EPtalk by Dr. Jayne 12/15/16

Lots of vendors are sending holiday greetings. Although I appreciate the sentiment, there’s a lot of noise this time of year and I think a lot of the messages get overlooked. I’d like to recommend that vendors consider sending friendly greetings throughout the year. Perhaps cardiovascular solution vendors might consider National Tap Dance Day on May 25. Geriatrics vendors may want to consider As Young as You Feel Day on March 22, where storage vendors may want to consider World Backup Day on March 31.

I was glad to have a couple of extra days off the road this week since several of my clients are still struggling with how they’re going to wrap up their reporting for Meaningful Use attestation and other quality programs. I know organizations are busy and healthcare is a crazy changing place, but there’s no reason for leaving things until the last minute. I have two clients who have yet to select their clinical quality measures for the year. They can’t seem to understand that if their numbers haven’t improved throughout the course of the year, there is no magical force that is going to get them to the desired threshold with only 10 patient care days left.

I mentioned this phenomenon before. A reader shared his experience with using LogicStream to measure adoption of workflow best practices down to the clinician level. Designed to reduce unnecessary variation in care, it sounds like a great way to track compliance with specific clinical protocols and alerts. However, there are a lot of physicians out there who still struggle with the idea of “variation in care,” especially in the ambulatory space.

Let’s face it, we have a lot more compelling studies from the inpatient arena, and given volumes at many acute facilities it’s much easier to see when a specific clinical pathway is superior than it is at the average physician office. I have a lot of physicians that fight me about the EHR workflow being “contrary to how I practice medicine” and it’s always a battle to try to explain that the way they are practicing might just not be best practice. Most of the top-tier EHRs are designed with best practice and evidence-based workflows. I know I’ve mentioned in the past the physicians who argue about reconfiguring preventive care guidelines to match their own personal practice that isn’t supported by the US Preventive Services Task Force, the American Cancer Society, or anyone else who actually has data.

I feel for the organizations that have to try to rein these physicians in. On the other hand, the organizations are to blame because they allow this to go on. I’m not going to say it’s easy to get rogue physicians under control, but it can be done. Sometimes they will respond to targeted interventions and sometimes it takes a change in their contract to elicit the desired behavior. But if you can’t get a physician in line even with a contractual agreement, I would argue that it’s better for the practice to consider making them available to the workforce. In the new world of transparency around quality, the viability of keeping someone around because they’re productive or popular is less every day, especially if they’re doing something squirrely related to established protocols for patient care.

Another project taking a lot of my time this week is a strategic planning engagement for a midsized, hospital-owned provider group. For the past couple of years, they have been running on fear and adrenaline, acquiring as many small practices as they could in hopes of solidifying their referral base. Now they have a provider organization that looks like the Wild West. The only referral metrics they’ve been tracking are hospital admissions and surgical cases, leaving physician-to-physician referrals completely unaddressed. I’m not even sure the physicians know who their peers are since the acquisition strategy didn’t include much internal marketing to other members of the group. Some members have been migrated to the enterprise ambulatory EHR and some were allowed to stay on their own office systems, so interoperability isn’t what it needs to be, either.

Because they were so focused on building their provider base, they lost focus on other key projects such as staying current with EHR upgrades and making progress towards patient-centered medical home recognition. The coding and compliance staff was focused on onboarding the new providers and stopped their regular audits of existing physicians. Rather than having quarterly audits like they’re used to, some physicians haven’t had a coding audit for more than a year. If someone’s gone off the beaten path with their coding, that’s not the kind of thing you want a delay in uncovering.

I had several calls with them this week, trying to prepare an agenda for a strategic planning retreat in January. They’re struggling with their end-of-year ACO and PQRS reporting, however, and all they wanted to talk about was the perceived issues they’ve having with their vendor. I say “perceived” because I have other clients working with the same vendor who are doing just fine. They say they can’t give the quality reports to their providers because they’re not granular enough and the providers don’t understand them. I’ve seen the reports, and they’re extremely clear – they have the name and number of the measure and a brief synopsis. The providers can drill down into the individual patients to see why someone is passing or failing. It turns out the organization has been printing them out, so of course they’re not as impactful as delivering them electronically so they can be used interactively.

The reason for the printed reports is so the office managers can use highlighter on them and sit down and discuss them with the providers. I’m not sure why the red-yellow-green display in the EHR report package isn’t good enough or why they can’t sit down in front of a screen instead of a piece of paper. This is a classic case of “blame the vendor” for an operational problem. I said as much, trying to steer them back to the agenda at hand, but they continued to try to return again and again to their “pressing issues.” I’ve been working for months to help them understand that they have to get out of the weeds and start looking at the bigger picture and not continue to be ensnared in “pressing issues” because it’s simply a classic case of avoidance behavior.

They need to decide who they want to be when they grow up. Do they want to be a big fish and keep growing? Or are they happy where they are and ready to make the most of their provider membership? Are they ready to start working on quality in earnest and remediating any poor performers? Until they set some direction, they’re going to continue to struggle.

I’ve got another call with them tomorrow to try to continue to nail down the agenda, but it’s slow going. They “forgot” to invite the CFO to today’s call and I wasn’t willing to move forward without the right players on the call. I’m planning to bring a second facilitator with me to the onsite planning meeting because I can see already that it’s going to take a village to keep them corralled. Sometimes these clients make me want to give up, but once in a while, one starts to really get with the program and those bright spots keep me going.

Does your organization have a strategic plan for 2017? Email me.

Email Dr. Jayne.

Morning Headlines 12/15/16

National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data From National Efforts To Make Health Care Safe

AHRQ releases a scorecard on hospital-acquired conditions which measures a 21 percent decline in HAC’s since 2010, representing an estimated 125,000 saved lives and $28 billion in saved healthcare costs.

PCORI Board Approves $42 Million for 19 New Patient-Centered Research Projects

PCORI approves $42 million in new research funding. The investments will fund thirteen projects, including studies focused on assessing the quality of communications between healthcare providers and patients, preserving patient privacy when data sets including medical information are linked, and measuring patients’ preferences.

Increased transparency and quality information via new Compare sites and data updates

CMS releases two new consumer compare websites, one comparing inpatient rehabilitation facilities and the other comparing long-term care facilities.

Telemedicine for PTSD no less effective than in-person therapy

In a study of 132 veterans with PTSD, researchers at the Ralph H. Johnson VA Medical Center (SC) find that PTSD treatment can be delivered remotely via telehealth services with no measureable differences in effectiveness.

CIO Unplugged 12/14/16

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

Iron Sharpens Iron

My dad is 83 and once again will carve the Christmas turkey. Since I was a child, Dad ceremoniously stood at the table, and before slicing the bird, carefully clanged heavy pieces of steel together as if he were in a sword fight. Meticulously he rubbed the carving knife in his right hand against the steel rod in his left. Once the knife was sharp, the blade glistened while descending, separating bone from flesh. It was like Messi splitting two defenders scoring a goal.

The meat of the bird fell to the side and the celebratory feast began. I still hear the sound of steel upon steel, the smell of German spices, and see the smiles on hungry faces.

Soon after landing my first CIO gig, I helped lead our organization through an EHR implementation. My mentor suggested seeking advice from others who had led large, complex transformative projects for their organizations. I tracked down the members of our board of directors and reached out to their CIOs. Each accepted my offer for drinks and dinner. I learned while developing relationships that I leverage today.

I briefed my CEO the next day and he asked what compelled such an approach. I immediately responded with, “Iron Sharpens Iron.” Tom thought it was profound and appreciated the initiative and approach.

Since that time, I have embraced this concept highlighted in ancient Proverbs. Like my dad’s knife, my sharpness increased exponentially as I began to continuously seek others’ wisdom and evaluated experiences rather then to rely exclusively on my own knowledge. I needed to stay sharp, and in doing so, helped others be sharp as well.

If you live and die by the sword, you’d better be sure it is always sharp. As I reflect on my career since that time, I can taste the results, smell the success, and see the smiling faces. All from living out a simple phrase of iron sharpens iron and having the humility to admit my shortcomings and accept that I can’t be effective on my own.

This fall I was walking the streets of NYC fuming. I was hurt and I was headed to my day in court, where I would justify myself and extract punishment. I had the fix and I would administer judgment. I knew operating out of anger was wrong, but I could not think objectively.

I called a peer a few minutes prior to the meeting. He spoke wisdom. He helped me become rational. He reminded me who I was. My anger softened, my thoughts become clearer, and I entered the meeting at peace. The meeting turned out better than I imagined. The positive outcome was a credit to my peer who sharpened me.

When I was courting my wife, we had to work through a bunch of baggage we both carried with us. We had serious conversations with one another, but we also were sharpened by friends and mentors. Had we relied on ourselves, we might not have become engaged, or worse, we would have become engaged and started our marriage with all sorts of junk we did not need. Rather, the people around us sharpened us and helped us understand what was fake versus real and we began our marriage with a fairly clean slate.

In Texas I kept hitting obstacles with Finance and was unable to secure needed funds for critical investments. I finally got on the phone and dialed up some of my heroes. They taught me a few methods I had not yet deployed. It took time, but it worked. Ultimately it cost me a couple of glasses of wine, but it was well worth the price.

I made a bad hire once. I knew what to do, but was frozen. Tom from Sherwin-Williams looked me straight in the eye and said fire him. I was a softie and avoided the obvious, but I needed someone I respected to remind me to do the right thing. I fired my friend and the organization experienced immediate improvement.

You don’t have to wait for a need before you sharpen yourself. I have admired Daniel, a successful CIO for many years. As fate would have it, we both ended up in NYC. We met recently for a drink and soon for a run in Central Park. Chuck and I have met all over the country the past few years — Chicago, Dallas, Orlando, Las Vegas, and LA last week. Dang, I left both these leaders feeling refreshed and ready to face any challenges ahead of me. I did the same for them.

Where do you find your iron? Humble yourself and seek clarity and opportunity. I see someone I admire, I reach out to them, and I also try to give back. Someone reaches out to me, I serve them, and often I learn in return. I am fortunate to serve on the faculty of the CHIME Boot Camp, and wow! – I  am surrounded by men and women who sharpen me twice a year. Also, don’t be afraid to look outside of healthcare. Remember, in as much as you receive, give back to others in the same way.

