Readers Write: In Defense of Bob Dolin

This comment was provided as a response to discussion about whether former Kaiser physician and HL7 chair Bob Dolin, MD should be allowed to return to industry work after serving a prison sentence for possession of child pornography.

I appreciate Mr. HIStalk’s comment that Bob should be able to work. Not only is should he be allowed to work, he is obligated to return to being a useful, productive member of society. Not just from my perspective, but from the government perspective.

I know more intimately than any of you what the real situation is and was. I am his wife. So much for anonymity.

Many of you know me. I am a strong, independent woman, dependent on no one. Someone who not only hates child pornography and the implications of what that means for these children, but one who also despises “regular” pornography and the industry’s encouragement for participants to descend into child pornography (think “barely legal”). I also recognize that most men have participated in viewing pornography, especially men in unhappy marriages. But I don’t hate them or think they are sick — they are just unhappy.

Why have I stayed with Bob? Why do I encourage him to do the work he loves and to which he has made such great contributions? Let me tell you the reasons.

Bob is not a depraved, sick person. He never inappropriately touched any child. He is as far away from being a misogynist as any man I know. Likely, he has been far more monogamous and faithful than most of you.

While you might surmise that children were harmed because he downloaded a few zip files in one period in his life over 10 years ago, it is highly unlikely. There is no empirical evidence for that. Again, I am not asserting in any way that this was OK.

I have been with Bob nearly 24/7 since shortly after this was discovered. In fact, I believe, our relationship and strong marriage has been a primary healer. Bob simply only has the desire for the intimacy that only a special love such as ours provides.

I am firmly asserting is that he is not sick or depraved. I am stating that back 10 years ago, as his previous marriage was ending, he was in a bad spot. Did he go out and rape anyone or touch any child? Did he even have affairs? No. He withdrew into himself and escaped by viewing “regular” pornography, and unfortunately purposefully downloaded some child porn. The was no money exchanged.

In regards to “infants and toddlers being sadistically abused,” I challenge you to find an ICE arrest announcement (that’s the branch of government that deals with child pornography cases) that does not say, “XXX number of child pornography pictures were found, including infants and toddlers being sadistically abused.” Simply, that is what is in those zip files. How do I know? I was told that by lawyers who specialize in this area. The media (and ICE) love to emphasize this aspect. Whether or not the offender actually spent any time looking at these images is unknown in most cases.

I wish ICE would spend more time on finding and prosecuting the abusers and creators of child porn (usually family members) than on the easy targets of introverted adult males. For that matter, how is it possible that such pictures can even be uploaded? Surely we have the technology to recognize them and prevent it.

After extensive testing, examination, and interviews, Bob was not deemed a danger to society. Exam after exam has revealed him to have made a single mistake in an otherwise exemplary life. Not only that, it was about five years from when the forensics were done on his laptop to when the feds decided to prosecute. We assumed during this time there was nothing worth prosecuting for – they must have had far more pressing cases to deal with.

Bob’s friends, family, and many colleagues are happy to see Bob back contributing his brilliant mind to the industry. They recognize the price he has paid. For those of you who are appalled that he dare be a contributing member of society and HL7, and will quit if Bob continues to go to HL7 meetings after downloading child pornography 10 years ago, spending 2.5 years in federal prison, and losing his career, I encourage you to grow up, act like a mature adult, and think about the logic of that.

To quote a famous Rabbi, “And why beholdest thou the mote that is in thy brother’s eye, but considerest not the beam that is in thine own eye?” Are you perfect? Even if your sins are not as severe as you have judged Bob’s to be, as they may not be, and you have taken it upon yourselves to so severely damn him, I ask, you to examine yourselves, your motives, and your personal issues.

Lastly, think of who you are hurting besides Bob. You are hurting me to the core. You are damaging my ability and desire to participate as a useful member of society. You are making me question nearly everyone at HL7 as to whether they have been two-faced to me these few past years, where I have remained a successfully contributing HL7 member by myself.

I won’t abandon Bob because of this. He is a good man, the best man I know, who made a bad mistake over 10 years ago.

