Curbside Consult with Dr. Jayne 10/4/16

The last 43 hours has been some of the most agonizing time I’ve spent in the IT trenches in recent memory. I’ve been working with a client on a small CMIO augmentation project, mostly helping them get organized from a governance and change control standpoint. It’s a mid-sized medical group, roughly 80 physicians, but none of them want to take time away from patient care to handle the clinical informatics duties. I suspect that this is because they’re mostly subspecialists and there’s no way the group would be willing to compensate them for the time they would miss from their procedural pursuits.

Until I arrived on the scene, the IT resources would just build whatever the physicians wanted, regardless of whether it made sense for everyone. This in turn led to a whole host of issues that is impacting their ability to take the upgrades they need to continue participating in various federal and payer programs.

I’ve been spending eight hours a week or so with them, mostly on conference calls as they work through a change control process. Much of my work has been in soothing various ruffled feathers and in trying to achieve consensus on issues that have to happen regardless, but I hope to get them in a good place where they can be well positioned for the challenges of shifting to value-based care. Nothing at their site has been on fire from an operational standpoint, and other than telling the IT team to stop building whatever people ask for, I haven’t had much interaction with them.

I stayed up late Saturday night working on a craft project (curse you, Pinterest), so I was awake when they called me in the wee hours of Sunday morning. It was the IT director. I could immediately tell he was in a panic. It took several minutes to calm him down. I was able to figure out that something had gone very, very wrong with their ICD code update.

Hospitals and providers have to update their codes every October 1 to make sure they have valid codes that can actually be sent out to billers. Most cloud-based vendors do the updates themselves and push it out to their clients, while non-cloud vendors that I have worked with provide a utility that allows the client to update their systems. Usually it’s no big deal, except for the vendors who are habitually late sending out their update packages and whose clients are cringing on September 30.

This particular client is on a non-cloud format and had planned to run the utility on their own. Although they had a solid plan with a lead resource and a backup resource, they never really anticipated having to use the backup resource. On the evening of the 30th, the lead resource became seriously ill and wasn’t able to do his duties. They decided to wait it out a day since they weren’t open on the weekend and see if he could handle it later in the weekend. When he was admitted to the hospital with appendicitis, it was clear that they would have to engage Plan B.

Although the backup resource had gone through the documentation, he had never run the utility or even seen it run. Apparently there was some confusion with a downtime playbook. Users were supposed to be dropped from the system before the backup cycle started and then were to be allowed back on the system after the code update was complete.

Somehow the users weren’t forced to exit and ended up being on the system while the backups started. Once the analyst realized users were still on the system, he attempted to halt the backups, but instead, the ICD update was started. I’m not sure what happened next, but the bottom line is that the database became unresponsive and no one was sure what was going on. To make matters worse, the fail-over process failed and they couldn’t connect to secondary/backup database either.

A couple of analysts had tried to work on it for a while and couldn’t get things moving, so they tried to reach the IT director, who didn’t answer. I can’t blame him since it was now somewhere near 1:00 a.m. After working their way through the department phone list, somehow I got the call. I’m not a DBA or an infrastructure expert, but I’ve been through enough disaster recovery situations to know how to keep a cool head and to work through the steps to figure out what happened. Since crossing to the IT dark side, I’ve had more late night phone calls for database disasters than I’ve had for patient care issues, but the steps are surprisingly similar.

Things were a bit worse than I expected since they couldn’t tell if the transaction logs had been going to the secondary database since we couldn’t connect to it. Even worse, I looked at the log of users who were on the system when it crashed and the senior medical director had been in, potentially documenting patient visits for the day. It took me at least 20 minutes to talk people down and get them calm before we could make a plan. The next several hours were spent working through various steps trying to get access to the secondary database to preserve patient safety. It was starting to look like a network switch might also have given up the ghost.

What surprised me the most was that they really didn’t have a disaster recovery plan. There were bits and pieces that had clearly been thought through, but other parts of the process were a blank canvas. Although there are plenty of clinical informatics professionals who are highly technical, it’s never a good sign when the physician consultant is calling the shots on your disaster recovery.

We engaged multiple vendors throughout the early morning as we continued troubleshooting issues. The IT director finally responded to our messages around 8:00 a.m. I realize it was Sunday morning, but he was supposed to be on call for issues due to the ICD code update and he frankly didn’t respond.

By 4:00 p.m. things were under control, with both the primary and recovery systems up and appearing healthy. My client created a fresh backup and decided to go ahead with the ICD code update. We weren’t sure how much of it had actually run given the aborted process from the night before. It appeared to be running OK initially, but after a while, it appeared that the process was hung. By this point, the team was stressed out and at the end of their proverbial ropes and there wasn’t any additional bench to draw from.

I finally persuaded them to contact the EHR vendor, thinking they would have had resources available since this was the prime weekend for ICD code updates even though my client was now more than a day late. It took several hours to get a resource to contact us back and then we had to work through the various tiers of support. Eventually midnight rolled around again and things still weren’t ready, increasing the anxiety as the team knew they’d have billing office users trying to access the system starting at 5:00 a.m.

Once we arrived at the correct vendor support tier (aka, someone who knew something), the team was run through checklist after checklist trying to figure out what was going on and whether we should continue to let it run or whether we should try to stop it.

The IT director finally made the decision at 6:00 a.m. that the practices should start the day on downtime procedures, and thank goodness they had a solid plan for that part of the disaster recovery game. The practices were given access to the secondary database in a read-only capacity for patient safety purposes and each site was said to have a “lockbox” with downtime forms. The group subscribes to a downtime solution that creates patient schedules, so they were quickly printed in the patient care locations along with key data for the patients who were already on the books for the day. Anyone who presented as a walk-in could be accessed through the secondary database.

At least on downtime procedures, users weren’t assigning any ICD codes to the patient charts since the utility hadn’t completed yet. It was restarted a couple of times and finally got its act together, completing around 4:00 p.m. Monday. After an hour or so of testing, we were able to let users back in the primary system to start catching up on critical data entry and billing.

Most of the day, though, was extremely stressful, not only for the IT team, but for everyone in the patient care trenches. It was also stressful for the patients since the group has a high level of patient portal adoption and there is no backup patient portal. Anyone who sent messages or refill requests or tried to pay their bills today was simply out of luck.

When an event like this hits your organization, all you want to do is just get through it. That’s not the hard part, though – the challenge is just beginning with the post-event review and attempts to determine the root cause of various breakdowns. It usually takes at least a couple of days to untangle everything and the work is not yet over. I’m happy to report that the analyst with the appendicitis did well in surgery and was discharged home before the EHR system was back online. I’m not sure having the primary analyst would have made a difference in this situation. I hope he continues to make a speedy recovery.

You never know when something like this is going to happen in your organization, and if you haven’t prepared for it or practiced you plan, you need to do so soon if not today. Similar to the practice of medicine, sometimes the most routine events can have significant complications.

Are you ready for a downtime? Is your disaster recovery plan solid? Email me.

Email Dr. Jayne.

