News 3/8/17

Top News

House Republicans unveil their plan to repeal and replace the Affordable Care Act, which they have named the American Health Care Act. It would:

• Roll back the Medicaid expansion that insures 10 million people
• Eliminate the requirement that people carry health insurance
• Allow large employers to opt out of providing coverage to their full-time employees
• Penalize those who let their insurance lapse and then sign up again
• Replace premium subsidies with income tax credits
• Allow insurers to charge much higher rates to older people
• Change Medicaid from an open-ended entitlement to a per-person block grant to each state
• Repeal the ACA-imposed tax surcharges on insurance companies, drug and device manufacturers, and citizens who earn more than $250,000.

The proposal would continue to prohibit denial of coverage for pre-existing conditions and lifetime caps and would allowing parents to keep children through age 26 on their insurance. It would eliminate ACA-mandated basic coverage provisions, allowing insurers to issue catastrophic-only plans as they did pre-ACA.

Two House committees plan to vote on the legislation without first asking the Congressional Budget Office to perform a cost estimate or to project how many Americans would become uninsured with the changes.

Reader Comments

From Under My Wheels: “Re: Epic’s App Orchard. A former Epic executive tells me that the legal terms of participating give Epic all intellectual property rights to the app. It might seem that they are protecting themselves in case they decide to create functionality that would compete with an App Orchard app. But another perspective is that Epic is taking customer heat for lack of innovation and App Orchard gives Epic a way to look over another company’s innovation and then squash it. It also makes customers happy because they might think they can monetize what they’ve been giving Epic for free. Judy made some big statements about openness through cozy journalists at HIMSS, but App Orchard isn’t as open as Epic would like everyone to believe.” Unverified.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Saturn Care. The company’s clinician-developed, patient-centric CDMP (Chronic Disease Management Program) supports value-based diabetes management for primary care by bringing together EHR and patient data into a single view with risk scoring and decision support tools, allowing care teams to improve both clinical (HbA1c) and behavioral (diabetes stress) outcomes. Patients provide behavioral data via mobile and other tools that the primary care team then reviews via CDMP to improve visit and care management efficiency. The company’s technology was developed with organizations such as UPMC, the VA, and Joslin Diabetes Center and has been clinically validated in an NIH study. It was designed to work within programs such as CPC+ and MACRA, which require measuring quality and cost metrics and for which the ADA guidelines are the best evidence-based means to improve outcomes. Practices can choose between a per-patient, per-month licensing structure or a turnkey services solution. Sign up for their April 12 webinar for more information. Thanks to Saturn Care for supporting HIStalk.

We funded the DonorsChoose grant request of Ms. M in Minnesota, who asked for STEAM-related books for her fourth grade class to use in a book club-like small group exercise. She declares them to be “awesome,” as they are being used in “lit circles” in the class’s unit on sustainability, environmentalism, and conservation.

Interest has been muted (non-existent, to be precise) in my quest for contributors in these areas that I mentioned in Monday’s post. Contact me if you are interested – compensation and anonymity issues can be worked out.

• Experts in nursing, laboratory, and pharmacy IT to provide updates in their respective subject areas at least quarterly
• Someone to write a digital health summary every so often
• An expert in non-US healthcare IT to write a regular summary of what’s going on outside the US
• A leader, provider, or technologist in their 20s or 30s who can represent that point of view

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

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

Acquisitions, Funding, Business, and Stock

Talent management software vendor HealthcareSource will acquire Centricity Contingent Staffing (formerly API Healthcare’s Clearview) from GE Healthcare.

Shares in NantHealth fell 23 percent Monday and another 10 percent Tuesday following a STAT report that describes a high-profile, $12 million gift to University of Utah from founder Patrick Soon-Shiong, MD that came with strings attached – the university had to buy $10 million worth of genetic sequencing services from NantHealth in a “partnership” and also provide patient data to help the company develop a new product. The article also claims that NantHealth misled investors in its November earnings call in claiming that one-third of its GPS Cancer screening tests were purchased by the university, which the university says isn’t true since it only ordered standard genetic sequencing tests that have nothing to do with GPS Cancer. Independent attorneys asked by STAT to review the agreements questioned why the university would sign such an agreement whose wording attempted to avoid the implication of indirect self-dealing, although one was blunt in concluding, “They’re laundering the funds through the University of Utah.” Shares in NH, which closed at $18.59 on their first day of trading last June a few weeks before the University of Utah announcement, have shed 73 percent since, valuing the company at $598 million.

Announcements and Implementations

Allscripts Sunrise, CareInMotion, and 2bPrecise solutions are accepted into NHS London’s procurement program.

WebMD adds health-related topics to Amazon Alexa-powered devices. I tried it today on the Echo – just say, “Alexa, enable WebMD skill.” It’s interesting, although it doesn’t always recognize drug generic names even when it knows the brand names.

Other

A Rand medical claims analysis concludes that employer-offered telemedicine services such as Teladoc offer convenience to users with respiratory infections, but actually raise employer healthcare costs because most of their employees would not have sought care for their self-limiting conditions otherwise.

A new searchable IRS database reveals that non-profit organizations paid 2,700 employees $1 million or more in 2014, with hospital operator Ascension leading the pack in providing $17.6 million in compensation to CEO Anthony Tersigni.

In England, a man who previously served as chair of two NHS trusts and CEO of a hospice is sentenced to two years in prison for falsifying his work history and claimed doctorate, with authorities finally discovering that his job experience was as a probation officer and a builder. The moral of the story is to always verify educational credentials, not so much because having them may or may not be a critical success factor for the job, but rather that you don’t want to hire someone who is willing earn a job by lying.

Sponsor Updates

• The Intelligent Health Association recognizes NantHealth CEO Patrick Soon-Shiong, MD with its Special Recognition Award.
• Meditech participates in the Northeastern University Nurse Innovation and Entrepreneurship Advisory Board, on which EVP Hoda Sayed-Friel serves.
• Besler Consulting releases a new podcast, “Practical steps toward MACRA implementation.”
• Carevive CEO Madelyn Herzfeld, RN discusses the challenges practice face when implementing new patient engagement tech in a new video series.
• CoverMyMeds will sponsor the SPCMA Business Forum 2017 March 8-9 in Orlando.
• The Relentless Health Value podcast features Diameter Health CEO Eric Rosow.
• EClinicalWorks releases a new podcast, “Tips from a Superuser – How to Improve Functionality.”
• Evariant releases a new case study, “Lehigh Valley Health Network: Engaging Consumers and Physicians in Tandem to Drive Revenue.”
• InterSystems features a Q&A with HBI Solutions CEO Eric Widen.
• InBusiness magazine includes Healthfinch VP Leah Roe in its 2017 class of “40 under 40.”

Blog Posts

• Is HIMSS Really Over? (Access)
• Transform how your front office engages with your patients (AdvanceMD)
• Succeed With MIPS: Improve Your Payment Adjustment In 90 Days (Optimum Healthcare IT)
• Population Health: An old-school approach to handling requests of your IT team [podcast] (Nordic)
• Get Moving in the Right Direction (Agfa Healthcare)
• Visions of the Future of Digital Health at HIMSS 2017 (Datica)
• Go For It! Everyone has Their Own Key to Success (CTG)
• Patient Access Throughput: The Strategy to Success (Culbert Healthcare Solutions)
• HIMSS 2017 Recap (Direct Consulting Associates)
• How Do You Succeed in a Value-Based World? Find a Strategic Partner. (ECG Management Consultants)
• The ACA Replacement: How the Views of Trump, Ryan, and Price Tell Us What to Expect (Hayes Management Consulting)
• Three Ways to Observe Heart Health Month Beyond February (Healthgrades)
• Four Focus Areas in Health IT for Care Coordination Workflow Success (Healthwise)

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 3/7/17

House GOP Releases Plan to Repeal, Replace Obamacare

House Republicans release a detailed ACA repeal and replace plan that would eliminate the individual mandate and replace subsidies with a new tax credit tied to an individual’s age and income level.

The HCI Group to Expand Its Technology Offerings

Mumbai, India-based IT services firm Tech Mahindra will acquire Jacksonville, Fla-based The HCI Group for $110 million.

How the world’s richest doctor gave away millions — then steered the cash back to his company

NantHealth stocks fall 23 percent following a STAT investigative report that found CEO Patrick Soon-Shiong publically donated $12 million to the University of Utah for a genetics research project, but mandated within the grant’s contract that $10 million be funneled directly back to NantHealth.

Missouri drug monitoring would combat abuse

Following increased pressure from neighboring state legislators, the Missouri state Senate passes a bill establishing a prescription drug monitoring program.

Delivery System Innovation

Health Affairs dedicates its March issue to innovation in care delivery, including a more than a dozen papers on the net benefits associated with specific delivery system innovations.

Curbside Consult with Dr. Jayne 3/6/17

Jayne Goes to the Hospital

You may have surmised if you follow my Twitter postings that I recently spent some time in the hospital, but not in a patient care capacity. It was one of those unplanned, middle-of-the-night type of events that no one ever wants to happen to them.

Of course, the chain of events might be different when you’re a physician. You sit at home wondering if you are over-reacting and generally second-guessing yourself. At one point, I found myself in severe pain, wondering if I could hang in there until my urgent care opened at  6 a.m. rather than risking the emergency department during flu season. When those thoughts start to cross your mind, it’s definitely time to go.

Based on my symptoms (including the fact that the pain was so bad I couldn’t bend over to put my own socks on), I had a sneaking suspicion that I was going to end up with surgery, so I grabbed my travel necessity bag and threw it in the back seat of the car. That’s the advantage of being a frequent traveler, but you never want to be that patient who rolls into the triage area with an overnight bag, so I left it in the parking lot, perhaps as wishful thinking.

My worries about being in the ED during flu season were unfounded and I wound up being the only person in the waiting room. Registration was a snap since I had my insurance card and photo ID at the ready, wanting no barriers between myself and some serious pain medication. I had to endure five minutes of bad late-night TV (some dating show involving “baggage” that was truly, truly horrid) and was called back.

There are times when you are sick, especially when you are a healthcare provider, when you wonder if you’re over-reacting to what you fear might be going on. I knew when my blood pressure was in the 160s/100s range with an elevated heart rate that whether or not my brain was over-reacting, my body most certainly had an issue with what was going on.

The ED physician ended up being the spouse of one of my urgent care colleagues, who fully appreciated what it means when a physician rolls into the ED in the middle of the night when they’re supposed to be working that morning.

Tests were ordered and an IV was started. After receiving some pain medication, I very quickly understood why people abuse it. The phrase “magic carpet ride” doesn’t begin to describe what it feels like when you see the privacy curtain flowing to the left and the door jamb scintillating off to the right side of the room.

I was pleased that my pain immediately went from 10 to 2, but even more grateful that my blood pressure and heart rate started moving more towards normal as I rolled off to get my CT scan. Once those results were back, the physician returned to complete a more thorough history and physical to prepare my admission documentation.

This time he had a scribe, or at least who I thought might be a scribe since we weren’t properly introduced. Normally I’d make a point of saying something, but I was still surfing on my cloud of Dilaudid and just wanted to know what the plan was and call my COO so he could find someone to cover my shift that was supposed to start in four hours. I was totally ruminating on that detail because I didn’t want to be “that doctor” who just doesn’t show up.