What I Wish I’d Known Before … Taking a Job Selling Software to Hospitals or Practices

I wish I would have known that the company had a policy of customizing the application to whatever they thought the prospect needed. Functionally what we wound up doing was demoing vaporware, and there was no way the clients would ever get that content without customizing. It’s entirely unethical. I was gone within a few months.

As someone who has started two small HIT software companies (both acquired by larger HIT companies) and was responsible for designing, selling, and implementing the systems and overall customer satisfaction, a couple things I would want to know:

What is the main value that customers get from the system?

What percent of the customers get that value? (Software companies love to highlight their reference sites, but what is more important is what benefit do the majority of the customers derive from the software. Reference sites are nice, but even a blind squirrel finds a nut once in a while.

Can you quantify the value?

How does the value stack up against the investment?

How long does it take to get the software installed and how long before the customer starts receiving the value?

How much work is it going to take by the customer to get the software running and keep it up and running and is that amount of work and cost part of the return on investment analysis?

Why would a prospect buy the competitors’ products rather than the product we are selling?

What is the customer retention rate, and don’t include the customers that have to renew because they are in a multi-year agreement. I would want to know what percent of customers renewed the last 2-3 years that had the option to turn off the system.

Do Epic and Cerner have a similar offering?

What is my quota and how have the current sales team done with respect to that quota over the last two years?

What is the retention rate of the sale staff over the last 2-3 years?

How long has the sales leader been in the role?

Can I live in San Diego?

Do I have to wear a tie to client meetings?

Most of the people you talk to or not meaningfully involved in the decision-making process.

The people who are using your software are often not at all involved in the decision process, which injects hostility once purchase and deployment happens.

Don’t sell your software without the client having a strong change management plan in place. The sale is usually worth less money than having your name dragged through the mud later if adoption is poor.

You should aim to sell one client multiple things over the course of a long relationship more than trying to get clients.

Take your estimate of the sales cycle and double it.

Old-fashioned networking and being able to discuss specific use cases that resulted in success are the best methods for selling. Healthcare is not very impressionable by social media, content marketing, email campaigns, or other more modern marketing tactics.

How lonely the job can be.

For five years in my career, I sold an EMR to physician practices. Looking back, I wish I had understood better the degree to which physicians lacked the appreciation of the overall efficiency and throughput of their practices (which they usually owned) versus their role within the practice. Most thought only in terms of themselves and their own time, and these were the ones that struggled or refused to modernize their practices (also usually the ones with full waiting rooms of frustrated patients). Those I worked with that recognized that they were a part of a larger system embraced changes to their practices supported by EMR, they flourished, and tended to have happier patients with shorter waits for appointments.

How difficult it was going to be to accurately forecast when the sales would close.

My job is a hybrid, or at least it’s supposed to be. I have a half dozen clients that I am responsible for their satisfaction as well as a quota for each client. However much our company likes to say “It all comes down to satisfaction! Keep your clients happy!” and even with tying a portion of our compensation to client satisfaction surveys, it’s obviously all about selling. Leadership would rather you sell whatever you can, however you can, even if you piss off everyone in the process. It’s a very short-sighted model, but with how the direction this company is moving, I’m not very surprised. If you have any ounce of empathy, or like to forge client relationships that focus on more than dollars and cents, selling may not be for you. (If there are companies we can work for that actually give a hoot about clients beyond what they buy quarter to quarter, please share!)

That some of the “function and features” are pure vaporware. They haven’t been tested or met compliance in any setting other than the developer’s environment. This obviously causes major concerns from the client at go-live. I end up selling future versions that a user will not experience until 12-24 months later.

In no particular order or rank, here are a few of the things I wish I’d known before getting into the HIT sales field.

The training for salespeople is very limited and you’ll hear, “We don’t want you to train them, just sell it.” My product training for my first job included watching two demos of the application by my manager, one of which was provided while we waited for our plane at the airport. EHR software is complicated enough that vendors should either sufficiently train sales reps or use product specialists for all demos.