Morning Headlines 10/4/16

Community Health Systems Adopts “Poison Pill’

Community Health Systems (TN) has enacted a ‘poison pill’ stockholder protection agreement as Chinese billionaire and activist investor Tianqiao Chen increases his stake in the company to 9.9 percent.

New Wearable Microscope Could Enable Continuous Patient Monitoring at Home in the Future

Researchers from UCLA and Google’s Verily Life Sciences lab have miniaturized a microscope that can track biochemical reactions through the skin. Researchers see applications in remote patient monitoring and medication adherence.

The New Data Experts Our Health-Care Professionals Need

Drew Harris, MD and director of health policy and population health at Thomas Jefferson University’s College of Population Health publishes an op-ed calling for an increased focus on analytics in medial, nursing, and health professional schools as providers continue to generate more data but struggle to generate meaningful intelligence from it.

What it’s like when Alphabet’s venture arm invests in your startup — and helps grow it to a $1.2 billion company

Business Insider profiles Nat Turner and Zach Weinberg, founders of Flatiron Health, which secured a $130 million Google investment in its oncology clinical decision support software.

HIStalk Interviews Michael Poling, SVP/GM, Infor Healthcare

Mike Poling is SVP/GM of healthcare for Infor of New York, NY.

Tell me about yourself and the company.

I’m general manager of healthcare at Infor. We’re a $3 billion software company. Healthcare is about $500 million of that. I came from Lawson Software and was previously at Siemens. My entire career has been in the healthcare IT industry.

As a vendor of an integration solution, what are the opportunities and challenges in an era where everybody wants interoperability?

In the world of acute care consolidation as well as extending care outside the walls of a hospital, data itself and the integration of data becomes mission critical in terms of analyzing patient outcomes married to cost. Everybody wants to understand what their cost is relative to delivering care as well as the satisfaction ratings that are wrapped around it. Data becomes the center of importance.

Does a new level of sophistication exist where health systems are aware of the incremental cost involved with delivering a particular service or a product?

Yes. There’s a need for healthcare to report on lines of business — both in terms of profitability, revenue as well as cost — because of where the industry is in terms of the switch from fee-for-service to more of a bundled fee for delivering care. It’s mission critical for my customers to understand where they’re making money and where they’re not. Line-of-business reporting has become mission critical for them.

What are the staffing, recruiting, and productivity challenges that health systems are dealing with given that a high percentage of their cost involves labor?

Going back to what I said before around the lines of business, you want to make sure that you’re focusing the right talent and the right job to perform the right service. That, married along with where a hospital can continue to remain profitable, is very important. It takes certain skills. If you take it to a specialty hospital, like a children’s hospital as an example, nurses and doctors who deal with children have a certain skill set, a certain mental approach, and a certain soft skill. That goes across the board, depending on what type of care that you’re delivering.

Specializing and understanding what certain behaviors are relative to delivering care and making sure that since 60 to 70 percent of the hospital’s expenses are related to labor, you want to make sure that you’re hiring the right people, that you’re onboarding them, that you’re keeping them for a long period of time to reduce those expenses.

Is the idea of clinical staffing based on patient acuity still controversial?

The industry is still hanging on to the idea. I would say that nobody’s mastered that. Having the right person at the right bedside with the right supplies and with the right skill, but also then maximizing your workforce productivity — that’s still nirvana or utopia.

There are products in the market that help with that, but getting to the point where you enter things in like seasonality as well as population health and population management to predict hospital inpatient stays as well as outpatient care delivery needs — that’s where we still need some assistance in the healthcare industry.

Floating nurses to cover other areas based on workload needs appeared to worsen patient outcomes because they weren’t as familiar with the workflows and relationships in those areas. Have hospitals improved that situation to give them more workforce flexibility?

It’s the reason that you’re seeing the world of the minute clinics and delivering care in mall settings as well as in the retail space. There’s a need to push those types of resources out to the population. That trend is going to continue, where you have more skilled labor outside of the acute care setting and putting them in those remote settings.

There’s a balance to that as well. You need to have people that continue to deliver family practice medicine, but specialize in some of the things that you’re talking about. The US is going to continue to have the need to push services out into the population. Balancing that with the costs that we’ve been talking about is the real challenge.

Do hospitals have the necessary expertise to run freestanding EDs, urgent care clinics, and population health management programs?

That’s a very good question. What I see is that there are more executives who are coming outside of healthcare into the healthcare world, as well as more physicians who are getting into IT-related services. The reason for that is that if you come from a manufacturing or retail world and understand things like distribution, workforce management, and the distribution channel, that’s different from somebody who has been in healthcare their entire career.

If you layer on top of that the care delivery path aspects that a doctor or nurse understands, that adds that layer of knowledge as well as flow to what needs to be delivered to remote locations that are delivering care.

How do hospitals use technology to help them continue to offer money-losing services by funding them from profitable lines of business?

There’s certainly a technology aspect to what you’re talking about. What I see is that there are more referral networks that are being built through affiliations, through relationships, through of course ownership and consolidation. You make decisions as a hospital what you can and you can’t do. Then you build affiliations around things that you need to deliver.

Labor and delivery is a good example of that. Heart would be another good example of that. If you have somebody who needs critical care related to a heart condition, you want to have an affiliation, a brother or sister hospital that you can send that person to given the time available to do that. I see that as driving the need for technology.

Building the referral network drives the need to then share information between those facilities to get integration. Certainly resource sharing as well as supply sharing. Twenty or 25 percent of a hospital’s expenses are supply related, so you have to make sure you’re maximizing those as well. The technology is needed to accomplish the things I talked about.

Some hospitals choked in the late 1990s and early 2000s  by trying to implement SAP, which was then mostly known as an enterprise resource planning system for manufacturing. What’s the status of ERP in healthcare and how has that evolved from yesterday’s materials management systems?

I laughed when you said SAP. I had a couple of personal friends who left Lawson when I was there to go run the SAP healthcare practice. I know exactly what those challenges were.

What ERP is turning into for healthcare specifically is sitting adjacent to the electronic health record and enabling a healthcare institution to be able to capture the cost components that we’ve been talking about. Analyzing that and looking at lines of business reporting.

ERP has become the need to start to drive the analytic, which we believe starts right with setting up the general ledger and setting up how you’re going to look at the lines of business and then reporting from those. Controlling labor, controlling cost, as well as measuring the cost. ERP in healthcare has become a central strategy to being able to do those things.

The pendulum swung hard to the left to implement EHR systems in the past. It’s now swinging back to the right. Once those EHR systems are implemented, now you need to implement and maximize the other side, which is where an ERP system comes into play.

Do hospitals expect their EHR and ERP vendors to share information bi-directionally?

Absolutely. They’re looking for plug-in integration points. From my side, they want my system to immediately talk to Cerner, Epic, or Allscripts. Give me something that’s going to plug right in where I don’t have to build point-to-point integrations, because we know what integrations need to happen. We know where the data needs to reside and where it needs to get to. That’s what we’re being asked to do and what we’re delivering.

