have to honestly say that if you gave me a pencil and paper and said to write down the perfect job, this would have been the result. I work from home when I am not traveling, and while I do get a tad lonely, it is the most rewarding job I have ever held. I am slowly getting used to working in the for-profit vs. non-profit world.” The ability to wear fuzzy bunny slippers to work cannot be underestimated. It can be a drag, though, when you realize you’ve been wearing pajamas all day and have been so busy working that you’re not even sure you brushed your teeth today. I’m always happy to hear when people find something that really clicks and hope that it lasts for them.

From What The?: “I wrote you a couple years ago about the perfect job and thought you might appreciate an update. I had decided after being a healthcare IT consultant that I knew without a doubt that I wanted to be a doctor. I have a liberal arts degree and zero science background, but seeing how people like you approach healthcare convinced me that this was something I needed to do. I was accepted to my medical school of choice last fall and am doing contract HIT consulting work to save up money until I start classes. I just got an email about my white coat ceremony in July and could not be more excited about the opportunities ahead.” This put a big smile on my face. Although sometimes those of us in the profession knock it due to the hours, the stress, the external pressures, and more, being a physician is still one of the greatest privileges any of us can have. For patients to trust us in their times of vulnerability and weakness is truly something special. Even though there are tens of thousands of “healthcare IT people” who never go anywhere near a patient, we need to continue to remember why we are doing this. It’s about our grandmothers, brothers, sisters, and everyone else who relies on the systems we use to make decisions and deliver care.

Email Dr. Jayne.

Morning Headlines 2/2/17

Republican senators say fixing individual market should be first step in ACA repeal

Senate HELP committee chairman Lamar Alexander (R-TN) suggests that stabilizing the individual marketplaces should come before efforts to reform Medicaid or roll back expansion.

Rep. Tom Price Got Privileged, Discounted Offer on Biomedical Stock, Company Says

The Wall Street Journal reports that Tom Price, President Trump’s nominee to run HHS, was offered a privileged opportunity to buy stock in a biomedical company at a special discount, despite confirmation hearing testimony to the contrary.

This polymer pill could soon drip feed drugs into your body for weeks

Biomedical engineer and MIT professor Robert Langer, recognized as the most-cited engineer in history, invents a long-acting pill that would release a steady dose of a drug for weeks.

Readers Write: The Patient Experience Is Clinical

The Patient Experience Is Clinical
By Mark Crockett, MD

As quickly as healthcare began to focus on patient experience, the law of unintended consequences kicked in. While well received as a tool to help improve care, this situation unintentionally gave rise to a consumer culture around patient treatment. Today’s value-based care arrangements call for providers to take a fresh look at patient experience.

While patients certainly deserve to be treated with dignity and listened to carefully, the top patient experience expectation is receiving safe, quality care. “Patient experience [is] not about making patients happy over quality,” says James Merlino, MD of the Association for Patient Experience. “It’s about safe care first, high-quality care, and then satisfaction.”

The best way to deliver on this expectation is for providers to view these issues of safety, risk, and compliance as a cohesive whole, thus enabling patients to receive the safe, quality care they expect, in the caring and supportive environment they deserve.

The Beryl Group defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influences patient perceptions across the continuum of care.”

That’s a big job. Most providers lack the tools to make that happen. Where to start?

It begins with developing provider/patient and provider/organization relationships that encourage collaboration.

In 2013, a British Medical Journal review of 55 studies found that patient experience is “positively associated with clinical effectiveness and patient safety, and supports the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.”

What the BMJ study revealed, and my own anecdotal evidence bears out, is that if a patient experience is positive, the patient feels empowered and can enter into a therapeutic “alliance” with the provider. Patients are motivated to follow treatment plans and are less likely to withhold information if they don’t feel intimidated—or worse, ignored—by their provider and the hospital where treatment was rendered. This supports swifter diagnoses and improved clinical decision-making and leads to fewer unnecessary referrals or diagnostic tests.

Many hospital CFOs don’t need the BMJ study to know a positive patient experience is a clinical indicator that ties to financial outcomes. As outlined in the chart (Figure 1), patient experience is directly associated with a hospital’s Star Rating and patient outcomes:

Creating a positive patient experience, and better clinical outcomes, begins with an understanding of what patients expect from providers. The primary expectation of any patient is, first and foremost, safety. To the unfamiliar, hospitals are scary places. Patients no doubt have read or heard stories (or watched doctor shows on TV) of medical errors and medication mix-ups or of being treated by an unqualified caregiver. Hospitals and other healthcare settings must communicate clearly that theirs is a safe place where patients can trust their caregivers.

If patients believe they are in a safe, trusted environment, their next expectation is, of course, to get better. To be healed. This requires consistent excellence across a wide variety of performance areas. Finally, patients expect to be treated with courtesy and respect.

How do we establish patient experience as one of the pillars of quality healthcare? Not surprisingly, it’s a judicious combination of technology, effective communication, and employee engagement and physician alignment.