You’ll want to ask a lot of questions about your territory (how often does it change, how successful were previous sales reps, what is the turnover in this territory, are there any/many happy customers in my territory, etc.) to try and figure out if you really can make your numbers. Sales managers like to pretend that all sales territories are created equal, but they are not.

To truly provide a demo that shows a provider how your software works for their workflow, you will need to do a discovery with the provider or someone who truly understands the workflow. In the ambulatory physician space, it can be very difficult to get face time with the doctor and critical staff, so you know this beforehand and be able to prepare sufficiently to show them what they want/need to see. This discovery isn’t or shouldn’t be done to use smoke and mirrors and trick the staff. It’s no different than a doctor not being able to accurately diagnose a patient unless they’ve had sufficient time to do an assessment and evaluation before they prescribe the correct treatment. Salespeople should really refuse to do demos if they don’t get this time, but as long as they have quotas, they will do it.

Many physicians and their practice staff won’t bother to complete the requisite pre-work before their implementation, which further compromises their ability to optimize the expensive software they just bought. It is time-consuming, but it’s usually a question of “pay me now or pay me later.”

Not sales, but working in HIT for 16 years for companies that sell commercial software to doctors and nurses. I wish I’d known about the stress of being morally compromised on a daily basis as keeping my job (and thus my ability to pay my rent and buy food) requires either doing things I know are the wrong thing to do, or not doing things that are the right thing to do (way more of the latter than the former, fortunately). I’ve seen some very dark instincts on the business and technology “leadership” side of the house. If you ask why I stay, the only answer I have is: if I leave, that’s one less person banging the drum for what is right.

How often solutions aren’t fully baked before companies try to package them as GA.

Does the product actually work? Can the company actually implement and deliver it? Can they support it? Do they have any idea who will actually buy it? And who pays for it? Too many healthcare software companies I’ve worked for/with think that “if it treats patients better” or “makes the organization better” or “makes clinicians better” or “makes patients safer” (etc.) their product will fly off the shelves. All you, Mr. Salesperson, have to is bust your hump, get in front of the right people, and do your sales magic. Healthcare sales today is ALL about compliance or cash. C-Levels are only buying that which they HAVE to have, will save them money, or make them money (hard ROI).

Who are the competitors who are investing in the same product line?

While software is 100 percent margin, software companies in healthcare don’t want to pay as much as other technologies and their products are usually late.

I was in a sales support position, demonstrating application software. I suppose I was naïve to think that I would have to stretch the truth about the functionality of said software. Salespeople would provide me with what my response should be to certain questions. To which I stated, “That’s when I turn to you, because I won’t lie.” Ultimately, I transferred to another department within the vendor company to training so that the end user would find out how the system really worked. I would hear, “But they said [that being the salesperson] the system could do that.” To which I replied, “I know what they said, but I’m here to tell you the truth.”

Weekender 2/9/18

Weekly News Recap

• Former GE CEO Jeff Immelt is named board chair of Athenahealth.
• Former CMS Acting Administrator Andy Slavitt launches United States of Care, a non-profit that hopes to spur development of healthcare policies that allow all Americans to obtain health insurance and avoid medical bankruptcy.
• JPMorgan CEO Jamie Dimon assures the company’s healthcare banking customers that its venture with Amazon and Berkshire Hathaway won’t really be disruptive, but instead is an effort to lower the employee healthcare costs of the three companies through price negotiation.
• A review by the Economist finds that the number of prescription-only digital health apps that have earned FDA approval is rising sharply.

Best Reader Comments

Regarding Dolin, I think looking at pics of infants and toddlers being sadistically abused makes you permanently toxic. Just because he’s out of jail doesn’t mean there won’t be social consequences for his depravity. I get what you’re saying, but I would find it difficult to have collegial feelings for the man. It wouldn’t make for a very productive work environment. (Sorry)

Those C-level org changes give you a clear mandate and direction for where your business IT systems need to go. And there’s a deep well of work to be fulfilled in order to get there. However, this also means that IT can fall far behind the curve of what the organization needs. Imagine the C-suite doing an M&A deal every 1-2 years. Meanwhile bringing those accreted organizations into payroll, into G/L, into EMR, into ERP, into purchasing, into HR. That can take 4-5 years or more, especially if the entire organization must be re-done around a new system.(Brian Too)