There was a parade of different nurses through the room. I received some antibiotics and some different pain medication. Then it was off to the inpatient unit to wait for the surgeon to meet me before I was whisked off to the operating room.

I received a room assignment on a brand new wing (confirmed by the new paint smell) and arrived right before shift change. Both the outgoing and incoming nurses were wonderful, explaining everything that was going on and letting me know when my next doses of antibiotics and pain medication were due. The outgoing nurse got a chuckle out of administering my intake questionnaire since I knew the answers to all the race, ethnicity, blood product acceptance, and cultural pain practices questions before she was even done asking them.

I was trussed up with DVT-preventing sequential compression leggings so I didn’t get a blood clot. Thankfully, she showed me how to disconnect myself so I could get to the restroom without having to call for help. I guess there are some benefits to being a physician.

The surgeon came by promptly and said he wanted additional confirmation of the diagnosis in the form of an ultrasound, which was performed immediately at the bedside. You know when you’re in trouble when the ultrasound tech takes a bunch of extra pictures even if you can’t see the screen.

Not more than 20 minutes after the test was done, the nurse came in to announce that they would be coming to take me to the operating room sooner than later. She was followed by a patient care tech bearing a couple of packets of pre-op scrub wipes, who dropped them off with instructions on what to do.

By this time, I had non-medical family at the bedside. They were shocked that the staff would expect the patient to do their own pre-operative prep. I’m no expert on pre-surgical care, but I’m hoping if the patient wasn’t a relatively healthy and mobile person that they would assist a bit.

I went quickly to the operating room after that, rolling out the door while reminding my family where to find the healthcare power of attorney and living will if something went wrong. I didn’t have time to get a copy before then, but you can bet that it’s in my Dropbox now. I had my noon dose of antibiotics in my lap since it would be due while I was downstairs and my nurse didn’t want them to be late.

The weekend operating room staff was excellent. I woke up feeling like no time had passed and with all my teeth still where they belonged. I’ve always been afraid of general anesthesia and having my teeth messed up during the intubation, so it was the first thing I thought of. In hindsight it’s pretty weird, but healthcare people think of all kinds of weird things based on what we’ve seen. I had a happy little pillow from the hospital auxiliary tucked under my blanket to brace myself with in case I had to cough and was back in my room in a flash.

The next shift change signaled a change in the level of care I received. As the nurses rounded together, the incoming nurse commented about me deciding to “self-discontinue” the DVT-prevention leggings. Since I had just come up from the operating room and hadn’t left the bed yet, I had no idea what she was talking about. I still had the leggings on, but it turns out someone removed the controller and inflation tubing from my bed when they took me to the operating area. It didn’t occur to me in my post-anesthesia haze that they weren’t connected to anything. Blaming the patient for a process issue isn’t a good way to start a patient care relationship.

From there, things trended downhill. What I did have was a lovely private room with a (no kidding) 60-inch flat screen television and dietary staffer who personally went through the menu options with me for dinner and breakfast. What I did not have was timely antibiotics and pain medication or consistently visible handwashing or foaming. I also did not have a functional IV access site and had to argue to have it moved when it was oozing enough blood that it was leaking out of the dressing and onto my hospital gown.

It turns out that due to staffing and census issues, my nurse was split between two hallways. What that translated to was feeling like I wasn’t getting good care and that I was last on the list. I know hospitals are busy places and there probably were patients sicker than me, but when I’m on scheduled medications, I’m not giving you more than 15 minutes grace before I ring the call button. I was close enough to the nursing station that I could hear the call signal sounding at the desk when I rang it. I could also hear when it went into “alert mode” because it hadn’t been answered by the first-tier response time. Eventually a patient care tech answered and said she would contact my nurse, who didn’t come in.

This cycle repeated every 15 minutes until my antibiotics finally arrived. The nursing staff was equipped with Vocera two-way communications lavalieres, so there was really no excuse for lack of communications while I waited for my antibiotics to arrive over an hour and 15 minutes late.

Although she was apologetic and said she’d return in 30 minutes as soon as the infusion was over, she did not. That led to another 30 minutes of call light and alarming IV pump nonsense until someone came to the rescue.

By now it was 11 p.m. I was due for scheduled pain medication at midnight, but I was honestly afraid to go to sleep because I knew I couldn’t count on getting medications when they were due without being a call-light stalker. By this point, I wasn’t taking any narcotic pain medications, just scheduled NSAIDs, and I wanted to keep it that way. It’s a terrible thing for a patient to be afraid to sleep for fear they won’t get their meds.

As predicted, they didn’t arrive on time, leading to another 30 minutes of call-light tag before they arrived. She was happy to offer narcotics for breakthrough pain, but if a patient is doing well on scheduled meds and gets them on time, there shouldn’t be any need for breakthrough treatment. Needless to say, we had a few words about the timing of the medications.

I was finally able to sleep for about four hours, although it was restless sleep with the anti-DVT leggings pumping up every 30 seconds despite the fact that I had also received heparin shots for clot prevention and was ambulatory. The phlebotomy started at 5 a.m. I dozed a bit until vitals at 5:30. Surprise, after the last “conversation” with my nurse, my medications arrived promptly at 6 a.m.

I knew there was a good chance I’d be discharged that day, so I decided to wash up, throw on some mascara to look less pathetic, and make arrangements for a getaway car. Many surgeons round early and I was crossing my fingers for that kind of schedule. I was feeling really good, and after my Garmin registered 500 steps in the room and the administration of a second heparin shot, I decided the annoying DVT leggings really could come off.

Back when I was still delivering inpatient care at this hospital, we made a big deal about the discharge day and discharge planning and making sure the patient understood the planned schedule and would be ready to depart at the appropriate time. The primary care physicians were scolded if we rounded after 9 a.m. because that interfered with the 11 a.m. discharges.

Things must have changed because the discharge plan was significantly fluid despite my wishful thinking, lovely eyelashes, and fully dressed status. The dietary team came up to go over the lunch menu around 11 a.m. and I waved them off, saying I didn’t plan to be there for lunch. I was finally released from captivity a little after noon. I went home and immediately went to sleep, waking only when my alarm told me it was time for pain medication.

I’ve been recovering nicely with a steady diet of ibuprofen, Tylenol, and Pepcid. I’d kill for the martini that isn’t on the list of prohibited dietary items, but I’d rather wait until I can really enjoy it. Everything tastes strange, even a week out, and despite the lovely covered dishes that have showed up on my doorstep.

Urgent surgery is a heck of a way to get out of working your scheduled urgent care shift, so I wouldn’t recommend it to anyone. I’m just glad this little adventure in healthcare didn’t happen at HIMSS or on any one of my frequent trips across the country. I’m happy to be doing a little more activity every day, even though the score still stands at Gallbladder 1, Jayne 0.

I’ve mentioned my experience to friends who work in the process excellence realm at the hospital in question, so hopefully some change may come of it. I had to chuckle, though, on Wednesday, when I received a thank you card from the hospital: “It was our pleasure to provide your care throughout your stay with us. Our goal is to always provide you with quality care and excellent service.” Of all the people I interacted with, it was signed by the overnight staff who gave me the most concern about quality.

Email Dr. Jayne.

HIStalk Interviews Peter Embi, MD, CEO, Regenstrief Institute

Peter Embi, MD, MS is president and CEO of Regenstrief Institute; professor of medicine and associate dean for informatics and health services research at Indiana University School of Medicine; vice-president for learning health systems at Indiana University Health; co-founder and chief medical officer of Signet Accel; and chair-elect of AMIA.

Tell me about yourself and your work.

I am a physician and an informatician. My main role is as president and CEO of the Regenstrief Institute here in Indianapolis, which is a support organization to Indiana University and specifically the Indiana University School of Medicine. We work with a number of elements of the School, the University, and the various healthcare systems around the region.

I wear other hats at Indiana University. I’m a professor at IU, associate dean in the School of Medicine, and vice-president for learning health systems in the Indiana University Health System, which enables us to take a lot of the expertise that we have in informatics, health services research, and aging research and bring that to bear on how we create the learning health system of the future by leveraging our health system. Not just that health system, but also others in the region that we traditionally have collaborated with. There’s a lot more I can say about that, but those are my titles at the moment.

My history is that I’m a physician. I trained in Florida, where I was born and raised. Then I went to Oregon, where I did my internal medicine training and then did my fellowship and got a master’s degree there in informatics under the group led by Bill Hersh. Then I went to Ohio, where I had been  until a few months ago when I took this role. I started off at the Cleveland Clinic, where I did training in rheumatology and immunology. I’m still a practicing rheumatologist. That’s a pretty small part of what I do these days because of all my other responsibilities, but that is my clinical practice.

I went to University of Cincinnati for almost seven years, where I started the Center for Health Informatics and did a number of things there around informatics. Then I went to The Ohio State University, where I was until just recently. I served as the first chief research information officer for the organization, really the first person to hold that role nationally. I also served as the vice-chair and ultimately the interim chair for biomedical informatics before I departed at the end of November.

What areas of biomedical and clinical informatics are most promising or most exciting?

It’s an exciting time to be doing informatics. The kinds of things that we’re seeing emerge with what can be done — now that we’ve gone a long way toward deploying electronic health records — is very promising.

There’s a lot of work to be done to improve our use of electronic health records to make them more usable and to incorporate them into practice better. There’s a lot of interesting work ongoing to help with the efficiency and use of electronic health records. Then, some of the most exciting things have to do with how we leverage the data that’s increasingly growing from not only those electronic health records, but from other sources, like genomic data and other ‘omics, if you will — environmental data, the kinds of social and behavioral determiners of health that increasingly we all recognize to be terribly important for not only improving what we do in healthcare, but fundamentally improving health.

Part of what we need to focus on moving into the future is how to leverage the data, the technology, the capabilities that we have, and the exciting developments happening in technology — including apps, wearables, and the Internet of Things — to understand how it is that populations — not just our patients, but people generally — are interacting with the world in ways that we need to understand better if we’re going to, as a system, inform improvements in health. Keeping people healthier, preventing disease, and then when people do become sick, most effectively getting them the kind of treatment that they need. Then being able to enable research so that we can learn how to better take care of people in the future.

One of the things that I have been studying for a long time and have focused a significant part of my career on is the area of research informatics. How do we take technologies and solutions to improve the elements of the research process, whether it’s designing studies, recruiting participants for studies, or making systematic evidence generation a more routine part of what we do through practice so that we can be learning from every patient and create what the Institute of Medicine has called the learning health system at the local level as well as at the regional and national level? That provides context for a lot of the exciting things that we can do moving forward. It’s certainly a lot of what drives me and the group here at Regenstrief on a day-to-day basis. Actually, it is a lot of what drove us and continues to drive us with regard to Signet Accel, too, and the work that’s happening there.

It’s been said that Facebook knows a lot more about people than their doctor. Can we combine enough data sources to create a holistic view of an individual that can support public health instead of just episodic healthcare encounters?

That’s a critical thing that we need to be focused on as a community, as a healthcare community, and as a biomedical research community, because I don’t think we’re there yet. We all understand that there’s incredible potential to be unlocked in those sources. Despite some pockets of work that are doing excellent early work in figuring that out, we have a lot more to learn in terms of how we can take all of these other socio-behavioral determinants of health, environmental information, information about what eat, what we consume, what we breathe, the activity that we track increasingly. All of those elements that say a lot more about how healthy we are, or how not healthy we are, than the sliver of information we have when people happen to intersect with the healthcare system. To me, it’s at that intersection point while we’re simultaneously trying to improve what we do in the healthcare systems.