Most patients assume all clinicians are highly qualified and fully credentialed. A robust credentialing platform helps providers deliver on that assumption. Other examples of technology impacting patient experience is the ease of electronically submitting information to a Patient Safety Organization. Participating in a PSO not only enables federal protection under the Patient Safety and Quality Improvement Act (PSQIA) but enables the organization to share and learn from peers as it relates to patient safety initiatives that most certainly impact patient experience.

Effective communication improves not just patient satisfaction, but also physician satisfaction. It boosts patient adherence and compliance and reduces medical errors and malpractice claims. The benefits of a culture that encourages open, honest, and direct communication among patients, providers, and staff go directly to the heart of patient experience.

There is a tremendous benefit to incorporating digital rounding (levering mobile technology to gather information in real-time during the rounding process) into a health system’s employee engagement strategy to generate information from patient rounding, safety rounding, and leader rounding. There is much to be learned from the voices of providers, patients, and employees.

For example, although nurses and physicians generate an equal number of complaints, nurses are three times more likely to have positive reports as compared to MDs. However, physician complaints have higher severity and fewer resolutions.

Patient feedback gathered through a rounding process identifies critical focus areas including peer review events, compliance events (particularly in infection control), and patient and employee safety issues.

For one healthcare system, more than 50 percent of all peer review cases at its 30 facilities actually began in patient relations. In addition, validation audits from compliance organizations (specifically CMS) often stem from a patient complaint. Another reason to centralize data gathered from the feedback of patients, providers, and employees is to identify patterns that allow organizations to transform risk management from a reactive process to a proactive component of healthcare delivery.

Patient experience is clinical. It matters to value-based care and has direct impact on an institution’s long-term financial survival. Organizations that sideline patient experience, or simply meet the minimum standards required, do so at their peril.

Mark Crockett, MD is CEO of  Verge Health of Charleston, SC.

Readers Write: No Easy Answers For Scheduling Physician On-Call Coverage

No Easy Answers For Scheduling Physician On-Call Coverage
By Suvas Vajracharya, PhD

Recent criticism of on-call scheduling practices in the retail sector means that it may be time for healthcare operations leaders to review on-call scheduling practices for their physician teams.

In recent weeks, the retail sector has experienced close scrutiny for on-call arrangements with their staff. According to Reuters, New York Attorney General Eric Schneiderman and “his counterparts in seven states, including California and Illinois, have sent letters to a number of companies in the last year requesting information about their scheduling practices.” In response, employers like Aeropostale and Walt Disney have begun discontinuing the practice of keeping hourly workers on call for last-minute shift changes to avoid further legal disputes.

In healthcare, on-call coverage is regulated under the Emergency Medical Treatment and Active Labor Act (EMTALA). Most medical institutions choose to pay on-call physicians to ensure appropriate coverage under these rules. According to a 2012 SullivanCotter report, nearly two-thirds of healthcare organizations provided call pay to at least some physicians, up from 54 percent in 2010. However, the EMTALA regulations are excessively vague and “in a manner that best meets the needs for the hospital’s patients” can be interpreted in ways that leave physicians feeling like they’re receiving an unfair deal.

“In the MGMA’s 2013 Medical Directorship and On-Call Compensation Survey, primary care physicians reported a median on-call rate of $100 to $150 per day,” according to an article in Medical Economics.

From the physician perspective, these rates may not fairly balance the sacrifices they are making to provide on-call coverage during their days off — if they are receiving compensation at all. For retail employees, state officials concluded workers can be harmed by “unpredictable” schedules that can increase stress, strain family life, and make it harder to arrange child care or pursue an education. Fundamentally, to be on call as either a retail employee or a physician requires foregoing activities and flexibility with free time.

With physician burnout on the rise, heavy variation in the frequency of calls and a wide range in the number of physicians participating in call rotation, health leaders should invest proactively in finding fair on-call strategies to ensure the hospital’s access to physicians and to prevent turnover. How do we fairly compensate a physician for remaining in close proximity to the hospital and being physically and mentally capable of providing direct patient care at a moment’s notice? How do we weigh the difficulty of taking calls on holidays or weekends or being on primary call versus backup call?

Providing adequate on-call coverage remains a constant challenge for most healthcare institutions. Making it a program that is seen as fair and respectful of physician staff can be a crucial first step. Using scheduling technology instead of a manual process not only removes the sense that personal bias may be influencing how on-call hours are assigned, but also provides transparency across teams and flexibility for swaps. Scheduling technology with advanced algorithms based on artificial intelligence can also ensure that on-call schedule enforces work patterns in harmony with circadian rhythm of physicians who need to work at any hour.

Healthcare operations leaders should want to follow the lead of companies like Gap, who proactively change their policies to stay ahead of on-call criticism. Small policy changes can dramatically reduce risk for healthcare operations and improve physicians’ professional satisfaction.

Suvas Vajracharya, PhD is founder and CEO of Lightning Bolt Solutions of South San Francisco, CA.

Readers Write: Future Health Solution

Future Health Solution
By Toby Samo, MD

Health information technology (HIT) has made significant advances over the last two decades. While adoption is not necessarily a good marker for successful EHR usage, adoption of office-based physicians with EHR has gone from about 20 percent to over 80 percent and more that 95 percent of all non-federal acute care hospitals possess certified health IT. HIT implementation has led to improvements in quality and patient safety.