If you don’t need anyone to sharpen you, I am sad for you. Not only are you missing out on increasing your effectiveness, but you are robbing those you serve. You are stealing joy from those who are called to sharpen you and stealing performance from those you are to sharpen. Pride is the ultimate act of selfishness.

I am thankful I have others in my life who sharpen me and whom I can sharpen. I unashamedly admit that I need others to help fulfill the calling that is placed on my life and career. To those who sharpen me, thank you. To those who will in the future, thank you. To those who have in the past, thank you. I would not be who I am today or who I become tomorrow without you.

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

Morning Headlines 12/14/16

Carequality and CommonWell Health Alliance Agree on Connectivity and Collaboration to Advance Interoperability

CommonWell will integrate its health information exchange network with Carequality, allowing customer organizations  to exchange health information through direct queries across both networks. Epic is a Carequality member, while Cerner and many other notable vendors are CommonWell members.

California Prison Record System Cost Doubles to $386 Million

The cost of a Cerner implementation aimed at modernizing the paper-based medical records system used by California’s prison system has doubled from the original budget of $182 million to nearly $400 million.

Chief data officer leaving Centers for Medicare and Medicaid Services

Niall Brennan, the chief data officer at CMS, will leave ahead of the change of administrations, and will be replaced by his deputy, Chris Cox.

Retired carer left to die after hospital replaced ‘old-fashioned’ whiteboard with computer system

In England, a woman dies when clinical staff inadvertently stop rounding on her after replacing their traditional unit whiteboard with an electronic patient census system.

News 12/14/16

Top News

CommonWell Health Alliance and Carequality will connect their respective systems, allowing their members to share information.

Most notable (but unstated) in the announcement is that Epic uses Carequality’s Interoperability Framework but is a notorious non-participant in CommonWell, with the agreement potentially allowing Epic to connect to other systems outside of its own proprietary connectivity suite. Likewise, Cerner is a CommonWell founding member but doesn’t participate in Carequality.

I’m not sure if the announcement can be accurately characterized as health IT’s version of the transcontinental railroad’s golden spike, but it has potential to become a significant joining of the patient data tracks, assuming of course that competing health systems are actually willing rather than conveniently unable to exchange patient information.

Reader Comments

From Much Too Much: “Re: HIMSS17 registration list. Vendors received it Friday. For the first time, this list does not include a postal address. Vendors wishing to send direct mail will have to have the campaign approved by HIMSS and then use HIMSS preferred mailing vendor. The cynic says this is just expanded vendor extortion, while the optimist says that maybe we’ll get less junk in the mail before the conference.” I surmise that the motivation was income rather than junk mail curtailment. However, from a purely economics standpoint, HIMSS should keep raising the exorbitant prices it charges vendors for the annual conference until they push back by not participating. The frenzy to rack up HIMSS points to allow spending even more money on prime exhibit hall square footage suggests that the supply-demand curves do not yet intersect.

HIStalk Announcements and Requests

HIStalk reader Mike sent a DonorsChoose donation that, with some pretty amazing matching money, will give Ms. A’s fourth grade class in Stone Mountain, GA an iPad Air, Amazon Echo, and Amazon Fire and also economics books and games for Mrs. M’s gifted classes in Springdale, AR. Mrs. M responded, “It is so exciting to have others help in providing amazing resources to my students. Your generosity is appreciated more than you can imagine! I can not wait to receive these resources to share with my students! Your help allows my students to experience hands-on real world economics.”

Mrs. G in Wisconsin says the best part of the day for her elementary school students is using the makerspace materials we provided in funding her DonorsChoose grant request, as their confidence is growing from making decisions together as teams. 

Listening: the latest album from Australia-based Wolfmother, which is down to just one of its three original members but still rocks it out well in the fashion of Black Sabbath or perhaps Led Zeppelin. If rock ever makes a comeback, these guys should be part of it.

Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.

Here’s the recording of the recent webinar titled “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” 

Acquisitions, Funding, Business, and Stock

Analytics vendor Inovalon lowers full-year revenue and earnings guidance after a collaboration agreement with an unnamed partner fell through last week unrelated to the company’s offerings. Inovalon expects annual revenue of $426 million instead of $470 million and net income of $25 million vs. the previous guidance of $43 million. Shares were predictably hammered on the news, shedding 36 percent of their value by the market’s close on Tuesday. INOV shares are down 64 percent in the past year vs. the Nasdaq’s 12.5 percent increase.

EHR vendor IMedicor warns that three of its financial statements from 2014 and 2015 should not be relied on because they misstated liabilities that were later discovered in a year-end audit. The amount involved was only $471,000, however, caused by double-recording the same set of warrants in two accounts. The greater question might be how a money-losing company with a market cap of barely $1 million can afford to remain publicly traded with a current share price of $0.0009, which suddenly makes that $471K seem more significant.

Canada-based VSS Medical Technologies acquires a majority interest in Legato Healthcare Marketing. VSS also owns Sigmund Software, MedicFusion, VersaForm, DeviceTrak, and Health:PCP.

Sales

In Canada, Mackenzie Health chooses Orion Health’s Rhapsody integration engine.

AtlantiCare Health System (NJ) selects Santa Rosa Consulting to strengthen its analytics program.

Frances Mahon Deaconess Hospital (MT) will upgrade to Meditech’s Web EHR.

People

Tom Clark (Direct Recruiters) joins Direct Consulting Associates as VP of operations. He is a former US Army captain and Airborne Ranger.

Announcements and Implementations

The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia, which will establish best practices for mobile health apps. It’s the second time around for Xcertia, having been originally announced a year ago under the direction of Columbia University and vendor Social Wellth, which bought the assets of defunct health app certification vendor Happtique in December 2014 and created its own app guidelines. SocialWellth CEO David Vinson created the non-profit DHX along with the AHIP insurance company trade group with the intention of offering app certification, which apparently isn’t a priority for Xcertia 2.0.

Black Book’s 2016 RCM survey finds that hospital outsourcing of complex claims has jumped from 20 percent to 40 percent in the past three years, with hospitals that previously wrote off those claims because of the effort and expertise required to pursue them realizing they were leaving significant money on the table.

Another Black Book survey finds that competing priorities have killed off hospital ERP implementations, with just a 29 percent penetration and 2 percent growth in 2015. Shockingly, more than one-third of those hospitals that have bought ERP systems aren’t keeping up with available upgrades, rendering those systems basically obsolete. More than half of hospital C-suite executives admit that they didn’t really understand their supply chain (which represents nearly a third of hospital budgets) until the move to value-based care forced them to dive deeper.

Consulting firm RTI International and Validic partner to optimize the use of wearable consumer sensors in health research.

Centralized tele-ICU programs can increase case volume by 44 percent and contribution margins by 665 percent, according to a journal-accepted study by UMass Memorial Medical Center (MA), which uses Philips eICU. 

Connected home software vendor Orbita releases a development tool for creating Amazon Echo-powered home health voice assistant apps.

Government and Politics

President Obama signs the 21st Century Cures Act into law.

CMS’s chief data officer Niall Brennan is among the federal political appointees leaving their jobs (voluntarily or otherwise) with the administration change. He will be replaced in interim by Office of Enterprise Data and Analytics Deputy Director Christine Cox.

The VA creates a website for its Digital Health Platform, which describes its approach and includes use case videos. Previously issued documents indicate that the VA plans to acquire five system components:

• An EHR
• An operation management platform (resource allocation, financial, supply chain, and HR system) integrated with the EHR
• A CRM system
• An analytics system
• An API framework

The FTC settles consumer deception charges it had brought against Aura Labs, which sold $600,000 worth of its $4, smartphone camera-based Instant Blood Pressure app that it falsely claimed to be as accurate as a blood pressure cuff.

Privacy and Security

Quest Diagnostics notifies 34,000 people that a hacker has breached its systems via a vulnerability in its MyQuest mobile app, exposing their demographic information and lab results. The app also allows users to record their provider contact information, prescription information, allergies, and health statistics.

Financial consulting firm PwC threatens legal action against a security advisory firm that had warned it of a vulnerability in a PwC-developed security tool, insisting that the company not go public with details. PwC says it has fixed the problem and says the security firm wasn’t licensed to work with its software. The security firm ignored the warning and published its security advisory anyway.

Grammar matters: Russian hackers were able to penetrate the Democratic National Committee’s email system even though a Clinton campaign aide intercepted a phishing email sent to Campaign Chairman John Podesta. In his haste to alert Podesta, the aide mistyped “illegitimate email” as “legitimate email” in his urgent warning, after which Podesta obligingly clicked the phony password update link that compromised his account.

Innovation and Research

Inova Health System (VA) launches a venture capital arm and its Personalized Health Accelerator.

Technology

A surgeon in England uses Snapchat’s Spectacles – $130, camera-equipped sunglasses — to record 10-second video clips of a surgery he performed, allowing medical students follow his progress live and afterward.

Other

Cost estimates for the California prison system’s implementation of Cerner have doubled to $400 million in the past three years as the state realized it signed a contract that omitted the cost of maintenance, hardware replacement, mobile devices, additional required software, and dental recordkeeping capability. The federally appointed receiver in charge of the system mostly blames Cerner, which is being paid $177 million over 11 years, but also says his own office bears considerable responsibility for the overrun in missing several required items. He also says employees are struggling to learn the system, doctors don’t like doing their own data entry and are seeing one-third fewer patients due to the extra work required, and the pharmacy system was “damn near unusable” due to design and implementation problems. The state turned control of the prison healthcare system to the federal government in 2006 to settle lawsuits claiming that poor inmate care constituted cruel and unusual punishment. The receiver’s budget has since doubled to $1.9 billion per year.

The imaging system used by hospitals in South Australia goes down for six hours due to unspecified technical issues. 

A report from Imprivata and the Ponemon Institute finds that misidentification of hospital patients is a regular occurrence and the average hospital loses $17 million per year due to rejected claims due to missing or incorrect patient information, with respondents favoring the implementation of biometric ID at registration to improve both situations.

In England, an woman dies after a hospital admits her for a broken arm but then fails to send anyone to treat her for several days. The hospital had changed the way it lets doctors know they have new patients, moving from an old-school whiteboard to an email-based program. The patient shared a first name with another patient and the unit secretary mistakenly removed the woman’s name thinking it was a duplicate entry.

AHRQ reports that hospital-acquired conditions are down 21 percent since 2010, with potential savings of 37,000 lives and $28 billion in costs. I guess the good news is that hospitals still harm and kill people every day with their screw-ups, but at least less often than they used to.