There’s a push for hospitals to implement customer relationship management systems for both business and population health management purposes. How are hospitals addressing that need?

Most of the time when we get into that conversation with a customer, we drop the “C” part of CRM and talk about relationship management, which seems to resonate. Their relationships with their patients …you immediately go there with population management, measuring customer satisfaction or patient satisfaction, making sure that you’re engaging the patient on an ongoing basis. Once they’re discharged, make sure that they’re following their instructions for their medications, those types of things. That relationship that you have with the patient certainly is important.

The other relationships that are important … I talked before about the referral network. The physician referral process and physician referral relationship is extremely important. One physician referring to another physician that’s in the network of the hospital that has built, either through acquisition or through affiliation, this network that they want to continue to feed. The relationships between the physicians become strategic and important as well to making sure that you’re keeping the patients inside of your health network.

We see those two huge needs as relationship management going forward. Of course then you can take the relationship management to the population health to that next step, being able to look at recurring patterns in your population for certain patients and patient outcomes via that relationship management.

Morning Headlines 10/3/16

By The Numbers: Our Progress In Digitizing Health Care

National Coordinator for Health IT Vindell Washington, MD and his predecessor Karen DeSalvo publish an article in Health Affairs looking back on the health IT achievements that the last seven years have brought.

Ochsner’s David Carmouche: Population Health and Top-Quality Care

The president of 25-hospital Oschsner Health System (LA) discusses how EHRs and disease registries are being used to help the organization target and engage with at risk populations as it moves away from fee-for-service reimbursement.

About the SPRINT Data Analysis Challenge

NEJM announces a data analytics contest in which contestants are asked to analyzed a data set of clinical trials data in search of new scientific or clinical discovery.

The terrorist inside my husband’s brain

Robin William’s wife publishes an article in the Journal of the American Academy of Neurology about Lewy body disease, the debilitating condition that led to her husband’s 2014 suicide.

Monday Morning Update 10/3/16

Top News

Former and current National Coordinators Karen DeSalvo, MD and Vindell Washington, MD take to Health Affairs to detail the “health IT transformation” seen across the country since the HITECH Act was passed in 2009. A few stats:

• 96 percent of hospitals and 78 percent of physicians use certified EHRs.
• 84 percent of academic literature review studies showed that certified EHRs had a positive or mixed-positive effect on care quality, safety, and efficiency.
• 80 percent of hospitals electronically exchanged lab results, radiology reports, clinical care summaries, or medication lists with providers outside their organization in 2015.
• 84 percent of providers reported in 2015 that their EHR met or exceeded their expectations.
• 90 percent of hospitals had digital health data they needed from outside sources or providers available at the point of care – double the national average.

The duo, who both have fond memories of caring for patients in Louisiana, emphasize that continued transformation will require federally recognized standards, combating data blocking, and creating an ROI around interoperability.

Last Week’s Most Interesting News

• Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs.
• InstaMed announces a $50 million investment from Carrick Capital Partners.
• Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.
• The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.
• Hilary Clinton outlines in NEJM her plans for improving healthcare, which includes improving ACA, working to “integrate our fragmented healthcare delivery systems,” and helping to increase research and innovation.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Safety Net Connect and private equity firm Gary Comer Inc. acquire Chicago-based patient engagement and care coordination technology company VCareConnect for an undisclosed sum.

Senior care services provider US CareNet forms a new company, HC360 Technologies, after purchasing the chronic care and transitional care management technology used in its NavCare care management division.

Announcements and Implementations

Miami Children’s Health System adds ambulatory business office services including RCM to its existing Millenium EHR partnership with Cerner.

Cohen Veterans Network (CT) selects Netsmart’s MyEvolv CareRecord to help it provide free mental healthcare to veterans and their families. The network, which launched in April, have opened five Steven A. Cohen Military Family Clinics across the country and plans to open 20 more over the next five years.

Community Health Partnership (CO) will implement ClientTrack case management software from Eccovia Solutions to better assist its membership of 25 organizations coordinate medical and behavioral healthcare.

Technology

Drchrono develops a “native” iPad and iPhone app for e-prescribing of controlled substances.

Government and Politics

The Dallas Morning News spotlights the refusal of the Texas Department of State Health Services to release data related to pregnancy and maternal death rates to reporters and other organizations looking to gain a better understanding of why the state’s death rates doubled between 2011 and 2012. The department has even refused – without explanation – to release a data record layout, akin to a table of contents that shows what data it collected and how it’s stored. “It’s ridiculous,” says Texas-based lawyer and open records expert Joe Larsen. “We have a clear public health problem, and the people really need to know what in the world is going on here, and they’re stymied by this," he said. "A record layout is not software. It’s not code. It’s not source code. Period. I liken it to the key of a map. It’s actually public information itself.”

Privacy and Security

From DataBreaches.net:

• Marin Medical Practices Concepts notifies 5,000 patients that their medical records were lost during a recovery process stemming from a ransomware attack in July. After patient files were held for 10 days, the California-based billing and EHR company decided to pay an undisclosed ransom amount, which successfully unlocked the files. MMPC attributes the lost files to a faulty backup, adding that the recovery was done during a system upgrade.
• Urgent Care Clinic of Oxford (MS) notifies patients seen before August 2 of a likely ransomware attack initiated in early July, noting in their letter that, “The hackers held the server for ransom before turning control back over to the Urgent Care staff.” The clinic shut down their server’s remote access shortly thereafter, implying that the hackers (thought to be of the Russian variety) snuck in via remote desktop access.
• Martin Army Community Hospital (GA) alerts patients of a possible HIPAA breach that took place at Fort Benning between January 2011 and December 2013. The breach stems from “criminal activity involving identity theft by an employee in the laboratory shipping section.” The employee, who was tried for the crime and is now serving time, apparently used information from discarded lab specimen labels to file fraudulent tax returns.

Other

Ochsner Health System (LA) SVP David Carmouche highlights EHRs, registries, and new compensation models as integral to its population health activities and overall move away from fee-for-service:

“We’re leveraging electronic health records, which connect all of our systems. We have created some 20 registries identifying groups of patients with certain diseases and conditions, and we’re reaching out to them proactively, to make sure they’re getting the care they need, when they need it. We’re realigning physician compensation for Ochsner-employed physicians, moving away from fee-for-service payment to higher payment for high-value, high-quality care. We’re looking at physician preference items, trying to consolidate down to one or two knee implants, or one or two cardiovascular implants, so that we can get better pricing from manufacturers. The best way to keep costs down will be to provide high quality care, so patients can go home quickly and recover fully.”

The system went live on Epic in 2011, and three years later became the first provider to integrate Epic with Apple’s HealthKit.

Scientific American takes a long-form look at the ways in which the FDA (and, increasingly, other federal agencies) manipulates the media, denying access and offering not-so-true findings to some news organizations, while enforcing restrictive rules like the “close-hold embargo” on others. “By using close-hold embargoes and other methods, the FDA, like other sources of scientific information, are gaining control of journalists who are supposed to keep an eye on those institutions,” writes Charles Seife. “The watchdogs are being turned into lapdogs.”