When people interact with their physicians, care providers, and hospitals, we need to make that as good as it can be and as evidence-based as it can be and use those encounters and opportunities to learn. But I think one of the most exciting things is exactly what you allude to, this idea that increasingly as we look at populations and we look at how we can help keep people healthier out in the community, we’re necessarily going to have to understand how we analyze and interact with all the other data in the world. That data, one can easily argue, has a much bigger impact on health than a lot of the kinds of things that we do in healthcare, except for those who are ill. That’s an area where I’m starting to focus a lot more attention and I know a lot of other people are. More work is needed, but it’s critically important.

Have incentives evolved where there’s a business case to be made for providers and thus their technology vendors to look at an individual consumer beyond those little chunks of automation that exist just to improve the business of healthcare?

It’s an open question. A lot of people are banking on that. There’s some examples of folks that are moving in the direction of recognizing the importance of that and the potential of business models around how you can help people stay healthier. There certainly are individuals who are motivated to keep themselves healthier. Some of them are voting with their wallets in terms of apps that they’re buying and devices that they’re buying, increasingly taking control of and responsibility for their own health in ways that increasingly leverage technology and information. I think we’re seeing some of that emerge. I don’t think it’s settled. 

Beyond that, we have incentives in a number of other areas in terms of our systems, one being the healthcare systems. Increasingly as they go at risk for populations — which you know inevitably is going to happen considering the cost of healthcare –  how do we go about keeping our populations healthier so that we can spend the limited dollars we have on those who are sickest and keep people healthier so that they are healthier and they cost the system less? Forward-thinking health systems are already working along those lines, focusing on programs around keeping populations healthier, keeping people out of the hospital. That kind of thing can be seen increasingly through incentives that have been aligned around some of the reforms in healthcare payments and the like that one way or another are critical to what we’re doing and have to continue.

The other is from the perspective of our society — and I think increasingly we are seeing it from the perspective of companies — that recognizes that the healthcare costs of their employees are a big part of what they spend on. That’s a big expenditure. That the more that corporations and companies that are responsible for their employees can keep them healthier, can keep them happier, they’re more productive at work, they’re more present, and they cost less when it comes to the premiums that they’re paying for their employees.

Finally, our municipal, state, and federal governments are concerned in terms of trying to keep the population healthier, because one way or another, whether it’s focused on decreasing smoking rates or decreasing our rates of obesity, generally keeping our population healthier is just better for our economy. We’re seeing more focus on that at the state level and in different levels of government in terms of some legislation that’s already been passed and that will be passed.

I think it’s multi-factorial. It’s still coming together, but it does make sense from the perspective of what it is we need as a society, as individuals, and increasingly for our economy.

Precision medicine, artificial intelligence, and the idea of a cancer moon shot get a lot of technology attention. Is that a distraction from the fact that proven, well-documented medical information isn’t being consistently used on the front lines?

I don’t know that they’re a distraction. It’s important for us to have our eye on the future and to always keep an eye on where we need to be and what major items are on the horizon that are going to help us better take care of people in more innovative and impactful ways.

I think you’re correct that we can’t do that to the exclusion of — or in any way diminishing — how we can take better care of people with what we know today. I think you’re exactly right that probably not enough attention is being paid to the kinds of improvements that we can make in what may seem like the more mundane and routine activities of just making sure that, to the extent that we can, we’re practicing healthcare in an evidence-based way, that we’re leveraging our systems in ways that are going to make that more efficient and effective and easier for everybody involved to do the right thing and keep people healthier and avoid errors and do a lot of those sorts of things.

I see those as not mutually exclusive. I think we need to be doing both. But certainly to the extent that one overrides the other, that would be a mistake, so hopefully we don’t go in that direction.

I can tell you that here, for instance, we have a big emphasis on precision health and understanding that there’s a lot of elements to that. Of course it’s about genomics and proteomics and the like and how that can better inform tailored treatment of individuals when they develop certain conditions that have a genetic basis. But there’s also other elements of precision health which have to do with non-genetic components, a lot of the information that we have today. We’ve always wanted to make sure that when we’re treating an individual, we’re applying the best evidence to the care of that individual, taking into account their particular circumstances. If we do that right, we necessarily will benefit from a lot of knowledge that we already have.

A lot of it just informs the way we implement and deploy and use our systems today. I don’t see that necessarily as the dichotomy that it may seem, but I think it’s an important question to ask and make sure that we don’t fall into that trap of thinking that it’s just about one thing or something that we’re going to figure out 10 or 20 years from now. It’s what do we do today and what do we do in 10 years.

A newly published study found that patient advocacy groups are often funded by drug and device manufacturers in what could be perceived as a conflict of interest involving their patient members, especially in the area of support for drug pricing decisions. Is it difficult for member organizations to figure out that line between the interests of patients, provider members, and corporate members?

That’s a good question. Certainly at AMIA, we have a very diverse group of members, very thoughtful, that represent the broad constituency. Businesses are motivated by what they exist to do, which is to innovate and bring things to market and ultimately be profitable so that they can keep doing what they’re doing. While it can of course be at odds, I haven’t really found that that in any way negatively impacts what we do as a society or as an association. In fact, making sure that we’re listening to all voices and recognizing the perspectives of those who are working in different sectors actually helps to inform the overall membership.

Not to take away from the concerns that of course sometimes business interests will conflict with social good. More often than not. that’s not the case. If you find that a company is working on trying to solve a problem that is impactful to society, then it’s good to recognize that that work is ongoing and take it into account as you’re thinking about where it is that we need to be going as a group of informaticians, in that case, or as another society.

There’s clearly areas that people recognize very well around conflicts of interest and the like that need to be managed very carefully. I was the former chair of the ethics committee at AMIA and helped to author the conflict of interest policy, so I take that very seriously and we have to be very careful about that. I have found that the industry representatives who interact with professional societies tend to come at it from the perspective of, how do we all win? How does it help society? How does it help everyone? Because ultimately that creates more opportunity for them and allows them to have a bigger impact in their market, which happens to be the world. Not to be naïve about it, but I think it can be a win-win. You just have to keep your eye on the details.

Sunshine laws, being transparent, being open … increasingly because of some examples where that wasn’t done effectively and did cause problems in, for instance, the medical publishing world, right now we have very clear guidelines about making sure that whenever anybody does work, whenever they publish, whenever they talk about what they’re doing, they have to declare all of their relationships and the like. You have to know that in order to be able to then discern what’s happening.

AMIA is not, per se, a patient advocacy organization, although we obviously have patient members and are very concerned about patients as a driver of what we do, like any medical organization. So I can’t speak directly to that piece of it, but I can tell you that whole idea of transparency and openness is critical to everything we do, because trust ultimately is what that’s all about. I would think for a patient advocacy group, it’s even more important.

What makes you most optimistic about the role of informatics in improving of the healthcare system?

Everything that we do in healthcare, population health, and the like fundamentally comes down to making sure that we understand what’s happening. That means we have to have data, information, and ultimately the knowledge that comes out of analyzing all of that to be able to inform what we do moving forward.

Increasingly in the information age, people who have expertise at the intersecting points of health, healthcare, and informatics are at that junction that is going to ultimately inform how we improve the health of our populations. How do we do that in the most cost-effective way? How do we ultimately achieve the goal of having a healthier population at a lower cost?

That means that those of us who are working in this area of informatics and data science are sitting at a very exciting point, at the juncture, at a very exciting time. To be able to influence where healthcare is going and have a real impact on the lives of everybody, because everybody’s concerned with their healthcare, as they should be. That’s what excites me the most. 

The maturation of the technologies that we’re seeing now, the kinds of platforms that we have available, the interconnectedness that we have, the vast amounts of data, while daunting, are just really so promising. The health of all of us, the health of my children, is going to be so much better because of the work that we’re doing. That gets me up every day and makes me excited about what we’re doing in this field.

Tech Mahindra Will Acquire The HCI Group for $110 Million

Mumbai, India-based IT services firm Tech Mahindra will acquire consulting firm The HCI Group for $110 million.

Tech Mahindra said in a statement, “Healthcare is one of the few sectors globally that is driving adoption of digital technologies. The acquisition will not only position Tech Mahindra as a significant player in the healthcare provider space, but will also provide an opportunity to go deeper in this space via EMR implementation and surrounding services route.”

Jacksonville, FL-based The HCI Group reports annual revenue of $114 million and has 500 employees.

Tech Mahindra has annual revenue of $4.2 billion and has 117,000 employees in 90 countries. It is part of the Mahindra Group conglomerate.

Morning Headlines 3/6/17

Elliott Settles With Advisory Board as Strategic Review Continues

The Advisory Board Company settles with activist investor Paul Singer to delay his efforts to launch a director-election proxy fight.

ePA National Adoption Scorecard

CoverMyMeds publishes data on the availability of electronic prior authorization functionality in EHR systems, noting that vendors in control of 70 percent of the EHR market have committed to implementing electronic prior authorization functionality, while 54 percent already offer it.

NHS’ Salford Royal Trust Partners with Validic on New Integrated Care Model with Personal Health Data

In England, Salford Royal NHS Foundation Trust will begin integrating patient-generated data into its EHR from wearables and medical devices.

Jonathan Bush talks Trump and problems with health care tech

Athenahealth CEO Jonathan Bush discusses his favorable opinion of HHS Tom Price, his lingering concerns with President Trump, and he sees the political changes will impact the EHR market.

Monday Morning Update 3/6/17

Top News

Advisory Board Company settles its differences with an activist investor, with SEC filings suggesting that hedge fund operator Elliott Management may be interest in acquiring some or all of the company after pressuring Advisory Board to hire an investment bank to explore strategic options.

Elliott had applied similar pressure to Cognizant Technology Solutions, of which it holds 4 percent of the outstanding shares, but reached an agreement with that company last month after Cognizant restructured its board. 

Elliott, which is ABCO’s largest shareholder with an 8.3 percent stake, declared the stock undervalued in January. (update: I incorrectly stated that new purchases reported to the SEC on Friday had raised Elliott’s ownership to 16 percent, but it remains at 8.3 percent).

Above is the one-year price chart of ABCO (blue, up 50 percent) vs. the Nasdaq (green, up 25 percent). The company’s market cap is $1.8 billion.

HIStalk Announcements and Requests

A slight majority of poll respondents who attended HIMSS17 say they discovered a product or service that has earned their further attention. Jef commented, “The lack of innovation is unnerving. This despite that 60 percent of exhibitors this year were first-time exhibitors! Makes one wonder where everyone has gone and why all the churn. Or maybe we know.”

New poll to your right or here: how will the health IT business change over the next year?

A reader recommended that I pose a weekly question to readers who can answer anonymously, with a follow-up post recapping the responses. He or she suggested this first question: describe one unethical decision your employer made in the past year.

HIStalk readers funded the DonorsChoose grant request of Ms. O in Missouri, who requested math materials for her second grade class. She says they have enabled her to differentiate the instruction and practice work she assigns, adding, “I love how I can make problems and the kids can manipulate the materials to show their thinking. I also love how even for my highest of kids I have something that they can work on because I can easily change the materials to fit what they need.”