A city in Japan offers free barcoded, personalized fingernail stickers for people with dementia who are prone to wandering, allowing police to scan the QR code to find their families. Stickers were already being attached to shoes or items of clothing, but those weren’t always being worn when needed.

A study finds that veterans with dementia who use the VA healthcare system and who also receive Medicare benefits have twice the odds of medication problems due to lack of connectivity between VA and non-VA doctors.

The bond ratings agency of PeaceHealth (WA) notes that its $293 million Epic implementation costs have temporarily hurt its margins. The same agency reviews Seattle Cancer Care Alliance (WA), which it says is considering replacing its EHR  (it doesn’t say which one, but I think they’re running Cerner and they have listed Epic jobs).

Here’s a frontlines report from the war on drugs. The owner of a chain of “clean and sober” residential drug recovery centers called “I.C. Clean People” in Washington State is arrested for drug trafficking, with a raid on his office turning up crystal meth, heroin, marijuana, oxycodone, methadone, and a loaded pistol.

Strange: a mother sues the hospital where she gave birth in a 2012 incident in which employees mistakenly gave her newborn baby to another mom to be breastfed. Abbott Northwestern Hospital (MN) says it has since switched to electronic bracelet baby-mother matching.

Sponsor Updates

• EClinicalWorks employees help out families through Project New Hope, Project Just Because, and the United Way.
• Medecision launches population health management consulting services.
• CloudMine and Validic will partner to advance integration of patient-generated health data into clinical workflows.
• Healthgrades SVP Chris Baxley joins the Nashville Health Care Council Fellows.
• Santa Rosa Consulting publishes a white paper titled “Critical Aspects of a Successful BI and Analytics Program.”
• The Indo-UK Institute of Health names GE Healthcare a preferred technology partner in its IUIH Medicities program in India.
• Agfa HealthCare will implement enterprise imaging for radiology in the first Acibadem International Medical Center in the Netherlands.
• KLAS includes Bernoulli as a top vendor option for clinical alarm management and alarm reduction.
• Besler Consulting releases a new podcast, Epic Conversion – Revenue Cycle Lessons Learned.
• Elsevier Clinical Solutions offers predictions for the next 100 years of medicine.
• Evariant releases a series of best practice guides on a variety of topics.
• Built In Colorado features Healthgrades Director of Talent Acquisition Jenny Truax.

Blog Posts

• A 180-Degree Turn From Illness to Wellness (Arcadia Healthcare Solutions)
• What a Trump Presidency Could Mean for Population Health (Caradigm)
• Physician Engagement for EHR Implementation (Impact Advisors)
• Top 10 Reasons CareSync is Number 1 (CareSync)
• Post-Election Healthcare and the Future of the ACA (Optimum Healthcare IT)
• EHR Replacement – Can You Afford to Wait? (ECG Management Consultants)
• New Technology Connecting Patients & Providers (FormFast)
• Our Top 10 Blogs of 2016 (Galen Healthcare Solutions)
• A Veteran and Cancer Survivor Sits Down with VP Biden to Stand Up to Cancer (GE Healthcare)
• The MACRA Final Rule: Easing the Pain of Implementation (Hayes Management Consulting)
• Healthcare Innovation: Why You Need an Innovation Team (HCI Group)

Contacts

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

Morning Headlines 12/13/16

Building A System That Works: The Future Of Health Care

HHS Secretary Sylvia Burwell publishes a blog in Health Affairs outlining the achievements made since the passage of ACA, and her vision for the road ahead.

Improving the Quality of Care for Medicare Beneficiaries by Increasing Patient Engagement

CMS will test two patient engagement strategies from the CMS innovation Center, the Shared Decision Making Model and the Direct Decision Support Model, both of which offer a variety of patient-focused decision support tools to help create more educated and engaged beneficiaries.

Medicare Value Based Payment Models: Participation Challenges and Available Assistance for Small and Rural Practices

A GAO report finds that small and rural practices considering participation in value-based payment programs face financial challenges associated with EHR interoperability, and staff expertise challenges associated with optimizing EHRs and analyzing population data.

In five years, machine learning will be a part of every doctor’s job, Vic Gundotra says

Former Microsoft and Google executive and current AliveCor CEO Vic Gundotra argues that artificial intelligence will become a critical tool for physicians within the next five years.

Curbside Consult with Dr. Jayne 12/12/16

As we approach the end of the year, things continue to be a flurry with clients who didn’t plan well screaming for services. I’ve reached the limit of what I can deliver with my small team since this is the last week my partner and I are spending on site with customers. We’re willing to let some business go because we’re not willing to run ourselves ragged trying to be everything to everyone. That’s the perk of owning your own business, although it’s sometimes challenging when you have to agree to disagree with clients.

For those clients that we would like to be able to serve but just can’t, we have larger consulting firms that we can refer them to when it’s crunch time. You would expect that some of them might elect to stay with the group that met their needs when we couldn’t, but a good number of them come back to us because they appreciate the fact that we knew our limits and steered them into capable hands.

One of the prospective clients that I steered to a colleague was one who wanted to hire an external help desk because they felt that their vendor’s help desk wasn’t meeting their needs. They feel the vendor’s Tier 1 support is passive-aggressive, doing things like intentionally calling the office after hours so that they can say they called back and didn’t reach anyone. The vendor offers a discount on maintenance if clients provide their own Tier 1 support, so they did the math and decided to outsource to a third party if the price was right. My colleague happens to be a former reseller for the vendor in question and was happy to take their business, so it was a win for everyone.

Since this is my last week on the road, I plugged in a post-upgrade go-live for myself so I could work Monday through Thursday and start my holiday travel a bit earlier than last year. It meant that I had to fly on the weekend, which is always interesting given the change in mix from business travelers to family travelers. I was pleased to see Chicago’s Midway Airport decked out for the holidays, with lots of twinkle lights and giant ornaments. There were “take a sweet treat” stands with bowls of Skittles. As I made my way down the B gates, there was even a man on stilts dressed as a toy soldier handing out boxes of candy. It was unexpected and made me smile so, kudos to the folks that put it together.

The mood didn’t last long once I reached my destination and had frantic voice mails from my customer that their upgrade wasn’t going as planned. I had encouraged them to start the upgrade on Friday night so that if they had issues, they would have time to resolve them. Instead, they insisted on starting it Saturday afternoon, citing staffing issues. This is the challenge of scheduling major projects around the holidays, because people want time off and to be with their families and weekends are challenging if they’re not scheduled well in advance or if your teams don’t have a lot of backup. They had done a dry run of the upgrade and theoretically should have had enough time, but ran into some issues.

Whenever I give training on an upgrade, I reinforce (and reinforce, and reinforce) how important it is to follow the upgrade playbook line by line. There is zero room for the kind of errors that result when steps are performed out of sequence or missed. Certain applications are finicky, and their pre-upgrade scripts are looking for specific criteria to be met in the client environment before they proceed. Depending on where a missed step occurs, it can cost hours to get the timeline back on track. Although I provided some high-level project management for the client, they were running the upgrade process themselves and I wasn’t supervising them as closely as I do when I am personally responsible for the upgrade event.

There is a step in their upgrade plan that requires them to disable their disaster recovery solution a certain way, and an enterprising DBA decided to do it a different way than what was documented. The result was the failure of the upgrade package, which wasn’t finding the conditions it needed. Instead of rechecking the plan and following it, the DBA restarted the upgrade two additional times expecting a different outcome. By the time I landed they were significantly off the timeline, and it took a couple of calls to figure out what had gone wrong and how to fix it.

The relative comedy of errors pushed on through most of Sunday evening, when they still hadn’t brought the upgraded system back up because data integrity checks were failing. We spend several hours on the phone with the vendor’s team trying to figure out what went wrong and weren’t able to isolate a cause. At that point, we had some decisions to make. We could either keep working on it and prepare to open the offices on Monday using downtime procedures, or we could restore the system from a backup and move forward. As we were weighing the choices, there was a question of whether users had been accessing the system during the backup that took some investigation and stalled things further.

We needed to make a decision as we approached midnight, and ultimately my client opted to restore from the backup and try the upgrade again at a later date. I was crossing my fingers that their backup process was solid since we all know clients who never test their backups or go to restore from one and find out it’s corrupted, or even worse, blank. Fate was smiling on us because the backup restored not only without a hitch but in less time than anticipated, which allowed us to get the users back on the system without too much of a delay.

Of course the end users were disappointed at their inability to use the new features, and the organization has to reschedule. We spent several hours today in a post mortem discussion of the event and what went wrong, and they appear to have learned some important lessons about following the playbook exactly and in asking for help when you run into a problem rather than just repeating the same steps over and over.

There wasn’t much go-live for me to support, so I am headed back to the airport. Although they failed, they made a smart decision and can try it again either after the first of the year. These are the hard lessons that most organizations learn at one time or another, and now they can join the club with the rest of us who have been there and done that.

What’s your worst upgrade story? Email me.

Email Dr. Jayne.

Readers Write: The Six Bedrocks in a Post-Trump Healthcare Landscape

The Six Bedrocks in a Post-Trump Healthcare Landscape
By Steve Levin

With a Trump administration and Republican-led Congress on the horizon, a shift in the direction of national healthcare policy is a near certainty. But the exact nature and timing of that change might be, unfortunately, less clear. Based on the principles outlined by Trump’s team themselves, the history of appointees, and conversations with clients and industry pundits, it feels as if there are some bedrock themes to orient efforts while Washington turns over and argues its way forward.