Sponsor Updates

• Forward Health Group CEO Michael Barbouche is featured in a Wisconsin State Journal article on Wisconsin healthcare technology.
• The HCI Group launches a new “Monday Morning Podcast” series.

Blog Posts

• Need help meeting your 2016 goals? Finish the year strong! (Nordic)
• Nordic’s 5th annual Open House Recap (Nordic)

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 9/30/16

My Vision for Universal, Quality, Affordable Health Care

Using NEJM as a podium, Hilary Clinton outlines her plans for improving healthcare, which includes improving ACA, working to “integrate our fragmented healthcare delivery systems,” and helping to increase research and innovation.

HITRUST Becomes First Healthcare Information Sharing Organization Connected to DHS Automated Indicator Sharing Program

Health Information Trust Alliance begins exchanging bi-directional cyber threat alerts with the Department of Homeland Security.

AARP, HHS Announce Winners of Challenge to Redesign the Medical Bill for Patients

HHS announces the winner of its “A Bill You Can Understand” design challenge. The challenge awarded two prizes, one for the bill that is easiest to understand, and another for the design that best improves the overall approach to the medical billing system.

EPtalk by Dr. Jayne 9/29/16

There has been a lot of chatter in the physician lounge recently about the “Pick your Pace” options for Medicare-related quality reporting next year. Of course, most of the chatter has been either from hospital administrators or from physician leaders of larger groups, since many smaller and independent physician groups may not even be aware of what is about to happen. I was part of a lively exchange this week around the fact that the program has to be budget neutral. To recap, the four options are: 1) Test the quality payment program (no penalty); 2) Report for part of the calendar year (small incentive); 3) Participate for the full year (modest incentive); and 4) Participate in an Advanced Alternative Payment Model (5-percent incentive). The devil may be in the details since it’s unclear how no penalty and small incentives can balance out to be budget neutral. Where is the incentive money going to come from?

It’s also not clear what the actual “test” process in option 1 is going to entail. Unless you’re just starting on your EHR journey, most organizations should be able to report for at least part of the year without significant difficulty. The data may not be of great quality, depending on how well you’re using your EHR, but you can still report it out. We’ll have to wait for the final rule, however, to see what the reporting requirements end up looking like. The partial-year option is going to be attractive to a great number of providers whose EHRs may not be ready for full-year reporting, so I expect to see the most questions on that option.

For providers that are in the thick of trying to comply with all the federal requirements, the 2015 Annual Quality Resource and Utilization Reports (QRURs) were released this week. The QRURs show what a provider’s payment adjustment will be for 2017 based on analysis of quality and cost domains. I attended the Medicare Learning Network call on the topic today. If I didn’t already know a considerable amount about the Value Modifier payment adjustment and the PQRS payment adjustment, I might be more confused after attending the call. The call began with a presenter essentially reading slides to the audience. There were constant references to the appendix, and fortunately the slides were available for download at the beginning of the call so that attendees could follow along.

I’m still mystified by the fact that it takes 21 months to analyze and release the data. We’re talking about using data from 2015 to determine how providers are paid in 2017. Although there was a Mid-Year QRUR that was released in the summer, it didn’t fully illustrate how payment adjustments might be applied. Regardless, the Mid-Year QRUR has little utility to encourage providers to modify their behavior in order to avoid adjustments, since it’s a look-back document. When trying to modify behavior, it’s most useful to provide real-time or at least fairly immediate feedback. Under the CMS construct, the feedback loop is delayed. Does it really take 21 months to aggregate and interpret the data? Or maybe the delay is intentional, as providers move deeper and deeper into a state of learned helplessness.

After about 15 minutes on the call, I felt my brain going numb as the presenter reviewed all the steps needed to access the QRUR. Providers or their designees have to go through the process of requesting an Enterprise Identity Management (EIDM) account which has multiple steps and sub-steps. The acronym soup became less savory as we learned about Provider Transaction Access Numbers (PTAN), which have to be obtained from the Medicare Administrative Contractor (MAC). Once you go through all the related steps and click your heels a couple of times, you can either view or download the presentation.

The presenter tagged-out to a second presenter who went through a table explaining the different sections of a “hypothetical” QRUR. Again, it was basically someone reading a slide to the audience – actually showing the various exhibits and sections while talking about them would have been useful. They did eventually go through some of the specifics, but I wonder how many attendees were following especially if this was the first time they were seeing this material. As the talk moved into discussion of the various quality and cost composite scores, and the need for a statistically significant deviation from the mean to be categorized as more (or less) than average, I wondered how many people attending the webinar understood those statistical terms.

Having spent my final two years at Big Medical Center working on a provider attribution project, I was eagerly awaiting the discussion of how Medicare beneficiaries were assigned to their respective Taxpayer Identification Numbers (TIN). This attribution drives the cost composite score found in the QRUR. Not only is CMS looking at spending per beneficiary, they are also looking at per capita costs for beneficiaries with various chronic conditions including diabetes, chronic obstructive pulmonary disease, coronary artery disease, and heart failure. They didn’t go into anywhere near the detail I expected for a provider to actually understand how the attribution was done. There are detailed elements involving whether a given TIN provided the majority of primary care services during the year, whether primary care services were received from subspecialists in the TIN, and more. None of that was covered.

Heading into the discussion of the “Informal Review Process” that providers can use to disagree with Value Modifier calculated for their TIN, the presenter became flustered due to a missing slide and rather than vamping her way through it, actually paused the presentation while they tried to sort it out. When she restarted, she actually re-read some scripted comments. I felt bad for her – we’ve all been on the downside of presentations that don’t go as planned. She then went into a discussion of various tables in the appendix, which again weren’t on the screen. Apparently, providers can download them in Excel and use them to analyze their own data, even de-identifying it by removing specific columns. It would have been good to see a screenshot of the data format to go along with the discussion.

Once she finally made it to the discussion of the review process, things were back on track. The review period began September 26 and is open for 60 days. The review has to be requested using the EIDM system and the process includes a Multi-Factor Authentication (MFA) step. Users have to remember to use the same MFA device type that they selected to use when they first created their accounts. Depending on how long ago one’s account was created, this may be a challenge. Users can then request the review, which leads to an additional three steps that weren’t shown in the webinar. Users can download a quick reference guide from the CMS website for more information on the reviews, although the link wasn’t shown in the webinar. As a side note, there were a couple of times at the beginning of the webinar where the speaker gave Web addresses verbally but with no link or text shown. Especially with a webinar platform, is there any reason why a link shouldn’t be shown on the screen and provided in the deck that was given to attendees? Another unusual statement (given by two different speakers) was that users should disable their popup blockers and should not connect wirelessly or via VPN but should connect via a wired connection. In this day of mobility and multi-platform device use, it felt like CMS is out of touch with how people use devices to receive information.