Listening: new from Portugal.The Man (that’s not a typo – there’s a period in their name), an Alaska-formed indie pop band whose music defies simple genre categorization beyond being personal, melodic, and featuring rich, expressive vocals and an everyman stage presence that lets the band’s talent speak for itself. Their acoustic album, 2009’s “The Majestic Majesty” is unbelievably good. Their spring tour starts this week, with the band swinging through Nevada, California, Arizona, New Mexico and then moving east through the end of July (with stops in HIT-heavy Madison, Atlanta, and Philadelphia). My gosh, they are amazing.

I’ve posted the results of my recent HIStalk reader annual survey. If you participated, thanks. I always learn from the responses. Readers suggest I pay an honorarium for regular contributions from people with these backgrounds, so let me know if you’re a candidate (note: it’s perfectly fine to write anonymously, as Dr. Jayne does, to avoid employer interference):

• Experts in nursing, laboratory, and pharmacy IT who would provide Dr. Jayne-like updates in their respective subject areas at least quarterly
• Someone to write a digital health summary every so often
• An expert in non-US healthcare IT to write a regular summary of what’s going on outside the US
• A leader, provider, or technologist in their 20s or 30s who can represent that point of view

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

This Week in Health IT History

One year ago:

• President Obama launched the Precision Medicine Initiative
• HIMSS VPs John Hoyt and Norris Orms announced their retirement
• EClinicalWorks announced plans to develop an inpatient EHR
• Google’s DeepMind Technologies formed DeepMind Health

Five years ago:

• Nuance bought Transcend Technologies
• Epocrates killed its EMR project
• The VA halted work on its $103 million enterprise service bus that would have connected external products to the EHR it was developing with the DoD
• Kaiser Permanente CEO George Halvorson announced that its new smartphone app got one million hits in its first month, also mentioning that 36 of the 66 EMRAM Stage 7 hospitals were KP’s

Last Week’s Most Interesting News

• McKesson and Change Healthcare Holdings complete the creation of Change Healthcare, which combines CHC’s software and analytics business with most of McKesson Technology Solutions in launching one of the largest health IT vendors with 15,000 employees.
• Mayo Clinic’s year-end financial report says it will spend more than $1 billion to implement Epic.
• An Amazon Web Services outage left some cloud-based EHR users, including those of Practice Fusion, without a system for a few hours.
• Memorial Healthcare System (FL) pays $5.5 million to settle HIPAA charges that two employees plus another 12 of its affiliated physician practices stole patient information to file fraudulent tax returns.

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

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

Acquisitions, Funding, Business, and Stock

Just-formed Change Healthcare is looking for a new headquarters location, reportedly considering a move to Atlanta from its leased offices in Nashville.

OhMD, which offers a texting app for patients and doctors, raises $1.2 million in a seed funding round.

“Shark Tank” billionaire Mark Cuban invests $250,000 in Denver-based Matrix Analytics, which offers big data-powered clinical decision support. Founder and chief medical officer Aki Al-Zubaidi, DO is an assistant professor and pulmonologist at National Jewish Health.

Claims management and payments vendor Zelis acquires dental PPO provider Mavarest Dental Network.

Sales

In England, Salford Royal NHS Foundation Trust chooses Validic to integrate patient-generated health data with its EHR, beginning with sleep and fitness information.

Decisions

• NYU Lutheran Medical Center (NY) went live with Epic in summer 2016.
• Fort Hamilton Hospital (OH) will go live with an Omnicell automated dispensing cabinet (ADC) in 2017.
• St. Joseph Healthcare (ME) will go live with BD Pyxis MedStation ADC in 2017.

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

People

Cheryl McKay, PhD, RN (Orion Health) joins Voalte as chief nursing officer.

Announcements and Implementations

Data science and point-of-decision platform vendor Clearsense will use big data technology components from Hortonworks.

Technology

Walmart enhances its app to allow pharmacy customers to order refills from their phones, pay for them electronically, then breeze through an express lane where they use their phone’s camera to scan a QR code at the register, after which their prescription is handed over and they’re done. Walmart, can you please buy up some hospitals and physician practices?

Other

CoverMyMeds publishes its electronic prior authorization scorecard, which finds that EHRs representing 70 percent of the market committing to implement it.

In Canada, inpatients complain about the cost of in-room TV, phone and Internet provided as a package by a private company, mostly because they can’t predict their stay and thus can’t sign up for longer-term, cheaper packages. The company says its biggest expense is revenue sharing with hospitals, but the hospital in question says it gets nothing for making the service available.

Swedish Medical Center (CO) — which is being sued by dozens of surgery patients who learned that an HIV-positive surgical tech tampered with their IVs to steal narcotics — had outsourced its employee background checks to a private company that failed to uncover the tech’s history of addiction, drug theft, Navy court martial for drug theft, and termination from four hospitals for stealing fentanyl. The class action lawsuit now includes Texas-based PreCheck. The tech, meanwhile, had an additional year tacked on to his 6 1/2 year sentence when he decided to take a family vacation on his way to prison.

Athenahealth’s Jonathan Bush weighs in on the state of health IT:

We’re in the Stone Age. Pretty much everybody thinks of an EHR as a piece of software. There’s no connectivity. Athena is trying to create the second generation. Doctors spend more money administering their office after investing in technology than they did before … That’s never happened in any other industry in history … If you look at companies like Allscripts and NextGen, they were in the toilet. They were about to go out of business, and all of a sudden, $35 billion in federal dollars are earmarked only for EHRs. It was like Cash for Clunkers …  in healthcare, the line is, nobody ever got fired for buying Epic. I think that a lot of people are going to get fired for buying Epic in the next few years. And by the way, this isn’t a fault of Epic. To make it to the last dinosaur, you have to be a phenomenal dinosaur. And Epic and Cerner are phenomenal companies. They’re just not network medicine companies.”

Bizarre: Arkansas will execute eight prisoners over 10 days in April even though capital punishment has been suspended there since 2005. The state wants to finish its work – punishment for murders committed before 1999 and thus prior to the execution ban — because its supply of execution drugs goes out of date on April 30 and manufacturers no longer provide it for executions. The state hopes the inmates expire before its midazolam.

Sponsor Updates

• TransUnion publishes a new report, “Money talks: Rethinking what it means to put patients first.”
• Verscend will exhibit at the RISE Summit March 6-8 in Nashville.
• Solutionreach publishes an ebook titled “Medical Marketing Today: Strategies for Marketing Your Medical Practice in a Digital World.”
• Vital Images produces a new video, “Revitalize Existing Healthcare IT Investments.”
• ZeOmega successfully completes the Direct Trusted Agent Accreditation Program from EHNAC and DirectTrust.

Blog Posts

• Two Big Reasons You Should Be Texting Patients (Solutionreach)
• #HIMSS17 fun, takeaways, giving [recap] (Nordic)
• Considering DRaaS? A Guide to Help Identify Your Best Path to the Cloud (TierPoint)
• Find Your Paperless Workflow and Ditch Your QuickTime Viewer (Ultralinq)
• Digital Discovery: Health Research in Virtual Labs (Validic)
• From the HEDIS trenches: Optimizing your chases (Verscend)
• What Organizations Need to Survive in a Value-Based World (Dimensional Insight)
• Using RTLS Data to Increase Capacity in Ambulatory Care (Versus Technology)
• Real Software NOW Available | Visage 7.1.10 (Visage Imaging)
• Where do we go from No. 1? (Voalte)
• The Hottest Topics at HIMSS17 (Spok)
• Getting the most out of your EHR implementation and adoption (Conduent Health)
• You could still be picked for a Phase 2 HIPAA Audit. Here’s how to be prepared. (Advisory Board)

Contacts

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

Reader Survey Results 2017

I do a reader survey once each year, usually right before the HIMSS conference. I then review the results along with other feedback I receive to plan the upcoming year. I always make at least a few changes that readers suggest. Thanks to everyone who completed the survey, including the person who won the random drawing for a $50 Amazon gift card.

I have a diverse and opinionated readership. Some people are interested in only a subset of industry topics. Others want a basic bullet list of headlines and nothing more. Still other readers either like or don’t like rumors, humor, or certain parts of HIStalk like CIO Unplugged or Readers Write. While I truly appreciate and will consider all suggestions, I don’t want to fall into the trap of “designing by committee,” where the quest to displease no one ends up in pleasing no one, either. So, don’t think I’m not listening just because I didn’t immediately act.

I’ve been able to stick to writing HIStalk for 14 years now only because I do it in a way that makes me happy and satisfied. I’m lucky to have found a self-selected audience that keeps coming back. I’m therefore in agreement with the most common “what should I change” suggestion, which is to not change anything significantly unless it’s a clear improvement that’s within my grasp. I have zero interest in getting bigger or slicker if it’s not fun.

I’ve also learned a big lesson over the years – everybody likes to read, but few like to write. Suggestions often involve getting new non-vendor contributors or participants, which would be fantastic, but that has failed every time I’ve tried. Writing is hard for most people and their jobs often limit their availability, so even the most eager writers often fade away after writing a handful of times. Read on below for the kinds of contributors I can use and would be willing to pay for (another lesson learned – consistent contribution requires some level of payment).

Respondent Characteristics

I received 201 survey responses this year. Some respondent highlights:

• 80 percent have worked in the industry for at least 10 years
• 28 percent work for a provider organization
• 8 percent are CIOs
• 33 percent work for providers and have buying authority greater than $10,000
• 88 percent have a higher appreciation of companies that they read about in HIStalk
• 45 percent have a higher appreciation of companies that sponsor HIStalk
• 92 percent say reading HIStalk helps them do their job better

That last stat is what keeps me coming back every day. Readers, too, probably.

Elements Appreciated

I asked which HIStalk features the respondent appreciates most. I should note that I haven’t run an Advisory Panel for a long time since I was getting fewer and fewer responses, so many respondents probably don’t recall what it is.

Suggested Changes

Here are the most frequently suggested changes, along with my responses.

Improve the search function.

I’ve added somewhat effective “search by date” capability in the sidebar. It’s not perfect, but it works well enough that even I used it when trying to find something I’ve written in a given date range.

Move the Readers Write bios to the top of the article and include that in the email notification.

Good idea. I will do that. I initially had a reason for putting the bio last, but I’ve forgotten what it was.

Create articles around questions that readers can answer anonymously.

I like that idea a lot and I’ll start that this weekend. It will fizzle out quickly if I don’t get responses, but it’s worth a shot.

Spotlight consumer digital healthcare.

I’m a hospital guy, so while I cover the topic when something interests me, it’s not a big emphasis. I would be happy to add a weekly digital health summary if someone wants to write it or help me figure out the kinds of topics it should include.

Add non-US coverage.

My non-domestic audience is about 5 percent, with the top five non-US countries being Canada, India, the UK, Netherlands, and Australia. I would be willing to add a weekly summary of non-US healthcare IT news if I can hire someone knowledgeable to write it in adding more value than I could.

Add the ability to see all of a particular type of article, like Dr. Jayne or CIO Unplugged.

That’s available now. Hover over the Archives link at the top of the page, then click Dr. Jayne or Ed Marx to see all of their posts. You can also hover over Articles and then choose Index to see a newest-to-oldest list (rather than the full articles) by category, then click on any article to jump to it.

Add Dr. Jayne-like commentary from nursing, lab, pharmacy, etc. even if only quarterly.