I was pretty bummed to hear about Jamie Dimon hitting the phones to play down the JPMorgan / Amazon / Berkshire deal. Either they’re lying to their healthcare clients and they actually do want to do something disruptive or they shouldn’t even bother because they won’t move the needle. If JPMorgan and Amazon can’t bargain based on volume already, I don’t know what makes them think they’ll be more successful together. Group purchasing is probably more beneficial in the small / mid market. They want to attack healthcare costs, yet they don’t seem to want to cut any of the cost. (MN fan)

Workplace wellness programs show recent evidence that already-healthy people are the most active participants even when there is a small pot of cash (incentive) to be earned for demonstrating healthy behaviors for anyone participating. Similarly, providers will leave incentives on the table all day long, but if you send along a negative payment adjustment, providers will roar for more time. In the sticks and carrots analogy, carrots don’t seem to work in healthcare. (ellemennopee87)

To my fellow IS colleagues, don’t let disgruntled physicians or bedside providers distract you from your mission to serve the patient. Also remember that doctors are not upset with EHRs and IT most of the time — they are upset at healthcare in general. The EHR and IS tend to be a lightning rod for physicians to leverage their frustrations at. I am very empathetic to practicing physicians today and feel that if I can help save a few clicks or get them home sooner, then they will care for my mom, sister, friends, etc. much better. (Dave Butler, MD)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. T, who asked for take-home science and math games and backpacks to carry them in for her Michigan elementary school class. She provides an update: “The package was brought by our school secretary to the room right in the middle of our math lesson and also right during my principal’s visit for teacher observation. I apologized later to the principal for her not getting to see the whole math lesson and her reply was, ‘I loved it. You could feel the energy level skyrocket in the room when the secretary brought the box. I could tell how excited the kids were about this project.’ I have heard so many great comments like the little girl who came in smiling and said ‘I beat my Dad every time. I know lots more about force and motion then he does!’ I had two girls who were thrilled they were each taking home a backpack because they were having a sleepover together that weekend and said they would get to play the games out of each others’ pack. Thank you so much for helping make this year more fun and letting the kids feel special when they walk out of school with a backpack or win a game against their parents or sibling.”

Be careful getting your science news from Inc. or the several other crappy sites that ran this as sensationalized news. The researcher whose scholarly paper was turned into clickbait clarifies that, while a particular silicone product seemed to stimulate hair follicle growth in the lab and that same product is “reportedly” used by McDonald’s in its fryers, consuming it alone won’t cure baldness. He was baffled and then alarmed after seeing reader comments asking how many fries they need to eat to regain their tresses.

A nurse who sought care in a hospital in England for a mental health crisis is told that she’ll have to sleep on a row of chairs because no beds are available. Security camera footage shows her being groped by another patient as employees walk by without concern. The man admits that he kissed the woman, but says he didn’t sexually assault her, adding, “If she had told me ‘don’t’ I would have been like, OK, of, course, I’m a gentleman.” The man was found guilty, while the hospital assures the public that it was “an isolated incident.”

SNOMED International announces that its SNOMED CT clinical terminology will be used in the GE Healthcare’s Athlete Management Solution at the Winter Olympic Games. It also mentions a project called Olympic Healthcare Interoperability, which apparently will support cross-system athlete information exchange and portability to upcoming Olympics. 

Cardiologist and retired UC Irvine medical school professor John Longhurst, MD, PhD and his wife Cherril are killed when their single-engine plane crashes near San Diego. Newspaper accounts suggest that they were the parents of Chris Longhurst, CIO at UCSD Health.