1. Expect more creativity from payers. Multiple factors are at play here. Moving the locus of health insurance requirements from federal levels to the individual state organizations will promote flexibility. The pullback on the individual mandate means that the days of Bronze, Silver, Gold, and Platinum plans will go the way of the floppy disk drive. Couple this with increased incentives for consumers to set up HSAs and take control of their health insurance purchase means that payers can let loose their product design teams for new solutions to meet the range of consumer challenges.
2. Consumers will end up paying for a larger share of their healthcare. There is simply no money left in the checking accounts of government—federal, state, or city – or employers to fund the growth in healthcare costs. Add on more plan innovations, the disappearance of the individual mandate, and Medicaid expansion being reined in and the future for the consumer is pretty clear. If we have insurance, we are going to be paying more in the form of co-payments, co-insurance, and deductibles. More procedures will go from covered to un-covered. Many consumers will end up on the far end of the insured continuum —namely, uninsured.
3. Bundles and risk-based reimbursement will march forward. Over the past several years there have been pilots, tests, and more pilots and tests comparing and contrasting fee-for-service to something along the lines of pay-for-value. CMS has led the charge. While the incoming leadership has historically been less bullish on all the pilots and innovations, the results to date do suggest bundles can create positive care integration and control total costs. Readmission penalties, while still rough, are raising an issue that organizations know they need to tackle. Certainly the current risk programs are not polished and perfect, but they are driving integration around the patient and toward higher value at an overall lower cost. So build out those teams of contract modeling talents; continue the march toward building your own insurance solution; and figure out how you can process those contracts amid clinical workflows and revenue cycle in volume.
4. Time to become patient relationship experts. Combine items 1, 2, and 3 and a fourth bedrock principle emerges—specifically, figuring out how providers manage the patient relationship both clinically and financially before, during, and after treatment. This relationship will become of paramount importance. Moving forward, the patient is going to control a great deal of our cost structure and cash flow. Providers need to be proactive to shape patient decisions.
5. Extracting more value from every budget dollar will be table stakes. Every scenario comes back to the same operational mandate— lower operating costs and improve the impact of every activity. Eliminate the 20 to 30 percent of processing work that is predictably of no value or impact. The double whammy in my reading of the future is that every activity is more expensive when the counter party is the patient themselves and not a commercial or government payer. It is simply more expensive to manage patients than a large business partner. So regardless of how Washington reshuffles ACA, healthcare processes need to be more efficient at every turn.
6. Time to get more ROI from those EHR investments. Organizations spent millions on big-iron electronic health records and went through the agony of stabilizing processes. Now it is time to actually optimize those platforms using the higher quality information at hand. Using predictive analytics to reduce low and no-value efforts (see point five), optimizing insourcing and outsourcing logic, and targeting high-cost patient engagement processes are just examples of how these bedrock systems can begin to finally drive financial improvement.

Only time will tell what Washington actually decides and when those decisions truly have bearing on the thousands of hospitals and millions of patients. However, while the exact policies and processes are TBD, the six bedrock items listed here are most likely enabling and contributing regardless of the final rules and regulations.

Steve Levine is CEO of Connance.

Readers Write: How Trumpcare Could Win Big

How Trumpcare Could Win Big
By E. Todd Bennett

Government involvement in the healthcare industry has increased under HITECH, the Affordable Care Act (ACA), and now MACRA. The phrase, “large-scale change happens when customers demand it, suppliers agree on it, or the government mandates it,” certainly applies to healthcare and has played out in these legislative acts. These federal government initiatives, except MACRA (since the quasi-final rule was only recently published), have failed to improve quality and bend the cost curve in a broad and dramatic way to put the United States healthcare system unequivocally in a worldwide leadership position.

On the cusp of a new administration, it’s important to understand why these legislative acts aren’t dramatically improving healthcare quality and reducing costs.

Overall, incentives seem misdirected with the healthcare industry goals related to cost and quality. In fact, the definitions of the goals seem too fuzzy or missing altogether. For instance, we do not know the specific cost and quality goals to target for a total knee replacement or the defined cost and quality outcomes related to lifestyle-related chronic disease.

Instead of incenting attainment of specific cost and quality outcomes, existing regulation has incented the intermediate activities, behaviors, and organizational structures that some legislators and industry leaders believe will aid in reaching the outcomes. Even when the intermediate actions seem productive, the lack of compelling results leads to a conclusion that the actions are, at best, incomplete. The right combination of processes to achieve the desired cost and quality outcomes is not always clear, and in the absence of evidence-based clarity, practitioners need maximum flexibility to act in accordance with their training and experience.

By shifting to incentives based on optimal quality and cost outcomes, the Trump administration has an opportunity to reduce administrative burden from government agencies, reduce the compliance burden from healthcare organizations and practitioners, and create a competitive and innovative environment that is truly driven to achieve world-leading healthcare quality and cost-of-care goals.

Let me explain with some examples.

HITECH

While a digitized and connected ecosystem and at least aspects of electronic health records (EHRs) are surely part of the long-term solution to higher quality and lower costs, incenting adoption of EHRs and telling providers what stepwise features constitute Meaningfully Use is an industry-wide micro-management mandate. This movement to automate so many processes may be ineffective, inefficient, or both. The EHR is a tool— a complicated and expensive one – and like other tools available to providers, it has the potential to enhance certain clinical and administrative activities and/or become a source of frustration and waste.

Shifting incentives from Meaningful Use of EHRs to attainment of a desired combination of higher quality outcomes for care and lower cost gives providers the option to select and de-select the technologies that impact cost and outcomes the most. Providers who use EHRs or certain features may have a clear advantage, and if so, competition among providers would spur increased adoption of those features. In this scenario, the government defines the optimal quality/cost outcome at population and/or episode levels along with incentives for attainment and foregoes defining which EHR functionality is most important; the market will decide which technological features should be meaningfully used to help them achieve the goal.

ACA

Take the ACA’s formulation of Accountable Care Organizations (ACOs). ACOs use incentives and penalties to drive a more coordinated care delivery environment with the potential to reduce unnecessary care, increase patient safety, and lead to higher quality outcomes. An ACO has the best opportunity to impact quality and cost when patients get their care within the ACO network, but when patients go outside the ACO network of practitioners, care coordination wanes, reducing the opportunity to optimize quality and cost.

Unless incentives to coordinate care extend to every doctor who cares for a given member and not only to doctors who participate in the constrained provider organization, ACOs will continue to have blind spots that prevent their impact to the degree desired. The structure of the ACO and the incentives to coordinate care are not the ultimate goals, and even brilliantly coordinated care in the absence of other behaviors will fail to produce higher quality and lower cost. If healthcare providers are convinced of the benefits of coordinating care, they will facilitate care coordination regardless of whether the patient sees an in- or out-of-network provider and using whatever technology they deem appropriate. Once again, this reduces government involvement in managing care, reduces administrative and technical complexity for providers to what the provider deems appropriate, and creates a competitive and innovative environment where reaching the ultimate goal is rewarded.

MACRA

Incenting practitioners who treat Medicare patients with a potential bonus valued at less than a tenth of their total reimbursement from Medicare, using quality metrics reported two years prior to the incentive payment, and thinking that it will change practitioner behavior seems aspirational. Incentivizing process metrics and clinical practice improvement activities seems to have merit, but clinicians seem better positioned to define the process metrics and improvement activities themselves and incent their care delivery teams to operationalize them. Meanwhile, the federal government seems best suited to craft a measurement system for an optimal combination of quality and cost outcomes and a timely incentive program to reinforce those behaviors.

Resetting legislation and the associated rules to motivate our nationwide healthcare system to be the world-recognized leader requires understanding of granular outcome goals, prescribing fewer actions around how provider organizations function to give room for innovation, and aligning incentives that facilitate competition and reward successful attainment of the ultimate cost and quality goals.

If Trumpcare — whether a revision of Obamacare or something wholly different — can shift the role of the federal government to defining targets and driving the healthcare industry with incentives to reach them, American ingenuity, resourcefulness, and competitiveness will take over like never before and attainment of quality and cost containment goals will follow.

E. Todd Bennett is healthcare market leader for LexisNexis Risk Solutions.

Readers Write: Not Just Ransomware: Common EHR Threats You Need to Know

Not Just Ransomware: Common EHR Threats You Need to Know
By Robert Lord

It is no secret that data breaches are becoming more common and increasingly more expensive. New threats to patients’ electronic health records (EHRs) are constantly emerging, forcing healthcare organizations to be on the lookout for potential dangers so they can eliminate threats quickly. It is important for organizations to understand the array of potential threats to the EHR, allowing them to make decisions on how to best protect this sensitive data.

After talking with healthcare stakeholders inside hospital systems, the federal government, etc., and distilling themes that continually come up, I thought it would be useful share what I’ve learned.

Think Twice Before Opening That Email — Phishing and Social Engineering

Phishing scams represent a very real danger to EHRs, but they are often overlooked by healthcare organizations because they assume such threats cannot break through their security. Phishing scams are email or social engineering attacks that try to appear legitimate in order to get healthcare employees to release patients’ sensitive medical information. Such attacks often use email or website scams to either target patients’ information directly or to obtain an employee’s username and password, thereby gaining access to that organization’s entire EHR.

Just recently, a phishing email disguised as official OCR Audit communication about Phase 2 Audits went out to healthcare organizations. Thankfully, it was only a misguided attempt at marketing for a cybersecurity firm, but it could have been much worse. In December 2014, an employee of Seton Healthcare Family opened a scam email. The resulting breach released the medical record numbers, Social Security numbers, insurance information, demographic information, and clinical data of 39,000 patients.

Nevertheless, even if phishing attacks are not the cause of a breach, they can still represent a threat. After the massive breach of Anthem Inc., for example, affected patients began receiving scam emails that promised them free credit monitoring, thus demonstrating that phishing attacks remain a threat even in the wake of a data breach.

Star-Studded HIPAA Violations Can Be Costly — VIP Patient Privacy

The temptation to peek at the medical record of a celebrity or public figure represents a real threat to patient privacy. VIP patients deserve the same right to privacy as the general public, and steps need to be put in place to guarantee that their sensitive information is kept safe and the treating medical facilities out of the headlines.

In 2011, UCLA Health System came to a settlement with the federal government, agreeing to pay $865,000 after two unnamed celebrities alleged that UCLA employees had viewed their medical records without authorization. Two years before that, in 2009, California health regulators fined Kaiser Permanente $250,000 after some of its employees looked at the medical record of Nadya Suleman, the famous mother of octuplets. Unfortunately, there are many other examples of employees being fired or healthcare organizations being fined because they did not protect the privacy of their VIP patients.

The Family Doesn’t Need to Know Everything — Snooping Threat

The desire for relatives, friends, or even co-workers to snoop into patients’ records often result in messy – and costly – data breaches. In 2013, a nurse accessed the records of her nephew’s partner without authorization and saw that her nephew’s partner had given birth to a baby and put the child up for adoption five years earlier. The nurse then announced the news at a family funeral. After the victim sent a complaint to the hospital, the nurse was terminated and gave up her Florida nursing license.