I’ve appealed for such writers before with no takers, but I’ll throw it out there again and offer compensation for someone who is skilled and reliable. I always ask the person for examples of similar writing they’ve done or for them to write a sample article. That’s usually where the previously enthusiastic conversation ends. As I mentioned before, I can run the articles anonymously since I know first-hand from nearly being fired for writing HIStalk that employers aren’t always supportive.

Create an iPhone app since I like to do my reading in the morning.

Bringing up the site on a mobile device should display the site in an easily navigated mobile format. If not, scroll down and you’ll see the “desktop/mobile” chooser. I’ve looked at full-fledged mobile apps, but they don’t seem to offer a lot more than the mobile-optimized theme I already have.

Do more with social media.

My personal experience is that social media is overrated for a site like mine. I’ve looked at the stats and there’s no uptick in actual site readership from a blitzkrieg of tweets, Facebook posts, and LinkedIn items. I’ll think about revisiting, but social media campaigns work best for consumer sites rather than business-related ones. I’m happy to take advice from experts who believe otherwise.

Don’t quit writing HIStalk.

This came up a bunch of times. I have no plans to quit. Writing HIStalk is a hobby rather than a job to me, so I have no motivation to stop doing it any more than someone else would to quit playing golf, going to movies, or having dinner parties.

I know a lot of fellow readers of the site who are in their 20s (thanks to Epic staff for encouraging employees to read the site regularly) who would love to see some representation outside of predominantly older, white male execs. That’s a totally valid and relevant piece of the industry, but there are also a lot of badass young leaders, providers, and technologists (not just start-up founders shilling product) who I’d love to see on this platform, too.

That would be great if I could fine someone, even if they have to contribute anonymously for work reasons.

Offer an honorarium to ongoing contributors.

I’m perfectly willing to do that. 

Get rid of the smoking doctor’s pipe.

I’ve made so much fun of newbies who think they possess rare insight in noticing that the logo of a healthcare IT site is a smoking doctor that I have to assume this was (like the logo) intentionally ironic. If not, I’ll counterbalance it with another reader’s suggestion – give the doctor an additional accessory of a martini.

Add a thumbs up/down capability to articles and comments.

I admit I cheated a bit in reading this comment several weeks ago and then buying the thumbs up/down plug-in that’s on the site now. It has been used nearly 3,000 times since I installed it over the holidays, including by me.

Dump Readers Write.

I admit I’ve considered this several times. I turn down a lot of articles that are boring, unoriginal, vendor-slanted, or not all that related to health IT, but most of what remains still has some of those characteristics because vendors pay their PR people crank out dull, inexpert prose in which a vendor pitch is not too cleverly concealed. I keep thinking that providers will step up to the minor challenge of stating their opinion (even anonymously), but that rarely happens.

Suggestions

Convert webinars into podcasts so I can listen to them on my commute.

I think that’s probably doable. I also wondered whether people would appreciate having the transcribed webinar narration available to read as a PDF so they could distribute it, mark it up, etc. But let’s hear what you think – complete my little poll of which (if either) of those options you would use.

A Facebook-like look back of the news of that day five years back.

Great idea. I’ll add that to my calendar to add to each Monday Morning Update.

Use hashtags or tags of some sort so people can follow specific topics that interest them and get a weekly digest of headlines or posts relating to this topic.

Several people suggested that HIStalk posts could be repackaged into a curated summary of some type. I would have to understand the topics, but certainly one would be all items for specific vendors, which might then create a separate post (maybe on a separate site just to keep the clutter down) or as a weekly email with its own subscriber list. Tell me what you need.

Please stay focused on what you do. Additional news or too many communications can become overwhelming.

I agree, which is why I write one consolidated news article three times per week instead of blasting out every story individually. Anything I add would most likely have its own email subscriber list.

I love the idea of an email bulletin, beyond the headlines.

I agree. Email newsletters are hot again, especially if they are pithy and sassy. About three-fourths of a small number of respondents to a recent poll I ran said they would read a daily email, although I didn’t ask about a weekly one.

Facts are appreciated more than opinion.

Not to everyone. I know it seems obvious when you’re reading a site to think that every reader perceives it the same way, but I can say with certainty that it’s not that simple. More people say they read HIStalk for opinion, rumors, humor, and even music recommendations than say they wish I would stick to the same facts (usually from press releases) that every other site runs. I try not to be heavy-handed or to pedantically pontificate, but I also don’t hesitate to interject my opinion and welcome readers to agree or disagree in the comments.

Improve the home page layout. Having three columns is distracting and makes the page feel pinched when you get further down. And I never use the sponsor quick links – they just take up a lot of space on the screen, making it look busy.

I’m considering making some changes to skinny down the items in the right columns. Most are important, but they don’t necessarily need to display with each page view – a flyover menu of some sort would make them readily available without taking up space. Stay tuned.

Add one random and/or humor related item to the summary email you send for posts.

I try to do that, although I admit that I’m usually physically and emotionally drained by the time I send the email because I’ve been heads-down in deep thought for hours.

Get a DC insider to write.

I assume that means DoD and VA, although maybe I’m interpreting too narrowly and you’re actually interested in more political topics (in which case I’ll pass). As a reader, what would you like to see?

You could seriously sell your content curation and insights, especially if they were well-indexed for research purposes.  I would buy a personal subscription.

I’m not interested in selling anything, but tell me what you would find useful.

Comments

I invited respondents to say anything they want.

• How long until you quit? I want to make sure I’m done before then; I can’t imagine doing my job without you providing the necessary information I need for my job.
• It’s still my favorite work-related read of the day.
• I love HIStalk. It’s my favorite guilty pleasure.
• I like the balance of news and fun. Also appreciate your candor when people send you unsubstantiated information.
• Love it — and you’re great, but I’ve got to say that I get downright excited to read Dr. Jayne.
• This is a wonderful service to the community.
• I think you do a phenomenal job of bringing the news and sharing your personal insight as a long-time industry observer. I’ve been reading HIStalk since I started working in the industry 12 years ago. I think the site could be even better if it stopped running unsubstantiated rumors as if HIStalk was the National Enquirer or Fox News.
• Love it — specifically feel indebted to you for your summation of various complicated government rulings and policies. Also greatly admire what you have done with your reach when it comes to DonorsChoose.
• Dr. Jayne is my favorite. I also love how Mr. H is not cow-towed by disgruntled readers. Got the balance right!
• I continue to find HIStalk a very valued resource. You also made a recent comment about death and who cares once you are dead. I hope you are thinking about who would take over HIStalk when you lose the interest in keeping up with it. I do not think this is a prepare to die exercise — rather a realization that HIStalk is a valuable resource and honest broker of information in the HIT world and very worthy of continuing. Based on your humor, your often highlighted other interests, I assume that someday you will want to spend your time on other things beyond the care you put into HIStalk.
• Conduct regional social events where readers can get together, or do it at Health 2.0 meeting.
• I was once a complainer about the pro-Epic vibes and I have to say that I don’t feel the vibe anymore so if you were trying (or maybe I was over-analyzing and grew another year older?). Thanks!
• It’s an amazing site and any criticism I have is honestly quibbling — I would hate it if you hung it up.
• I work with the DoD and VA on their interoperability and have noticed that your periodic comments about that subject are quite dated. The two departments over the past 2-3 years are far more cooperative, interactive and mutually supporting in interoperability/data sharing needs than ever before.
• Appreciate all of your hard work.  Yours is the first news site I look at every day since I get both news and humor.
• It is an invaluable part of any HIS professional’s tool box.
• Thank you for this invaluable service. I truly appreciate that you offer thoughtful commentary, and not the generic re-spewing of outdated not-news that so many other healthcare IT sites espouse. My favorite articles are often Dr. Jayne’s blogs. I love hearing about actual in-the-trenches experiences. Of course, Weird News Andy is good for a chuckle or a smh. And I appreciate the donation updates.
• I check you daily and often share articles with others in my group. I’ve attended a few webinars and found them generally useful. On a regular basis I read something I find immediately useful for what I do, or something that spurs me to look deeper into some topic. In short, you’re great!
• I have been reading since the beginning and I’m a big promoter. I have mandated that my executives subscribe to the blog everywhere I’ve worked. So many people don’t bother to look outside their own little empires to understand the broader industry. You force readers to do that, and I am really grateful.
• So appreciate this resource. Single best blog I read and have read for 10 years now.
• I’m just a lowly independent Epic consultant (10+ years) but you really have helped me do my job better. I can chit-chat with a CIO waiting in line for lunch; and when I mention something I just read in HIStalk, he/she perks up and takes notice of me and we can carry on with a well-informed conversation. I have noticed that folks can tell if one has read HIStalk. I mention your site at least three times on every gig, so word-of-mouth DOES work. I can steer clear of (or be attracted to) Epic implementations that are in trouble, depending on the mood of my checkbook and my BS tolerance at any given time. I love Dr. Jayne’s commentaries and will go back to find one if I’ve missed a week. Her perspectives from "the trenches" are very beneficial from a physician’s perspective and I enjoy her writing style very much.  Your donor matching program for kids makes my heart sing — that’s all I can say, except you are contributing to a generation of life-long learners. Ed is Ed, and I like him. Weird News Andy is a hoot — wish he’d do more, but he’s probably busy doing real work most of the time. And you, Mr. H, should be commended for maintaining a non-biased and well-written site for all of us to benefit from. You are a voice of reason (or at least, devoid of BS) in this whirlwind of healthcare drama. Your dry wit doesn’t hurt, either — I get at least one chuckle a day guaranteed, if not a belly laugh. Please keep doing what you’re doing. Peace Out and Happy 2017!!
• Thank you for all that you do, Mr. H., and I hope you benefit from HIStalk as much as your readers do. I feel that the site is at its best when it provokes disagreement between readers, as this is a good indication of a particularly sticky problem yet to be solved.

Morning Headlines 3/3/17

McKesson and Change Healthcare Complete the Creation of New Healthcare Information Technology Company

McKesson’s Technology Solutions business unit and Change Healthcare Holdings’ analytics business unit finalize their planned merger, creating 15,000 employee Change Healthcare.

InterSystems wins multi-million pound Liverpool joint-EPR tender

In England, InterSystems is selected as the next EHR vendor for three major Liverpool NHS hospitals: Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool Women’s NHS Foundation Trust, and Aintree University Hospital NHS Foundation Trust.

Judge Certifies Overtime Case Against Cerner As Class Action

A group of Cerner systems analysts and delivery consultants have won the right to file a class action suit against the company, arguing that overtime wages had been improperly withheld.

CVS Health to Adopt Epic Electronic Health Record System for CVS Specialty Care Management Programs

CVS will implement Epic across its CVS Specialty care management programs.

News 3/3/17

Top News

McKesson and Change Healthcare Holdings (the former Emdeon) complete the creation of the new health IT company Change Healthcare, which combines CHC’s software and analytics business with most of McKesson Technology Solutions.

McKesson will own 70 percent of the 15,000-employee Change Healthcare.

The company’s leadership team is listed above.

Reader Comments

From Alhambra: “Re: EClinicalWorks. The only tool available for EP MU attestation is the MAQ dashboard, which contains a disclaimer that all users must accept when they first log in. ONC is aware and investigating since a certified EHR must be able to accurately produce the required attestation reports.” Unverified as to the ONC part, but above are the screen shots provided. I’m not sure requiring acknowledgement of a standard lawyer-verbose warranty either absolves responsibility to ONC or suggests a lack of capability, so I suppose the issue is who is liable if an incorrect attestation is filed because of flawed data and whether the disclaimer is binding either way.