The low-carb diet that I’ve been on for a couple of weeks has delivered spectacular results (zero hunger pangs, significant weight loss, improved mental clarity presumably due to better insulin control even though I’m not diabetic), so I was interested in this article. A comprehensive, 262-patient study finds that a low-carb diet combined with virtual adherence coaching from Virta Health yielded dramatic improvement in people with Type 2 diabetes:

• HbA1c was lowered from 7.6 to 6.3 percent on average
• Participants lost an average of 12 percent of their body weight
• 94 percent of insulin-using participants either reduced their dose or were able to go off insulin completely
• Every person who was taking an oral medication for diabetes no longer needed it

This will send ICD-10 wags searching for the right code. A Maryland hunter is airlifted to a hospital when the goose that someone in his party shot fell out of the sky onto his head, rendering him unconscious with head injuries.

In Case You Missed It

• News 2/9/18
• EPtalk by Dr. Jayne 2/8/18
• News 2/7/18
• Readers Write: Healthcare CIO Tenure Trends
• Readers Write: The Secret to Engaged Physicians at Go-Live: Personalize the EHR
• Curbside Consult with Dr. Jayne 2/5/18
• HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions
• Monday Morning Update 2/5/18
• What I Wish I’d Known Before … Bringing an Ambulatory EHR Live

Get Involved

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

Morning Headlines 2/9/18

Cryptomining Software Discovered on Tennessee Hospital’s EMR Server

Decatur County General Hospital (TN) notifies patients of a September data breach in which an unknown hacker installed cryptocurrency mining software on its vendor-maintained EHR server.

The Apple Watch can detect diabetes with an 85% accuracy, Cardiogram study says

A study of 14,000 Apple Watch users finds that the device’s heart rate sensor is capable of detecting diabetes in users already diagnosed with the disease.

Atrium Health and Navicent Health Announce Plans to Form Strategic Combination to Serve Communities in Central and South Georgia

Carolinas HealthCare System announces one day after renaming itself to Atrium Health that it will merge with Navicent Health (GA).

News 2/9/18

Top News

Former GE Chairman and CEO Jeff Immelt is named board chair of Athenahealth, replacing co-founder and CEO Jonathan Bush. Under a plan announced last year to appease an activist investor, Bush will remain CEO but will relinquish his president and board chair titles. The president’s job has not been filled.

Immelt will invest in Athenahealth and will buy $1 million of its shares on the open market.

A company SEC filing says Immelt will get standard Athenahealth board member compensation: a $60,000 annual cash retainer (plus another $50,000 per year for serving as chair), $281,000 in shares, and travel expense reimbursement.

Immelt ran GE from 2001 through 2017, during which time the company’s share price dropped 56 percent vs. the Dow’s 120 percent gain.

Reader Comments

From Bad Robot: “Re: Epic’s MyChart Central. Its terms and conditions clearly state, ‘You hereby expressly assume the sole risk of any unauthorized disclosure or intentional intrusion.’ Are they really off the hook in the event of a data breach?” I found the same wording in the T&C of a bunch of MyChart-using health systems, with additional interpretation suggesting that it’s to warn patients that their PCs or Internet connections could be compromised and thus might expose their information. Attorneys who would like to weight in can review Cleveland Clinic’s MyChart T&C, which basically says they are responsible for nothing even though that is most likely far from the truth. I assume Epic supplies the legal boilerplate, although it’s probably correct that Epic isn’t liable for any breach of a system it doesn’t host.

From Whistle Blower: “Re: Bob Dolin. The former Kaiser doctor and HL7 board chair served prison time starting in 2015 for possession of child pornography involving sadistic abuse of infants and toddlers. He’s apparently out now and attended an HL7 working group meeting last week. He’s also working with former Kaiser colleagues at Elimu Informatics as a senior clinical informaticist. Given recent news of US Gymnastics, can you imagine if the former chairman went to prison and then returned to participate?” I emailed HL7’s media contact but did not get a response indicating what role, if any, Dolin has with the organization. His LinkedIn says he’s an independent consultant. Here’s where I’m a little bit torn – what he did was incredibly sick, but should he barred from making a living after he has served his sentence and the job doesn’t involve contact with children? I have to say I’m leaning toward no – his informatics work isn’t likely to be a springboard to more crime. It’s still OK to detest him for what he did, but banishing him to a lifetime of unemployment in his late 50s doesn’t seem to improve public safety.