They opened the call to Questions and Answers and the first one seemed to challenge them, about whether the adjustment would be provided on a claim-by-claim basis or at the end of the year. Eventually they arrived at the per-claim answer. They answered the second question (about beneficiary attribution) by referring users to yet another website. I finally figured out why they wanted popup blockers disabled when a poll popped up asking how many people were viewing the session with me. There were also polling questions on whether I had difficulty accessing the webinar and whether I was satisfied with the webinar platform used. The questions continued, including one from a group who had discrepancies in the data from their QRUR. She was instructed to submit informal review for both QRUR and PQRS, and the latter has to be done through a different process that the group had difficulty explaining. They had to pause while they conferred, agreeing to look it up and provide it later.

That only served to underscore how complicated these programs are and how challenging it will be for provider groups of all sizes to try to keep up. Staying current with software and enforcing end-user behavior is hard enough, but this adds an entirely different layer of challenges for practice operations and management teams. I had to duck out for another call but am looking forward to seeing the rest of the Q&A in the transcript.

How is your organization coping with the QRUR? Email me.

Email Dr. Jayne.

News 9/30/16

Top News

Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs, and will provide its own 50,000 employees Apple Watches free of charge.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pontificates on the proper way for vendors to apologize for unexpected downtime. Enjoin VP James Fee, MD describes how physician engagement efforts can improve clinical documentation. Malvern Family Medical Clinic Owner Shawn Purifoy, MD offers insight into the benefits of joining an ACO and the struggle to remain independent. Medecision William Gillespie, MD lists three population health must-haves for primary care. Midwest Nephrology Associates Owner Gary Singer, MD digs into the benefits of Carequality’s Interoperability Framework.

This week on HIStalk Connect: Sirono Chief Revenue Officer Peter Longo discusses the problem with hospital billing and keys to successful patient payments.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

Vidyo launches a clinical design service to help providers integrate telemedicine into their workflows.

PatientPing and Vermont Information Technology Leaders deem their care coordination technology collaboration a success at the six-month mark. Since going live, 400 provider locations in New England have been “pinged,” letting them know that their patients have been seen at local hospitals. PatientPing has recorded 62,000 notifications on 12,000 Vermont citizens.

UAB Medicine will replace its connectivity software with Orion Health’s Rhapsody Integration Engine – a project that will include rewriting 300 interfaces.

Cypress Creek ER (TX) selects Wellsoft’s EDIS for its third freestanding ER, set to open mid-October. Angleton ER (TX) will go live with Wellsoft technology when it opens in December.

NewCrop adds specialty medication prescribing software from AssistRx to its e-prescribing software.

Acquisitions, Funding, Business, and Stock

Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.

MedWand Digital Health secures a “major investment” from sensor technology-focused Maxim Ventures, which the Las Vegas-based startup will use to work towards anticipated 2017 FDA approval of its diagnostic device for virtual consults.

People

Wendy Deibert (The VirtualEngine) joins Vidyo as VP of clinical services.

Teladoc adds the new role of COO to CFO Mark Hirschhorn’s responsibilities.

Greg Alexander (Evolent Health) joins Lumeris as national VP of market operations.

The Chartis Group promotes Michael Topchik to head of the new Chartis Center for Rural Health.

Michael Bain, MD (Qualified Emergency Specialists) will head Cincinnati-based TriHealth’s new clinical informatics department as CMIO.

Technology

Dr. Oz lends his gravitas to San Francisco-based wearables startup IBeat, becoming an investor, partner, and advisor to the company as it launches its heart-monitoring smartwatch via an Indiegogo campaign. For a mere $5,000, buyers can purchase the “Meet Dr. Oz Special,” which includes VIP access to this show, a two-night hotel stay in New York City, two watches and monitoring services, plus a signed book and scrubs. Oz was not involved in last month’s seed funding round of $1.5 million.

Government and Politics

HHS and AARP announce the winners of their “A Bill You Can Understand” contest. Designs from Los Angeles-based RadNet, which won in the easiest-to-understand category, and San Francisco-based Sequence, which won in the overall approach category, will be tested or implemented in six healthcare facilities – including Cambia Health Solutions – across the country. (Jenn talked with CHS President and CEO Mark Ganz about the challenge as part of “The Hypocrisy of a Simpler Patient Bill.”)

Hillary Clinton takes to the New England Journal of Medicine to outline her vision for universal, quality, affordable healthcare. Her short op-ed hints at healthcare IT among her four goals: “I am also committed to expanding access to high-quality data on cost, care quality, and health delivery system performance to help patients and doctors make informed choices, and entrepreneurs build new products and services.” Donald Trump has thus far declined the same editorial opportunity.

ONC awards seven organizations $1.5 million to improve the flow of health data for patients and providers, particularly data related to medication management, laboratory data, and care coordination. The funding comes via the office’s High Impact Pilot and Standards Exploration Award programs.

HIMSS presents Acting Assistant Secretary for Health and former national coordinator Karen DeSalvo, MD with the Federal Health IT Leadership Award during its National Health IT Week festivities.

Privacy and Security

HITRUST connects and begins bi-directional sharing of cyber threat indicators with the Department of Homeland Security’s Automated Indicator Sharing Program. The information exchange corresponds with HITRUST’s new CyberAid program, which helps smaller organizations select security solutions and contribute to the exchange.

From DataBreaches.net:

• The New Jersey Spine Center notifies patients of a July 27 ransomware attack that resulted in the provider paying an unspecified dollar amount to unlock all of its digital patient records. Files were reinstated on August 1.
• Royal Cornwall Hospitals Trust in England suffers multiple ransomware attacks over the past year.
• Australia Health Minister Sussan Ley apologizes to physicians for the accidental leaking of Medicare data, discovered after University of Melbourne researchers attempted to decrypt some of the data, thus inadvertently revealing sensitive information.

Research and Innovation

The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.

An American Telemedicine Association/Wego Health survey of 429 patients finds that just 22 percent have taken advantage of video visits in the last year, with the average patient engaging in between one and four virtual consults. Of that percentage, as many patients requested telemedicine services as their providers initially offered it. I’m not sure that “strong demand,” as tweeted above, is warranted with these results.

Other

Seems like #HIMSSanity has already begun.

British researchers have created a 3D-printed replica of the human body to help train surgeons, particularly when it comes to making that initial slice.

Sponsor Updates

• Fortified Health Solutions will exhibit at the HIMSS Southern California Annual Privacy & Security Forum September 30 in Newport Beach.
• Frost & Sullivan recognizes Orion Health with the 2016 European Frost & Sullivan Award for Product Leadership.

Blog Posts

• Ensuring a healthy, safe and environmentally conscious workplace—not only for patients, but your employees. (Infor Healthcare)
• The Dawn of Artificial Clinical Awareness (ClinicalArchitecture)

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 9/29/16

FDA Approves First ‘Artificial Pancreas’ for Diabetes

The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.

Aetna to Transform Members’ Consumer Health Experience Using iPhone, iPad and Apple Watch

Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs, and will provide its own 50,000 employees Apple Watches free of charge.

Fixing electronic health records is good. Adding scribes is even better

In a STAT editorial, an emergency medicine resident at the University of Virginia discusses the impact working with a scribe has on job satisfaction.