From Studiously Stoic: “Re: Becker’s Healthcare ‘150 Great Places to Work.’ We won and would like it mentioned.” I should stop being surprised when an organization that wins an award fails to note the worthlessness of their “win.” Becker’s employed no reasonable methodology to come with its click-baiting list – it accepts nominations, but then just lets its “editorial team” (mostly of them recent liberal arts graduates) make up the 150 winners based on unstated criteria that doesn’t seem to involve any research beyond Googling. It’s not like they actually surveyed employees or anything. This is not newsworthy.

From Banacek: “Re: ECG Management Consultants. Apparently cleaning house after last year’s acquisition of Kurt Salmon, with over 30 people being terminated. Senior partners are being targeted.” The company provided this response: “ECG recently completed a three-year strategic plan and organizational restructuring. This resulted in some departures and reassignments, primarily for our administrative function, but included a few consulting staff members as well. Overall departures have been minimal (fewer than five consultants from January 1 through February), and we have continued to make strategic hires – for example, in our revenue cycle and academic practices. Our business is strong and we anticipate continuing to grow in 2017.”

HIStalk Announcements and Requests

We provided a greenhouse and gardening kits for Mrs. M’s class of severally mentally and physically disabled students in Ohio. The students are actively participating and will present their work to their families in May and can then take the seedlings home to transplant them into their own gardens.

I’m annoyed at companies whose marketing people declare that their unchanged software has suddenly transformed into “artificial intelligence” just because it sounds cooler. AI is defined as a device that perceives and reacts to its environment in mimicking human reasoning in performing a complex, nuanced task such as solving a problem and then learning from the process to get smarter. Today’s version of AI is primitive, incapable of doing even a fraction of the intellectual processing of a not-very-bright human even when limited to a super-specialized task in a closed context. I suspect that most AI systems have a “man behind the curtain” who carefully programs the system to appear smart when it’s really not, hoping to find a profitable problem to solve without anyone digging too deeply into the methods involved. 

This week on HIStalk Practice: The Vancouver Clinic adds ActX genomic decision support. Drchrono opens its second office. CMS begins $100 million spend on helping small practices make the QPP switch. Jacksonville Children’s & Multispecialty Clinic selects PatientPay billing. The CMS Innovation Center looks for input on new pediatric care delivery models. Austin Regional Clinic adds Wolters Kluwer clinical guidelines to its Epic EHR. Coordinated care tech startup CrossTx raises $735k. Culbert Healthcare Solutions Executive Consultant Randall Shulkin shares value-based reimbursement success factors for medical groups.

Webinars

March 9 (Thursday) 1:00 ET. “PAMA: The 2017 MPFS Final Rule.” Sponsored by National Decision Support Company. Presenter: Erin Lane, senior analyst, The Advisory Board Company. The Protecting Access to Medicare Act of 2014 instructed CMS to require physicians to consult with a qualified clinical decision support (CDS) mechanism that relies on established appropriate use criteria (AUC) when ordering certain imaging exams. Providers must report AUC interactions beginning January 1, 2018 to receive payment for Medicare Advanced Imaging studies, with the CDS recording a unique number. Outliers will be measured against a set of Priority Clinical Areas and interaction with the AUC. This webinar will review the requirements for Medicare Advanced Imaging compliance and will review how to ensure that CDS tools submit the information needed for reimbursement. 

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

Acquisitions, Funding, Business, and Stock

AnalyticsMD changes its name to Qventus.

Consumer medication reminder free app vendor Medisafe, which apparently makes money by charging drug companies to nudge their patients into profitably taking all their ordered doses, raises $14.5 million. 

An employee overtime lawsuit that was filed against Cerner by delivery consultants and system analysts is certified as class action. The lawyer who represents current or former Cerner employees in several related lawsuits says that Cerner’s job titles make it sound as though learning consultants and delivery consultants are highly skilled positions, but claims that in reality, “these are folks that are entry level, straight out of college, with no real minimal requirements other than a college degree and a willingness to relocate to Kansas City.”

Tech-powered insurer Oscar, which offers exchange medical insurance policies in four states, loses $200 million in 2016. The company hopes to survive by raising prices, narrowing networks, and selling small business insurance plans to reduce its reliance on the volatile individual market.

Sales

The DoD chooses BD’s Pyxis ES automated dispensing cabinet for its 115 inpatient facilities and pharmacies in a $100 million contract award.  BD acquired the former Carefusion – which offered Pyxis dispensing technology, Alaris smart IV pumps, MedMined surveillance software, and medical supplies — for $12.2 billion in 2014. 

CVS Health will extend its use of Epic to its specialty pharmacy, which will join CVS’s MinuteClinic as an Epic user.

In England, three Liverpool trusts choose InterSystems TrackCare in a deal worth up to  $86 million.

People

Signet Accel names co-founder Peter Embi, MD, MS as chief medical officer. He remains president and CEO of the Regenstrief Institute.

Government and Politics

A federal grand jury in Texas indicts 16 people for fraudulently billing Medicare $60 million for hospice care. In addition to paying kickbacks disguised as medical director salaries and submitting false claims, the company’s CPA owner and nurses made medical decisions based on what paid the most, including placing patients on high-dose narcotics regardless of their need. The medical directors also gave their EHR log-in credentials to others to create and sign orders for services that were billed but not performed.

CDC publishes the 500 Cities Project, which allows visually comparing and downloading the prevalence of 27 chronic health condition measures between cities and down to the census tract level in a chosen city.

Other

Facebook is testing algorithms that can identify users who are having potentially suicidal thoughts, after which a company team will rapidly review the user’s posts and comments from friends and then send a message offering resources. Facebook is trying to balance its response to such incidents against the privacy issues that would arise if it automatically notified family, friends, or mental health groups without the user’s permission. It already allows users to manually flag suicidal posts, functionality that has now been added to Facebook Live streaming video. Facebook says it was working on the tools before a series of events in which people live streamed their suicides on Facebook Live, often with the encouragement of other Facebook users.

Amazon Web Services explains its four-hour East Coast outage on Tuesday: a script being run by a technician to take down a few problematic servers contained a typo that instead took a bunch of servers offline, including the one that indexes all locations for running database commands. AWS says it has updated the script tool to disallow taking servers offline if any subsystem will fall below its minimum capacity. It will also speed up an existing project to improve recovery time of the indexing subsystem.

NHS auditors find a hospital’s foreign doctor with poor English proficiency looking up medical terms on Google. The hospital says the doctor no longer works there and it will now require language checks.

A study finds that 80 percent of patient advocacy groups accept money from drug and medical device companies that sell products to people with the conditions they support, raising the question of whether the donations influence the frequent silence of those groups about drug prices. Some groups receive more than half of their funds from industry, while 40 percent of them have industry executives as board members. Even the umbrella group for patient advocacy groups took in 62 percent of its $3.5 million budget from industry. The groups claim such donations don’t affect their decisions, but the authors recommend that they be required to provide full disclosure.

A study confirms what we all suspect and fear – people are indeed peeing in public swimming pools and hot tubs, with an analysis of artificial sweetener content in two pools suggesting they contain from 8 to 20 gallons of urine. Hot tubs had much higher urine levels. Movie gags to the contrary, no blue dye exists to call out the pee-pertrators.

Sponsor Updates

• Medicity launches Community Interchange, which creates a single, de-duplicated, and normalized CCD for hospitals.
• CommonWell TV interviews LifeImage CTO Janak Joshi.
• Children’s Mercy Kansas City (KS) goes live on GetWellNetwork.
• MedData will exhibit at HFMA Utah’s Spring Alliance Meeting March 8-10 in St. George.
• National Decision Support Company will integrate its CareSelect decision support system with McKesson and Meditech. The company also announces that its client base has increased to 250 provider systems and 2,000 facilities in all 50 states. 
• NVoq will exhibit at the CHA Rural Health and Hospitals Conference March 8-10 in Denver.
• Recondo Technology releases a revenue cycle API for prior authorization, eligibility, medical necessity, and pre-service patient collection and related RCM processes.
• NTT Data and Oracle expand their existing relationship, adding cloud capabilities to Oracle’s Healthcare Foundation analytics platform.
• Netsmart extends its behavioral population health solutions to post-acute providers.
• Orion Health begins migration of its Amadeus precision medicine platform to Amazon Web Services.
• CloudWave chooses Commvault to power its backup-as-a-service healthcare offering.
• Definitive Healthcare launches a professional services team to help customers use its healthcare data to understand the market and executive plans.
• Obix Perinatal Data System will exhibit at the March of Dimes Perinatal Nursing Conference March 6-7 in Lombard, IL.
• Medicomp Systems announces Quippe Clinical Lens, a web-based, problem-oriented clinician view of relevant clinical information from EHRs and HIEs.
• Experian Health will exhibit at the FL AAHAM meeting March 8-10 in Palm Coast, FL.
• Uniphy Health releases UH4, an enterprise collaboration platform that supports patient-centric communications and provides real-time patient data at the point of care.
• Kyruus integrates ProviderMatch with Salesforce Health CLoud.
• PatientKeeper previews its new e-book, “Healthcare IT 2017-2022: First Comes Change, Then Comes Value.”
• PokitDok joins the AWS Marketplace, becoming an APN advanced technology partner.
• QuadraMed will exhibit at the ANA Annual Conference March 8-9 in Tampa, FL.
• Imprivata integrates its PatientSecure positive patient ID solution with registration kiosks from CTS, Vecna, and PatientWorks.
• The SSI Group will exhibit at the HFMA Region 5 Dixie Institute March 9 in Savannah, GA.
• The Surescripts National Record Locator Service is live at 14 health systems nationwide.

Blog Posts

• How Hospitals are Solving the Patient Experience Problem (Definitive Healthcare)
• I’ll Be Back: Return of AI and Machine-based Learning (Iatric Systems)
• Identity Theft Victimizes Businesses as Well as Consumers (ID Experts)
• Revenue Cycle Post-Implementation Support (Impact Advisors)
• How Saint Joseph Health System is making checking in more secure and accurate with biometric identification (Imprivata)
• Healthcare Consumer Experience Abounds at HIMSS17: Three Key Takeaways (Influence Health)

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 3/2/17

Trump CMS Pick Gets Second Vote After Tie at Senate Committee

The Senate Finance Committee vote on Seema Verma’s nomination to lead CMS resulted in a 9 to 9 tie Wednesday, requiring a second vote, which will be held Thursday.

Grail Closes Over $900 Million Initial Investment in Series B Financing to Develop Blood Tests to Detect Cancer Early

Life sciences start up Grail raises an unprecedented $900 million Series B funding round to fund the development of an early detection cancer screening blood test.

Trump chooses Pence ally to lead Medicaid

President Trump nominates Brian Neale, ‎executive director at the United States Congress Joint Economic Committee and former health care policy director for Vice President Mike Pence, as the director for Medicaid.

Losses Mount for Obamacare Startup Oscar as Repeal Looms

Health insurances startup Oscar Health, which hoped to profit in the ACA’s individual marketplaces, reports 2016 losses topping $200 million.