From Bombshell: “Re: ‘Giving Up Baldrige.’ It’s supposedly an HIT tell-all book that covers IT gaffes, Meaningful Use fraud, and Baylor’s Dr. Death and the suspiciously extensive wiping of computers.” I haven’t heard of it and neither has Google.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

From the Cerner earnings call:

• Q4 bookings were $2.3 billion, up 62 percent quarter over quarter and $300 million above guidance.
• Full-year bookings were up 16 percent.
• Cerner’s Works businesses are selling well, but their lower margin and short-term higher expenses are affecting earnings.
• The company will invest most of the windfall it will receive from the federal tax rate cut from 35 percent to 21 percent, planning to expand its campuses and hire 600 employees for the Works businesses.
• The company raised EPS guidance by $0.05, but that’s after a $0.19 gain from the tax rate change.
• The VA’s failure to sign a contract as expected in Q4 hurt results, although the company wasn’t expecting a huge revenue and earnings bump anyway.
• Cerner signed six Q4 deals of over $75 million.
• The company says the hospital EHR market has matured, with the biggest opportunity being full implementations in small hospitals that don’t have a currently marketed EHR.

People

CDI company Enjoin promotes James Fee, MD to CEO.

Sales

Intermountain Healthcare (UT) selects Elsevier’s Via Oncology pathway tool.

The Nebraska Health Network — an ACO serving patients of Methodist Health System, Nebraska Medicine, and Fremont Health – will use Koan Health’s population health analytics and consulting services.

Privacy and Security

Aetna sues Kurtzman Carson Consultants — the claims administrator that sent out mailings on Aetna’s behalf that disclosed the HIV status of recipients because of poor envelope design – for the $20 million Aetna paid out as a result.

Decatur County General Hospital (TN) notifies patients of a September data breach in which an unknown hacker installed cryptocurrency mining software on its vendor-maintained EHR server. The hospital didn’t name the vendor, but its patient portal is CPSI’s.

Announcements and Implementations

Carolinas HealthCare System – one day after renaming itself to Atrium Health – announces that it will merge with Navicent Health (GA). Atrium is also in merger talks with UNC Health Care (NC).

Technology

Monarch Medical Technologies adds self-service analytics to its glucose management software.

Innovation and Research

A study of 14,000 Apple Watch users finds that the device’s heart rate sensor is capable of detecting diabetes in users already diagnosed with the disease with 85 percent accuracy.

Other

A federal judge throws out a False Claims Act lawsuit brought against Epic by a former compliance employee of WakeMed (NC), who claimed in 2015 that Epic’s default setup double-bills Medicaid and Medicare by charging for both anesthesia base units and procedure time. The judge called the case, which had already been declined by the Department of Justice, “woefully deficient” since it included no proof that fraud had actually occurred. Epic’s motion to dismiss said the single document offered as proof by the plaintiff was not an anesthesia bill or claim.

A 20-minute power outage at Royal Adelaide Hospital in Australia leaves two patients undergoing surgeries in the dark, three patients stuck in elevators, and a score of anxious others. Officials have since pointed fingers at the hospital’s management company, which has attributed the unplanned outage at the recently opened $1.9 billion hospital to software glitches and a backup generator that ran out of gas.

Sponsor Updates

• Steve Febus, CFO, Pullman Regional Hospital, discusses how Engage helps rural hospitals succeed at IT.
• EClinicalWorks will exhibit at the 2018 AAD Annual Meeting February 16-20 in San Diego.
• Glytec will present at the International Conference on Advanced Technologies & Treatments for Diabetes February 14-17 in Vienna.
• Allscripts adds the Healthgrades appoint scheduling solution to its Developer Program.
• Healthwise exhibits at the 2018 South ACE User Group Conference in Raleigh, NC.
• Huron announces the promotions of 22 senior-level managing directors, partners, and VPs.
• HCIactive adds WiserTogether’s Return to Health treatment guidance tool to its Workplace Wellbeing software for employers.
• The Women Tech Council includes Health Catalyst on its 2018 Shatter List, which recognizes companies making an effort to increase the number of women working in technology.
• Agfa Healthcare adds new features to its Engage Suite for Integrated Care.
• LifeWorks Northwest (OR) adopts the Netsmart-powered Carequality interoperability framework.
• Indiana HIE will pilot Diameter Health’s data-cleansing capabilities.
• Adventist Health System’s Florida Hospital upgrades its digital radiography technology from Agfa HealthCare.
• Surescripts achieves HITRUST CSF Certification.