AMA Survey Finds Physicians Enthusiastic About Digital Health Innovation

An AMA survey of 1,300 physicians finds broad-based optimism for digital health innovations, but note that liability coverage, data privacy, workflow integration, and improved ease of use are all issues that need to be overcome before digital health tools will deliver at full capacity.

Safeguarding Smartphones in an Era of Escalating Vulnerabilities

HIPAA-related security concerns mount as smartphones become more ubiquitous across enterprise healthcare environments.
By @JennHIStalk

Ransomware headlines seem to reign supreme in healthcare news, and yet industry insiders know that the greater potential for cyberattack and financial loss resides in just about every person’s pocket (or pocketbook). Catholic Health Care Services of the Archdiocese of Philadelphia’s $650,000 settlement with OCR for HIPAA violations this summer is a prime example of the vulnerability of mobile smart devices. The settlement stemmed from the theft of a smartphone containing the PHI of 412 nursing home residents. Acting as a business associate, CHCS provided IT and management services to six SNFs, and was thus responsible for protecting resident PHI under HIPAA. OCR found that, in addition to a lack of encryption and password protection, CHCS also neglected to develop a risk analysis and accompanying plan for risk management.

While the organization’s lack of cyber safeguards and subsequent fine made headlines, it’s probably a safe bet to assume that other similar entities are operating without the appropriate security safety nets.

Getting on the MDM Hamster Wheel

Smartphone security “is a moving target,” says Alex Brown, director of strategy at healthcare communications company Voalte. “Today, there seems to be two layers of what people are looking into when it comes to smartphone security – applications on the device and the content of those applications. If your application has PHI sitting in it all the time, than you have a much higher risk than with an app that has PHI on it only when it’s connected to a server.

“Not every healthcare organization has the expertise to deploy security,” he adds, “which is why providers rely so much on vendors to make sure that they’re really keeping up to date with best practices around mobile device management.”

Brown finds that in today’s world of escalating cybersecurity concerns, constant dialogue with hospital customers about the importance of up-to-date MDM is a must. Hospitals are now faced with managing almost daily updates from Apple and Google, he explains, which, for many, has taken some getting used to.

“It’s an important piece that not a lot of sites think about,” Brown says. “It’s constantly moving. I like to refer to the smartphone space as a hamster wheel of updates. It can be a little daunting to get on it, and once you’re on it, you really have to keep up. If you don’t, that’s where you can introduce risk. The CHCS settlement was a gut check for other providers in the sense that they hopefully are now asking themselves, ‘Are we checking all the boxes constantly? Are there new boxes that we can now check?’”

Great Vendor Expectations

Parkview Medical Center (CO) CIO and Vice President of IT Steve Shirley has seen his fair share of cybersecurity practices, having spent 30 years in banking IT and nearly eight in healthcare. “In banking, we were mandated and audited on our vendor management programs. I routinely went onsite at vendor locations to audit their data centers, review their SaaS70 reports, and determine the overall security posture of the firm. We looked at their financials and did a significant amount of work to ensure the vendor was not only financially strong and stable, but secure, and that our data was safe.”

Shirley adds that security in the financial industry is at a higher level of maturation than in healthcare for obvious reasons. “They have to protect identities and money,” he explains. “Now that health data is under attack, we need to raise security to a higher standard. At Parkview, we’re heavy users of smartphones. The challenge is that in the BYOD world, other than our MDM strategy and provisioning, we don’t have a lot of control over what devices come in the door. And so we expect the highest level of security from our vendors. We include vendor management in our RFPs and require BA agreements for any vendor dialing into our system in any way. This is in addition to the standard requirement when the vendor has access to our data for things like analytical activity.

“When we implement new solutions,” he adds, “we collaborate with them to plan and design for security, whether at the mobile device level or system level. When we partnered with PatientSafe Solutions to roll out PatientTouch on the iPhone for services ranging from bedside medication verification to care team texting and communications, we brought in all of the vendors involved to develop a system that was not only reliable and functional, but also secure across all connections and access points. Six companies were involved: PatientSafe, their wireless vendor, our IT team and wireless vendor, Cisco, and Apple all participated in ensuring the system worked seamlessly and securely.”

Sticks Will Get the Cybersecurity Job Done

With regard to the CHCS breach, Shirley isn’t shy about sharing his opinion. “In the banking industry, I learned that we all mean to do good, but the movement of the day is so fast and furious that things tend to fall by the wayside,” he says. “And so the government stepped in with punitive measures for not meeting security or other standards. Y2K was a great example. The FDIC threatened to close banks if they didn’t have an appropriate Y2K strategy. I pray every day my hospital doesn’t get attacked and a breach occurs. As regretful and tough as the fine is, it’s a necessity because it creates an industry wakeup call for those who haven’t realized healthcare is under attack.

“It seems that while people understand that systems like servers, desktops, laptops, etc. are highly susceptible to attack if not properly protected, there’s a perception that smartphones are different,” he explains. “We, both industry and our consumers, need to get serious about understanding that a smartphone is a device that has access through the Internet and is thus vulnerable.”

Grace Hua, director of product management, clinical communications at PatientSafe, is of a like mind in her belief that hospitals should demand that vendors provide technology support and safeguards for clinician end users. “This should be a wakeup call not only for BAs, but for the industry as a whole,” she says in reference to the CHCS news. “BAs need to fully understand the importance of the data they are potentially putting at risk, and the implications of theft or security breach, as that data now has a dollar value tied to it. Hacking is now just as profitable in healthcare as other industries.”

Increasing Staff Awareness

When it comes to safeguarding smartphones and patient PHI, Shirley and his team are taking proactive measures to keep CHCS-type incidents at bay. Higher-level efforts include membership in security organizations like the SANS Institute and making sure that new technology deployments include a project milestone for evaluating and understanding potential security risks, and then developing a plan to mitigate them.

“This seems so intuitive,” he says, “but I think it is sometimes not the highest priority in the deployment of healthcare systems. Examples of this include installation of modalities for radiology that have communications facilities onboard, or even simple things like network printers.”

Shirley is especially excited about boots-on-the-ground efforts at Parkview. “We have a network security engineer who, in addition to his technical role, is responsible for security education. He regularly visits units during their daily huddles to give security tips like how to create strong passwords or how to validate that the person on the phone is authorized to receive information. Throughout the hospital, we use our digital wallboards to deliver security messages to everyone onsite. Our employee and physician newsletters have standing articles about safety. We’re also putting together a security video that will be required viewing for all employees. The effort has been huge in the last year to increase staff awareness.”

A Rising Tide Lifts All Cybersecurity Practices

Shirley is happy to report that his colleagues at neighboring institutions are paying just as much attention to securing mobile devices. “Two years ago, I would have said healthcare organizations are not paying enough attention to cybersecurity protection,” he says. “Now, I’m seeing new and extreme efforts every single day. Recently, a competitor healthcare system went to two-factor authentication for external access, and I think that’s awesome. At Parkview, we’ve implemented MDM for all of our devices. We don’t store data on laptops or mobile devices, and we don’t deploy any mobile hardware that hasn’t been encrypted. I think the industry understands healthcare is under threat and there are many points of potential vulnerability we need to address. It’s absolutely becoming more of a focus.”