A similar lawsuit involving Aspen Valley Hospital District and a former employee is currently ongoing. A former employee of the hospital, who was also a patient there, alleged that several employees of the hospital violated his privacy when they disclosed that he had HIV “as a piece of conversational gossip over drinks.” The unnamed patient is currently seeking an apology, compensatory damages, punitive damages, and attorney fees from the hospital. These are but two examples of how devastating these seemingly small breaches can be to the affected patients.

The Biggest Threat to Patient Privacy is Hiding in Plain Sight — Insider Threat

Some of the most dangerous threats to EHRs are criminal insiders. In this type of attack, an employee of a healthcare organization steals patient information from the inside, using his or her access to do so. Earlier this year, Jackson Healthcare Systems found out how dangerous these threats can be the hard way. In February, the health system reported that one of their employees had gone “rogue” and stolen the information of 24,000 patients over the course of five years. The stolen information included names, birth dates, home addresses, and Social Security numbers. As the Jackson Healthcare Systems example demonstrates, these breaches are so dangerous because they are so difficult to detect. In this case, it took five years before the organization was able to identify and eliminate the insider threat.

Business Associates and Contractors

Business associates and contractors within healthcare organizations represent a growing vulnerability for the EHR, especially in recent years. The US Health and Human Services (HHS) established the Omnibus Rule in 2013, which required the business associates of healthcare organizations to adhere to the HIPAA Rules. Unfortunately, there is still much work to be done to address this vulnerability.

In July of this year, Catholic Health Care Services, a business associate for six skilled nursing facilities, agreed to pay $650,000 for HIPAA violations after a mobile device was stolen. The data breach affected 412 patients. Moreover, this is not an isolated incident; according to a report from Protenus and DataBreaches.net, 30 percent of all data breaches in the first eight months of this year involved a business associate of a healthcare organization. In other words, 4.5 million patients have been affected by data breaches of third parties thus far in 2016.

Lost and Stolen Devices

One final threat to EHR is lost and stolen devices, including laptops and mobile devices. If the information on the lost device is not encrypted or the encryption is not working, all someone has to do is open the device and look at the information for a breach to occur. And if the device was stolen, the criminals do not even have to decrypt the information for them to be able to use it.

One example from this year involves Seim Johnson, an accounting and consulting services company. In February 2016, Seim Johnson reported to HHS that a laptop had been stolen. The encryption on the laptop malfunctioned, exposing the private information of almost 31,000 patients. And these types of breaches are becoming increasingly frequent, with Verizon’s 2015 Data Breach Investigation Report stating that 45 percent of all healthcare data breaches are the result of stolen devices.

Knowledge is Power

As more and more healthcare organizations make the switch from paper to electronic health records, it will become increasingly important for organizations to be able to protect their patient records. Of course, this also means that threats to EHR will become more varied and more sophisticated. Healthcare organizations must be well informed about the different types of threats that exist so they can put security measures in place to effectively combat them, and ultimately protect the privacy of their patients.

Robert Lord is co-founder and CEO of Protenus of Baltimore, MD.

HIStalk Interviews Hemant Goel, President, Spok

Hemant Goel, MBA is president of Spok.

Tell me about yourself and the company.

I have been in healthcare IT for over 30 years. I’ve worked for some large organizations, EMR providers, and I’ve worked for imaging solution companies as well. I joined Spok two years ago.

I’m very well conversant with all of the IT challenges for CIOs and hospitals and how it helps them. How IT has helped in patient care from "To Err is Human" to where we are now with Meaningful Use and all the advancement that has taken place in contributions of healthcare IT and helping clinicians out.

Spok is a player in healthcare IT, where we provide critical communication. Things that EMRs or other systems don’t do. This is fast paced, where minutes count in getting hold of nurses, physicians, alerts, codes, and who’s on call. Our mission is to provide critical communications in a timely basis to the right people so they can react to the situation.

Biomedical devices have evolved into IT or informatics systems. Will messaging follow that same path?

Pagers are going through a transformation as the messaging industry itself changes. Encrypted pagers are out there, two-way pagers, alpha-numeric. There has been an evolution of pagers. They have their own network. They don’t rely on the cellular networks like Verizon, AT&T, and Sprint kind of networks. They are their network with broadband and low frequency, so they are more reliable.

The change is that smart phone and the smart messaging technology are taking over, but reliability is still an issue. Oftentimes you say, I sent you my message, did you get it? They say, I didn’t see anything and the phone has been sitting right here. Those are some of the things that have to get better. When reliability improves, smart phones and smart messaging apps are the future. But pagers have a place right now.

The second thing is that for some employees – like cleaning staff or food staff — hospitals cannot give them smart phones because they are too expensive. Pagers are very convenient and suffice for them. We’re finding that there is a shift in pagers to the organization employees that are more staff. Pagers can help, they’re secure, and they maintain privacy.

There are also physicians who are not willing to give up the pagers. Just like if you go back to the imaging and PACS days, it took a long time before radiologists gave up film even though PACS systems were ready. Eventually it happened. That’s exactly what’s going to happen with pagers. Eventually the technology and reliability in messaging using smart phones and cellular coverage and Wi-Fi is going to be so much better that pagers will disappear. But I think that we are at least eight to 10 years out.

What kind of documentation of messaging activity and proof of delivery do hospitals need?

It’s a combination of both hospital and vendor-provided technologies, including carriers. One of the things we find is that hospital Wi-Fi coverage and overlap coverage is very important. It has to be there and coverage well tested.

On the technology side, I’ll give you a simple example. When I fly out of Minneapolis, there’s airport Wi-Fi that my phone picks up because I do it every day. If I don’t accept the terms and conditions, it kind of gets stuck there. When I don’t get an email after a while, I realize I did not accept terms and conditions. My phone is stuck because it’s defaulting to Wi-Fi data pickup as opposed to my cellular data pickup.

We are working with the providers and technologies to say, is it possible that if I subscribe to it in a way that says if my Wi-Fi is there but I’m not receiving data, switch to cellular and inform me that messages aren’t coming through based on some of my activities that I would expect. It’s a combination of us as vendors, infrastructure providers like cellular companies and their coverage, and of course Wi-Fi coverage inside the hospital. All three of them are advancing and they’ll get better and that will make a big difference in the reliability.

I read that cell phones are used a lot more for text messaging than for making or receiving voice calls. Does that provide any lessons learned for your business?

Millennials rely mostly on messaging and very little on voice calls. I’ve got kids who are millennials and they have WhatsApp and Facebook Messenger. I can’t tell you when they decide to use what, but they use both of them. Being  curious in the IT world myself, I’m trying to figure out the pattern as to what prompts them to use which one and where.

What we have found is that for some reason, messaging applications are more utilized. Texting is more utilized. It catches attention to respond right away in the transactional moment better than if you were either to send an email or have a phone conversation. One of the reasons for the demand for messaging applications is people saying, if I have an email or task that’s important or urgent, can you also text me? They respond to that much better.

I guess there is a human factor or psychology involved, but that is indeed true. People respond to messaging and texting and they are using it more for quick, urgent transactions and not emails and phone conversations that much.

Isn’t that phenomenon a technical validation of the pager model that people dismissed as primitive? The messages are once again asynchronous and text-based, with the only real difference being that they’re now sent and received on phones instead of on two-way dedicated pagers.

Sure, but it’s the consolidation of devices that drove it. Pagers were only doing paging. You couldn’t make a phone call on them. You had to look at the pager then you had to pick up the phone. Now you can look at a pager, send a  text message, and make a call to you without having to switch my devices.

The whole world of healthcare IT is about efficiency, quick access, integration, interoperability, single devices, what everyone would want. We have also found that the saturation is more than 100 percent of devices because most people now are starting to have two smart phones, professional and personal.

But you are right that at the end of the day, it’s going back. But because you can do more with your phone and more with the app and while pagers were just doing paging, the shift is there. For physicians, nurses, and emergency responders, pager reliability is still a reason to pick it up.

Is secure healthcare message a commodity? What are the differentiators?

I’ll broaden this a little bit because a lot of CIOs and CMIOs in my network have that question, too. You get secure messaging from IMessage. WhatsApp recently put up secure messaging. There are consumer applications that do secure messaging, but they don’t do it in the context of healthcare.

Now there’s a healthcare cadre of application providers that provide secure messaging, Spok being on of them. How do you differentiate yourself? The way we are approaching messaging is that messaging is one aspect of critical communication. It’s not just for physicians and nurses. Critical alerts are another one of them. The care team coordination, to help a patient get better — that’s what everyone is driving towards.

We will all eventually arrive at the same place, just like the EMR companies did. Cerner, Epic, Meditech, Allscripts, and McKesson all had their departmental solutions and eventually became a unified electronic medical record that everyone is driving towards. You hardly find any standalone pharmacy systems now. It just won’t happen with the advent of patient safety and Meaningful Use.

There are messaging companies that do messaging for physicians or for nurses. But eventually a critical communication that encompasses all stakeholders and role-players — physicians, nurses, patients themselves, family engagement like Meaningful Use talked about, the Affordable Care Act, plus other staff engagement and clinical engagement — all that should happen in a single platform with directory accessibility to drive efficiencies and clinical outcomes.

That’s what we believe and that’s what our drive is. Not just messaging for one stakeholder, but critical communication across the entire spectrum for all role-players. I believe everyone will end up there. Then, who’s got a good mousetrap?

What is the hospital demand for EHRs and other transaction systems to drive and document communication directly instead of requiring users to send messages manually?

Interoperability is going to be huge. You mentioned earlier that texting is more common than phone calls or emails. Electronic medical records initiate some things and we should be prepared as a technology to take that initiation and convert that into transactional messages that are needed.

On the flip side, sometimes our transactional messages can drive some of the things happening in the EMR, which is a system of record. We are a transaction in time that occurs. It can be driven by an EMR or we can help drive the EMR based on certain events. When there’s an emergency and there’s an ambulance coming in to the ED, nobody has the time to sit around and take a look at the EMR. You’re stabilizing the patient, you’re calling folks out, you’re calling the doctors, and codes are being initiated.

That’s where companies like Spok come in. The code message has to go to the right nurse, right physicians, and everyone has to come there. You don’t have time to sit down or the luxury to go research or pull up all the things that are happening in the system of record. That’s a clear example of how a messaging or a paging of those kinds of transactional systems can drive the EMR. Then you can go back and do your documentation into those.

Then there are situations in a hospital where you’re in the ICU or in other areas where the EMR can drive a text message to say the patient needs to be taken to radiology. Or there’s an urgent situation and you send a code out and everyone has to show up there.