Blog Posts

• You can never be too rich or thin – but you can have too much data (Medicomp Systems)
• Huntzinger Management Group Achieves KLAS Ranking in 2018 Best in KLAS Report (Huntzinger Mangement Group)
• Are You Ready for ERP in the Cloud? (Optimum Healthcare IT)
• Patient-centric focus, no more an extra in value-based care (Elsevier Clinical Solutions)
• Patient Education can Eliminate 3 of Your Biggest Challenges (Healthwise)
• Supporting the Human Connection in Healthcare (Redox)
• Patient Intake Process: 4 Ways to Improve Patient Satisfaction (Access)
• 3 Steps to Build Enterprise Healthcare Communication (Spok)
• Slash patient privacy auditing man-hours with automated data-driven workflows (Iatric Systems)
• Patient Misidentification by the Numbers (Imprivata)
• Three Large Issues Affecting Healthcare Providers (Leidos Health)
• Tying it All Together: Data Integration Makes Your Metrics Actionable (Influence Health)
• Decentralized vs. Centralized Access at Health Systems: The Patient’s Perspective (Kyruus)

Contacts

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

EPtalk by Dr. Jayne 2/8/18

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 2/8/18

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

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

US Judge Dismisses Whistleblower Claim Against Epic

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

Cerner will boost Kansas City workforce by 600

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

Morning Headlines 2/7/18

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

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

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

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

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

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

News 2/7/18

Top News

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

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

Privacy and Security

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

Other

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

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

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

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

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

This tweet is brilliant.

Sponsor Updates

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

Blog Posts

• Patient Intake Process: 4 Ways to Improve Patient Satisfaction (Access)
• Impressions from AOCR 2018 in Mumbai, India (Agfa Healthcare)
• ACO End of Life Challenges (Arcadia Healthcare Solutions)
• Is Managed Services a good option for your healthcare organization? 5 FAQs (Nordic)
• Putting Data to Work Hospitals are Awash in Patient Data – Why is So Much of it Never Put to Use? (Bernoulli Health)
• Women in Cloud: New Support for Female Entrepreneurs (Datica)
• Telehealth Services and MHealth Apps Improve Patient Care Quality (CareSync)
• Aligning on a Mission to Help Patients: A Chat with Express Scripts (Cover My Meds)
• Onboarding: The Key to Retention and Job Satisfaction (Direct Consulting Associates)

Contacts

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

Morning Headlines 2/6/18

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

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

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

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

Agility Health Announces Definitive Agreement to sell US-Based Operations

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

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

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

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

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

Readers Write: Healthcare CIO Tenure Trends

Healthcare CIO Tenure Trends
By Ranae Rousse

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Curbside Consult with Dr. Jayne 2/5/18

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

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

Morning Headlines 2/5/18

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

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

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

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

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

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

JPMorgan plays down health care company to clients

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

Monday Morning Update 2/5/18

Top News

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

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

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

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

Decisions

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

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

People

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

Government and Politics

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

Other

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

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

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

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

Sponsor Updates

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

Blog Posts

• 5 Buzzwords I’m Banning from Meetings in 2018 (Salesforce)
• Successful interventions, positive outcomes: understanding the impact of social determinants of health (Medecision)
• Understanding how HIPAA Impacts Text and Email Communication (Solutionreach)
• Be Prepared: The Importance of Investing in Business Continuity During Unplanned Network and EHR Downtimes (Summit Healthcare)
• The Importance of Vendor Selection in Legacy (Leidos Health)
• How Blockchain Could Revolutionize the Healthcare Industry (Conduent Health)

Contacts

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

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

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

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

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

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

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

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

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