Morning Headlines 9/28/16

InstaMed Announces $50 Million Investment From Carrick Capital Partners

InstaMed announces a $50 million investment from Carrick Capital Partners, which it says will be used to “drive the growth of the InstaMed Network, accelerate go-to-market strategy, and drive further innovation in healthcare payments technology.” The new round brings InstaMed’s total funding to $126 million since its 2004 formation.

Technology and Health Care: The View From HHS

HHS CTO Susannah Fox discusses the future of innovation in healthcare and HHS in a Wall Street Journal interview.

EHR Contracts Untangled

ONC publishes a guide on EHR contracting for providers.

Former Tuomey CEO to personally pay $1 million to settle False Claims Act case

Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.

News 9/28/16

Top News

InstaMed secures a $50 million investment from Carrick Capital Partners, bringing its total funding to nearly $126 million since launching in 2004. (CCP’s only other foray into healthcare IT seems to be a 2014 majority equity investment in post-acute software vendor Procura.) The Philadelphia-based company will use this latest round to further develop its healthcare payments technology and go-to-market strategy. CCP Managing Director Jim Madden will join InstaMed’s board, while colleague Chris Wenner will become a board observer.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock 

Waycross, GA-based Salus Telehealth and Chicago-based VideoMedicine merge under the Salus brand name to offer telemedicine hardware and software, including a direct-to-consumer app. Salus CEO Paula Guy will remain in that role over the newly combined company. VideoMedicine founder and CEO Charles Butler, MD seems enthusiastic about the merger, though his role moving forward remains unclear. Fun fact: He competed at the age of 18 in the 1998 Nagano Winter Olympic Games in the sport of ice dancing.

PeriGen confirms the acquisition of Hill-Rom’s WatchChild Fetal Monitoring System. The newly combined team will be led by PeriGen CEO Matthew Sappern, while the management team will include executives from both companies. WatchChild General Manager Brian Bishop will join PeriGen as chief product officer. PeriGen also closed a corresponding investment round led by Ambina Partners, giving AP founder Greg Share a spot on PeriGen’s board.

People

Sentry Data Systems promotes Tom Tran to CFO and COO.

Cerner President Zane Burke joins the board of Truman Medical Centers (MO), which signed on to a 10-year EHR deal with Cerner last fall.

Shelby Solomon (Connecture) joins Medecision as SVP, corporate development and strategy.

Announcements and Implementations

Sunnybrook Health Sciences Centre will implement patient registration technology from Harris QuadraMed across its three facilities in Toronto.

Cigna adds virtual consults from American Well to its telemedicine offerings for 2017 employer-sponsored and individual health plans. The payer rolled out a similar service from MDLive in 2013.

Standards development organization NCPDP works with Experian Health to develop a vendor-neutral universal patient ID management tool.

Several hospitals, including Boston Children’s Hospital and Mercy Health System (WI), and a Pennsylvania-based care program for the elderly, roll out Circulation’s medical transportation technology, which takes advantage of Uber’s API to help providers and patients schedule rides that cater to specific needs and preferences. 

Indiana-based HMO MDWise – a joint venture between Eskenazi Health and Indiana University Health – taps Valence Health to process its medical claims beginning January 1.

San Mateo County Health System (CA) implements NextGate’s EMPI patient-matching technology across its 10 divisions and six EHRs.

Privacy and Security

The GAO releases a “scathing” report on cybersecurity preparedness in health information technology, recommending that HHS “update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.”

A former Alberta Hospital Edmonton employee inappropriately accesses the records of 1,300 patients over the course of 11 years, most likely out of “personal curiosity,” making it the Canadian province’s largest deliberate breach of health data.

Technology

SnapMD adds provider-to-provider consult capabilities to its telemedicine technology.

Varian Medical Systems develops new cancer care coordination software that aggregates EHR, IS, and portal data from the patient, PCP, radiation, medical and surgical oncology, and social services.

Memorial Healthcare System partners with American Well to offer a telemedicine app for members of its managed care or consumer health plans.

Casenet rolls out the latest release of its TruCare care administration and management software.

Government and Politics

President Obama gives his stamp of approval to National Health IT Week, reminding citizens of the “billions of dollars” spent to encourage the adoption of EHRs at 97 percent of the country’s hospitals, and his efforts to launch the Precision Medicine Initiative.

Coinciding with nationwide health IT marketing push, ONC releases its Health IT Playbook, a Web-based manual that updates the Patient Engagement Playbook for Providers, offering guidance on a wide variety of health IT products and topics. The playbook includes a guide to EHR selection and contracts.

Research and Innovation

Despite past “snake oil” commentary, an AMA survey of 1,300 physicians finds that a majority are optimistic about the potential of digital health tools to improve patient care. Enthusiasm seems to outweigh adoption: Physicians cite liability coverage, EHR workflow integration, and data privacy as must-haves for successful and consistent adoption.

Sponsor Updates

• Forward Health Group Founder and CEO Michael Barbouche speaks at the Wisconsin BioHealth Summit September 27 in Madison.
• Impact Advisors releases a new white paper, “Realizing Clinical Benefits from EHR Investments.”
• Liaison Technologies and Meditech celebrate National Health IT Week.
• Meditech releases a new white paper, “The Benefits of an Integrated Approach to Critical Care.”
• Verscend Technologies kicks off its eighth annual conference, taking place in Palm Desert, CA through September 30.
• Glytec receives three patent notices of allowance for its EGlycemic Management System.

Blog Posts

• Who’s Ready for MACRA/MIPS? Why Aprima Is, of Course! (Aprima)
• National Health IT Week: Celebrating Industry Innovations (Spok)

Contacts

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

Morning Headlines 9/27/16

GAO slams HHS in health IT cybersecurity report

The GAO releases a “scathing” report on cybersecurity preparedness in health information technology, recommending that HHS “update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.”

Medical Record Mix-Ups a Common Problem, Study Finds

The Wall Street Journal reports on an ECRI Institute study on wrong-patient medical errors, of which 7,613 cases were identified between January 2013 and July 2015. The report calls for an increased use of barcode scanners and patient pictures embedded within the EHR, but stops short of calling for a national patient identifier.

A New Tool to Help Health Care Providers Get the Most Out of their Health IT

ONC releases its Health IT Playbook, a web-based manual that updates the Patient Engagement Playbook for Providers, offering guidance on a wide variety of health IT products and topics.

ACO Spillover Effects: An Opportunity Not to Be Missed

A NEJM study investigates what impact ACOs might be having on non-ACO patients being treated by the network.