You can have both sides of the equation. Interoperability is key to make sure we provide an open enough systems that those workflows are well accounted for.

What kind of hospital communications issue negatively impact patient satisfaction?

The biggest one we hear is alarm fatigue. The alarm annoyances in the quiet hospital — which is a big hospital initiative – is one of the most important areas when you’re in the acute care setting.

The second one is waiting on staff. Lots of times you’re waiting on somebody to show up. The care teams are big and there are lots of people and you are not sure who is coming to see you when. Something as simple as you’re ready to be discharged and you know you’re going to be discharged, but it takes three hours while you are waiting on someone to come in and say, "Yep, you’re good to go." That’s a problem. Many other things, but noise and wait times are the two biggest areas that we believe need to be addressed.

A quick text message that says, "You have discharged the patient, everything looks good, here is the discharge order that we can text securely” is a great way to get the patients out and get them feeling better about going home. As alarms thresholds go off or they are about to go off, it can alert the nurse and they can come and take a look at it, that’s even better. That’s a couple examples of how patient engagement and patient satisfaction are going to be hit directly by these kind of technologies.

Do you have any final thoughts?

It’s a great time to be in healthcare. The country and our healthcare system is going through a massive change. It’s always pivoting and changing, and for the better. The infrastructure of healthcare IT is in place, EMRs are in place. Now we have to take it to the next level of wellness and outcomes that are preventive healthcare and make our experience even better and better as the population gets older. I am very delighted to be in this field, have been for 30 years. I have seen a tremendous amount of changes. I’m glad to be a part of contributing to the way we treat patients and how we make lives better. It’s a good place to be.

Morning Headlines 12/12/16

Wireless-Life Sciences Alliance (WLSA) Combines Operations With The Personal Connected Health Alliance

HIMSS-owned Personal Connected Health Alliance merges with the Wireless-Life Sciences Alliance. Both organizations focus on promoting the use of technology in improving health and wellness.

21st Century Cures and the Road Ahead

John Halamka, MD presents his thoughts on the 21st Century Cures Act in a recent blogpost.

Partners posts $108m operating loss, its largest

Boston-based Partners Healthcare posts a $108 million operating loss, its largest in 22 years, despite a seven percent rise in revenue. Partners attributes its losses almost entirely to it low-income families and individuals on the state’s Medicaid program.

NIH competition seeks wearable device to detect alcohol levels in real-time

NIH launches a design competition with a $200,000 first place prize that challenges hardware developers to create a wearable that can actively monitor blood alcohol levels.

Monday Morning Update 12/12/16

Top News

The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.

PCHA — formed in 2014 by Continua Health Alliance, mHealth Summit, and HIMSS – merged with the Partners Connected Health Symposium in October 2016. 

PCHA’s Connected Health Conference, the former mHealth Summit, kicks off today (Monday), but its speaker star power seems to have dropped off considerably since I saw Bill Gates there in 2010. Here’s what I had to say about the mHealth Summit when I attended in 2013, which anyone attending this week’s show is welcome to compare and contrast:

I felt as though I had intruded on a geeky academic conference in 2010 … Presentations back then were often about public health projects in Africa, government informatics research, and government policy … I felt somewhere between virtuous and bored being there. HIMSS, as it usually does, put all of that unsexy and unprofitable subject matter almost out of sight. Now the conference is a freewheeling ode to capitalism showcasing companies willing and able to pay big bucks for space in the exhibit hall and in the endless number of HIMSS-owned publications. The exhibit hall is like a downsized version of that at the HIMSS conference and most of the educational sessions are either about companies or feature vendor people as presenters or moderators … HIMSS seems to be positioning the mHealth Summit as the minor league of its conference portfolio. Most of the small mHealth exhibitors will be toast in a couple of years, but those who survive will graduate to the big show, the HIMSS conference … The same issues dominated this year as in 2010. Nobody’s really sure what mHealth is, basically punting off by saying anything that runs on a smart phone must be, which means the subject matter is entirely unfocused and confusing. Startup companies keep trying to convince each other that they can hang on long enough to be bought out. Everybody fervently believes that mobile apps and brash startup spirit can transform the US healthcare system into one that’s cheaper, more health-focused, and more consumer driven. It’s always easy for me to be cynical and dismissive, but especially so at the mHealth Summit.

Reader Comments

From FlyOnTheWall: “Re: SPH Analytics. President and CEO Al Vega is out and the VPs, SVPs, and enterprise teams are all gone.” Unverified, but Vega’s bio has been expunged from the executive page and four of the eight execs listed on the August 2016 cache of the page are equally invisible. Vega’s apparent replacement, J.T. Treadwell, is a money guy who sits on the board of half a dozen companies. I didn’t recall having heard of SPH Analytics, having mentioned them just twice in HIStalk, once for hiring someone and another for choosing an underlying technology.

From The PACS Designer: “Re: CDI with ICD-10. With the launch next month of ICD-10 Procedure Codes, the increased specificity of ICD-10-PCS Clinical Document Improvement will give procedures much improved descriptions of what treatments a patient has endured. For example, a patient having a two stent insertion procedure would have the following ICD-10 Procedure Coded recorded: 02710D6 Dilation of Coronary Artery, Two Arteries, Bifurcation, with Intraluminal Device, Open Approach. This more specific ICD-10 code replaces 5 ICD-9-CM codes which are 36.03,00.41,00.44,00.46, and 36.06. As one can see, ICD-10 is a big improvement over ICD-9.”

From Smelly James: “Re: IBM. Putting itself at the feet of Donald Trump with several healthcare mentions. It wasn’t shy about suggesting future business interest with the VA. This letter will fit well in future RFP protests.” IBM CEO Ginni Rometty apparently congratulated Trump right after the election, suggesting six areas in which IBM could support his political agenda, including a cognitive computing system for the VA. She also dropped not-so-subtle hints that IBM would appreciate his proposed changes to a “punitive” tax system in which IBM’s $68 billion offshore cash stash would be taxed at a Trump-proposed 10 percent vs. the current rate of 35 percent in bringing it into the US, saving the company (and costing taxpayers) $13.6 billion.

From Rural HIT: “Re: Smith County Memorial Hospital and Family Practice. Went live on Cerner, the first of 25 critical access hospitals in the Great Plains Health Alliance switching to Cerner CommunityWorks.” The internal announcement suggests that the hospital was using Siemens Soarian and was steered to Millennium by its new owner Cerner.

HIStalk Announcements and Requests

Most poll respondents are interested in the most significant international health IT news stories. Mobile Man says it’s hard to make comparisons since other countries have different payment models, while Susan is interested because we in the US think we have the best healthcare in the world but really we excel only in spending the most. HIT Geek summarizes, “Innovation has no nationality.” New poll to your right or here: how do you expect your healthcare spending (including insurance premiums) to change in 2017 vs. 2016?

Thanks to Jenn for covering my little pre-Christmas break last week. I waded deep into some HIStalk website technology catch-up when I returned, with some tricky upgrades to newer versions of PHP and other stuff that will hopefully make the site more stable and secure.

I was chatting with someone about terrible singers who still have managed to create hugely successful singing careers – the names that came up included Neil Young, Bob Dylan, Willie Nelson, and Rod Stewart. That doesn’t even count those warblers who sound passably good only through audio techno-trickery. One who could carry a tune, though, was Emerson, Lake, and Palmer’s Greg Lake (also of King Crimson), who died last week at 69. We lost two-thirds of ELP in 2016 with the suicide of Keith Emerson, leaving just P and ensuring that their collective demise will be alphabetical.

Listening: a new cover of the telethon chestnut “You’ll Never Walk Alone” from Massachusetts celt-rockers the Dropkick Murphys.

We provided 21 sets of headphones for Ms. S’s elementary school class in Tennessee in funding her DonorsChoose grant request. She teaches math and science to two classes totaling 44 students and says the classroom sounded like an arcade as students used the Chromebooks for assigned exercises, but now it’s quiet and they can concentrate.

Donations from reader Laura and Direct Consulting Associates, plus matching money, fully funded these DonorsChoose teacher grant requests:

• An amplifier and microphone for Ms. L’s high school class in Center Line, MI
• Two Chromebooks for the seventh grade math class of Ms. F in Phoenix, AZ
• Two tablets and headphones for the kindergarten class of Ms. W in Los Angeles, CA
• A library of 26 science books for Mrs. G’s first grade class in Saint Paul, MN
• A greenhouse set for Mrs. M’s high school class of severely mentally and physically handicapped students in Elyria, OH
• Eight tablets for reading and math listening libraries for Ms. B’s kindergarten class in Kansas City, MO
• A 9×12 reading circle carpet for Mrs. V’s first grade class in Seagoville, TX
• A document camera for Ms. B’s second grade math class in Phoenix, AZ
• 15 sets of headphones for Mr. S’s second grade class in Yonkers, NY

Ms. W sent a note saying, “Your kindness and generosity bring tears to my eyes! I love telling my students how amazing and kind people all over the world donated and funded our projects so we can have fun learning and be successful in the future. Then, I remind them when they have accomplished that to remember to pay it forward. For now they will learn how they can help protect our environment with the tablets!”

Last Week’s Most Interesting News

• The Senate passes the 21st Century Cures act, which includes healthcare IT provisions related to interoperability, privacy, and security.
• Entrepreneur Sreedhar Potarazu, MD, founder, chairman, and CEO of the now-defunct business intelligence vendor VitalSpring Technologies, pleads guilty to defrauding shareholders of the company by hiding its tax liabilities, overstating its financial condition to the tune of $30 million, and falsely telling investors that the company was on the threshold of being sold for a profit.
• CompuGroup Medical ends discussions about a possible takeover of Agfa.
• Epic’s quality assurance employees again sue the company claiming they were misclassified in being ineligible for overtime pay.
• China-based Apex Technology completes its acquisition of Lexmark, renaming its enterprise software group (which includes the former Perceptive Software) as Kofax and announcing plans to sell it.

Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.

Here’s the recording of last week’s webinar titled “Get Ready for Blockchain’s Disruption.”

Acquisitions, Funding, Business, and Stock

Asset monitoring vendor Emanate Wireless raises $1.5 million in angel funding.

Health coaching app vendor Vida Health raises $18 million in a Series B funding round, increasing its total to $24 million.