Lorre’s HIMSS17 Summary 3/2/17

During the months leading up to HIMSS, I feel like a CPA anticipating April 15. It is a huge push to get an unbelievable amount of work done in not nearly enough time. After all, I’m the one and only HIStalk team member other than the folks whose time is fully committed to writing what you read every day.

As in previous years, I enlisted the help of a couple of my family members to help me get things to the convention center and distribute the HIStalk sponsor signs. Our booth is small and there is little to it, so it takes about 15 minutes to set up.

It usually takes a couple of hours to deliver all of the sponsor signs since we do it before the exhibit hall setup is complete. It’s hard to find the booths with just their numbers because of irregular aisles. This year, we waited until the opening day when all of the booth signs and numbers were up. We got it done in record time.

Midway through HIMSS16 a year ago, I went to my first booth selection appointment. With the help of someone there, I chose our booth location purely because it was at the top of an escalator and not in the back of the exhibit hall near the loading docks or restrooms like we usually get for our tiny 10×10 space. On Sunday afternoon when I arrived to set the booth up, our booth was the first thing I saw.

Even that first look at our pretty decent-looking spot could not prepare me for the opening of the doors to attendees at 10:00 Monday morning. People were lined up as far back as I could see. The location of the booth made up for all of the prior years combined. Our booth was busy from the time the exhibit hall opened until it closed each day.

Here are the Top 10 comments and questions I heard at the booth:

1. I love HIStalk, I read it every day.
2. Please tell Mr. H not to ever stop writing HIStalk.
3. I am new to healthcare IT and I read HIStalk because it makes me look smart. (I heard this a lot)
4. HIStalk is required reading where I work.
5. Does that really look like Mr. H? (asked while pointing at our cardboard standee of the smokin’ doc).
6. Do you know who Mr. H is?
7. Why are so many people visiting your booth? What do you guys do?
8. Would it be OK to take a selfie with Mr. H? (our cardboard standee)
9. Do you have any extra tickets to HIStalkapalooza?
10. I heard a rumor that this was the last year for HIStalkapalooza. Please tell me it isn’t so!

I am always excited to meet the guests who spend time in our booth. This year I had a chance to talk with Nancy Ham, named as one of the most powerful women in health IT. She spoke about the importance of mentoring young women in the workforce. Keep an eye out for an upcoming HIStalk-sponsored webinar where she will cover a similar topic.

It was interesting to talk with Dr. Regina Benjamin, the 18th Surgeon General of the United States. She was at HIMSS with accessURhealth to emphasize the need for tools and resources to positively impact the identification, treatment, and awareness of mental and behavioral health.

I packed up and left the booth early on Monday so I could be a the House of Blues by 4:30 to walk through the logistics of HIStalkapalooza. It was like HIMSS all over again – we were two hours from opening the door to the attendees and there was so much left to be done. None of the sponsor banners were hung and the step-and-repeat red carpet backdrop I had bought online for $250 was delivered to my feet in two big boxes. I showed the people who would hang the banners where they should go.

I know Mr. H mentioned this, but you had to be there to appreciate the ingenuity and determination Jenny and Val from Optimum Healthcare IT demonstrated. I asked the House of Blues if they could provide someone to help us assemble the frame that holds the step-and-repeat. After spending about 30 minutes on it, one of their production crew told me we were probably missing a part and it couldn’t be put together, leaving us without a backdrop and Mr. H with a wasted investment. I sighed with frustration and went on to the next urgent matter. When I returned, Jenny and Val were sitting on the red carpet with the pieces of the frame spread out, trying to figure out how to assemble it. A few minutes later, they had it standing, albeit a little bit propped up.

There were a lot of challenges with the House of Blues this year, but as always, someone trying to do a good job provided a highlight. I ordered a toast for a group of people and the bartender said a manager would need to approve. She arrived after 15 minutes and said they aren’t allowed to provide shots at events like ours. After the manager was out of earshot, the bartender decided that as long as he placed an ice cube in each glass, it’s not technically a shot. The tradition was upheld.

The result was the now-famous Longo Lemonade toast.

This is Jean, a HIMSS shuttle bus driver who also provided amazing service. I had waited 30 minutes for the shuttle to stop near where I was staying and it finally arrived just as it started to rain. As the last passenger stepped off of the bus and I took the first step to enter, Jean received a call from his dispatcher telling him to return to the garage empty since the shuttle schedule was changing from every 15 minutes to every 30 minutes. After a bit of coercion, Jean agreed to take our group of passengers to the convention center before returning to the garage as instructed. I got there on time and still dry.

We gave out our usual HIMSS survival kits, thanks to Arcadia Healthcare Solutions. Meditech gave us a supply of “Mobile Pockets” and cool green pens to give away. I managed to grab a pocket for the back of my cell phone cover, but the pens were gone before I got one.

I don’t see a lot of cool things at our booth because most companies are demonstrating in their own booths. The one exception was Blausen. It is like a collaboration of WebMD and Pixar, They claim it is the world’s largest library of medical and scientific illustrations and 3D animations, but that was an understatement. Each one has a short video that describes the condition, symptoms, and treatment clearly with visuals that are hard to stop watching.

The team from Spok stopped by for a picture and I admired their company-branded shoes. The Spok logo was subtle and the color matched the logo on their shirts perfectly.

HIMSS17 was manageable for me because of the help I received from Brianne, shown here backstage at the House of Blues with some of the Party on the Moon dancers. She spent the weeks leading up to HIMSS making sure all of the HIStalkapalooza invitations were sent and all of the (never-ending) changes were kept straight. She answered questions from sponsors and kept them on track. During HIMSS, she spent time in the booth and gave people information. She spent almost all of her time at HIStalkapalooza at the door enforcing the rules for admission. Thank you, Brianne.

My favorite part of HIMSS every year is connecting with the readers and sponsors. I interact with people on the phone and through email all year, so it is really a treat to meet people I have only spoken to and get a hug from those I have known for years.

I thought HIStalkapalooza was fantastic again this year. Thanks to the many sponsors that made it possible.

Despite the fact that Mr. H swore he wouldn’t do it again because of the work involved and the financial risk he takes in hoping he can cover the cost with sponsorships, I am already hearing him softening up a  bit. My plan is to find sponsors willing to sign up early to avoid our last-minute panic and reduce his risk. It makes sense to limit the number of sponsors to those who can commit early and thus make it extra special for them. Stay tuned!

Contact Lorre.

Readers Write: It’s Time to Bring Back the Noise

It’s Time to Bring Back the Noise
By Andrew Mellin, MD

A very memorable moment for me at one of the first go-lives for a hospital EHR was when I stood on the unit and realized there was an eerie silence. While the beeps of the monitors and the drone of the overhead pages continued, the buzz of the caregivers talking to each other was gone as everyone was staring intently at a computer monitor.

As an implementation team, we quickly learned we needed to frequently remind the caregivers to keep talking to each other as part of our go-live training for future sites. But years later, it is clear the EHR has fundamentally changed the dynamics of how providers and care teams communicate.

The impact of this dynamic is well recognized. The change in communication patterns, sometimes called the "illusion of communication," is identified as one of the key unintended consequences of implementing an EHR. With today’s EHRs, we now have all the information we need at our fingertips, yet the ability for care teams to collaborate in an ongoing, continuous dialogue is not well supported by the systems’ encounter, inbox, and order-based models.

We still have noisy hospitals, but now we hear the wrong kind of noise: the sounds that keep patients awake and require caregivers to respond to beeps emitted from devices in stationary locations that make it difficult to find a real signal that requires action.

It’s time to bring the right kind of noise back to patient care. Not the auditory noise that we hear, but the cognitive buzz that is generated when high-functioning teams are communicating in an effortless, asynchronous manner.

Think of how communication models like iMessage, WhatsApp, and SMS have changed the way we communicate in our personal lives. There’s very low effort required to initiate a simple message. We have the ability to share rich information — such as images, videos, or voice — as well as expressive notifications. We even have an ongoing transcript of the conversation and acknowledgement of message receipt.

Healthcare communications benefit from the same communications models, but require HIPAA compliance, message traceability, integration to other initiators of messages (e.g., the hospital operator), and EHR integration.

The actual messaging app, however, is simply the user window into communications technologies that not only improve care team collaboration, but more importantly, drive improved care team efficacy and patient outcomes.

For example, physicians work in shifts that are largely defined by an on-call schedule. When I worked as a hospitalist on weekends when the staff frequently changed, I needed to find an on-call schedule to determine which specialist would see my patient that day (usually I just asked the nurse or HUC to page a person for me because it was too hard to figure out who was on call.)

To solve this problem, a healthcare communications platform needs to support messaging to a role that resolves to their correct on-call individual. And secure mobile messaging is not only about person-to-person communications — rather it is a way to notify an individual of any important piece of information about a patient, whether it is generated by a machine or a human.

For example, when a CDS alert in an EHR is triggered to indicate that a patient may be becoming septic, a rapid response team can be automatically and immediately notified. When a device triggers an alarm, instead of a loud beep that has to be interpreted, the specific, detailed message with patient context is sent to the right person’s device with the appropriate sense of urgency.

All technologies have limited value unless directly leveraged to improve organizational goals, and communication tools are often an underrepresented element of process improvement initiatives due to the limited modes that exist without a modern communication infrastructure. I’ve seen dramatic operational and clinical improvements achieved when these tools are embraced, such as 30-minute reduction in admission times from the ED and material improvement in HCAHPS scores.

These tools do not eliminate the phone call that is essential in a complex situation or the need to document the care plan in the EHR. Rather, these tools augment the EHR and elevate the quality and cohesiveness of the care team collaboration. The magnitude of the value of healthcare communications is under-appreciated: One large academic medical center sends over 150,000 messages to the caregivers and support staff in their organization every week.

It’s time to give caregivers the communications tools they need to improve the patient’s care experiences and outcomes and care team efficacy while eliminating the auditory noise where care is delivered. And it’s time to bring in the kind of high-value noise where caregivers are rapidly interpreting and responding to targeted messages on the go on their mobile device.

Andrew Mellin, MD, MBA is chief medical officer of Spok of Springfield, VA.

Readers Write: Growing Contingent Workforce Benefits Both Healthcare Organizations and HIT Professionals

Growing Contingent Workforce Benefits Both Healthcare Organizations and HIT Professionals
By Frank Myeroff

There’s high growth when it comes to temporary workers, contractors, independent consultants, and freelancers within healthcare IT. New technologies, cost factors, and a whole new generation of HIT professionals wanting to work in a gig economy are fueling this growth. The rise and growth of the contingent workforce is only expected to accelerate over the next few years into 2020.

This dynamic shift to a contingent workforce makes sense for healthcare organizations and the benefits are well worth it. With a contingent workforce, healthcare organizations experience a big efficiency boost, risk mitigation, and derive a substantial cost savings in these ways:

• The rise of managed service providers (MSP) enable health systems to acquire and manage a contingent workforce. As contingent labor programs continue to grow, these partnerships will be one of the most important workforce solutions that a health system can adopt to effectively manage risk and decrease healthcare hiring.
• The use of vendor management systems (VMS) is a fast way to source and hire contingent labor. These systems make it easy to submit requisitions to multiple staffing suppliers.
• Outsourced expertise will be able to assist healthcare facilities in meeting the January 2018 EHR system requirements. In addition, they often have the extensive knowledge needed when it comes to medical coding. For example, according to the AMA, 2017 ICD-10-CM changes will include 2,305 new codes, 212 deleted ones, and 553 revised ones.
• Healthcare organizations can dial up or dial down staffing as needed without having to pay FTE benefits.
• Improved visibility and the provider stays in control through the use of structured reporting, governance processes, and dashboards.
• Internal resources are freed-up to focus on higher-priority, clinical-facing initiatives such as workflow optimization.