However, many of the goals of increased HIT implementation have been stymied by social and technical roadblocks. A “one type fits all” approach may help reduce training and configuration costs, but there are many approaches to patient care and unique workflows between specialties and among individual users.

Most EHRs are burdened with three major legacy issues:

1. Technology. Present EHR systems are mostly built on what would now be considered old technology. Some of the ambulatory products and small acute care products have moved onto cloud-based architecture, but most are client-server. While hosting instances of a product reduces the technical expertise needed by the client and can lead to better standardization of implementation, it does not necessarily deliver the advantages of a native, cloud-based architecture.
2. Encounter-based. EHRs have been built on the concept that interactions with patients (or members or clients) are associated with a specific encounter. This functions well for face-to-face visits and for specific events, but is limiting where longitudinal care is required.
3. User experience. The user experience has for the most part taken a back seat to functionality in HIT software development. A quick view of most HIT systems shows the interface to be cluttered and does not draw the user’s attention to the areas that need the most attention. Most users access only a small percentage of the functionality that is present within the system, but vendors continue to add functionality rather than clean up the interface.

Platforms have revolutionized the way business is conducted in many industries. Numerous examples have made household names out of companies like Airbnb, Uber, Facebook, YouTube, Amazon and many more. A platform is not just a technology, but also “a new business model that uses technology to connect people, organization, and resources in an interactive ecosystem.”

There is a need for a HIT platform that would support the multitude of components necessary to move the delivery of HIT into the next generation. The future health solution needs to use contemporary technology that will have the flexibility to adapt to ever-changing requirements and use cases of modern healthcare. Some of the characteristics of the future health solution are:

• Open. One of the biggest complaints of users and regulators is the closed nature of many HIT systems. The future health solution needs to be built as a platform that is able to share and access not only data, but also workflows and functionality through APIs
• Apps and modules. A modular structure will enable components to be reused in different workflows and encourage innovation and specialization.
• True, cloud-based architecture. Cloud computing delivers high performance, scalability, and accessibility. Upfront costs are reduced or eliminated and minimizes the technical resources needed by the client. Management, administration, and upgrading of solutions can be centralized and standardized.
• Multi-platform. Users expect access to workflows on their smartphones and tablets. Any solution must develop primary workflows for the mobile worker and ensure that the user interface supports these devices
• Scalable (up and down). To meet the needs of small and large organizations, the future health solutin will need to scale to accommodate changes in client volumes.
• Analytics, reporting, and big data. HIT systems have collected massive amount of data. The challenge is not just mining that data, but presenting the information in a way that can be quickly absorbed by the individual user.
• Searchable at the point of use. All the data that is being collected needs to be readily accessible. Using universal search capabilities and the ability to filter and sort on the fly will facilitate the easy access to information at the point of care.
• Privacy and security. The core platform will need to be primarily responsible for the security and privacy of the data. The other modules built on the platform will need to comply to the platform security and privacy practices, but will not need to primarily manage these issues.
• Interoperable. Need to adopt all present and future (FHIR) standards of data sharing. The open nature of the platform will facilitate access to data.
• Internationalization and localization. Internationalization ensures that the system is structured in such a way that supports different languages, keyboards, alphabets, and data entry requirements. Localization uses these technical underpinnings to ensure that the cultural and scientific regional differences are addressed to help with implementation and adoption.
• Workflow engine. Best practices can change and can be affected by national and regional differences. An easy-to-use workflow engine will be a necessity to help make changes to the workflow as needed by the clients.
• Task management. Every user has tasks that need to be identified, prioritized, and addressed. Therefore, a task management tool that extends beyond a single module or workflow will be needed.
• Clinical decision support. Increasingly sophisticated decision support needs to be supported, including CDS, artificial intelligence, and diagnostic decision support. These capabilities need to be embraced by the platform, allowing external decision support engines to interface easily with the other modules.
• Adaptable on the fly by the end user. Allowing the end user with proper security to make changes to templates and workflows would help improve adoption.
• User experience. Probably the most significant barrier to adoption of HIT is the user experience. Other industries are way ahead of healthcare in the adoption of clean, easy-to-use interfaces. It is vital that a team of user experience experts be integrally involved in the development process. All user-facing interactions, screens, and workflows need to be evaluated by user experience experts who can recommend innovative ways the user interacts with the system and how information is displayed.

The HIT industry has hit a wall that is preventing it from developing innovative products that use the newest technology and have an exemplary user experience. A new platform has the potential to support a robust, flexible, and innovative series of products that can adapt to meet the needs of the various healthcare markets globally. Such a project would have to build slowly over time, as does any disruptive technology. The legacy systems and other HIT systems that exist do not have to be excluded, but rather can be integrated into this new platform.

Identifying technology that, at its core, has the privacy, security, data management, and open structure could lead to the next generation of healthcare management systems. While some of these characteristics are obvious to developers and users alike, it is the sum of the parts that is important. Integrating most if not all of these characteristics into a single model is what can lead to enhancing the value of HIT and the delivery of care.

Toby Samo, MD is chief medical officer of Excelicare of Raleigh, NC.