Sales

Rusk County Memorial Hospital (WI) chooses Harris Healthcare Affinity ERP.

Los Angeles County Department of Health (CA) selects Allscripts EZCap for benefit management.

Decisions

• Cogdell Memorial Hospital (TX) will go live on Cerner in 2017.

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

People

Ed Park will join Athenahealth’s board following his previously announced resignation as EVP/COO that takes effect December 31.

Steve Holmquist, industry long-timer and SVP of new client development at Allscripts, died on November 29, 2016 in Phoenix, AZ. He was 55.

Announcements and Implementations

New Zealand primary care provider Pegasus Health chooses Canada-based Intrahealth as its patient management system vendor of choice, ruling out Epic due to its cost.

Government and Politics

John Halamka summarizes the health IT impact of the 21st Century Cures act. He seems mostly positive, but is concerned about the effort required of EHR developers. His highlights:

• ONC’s HIT Policy Committee and HIT Standards Committee will be merged into a single HIT Advisory Committee.
• HHS is charged with developing voluntary certification of health IT for medical specialties and sites where the technology isn’t available or is not mature.
• Vendors are prohibited from information blocking, are required to publish APIs, and must provide HHS with performance documentation. HHS is empowered to reward or punish performance as appropriate.
• New interoperability, security, and certification testing criteria will be developed and ONC will get $15 million to support them.
• HHS will develop or support a trusted exchange framework and ONC will publish an annual list of health information networks that are capable of using it.
• Vendors must be able to exchange data with registries and will be treated as patient safety organizations for reporting and conducting care improvement activities.
• The GAO will review ONC’s work on patient matching.
• The GAO will conduct a study of the ability of patients to review their own PHI.

NIH issues a challenge to develop a wearable sensor that can measure blood alcohol levels in real time, offering $200,000 for the first-place prototype and $100,000 for second place. The sensor would help researchers study alcohol use disorder and related conditions without relying on questionably reliable self-reported drinking data.

Privacy and Security

Fortified Health Security releases a review of 2016’s significant cybersecurity issues and its outlook for 2017.

Other

EClinicalWorks issues a curious patient safety announcement about its EHR as part of its “ongoing effort to respond to and minimize such risks,” suggesting that users:

• Pay attention to the company’s patient safety notices and apply available patches and upgrades
• Update their Multum or Medispan drug databases
• Designate a patient safety officer as ECW’s patient safety liaison
• Confirm that orders are accurate and encourage patients and their families to do the same
• DC and re-enter changed medication orders rather than modifying the existing order.
• Limit the use of custom medications
• Report any patient safety concerns or unexpected software behavior to ECW or by filing an ONC complaint.

ONC cited ECW’s announcement as the key item in its email newsletter, echoing the company’s recommendation to iECW’s customers that they apply available upgrades and report problems to the company and via ONC’s complaints website. I asked ONC If the announcement was triggered by a settlement with ECW over some unspecified issue and they said no, but the announcement suggests some kind of problem that raised ONC’s interest.

Partners HealthCare posts its largest operating loss ever at $108 million, most of that coming from its Medicaid insurance division. Partners says it isn’t being paid enough by commercial insurers and government programs to cover its labor and drug costs. Including investment performance that must have been awful, Partners lost $249 million in 2016.

India-based media claim that 280 people have died of grief and shock following the December 5 death of Tamil Nadu Chief Minister Jayalalithaa Jayaram, raising the question (at least for me) of how their cause of death was determined. The political party in power says it will compensate their families and will also pay $750 to a party official who set himself on fire and another who cut his finger off in mourning.  

Sponsor Updates

• Spok publishes a case study of the implementation of its Care Connect Suite at St. Dominic – Jackson Memorial Hospital (MS).
• TelmedIQ earns a 91.4 score in KLAS’s review of secure communications.
• Dimensional Insight earns top scores in 14 KPI categories in BARC’s “The BI Survey 16.”
• The Chartis Group publishes “Election 2016: Implications for Providers.”
• PeriGen’s PeriCalm Checklist is nominated for an Edison Award.
• TeleTracking releases a new podcast, “The Essentials: 2017 Regulatory and Compliance Requirements for Patient Flow.”
• CIOReview names Validic a Most Promising Healthcare Solution Provider of 2016.
• Glassdoor ranks CoverMyMeds and Health Catalyst in the top 50 places to work nationally.
• Verscend Technologies celebrates the 20th anniversary of its DxCG risk adjustment and predictive modeling solution that serves as the foundation of CMS’s hierarchical condition categories.

Blog Posts

• 5 Healthcare IT Trends to Watch in 2017 (PokitDok)
• Meditech’s 6.1 Revenue Cycle Drives Efficiency at Anderson Regional (Meditech)
• New Report Suggests Increased Patient Financial Responsibility Impacts Provider Net Revenue (Patientco)
• The Fourfold Impact of Secure Communication Platforms on Healthcare Delivery (Uniphy Health)
• Health IT’s role in the radiology value equation (Lexmark Healthcare)
• How to avoid peer-to-peer conversations (Qpid Health)
• Considerations When Preparing for a Cardiology Install in 2017 (Sagacious Consultants)
• The Month After … What Does It Mean for Healthcare (Summit Healthcare)
• How Medication History is Creating Value and Improving Care at Health Systems Nationwide (Surescripts)
• 5 Reasons Organizations are Driving Toward Hybrid IT (TierPoint)
• Best Practices to Ensure End-to-End Payment Accuracy in Your Organization (Verscend)
• Simple Communication for Complex Care. (Voalte)
• 3 Lessons for Healthcare Providers on Improving the Patient Experience (West Corp.)
• Preparing for patient financial responsibility and consumer expectations in 2017 (ZirMed)

Contacts

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

Morning Headlines 12/9/16

Expanding Capacity for Health Outcomes (ECHO) Act Requires Exploration of Digital Health Opportunities

The House of Representatives passes the ECHO Act, a bill that will expand telehealth services to remote and underserved communities. The bill will now make its way to the President’s desk for signature.

Former Google Ventures CEO Bill Maris is raising a new $230 million fund to focus on health care

Google Ventures founder Bill Maris announces that he is raising a $230 million investment fund that will focus on health care investments.

Physician Productivity Startup Augmedix Secures $23 Million to Continue the Nationwide Expansion of its Smartglass-based Remote Scribe Services

Google Glass startup Augmedix, which offers remote scribe services to help doctors navigate EHRs and document encounter notes while in the exam room, raises a $23 million investment round.

Fitbit buys smartwatch maker Pebble’s software assets

Fitbit acquires smartwatch maker Pebble’s software and intellectual property. Financial terms were not disclosed, but analysts value Pebble at $40 million.

News 12/9/16

Top News

The Senate passes the 21st Century Cures Act in a 94 to 5 vote, sending it to the President’s desk for signature. The President praised the $6.3 billion legislation Wednesday and confirmed that he would sign it. Sen. Lamar Alexander (R-TN), chairman of the Senate health committee and one of the most ardent proponents of the bill, was understandably excited given that it has been circulating for two years and is considered to be one of most heavily lobbied pieces of legislation in recent memory. It provides money for cancer research; funds mental health treatment and resources to combat the opioid abuse epidemic; helps the FDA speed up drug approvals; and bolsters healthcare technology goals related to interoperability, privacy, and security.

HIStalk Announcements and Requests

This week on HIStalk Practice: Arianna Huffington includes Doctor on Demand in new wellness venture. Banner Urgent Care goes with RCM services from Zotec Partners. Health apps found sorely lacking in privacy precautions and safety standards. Marathon Health upgrades its EHR for workplace health centers. Montana preps for statewide HIE. PPJ Healthcare Enterprises raises $5 million.

Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.

Acquisitions, Funding, Business, and Stock

Google Ventures founder Bill Maris raises a $230 million venture fund dubbed Section 32 (a likely homage to Star Trek’s Section 31 security operation) that will focus on healthcare investments. Maris, who left Google earlier this year, plans to run the fund solo from San Diego rather than Silicon Valley.

Augmedix closes a $23 million round of funding led by new investors McKesson Ventures and OrbiMed. It has raised over $60 million since launching its Google Glass-powered remote scribing service in 2012. Jenn talked with CEO and co-founder Ian Shakil about the company’s plans to move beyond its core services in “Value-based Care Prompts Glass to Grow Up.”

Brentwood, TN-based consulting and staffing firm Vaco merges the newly acquired Pivot Point Consulting and Greythorn – both based in Washington – to form Pivot Point Consulting, a Vaco company. The new subsidiary brings together 50 employees and combines Pivot Point’s EHR implementation and advisory services with Greythorn’s recruitment expertise.

The patent case over CRISPR-cas9 technology, likely the most valuable patent in biotechnology, begins as the University of California argues to have MIT and Harvard’s patent invalidated and transferred to UC. The patent office awarded The Broad Institute of MIT and Harvard its first CRISPR patient in April 2014, during which time it was reviewing UC’s patient, filed in May 2012.

After much speculation, Fitbit buys Pebble’s software assets for an undisclosed sum, though Bloomberg has valued the transaction at less than $40 million. Pebble, which launched via a crowdfunding campaign in 2012, will no longer produce or sell its smartwatches.

Looking to further bolster its diminishing wearables market share, Fitbit also will work with Medtronic to add glucose monitoring to its fitness trackers. Type 2 diabetes patients will be able to combine their Fitbit-generated data with Medtronic’s IPro2 Continuous Glucose Monitoring system, which can send pertinent data to a patient’s provider.

People

Juliana Hart (Verscend Technologies) joins MedCPU as vice president of market development.

Brooke Patterson (FEI Systems) joins health IT and management consulting firm ARDX as SVP of government services.

Cricket Health appoints University of California-San Francisco nephrologists Carmen Peralta, MD chair of its medical advisory board, and Anna Malkina, MD medical director.

Announcements and Implementations

Chicago-based Union Health Service implements RadNet’s RIS, speech recognition, and mammography tracking.

Nemours Children’s Hospital, Seven Rivers Regional Medical Center, and Westchester General Hospital sign up for the Florida HIE’s event notification service, which patient hospital encounter notifications to participating ACOs, physicians, and payers.

Technology

SecureDx.net develops Secure Data Exchange messaging technology featuring two-factor authentication.

Sales

Looking to set up a private HIE, Chicago-based Rush Health chooses HealthShare interoperability technology from InterSystems.