For HIT professionals, contingency work in the HIT space is attractive since opportunities are plentiful, the remuneration is desirable, and the work is rewarding. In addition, work is becoming more knowledge- and project-based and therefore is causing healthcare organizations to become increasingly reliant on their specialized HIT skills and expertise. According to Black Book Rankings Healthcare, this reliance will help to fuel the growth of the global HIT outsourcing market, which should hit $50.4 billion by 2018.

However, making the change from an employee to a contingent worker takes thought and preparation before just jumping in. Here are a few suggestions:

• Identify the niche where you have skills and expertise. Know your passion. Also, pinpoint what type of HIT services and advice you can offer that healthcare organizations are willing to pay for.
• Obtain the required certifications. Getting certified is a surefire way to advance your career in the IT industry. Research IT certification guidesto identify which ones you will need in the areas of security, storage, project management, cloud computing, computer forensics, and more.
• Build your network and brand yourself. It’s important to start building your network once you’ve decided to be a consultant. A strong contact base will help you connect with the resources needed in order to find work. Also, position yourself as an expert, someone that an organization cannot do without. Now combine both a professional network and social network to help you spread with word faster.
• Target your market and location. Determine what type of facility or organization you want to work with, and once decided, think about location. Do you want to work remotely or on site? Are you open to relocation or a commute via airline to and from work?
• Decide whether to go solo or engage with a consulting and staffing firm. If you have the entrepreneurial spirit and want to approach a specific organization directly for a long-term gig, you might want to go solo. However, if you’re open to both short-term and long-term opportunities in various locations, a consultant staffing firm might be the answer.

The rise of a contingent workforce and gig economy will only continue to grow, and with it, much opportunity. A consultant or contractor has more freedom than a regular employee to circulate within their professional community and to take more jobs in more challenging environments. For healthcare facilities, a contingent workforce means acquiring the right HIT skills and expertise needed without the overhead costs associated with payroll benefits and administration. No doubt, a win-win situation for both.

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

Readers Write: Automate Infrastructure to Avoid HIPAA Violations

Automate Infrastructure to Avoid HIPAA Violations
By Stephanie Tayengco

Every other week, news of HIPAA violations comes to light, bringing attention to the challenges of maintaining privacy in the ordinary course of doing business and providing care.

Take, for example, a recent HIPAA violation settlement. Illinois-based healthcare system Advocate Health Care agreed to pay a $5.5 million OCR HIPAA settlement in August after it was found that the company failed to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to all of its ePHI. Earlier this summer, The Catholic Health Care Services of the Archdiocese of Philadelphia agreed to pay $650,000 for failing to implement appropriate security measures and address the integrity and availability of ePHI in its systems.

It is unclear in both cases whether infrastructure configurations were directly to blame. However, addressing the infrastructure-related elements of HIPAA and HITECH take considerable time and effort, time that could be spent addressing the critical application and mobile device-level security standards that result in the vast majority of violations. To refocus engineers away from time-consuming infrastructure compliance, the practices of infrastructure automation and continuous compliance are the key.

Reduce the chance for human error

The foundation for compliant IT infrastructure is implementing strong standards and having guardrails in place to protect against changes that are inconsistent with those standards at the server, operating system, and application level. This is the next evolution of compliance — building a system that can self-correct errors or malicious changes and maintain continuous compliance.

In a recent survey, IT decision-makers shared that 43 percent of their companies’ cloud applications and infrastructure are automated, highlighting that while companies already recognize the tremendous value of system automation, they can do even more.

The road to automation must begin with an IT-wide perception shift — that manual work introduces risk. Any time an engineer is going into a single piece of hardware to perform a custom change, error is possible and system-wide conformity is threatened. This does not mean replacing engineers with robots. It means tasking engineers with creating the control systems. This is an equally challenging (but far less boring) technical task for engineers, but it creates more value.

Part of this control system will be configuration management at the infrastructure level and for application deployment automation. Equally important is the operational shift to train engineers not to make isolated changes to individual machines  and instead to use the control system in place and implement changes as code. Code can be easily changed and tested in non-production environments. Code can be versioned and rolled back. Software deployment tools provide an audit trail of changes and approvals that can be easily read by auditors.

Invest in transparency

One of the main causes that can lead to non-compliance is a lack of transparency, usually in one or both of two key areas:

• Lack of transparency into where critical data resides
• Lack of transparency into current state of system configurations (i.e., how/where data is encrypted, who has access to that data, how privileges are maintained, etc.)

Many companies rely on manual processes and spreadsheets to track the configuration of their systems. In a cloud environment that changes frequently, this can be a real headache.

The single biggest change to make today is to improve the visibility of data criticality and system configurations is to implement configuration management. Rather than rely on manual documentation after the fact when changes are made, configuration management tools allow describing a desired state and creating and enforcing it across the infrastructure. Ideal configurations are coded in a single place, providing the current state of all systems at any time. This is a huge leap forward and it is applicable for operating either on bare metal or in the public cloud. Making long-term investments in operational transparency can help avoid HIPAA headaches.

Focus on mission-critical apps, not infrastructure

As healthcare companies improve IT operations, they should be focused on developing or delivering great patient-centered applications and services, not infrastructure maintenance and compliance.

Migrating to the cloud is the first step. Migrating to a public cloud platform like Amazon Web Services (AWS) provides the benefits of a government-grade data center facility that has already been audited for HIPAA and HITECH compliance. Signing a BAA with Amazon means that a portion of the physical security standards is taken care of (note: regular assessments are still required). That is a huge reduction in risk and cost burden right off the bat.

In addition, the cost of change is significantly reduced in the cloud. Adding, removing, or changing infrastructure can mean a few days of work, not months. That means systems engineers can focus on improving software delivery and the configuration management system, not on manually configuring hardware.

Just one word of caution. Beware of any cloud vendor or service provider that describes the cloud as “no maintenance.” It is true that cloud systems are more efficient to maintain, but maintenance is still necessary. The IT team will focus more of their time on maintenance tasks that are more critical to the business, like building a new testing ground for an application development team or refining the code deployment process, not on undifferentiated data center tasks.

It is only a matter of time before the industry witnesses its next HIPAA violation. Automating infrastructure can significantly reduce the cost and effort of maintaining infrastructure compliance, and can refocus IT on higher-impact areas such as device security.

As health IT evolves, expect to see these two key of technologies — cloud and automation — driving the next wave of efficiencies in health IT.

Stephanie Tayengco is SVP of operations of Logicworks of New York, NY.

CIO Unplugged 3/1/17

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

Attitude, Not Aptitude, Determines Altitude

I have never been the smartest person in the workplace. I never will be. We all have talents, skills, and special gifts, but you won’t see my name on any Top 10 lists for brainiacs. Not even the Top 1,000.

I can’t blame genetics since my siblings are pretty dang smart. Each of my kids excelled academically as well. Our gifts are unique to each individual. I suspect what makes the difference is how we steward our gifts.

I was going through my school report cards with my youngest daughter recently. Not pretty. From first grade through high school, it was clear I was not the sharpest tool in the shed. College undergrad was the worst, starting with a wicked 1.6 GPA.

My lackluster grades made my Army Officer assignment of combat engineer all the more perplexing. I was the only non-engineer, non-math major accepted into our cohort. I barely graduated with a degree in psychology and there I was in engineering school! On our second day, we took math and engineering competency exams and I was immediately directed to the remedial section.

Out of desperation, I clung closely to the Zig Ziglar quote that, “Attitude, not aptitude, determines altitude.” I had no choice. Ziggy gave me hope that, despite my intelligence, I could still thrive by adopting a positive outlook.

As I entered the workforce and looked towards the ranks of management, I could not compete on sheer aptitude, but I could with attitude. I was astonished to surpass peers who were much smarter than I. While I worked on building my core business and technical smarts, I doubled down on ensuring an infectious attitude. I started to see that altitude was something I could control.

We all know people who are super smart, but who never realize their full potential. Clearly there are many reasons why this happens, but certainly a lackluster attitude robs many of the personal and professional heights they were destined for.

That said, it’s not only people of average intelligence that benefit from good attitudes. Everyone, regardless of aptitude, benefits from good attitudes.

I’ve shared previously my experiences of being part of strong teams that accomplished some pretty cool things. One common characteristic of each team member was attitude. I understand my success as a leader is predicated on having a good attitude, which ultimately separated me from many peers. I wasn’t better-looking or taller. I did not always dress the part. I was not the product of private schools, nor boosted by a familiar family name. I had few if any advantages.

As I said, I was not smarter. I was pretty much average, except for my attitude. Attitude is one key to a prosperous life. And you control it.

How can you change your level of attitude?

• Admit you need to change your attitude.
• Hold yourself accountable to people who will get in your face and tell you the truth when your attitude is poor.
• Surround yourself with people who have infectious attitudes and soak it in.
• Seek professional help if there are unhealed wounds that keep your attitude low.
• Practice the art of smiling and don’t stop even on bad days.
• Accept your shortcomings and move on.
• Avoid negative self-talk or putting yourself down in front of others.
• Be thankful daily for something. Anything.
• Step outside of yourself and see a different perspective.
• Remember the big picture.
• Live a balanced life, routinely taking time for yourself to recharge.
• Drop friends and colleagues who have bad attitudes.
• Surprise someone every day with something that makes them laugh.
• Pray for your haters.
• Stop feeling guilty for things you have not done.
• Address the gaps or barriers in your life that may be driving you down.
• Don’t worry about things you can’t change.
• Believe in something bigger than yourself.
• Practice random acts of kindness.
• Be the bigger person and mend broken fences.

I believe that because of a shift in my attitude, I was able to transform from college flunky to holder of multiple master’s degrees.

I believe that because of a shift in my attitude, I went from remedial Army Engineer student to graduating in the top 10 percent of my cohort.

I believe that because of a shift in my attitude, I went from average career to something beyond my dreams.

I believe that because of a shift in my attitude, I love life despite my wounds.

Simply put, not only do people with bad attitudes typically underperform, nobody wants to be with them. They are sad, mad, full of unconstructive criticism, and no fun. No wonder they are not getting promoted.

Attitude does determine altitude.

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 3/1/17

Mayo Clinic: Consolidated Financial Statement

Mayo Clinic’s will spend $1 billion for its five-year Epic implementation, according to its annual financial statement.

Shulkin proposes eliminating 40-mile, 30-day rule for non-VA care

Speaking at the Disabled American Veterans annual conference, VA Secretary David Shulkin proposes eliminating a policy that limits veterans from receiving private-sector care.

Hospital illegally overcharged patients for medical records: suit

New York-Presbyterian Columbia University Medical Center is sued after charging a patient $3,000 for a copy of their medical record.

The 21st Century Cures Act: Implications for Research and Drug Development

A panel discussion hosted by Harvard’s T.H. Chan School of Public Health covers the expected implications 21st Century Cures Act will have on the pharmaceutical industry.