Schleicher County Medical Center and Nursing Home (TX) taps CPSI subsidiary American HealthTech to help it implement technology upgrades to its clinical and business management operations. The company will also provide Medicaid AR management services.

TaraVista Behavioral Health Center (MA) signs on for MedSphere’s OpenVista EHR. The inpatient facility will also utilize the company’s Phoenix Health Systems division for IT support.

Government and Politics

The FBI indicts 21 employees from Forest Park Medical Center (TX), claiming that they paid $40 million in bribes and kickbacks in exchange for referrals to its purely out-of-network health system. Those indicted include owners Alan Beauchamp, Richard Toussaint Jr., Wade Barker, and Wilton Burt; and Jackson Jacob and Andrea Smith, both of whom set up separate shell companies to funnel bribe and kickback payments to surgeons in exchange for the referrals.

The DoD taps Medical Information Network – North Sound to develop and maintain an HIE-like portal that will be accessible in any clinic or hospital within the DoD system. Integration with the department’s new Cerner-built EHR, currently in pilot phase at several bases in Washington, is expected.

The House passes the telemedicine-friendly Expanding Capacity for Health Outcomes (ECHO) Act, which now heads to the president’s desk after receiving unanimous Senate approval last week. Once signed into law, the act will set in motion an HHS study on the feasibility of training providers to expand technology-enabled healthcare delivery in underserved areas.

Research and Innovation

NantHealth makes its Quantum Immuno-oncology Lifelong Trial (QUILT) Programs available via ClinicalTrials.gov. CEO Patrick Soon-Shiong, MD believes making the QUILT trials available through the NIH registry will improve patient access to active and future immunotherapy-based trials for a variety of cancers.

Other

Quite a space oddity: David Bowie treats former astronaut Buzz Aldrin in a New Zealand hospital after Aldrin was rescued from the South Pole after falling ill. The 86 year-old was part of a tourist group that was visiting the Amundsen-Scott South Pole Station through December 12.

Sponsor Updates

• Imprivata will exhibit at the CIO Forum December 8 in Yorba Linda, CA.
• Ingenious Med receives the Emerging Company of the Year Phoenix Award from the Metro Atlanta Chamber.
• Database Trends and Applications Magazine names InterSystems Cache a trend-setting product in data and information management for 2017.
• Kyruus will present at the Carolina Healthcare Public Relations & Marketing Society meeting December 9 in Charleston, SC.
• Liaison Healthcare expands its relationship with London-based reseller partner AK Loman.
• LifeImage releases video insights from RSNA 2016.
• Gartner includes LiveProcess as a representative vendor in its 2016 market guide for clinical communication and collaboration.
• Meditech shares a brief case study featuring Anderson Regional Medical Center (MS).
• Netsmart will exhibit at the Community Behavioral Healthcare Association of Illinois Conference December 12 in Schaumburg.
• Computerworld names NTT Data VP of Digital Experience Lisa Woodley a 2017 Premier 100 Technology Leader.
• Black Book ranks Nuance first in CDI for the third consecutive year, and first for end-to-end coding, CDO, transcription, and speech-recognition technology.
• Health Catalyst receives the 2017 Glassdoor Employee Choice Award.
• Rock Health names Health Catalyst CEO Dan Burton the winner of its annual Most Beloved CEO award for 2017.
• Verscend Technologies publishes a new white paper, “The Evolution of DxCG, the Gold Standard in Risk Adjustment and Predictive Modeling.”

Blog Posts

• Your Breach Response Team May Not Matter … Until it Does (ID Experts)
• Top 5 Success Strategies for Integration Projects (Impact Advisors)
• Prepare Your Hospital’s 2017 Digital Marketing Strategy (Influence Health)
• The Pollsters Were Wrong: What are the Big Data Implications? (Liaison Healthcare)
• Telling Your Front-Office Team, “I’ve Got Your Back!”: Tips for Maximizing Patient Payment Revenue (Navicure)
• Printing Healthcare’s Bright Future, in 3D (Orion Health)
• CHIME 2016 Fall CIO Forum underscores increasing financial pressures in healthcare; need for better analytics (Infor Healthcare)
• Innovations in Encrypted Paging Protect PHI (Spok)

Contacts

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

EPtalk by Dr. Jayne 12/8/16

The FDA is making available its data on adverse events stemming from foods, dietary supplements, and cosmetics. I found it interesting that the coded symptom data contains numerous British English spellings: hospitalisation; dyspnea; diarrhea; and pale faeces to name a few. Pretty unusual for a United States governmental agency. Repeat offenders included the full range of “5-Hour Energy” products; B-complex vitamins; cabbage; and a number of products with the name “cleanse” in their names, which is not surprising to this physician.

I attended a continuing education session this week. Although I learned a lot, it was the first time that I heard so many gambling metaphors in one place. I’m used to hearing sports phrases, but the gambling references were new to many of the attendees. I had the privilege of explaining what “table stakes” were to a newly-minted pediatrician, as well as the meaning of “double down.” I’m grateful to my former partner who once invited me to be part of a ladies’ poker night, which ended up being less about poker and more about wine and catching up. It’s always a good reminder for presenters to consider their audience before including figures of speech. There were also some Yiddish references and some regional slang, which, although entertaining, might have been confusing to some.

The reader mailbag brought quite a bit of correspondence this week. I always enjoy hearing from readers, even if it’s just a “thanks for writing” type comment. Being anonymous and doing most of my work solo while watching “Call the Midwife” can feel pretty lonely, so thanks for the feedback.

From Texas Tornado: “I enjoyed your recent mention on MU reporting. Would text analytics be helpful in this MU attestation scenario? I understand the push to do more discrete documentation, but what if you could report on structured and unstructured data combined? Does it really matter if the data is discrete or not as long as you can report on it?” That type of approach would certainly be appreciated by many clinicians who have been clicking their little hearts out over the last half decade. With most of the EHR-based quality reporting platforms I’ve seen, however, most documentation has to be discrete and in a fairly narrow workflow to “count” for quality measures. Ultimately, as natural language processing evolves, I think we will see more information being transformed to discrete data points; but I’d love to see some other approaches.

From Roaring Waters: “Thanks for your discussion of the need for clinical participation in IT projects. As a vendor selling to the acute care environment, I am always shocked at how often patient care workflow solutions are handed to an IT or non-clinical person to evaluate and determine how it will impact clinical workflow. I know people have been talking about end-users making user workflow decisions for decades, but for some reason these basics of project management are lost. Providers themselves are just as guilty, as I see them constantly passing these decisions off to a non-doc or non-clinical user to make decisions about their workflow and ultimately the patient care they deliver. It’s mind-boggling!” The providers that pass the buck for decision-making are often the first to complain when workflows or solutions don’t meet their needs. Another variation on this that I’ve seen lately is to pass the decision to a clinical representative who doesn’t actually practice or who doesn’t have any real buy-in to the clinical situation at the institution. I’ve been working with a group for nearly a year that has a CMO who constantly criticizes the EHR and demands a move to Epic, yet hasn’t shown up at a single executive briefing or strategy session where the EHR has been discussed. His comments are strictly hit and run via email and one-off conversations with the Board of Directors, which hasn’t learned to say no to his shenanigans. His peers are working hard for solutions and all he does is tear down their work, which is unfortunate.

From Science Guy: “Thank you for your comments about clinical staff having to take ownership of the quality reporting. Having worked in healthcare in both the payer and clinical side … there is a paradigm shift taking place that many clinicians have not come to grips with. That is that the payers are driving more and more of the clinical decisions based on outcome data and not clinical judgment. It is becoming increasingly difficult to practice medicine in a vacuum without using clinical information to justify decision making. Having worked at a University Medical Center, I saw this very plainly as the more experienced physicians struggled with this very topic and resented the IT staff for ‘creating additional hoops for them to jump through.’ I heard the statement more than once that ‘my time is too valuable for this … and my time is better spent healing patients than working on the computer.’ On the other side of the coin, there is a whole new generation of physicians coming out of school that are much more computer literate. They embrace using information from the health record to support their decision making. They realize this information could assist them with their clinical decisions, and all of this data was really just another clinical diagnostic tool to improve care. I guess my point is that like any other change, this current shift will cause a lot of frustration for a lot of staff, but it is certainly not going away. Hopefully many of the more experienced staff will be motivated to change as they see their younger peers embracing this technology and ultimately the patients will benefit from these changes. But hopefully, in the meantime, your information will help with the whole ‘shooting the messenger (the IT staff) mentality.’”

As a young physician working in clinical informatics for the first time, it took me longer than it should have to learn to stop shooting the messenger. Looking back, I realize I was working with a very inexperienced IT staff that had no idea how to work with physicians and didn’t understand how much havoc a poorly-run EHR project could have on a practice. I assumed that since the hospital had contractually agreed to provide me a paperless practice with a functional HER, that they would also provide staff that had the skills to deliver it. Some of the individuals involved in that debacle are now some of my information technology BFFs and we continue to learn a great deal from each other. Whether it was encountering chicken wire in the wall that was interfering with wireless connectivity or having providers install their own black-ops routers under their desks, it was kind of fun working in the early days (read “Wild Wild West”) of health IT.

Have you ever used poultry netting as a drywall patch? Email me.

Email Dr. Jayne.

Morning Headlines 12/8/16

Congress passes 21st Century Cures Act, boosting research and easing drug approvals

The Senate passes the 21st Century Cures Act in a 94 to 5 vote, sending it to the President’s desk for signature. The President praised the bill Wednesday and confirmed that he would sign it.

Twenty-One Indicted in the Forest Park Medical Center Health Care Fraud

The FBI has indicted 21 employees from Forest Park Medical Center (TX), claiming that they paid $40 million in bribes and kickbacks in exchange for referrals to its purely out-of-network health system.

CRISPR court hearing puts University of California on the defensive

The patent case over CRISPR-cas9 technology, likely the most valuable patent in biotechnology, begins as the University of California argues to have MIT and Harvard’s patent invalidated and transferred to UC.

Slavitt: ‘There should be no pride of authorship’ with healthcare reform

During an interview at Modern Healthcare’s 2016 Leadership Symposium, Acting CMS Administrator Andy Slavitt called on lawmakers to focus ACA reform discussions on parts of the law that are not working, saying “If we can improve upon the things that were started in the ACA, we should do it. It doesn’t matter if that comes from a Democrat. It doesn’t matter if it comes from a Republican.”