Curbside Consult with Dr. Jayne 9/26/16

National Health IT Week is underway. According to the press release, “This annual celebration is a time for all of us to reflect on the progress we have made and recommit ourselves to advancing the promise of health information technology.” The newest National Coordinator for Health IT, Vindell Washington, MD will host a Twitter chat on Tuesday starting at 11am ET using the hashtag #AskVindell. Topics include the current and future state of health IT as well as questions and answers. There are all kinds of National Health IT Week activities taking place across the country. I’m out with clients this week so I won’t make it to any of the festivities. Still, I wanted to take a chance to reflect on my own time in the Health IT trenches.

I was fortunate to attend a medical school that rotated its students through hospitals that embraced technology. Looking back, some of it was pretty primitive, but back in the day we thought we were cutting edge as we navigated through the lab system with light pens tethered to green-screen terminals. One hospital had started its own EMR. Even in the early days, it had most of the data needed to round on patients – laboratory data, vital signs, medication lists, and more. It was a luxury to prepare for rounds at a single workstation rather than having to round up paper charts and dig through them.

Surprisingly, the more advanced hospital was a community hospital rather than the primary academic hospital. Looking back, it may have been easier to pilot informatics platforms on the community side since the roster of admitting physicians was fairly stable. Although residents and students participated in patient care, it wasn’t at the same volume as the academic hospital. The community hospital was progressive in other ways, building the first hospitalist program in the city and serving as a pioneer in laparoscopic surgery.

My medical school class was the first one to have email accounts issued to everyone with the expectation that we’d actually use it, as opposed to it being optional. Granted, it was Lotus Notes, but it was high tech at the time. We still did our histology coursework looking at carousel after carousel of 35mm slides, however. We had a transcription service where someone took notes at every class and distributed them; without laptops, we took old-fashioned paper notes then typed them up later, printed them, and photocopied them. No one seemed to put two and two together that we could have been emailing them around. Today, my school augments its gross anatomy program with virtual anatomy – 3D computer simulations based on CT scans taken of live individuals. Very different than the cadaver cross sections that we worked with.

Health IT really started to boom while I was in my residency training, with increased nursing documentation being done electronically, although paper copies were still printed and added to the chart. There was a lot of fighting over PCs because the hospital hadn’t really thought through the computerization piece or what it would look like from a workflow standpoint. The residents thought we were cool because we could dictate our History and Physical documents and Admission notes using Dragon. It not only helped avoid the lengthy, handwritten note process but made sure the documents were on the chart quickly compared to the turn-around time required for “regular” transcription. No one at the time thought of outsourcing transcription services to 24×7 resources in another country, and certainly no one thought much about natural language processing.

I purchased my first handheld device as a Chief Resident. While others seemed to be leaning towards the Palm Pilot platform, I went with the Pocket PC. Although I legitimized my purchase by using it to take attendance at Grand Rounds and to use Excel to track various program requirements, I secretly thought the coolest feature was the fact that you could put music on it. The ultimate mix tape was now in your pocket at all times (or at least as long as the battery lasted). I found that Pocket PC in a drawer a few weeks ago and it fired right up. The data files were gone but the music was all still there, providing a much-appreciated blast from the past.

When I opened my solo practice, I was supposed to be on an EHR from day one, but there were implementation issues, forcing me to spend a year on paper charts in an office that wasn’t built to house paper charts. When we finally got our system, we learned a lot about vendor bait-and-switch, starting when the trainer first arrived and tried to train us on a system that was different than what we actually had installed. It went downhill from there and ultimately resulted in a de-installation. That experience, however, set the groundwork for my career in health IT, as hospital leadership realized I had been through the wringer but learned quite a bit, and could be an asset to their future EHR plans. I slowly crossed over into the technology side of things and never looked back.

People occasionally ask whether I think it was a waste of time to go to medical school. They often assume I don’t see patients anymore. Being a physician first was critical to me winding up in the wild and crazy world I work in today, and I wouldn’t trade it even with the hideous student loans and the long, torturous work hours. I learned health IT on the side and on the fly, while building a practice and settling in as a young physician. We’ve gone a long way past many of the things I used to struggle with early in my career – trying to access charts in the middle of the night, dealing with pharmacies that weren’t comfortable with electronic prescriptions, and bringing faxes directly into the EHR. Now we’re moving into an age where pharmacogenomics is a reality and we have the world’s library at the tips of our fingers at all times.

I remember doing an interview for the hospital newsletter early in my career. The CMO called to blast me for saying that having computers in the office allowed me to look things up during the patient visit. He felt that my statement implied that I was inexperienced and that patients would avoid me. Quite the opposite: Patients appreciated having a physician who was willing to look things up and show them the actual literature so that we could make decisions together. Having technology in the room transformed how I practiced in a positive way, and I know it made a particular difference for many of my patients. Sometimes, as we reflect on how we work with technology today, we tend to demonize it without putting into perspective what our daily lives would look like without it.

Even though it sometimes drives me crazy, I’m grateful for healthcare IT and what it has done for me personally. I’m hopeful for what the future holds, even despite the mandates and regulations. I can’t wait to look back in another five or 10 years and see where we’ve gone.

How has health IT impacted you, personally or professionally? Email me.

Email Dr. Jayne.

Morning Headlines 9/26/16

GE Healthcare Aims to Fund up to $50M for Global Health Startups

GE launches a healthcare-focused accelerator with $50 million in funding.

Our Decision to Exit the ACA Marketplace

BCBS of Nebraska announces that it will exit the state’s health insurance exchange, citing the $140 million in marketplace-related losses it has suffered thus far.

Remote Alaska port clinic goes modern with telemedicine

Providence Alaska Medical Center (AK) begins offering telehealth critical care consults to a clinic in Unalaska, the remote town that is home to Dutch Harbor, one of Alaska’s busiest fishing ports.

HIPAA settlement illustrates the importance of reviewing and updating, as necessary, business associate agreements

Care New England Health System pays $400,000 to settle HIPAA violations after OCR discovered, while investigating a lost backup tape, that it had hadn’t updated its business associate agreement with Woman & Infants Hospital (RI) since 2005.

Monday Morning Update 9/26/16

Top News

GE Healthcare launches Five.Eight, an accelerator (not to be confused with the Athens, GA rock band) for global healthcare startups aimed at improving outcomes for the estimated 5.8 billion people in the world who don’t have access to quality, affordable care. The accelerator hopes to enroll 10 companies in its first program, each of which will work with GE on developing scalable products for potential distribution or integration into GE’s portfolio. Seed funding of up to $5 million per startup may also be available.

India-based Tricog is the first member of the new accelerator. The startup has developed technology to help ED physicians diagnose heart attack patients within minutes, decreasing time between symptoms and treatment and increasing survival rates.

HIStalk Announcements and Requests

It’s Hillary Clinton in a landslide with heavy HIStalk reader turnout. Maybe I’ll run it again after the debates. New poll to your right or here: continuing last week’s poll, which health IT salesperson LinkedIn credential would most impress you?

Welcome to new HIStalk Platinum Sponsor Ivenix. The Amesbury, MA-based company has transformed IV infusion delivery from the decades-old technology of competitors to the connected world to improve patient safety, eliminate workflow inefficiencies, and protect the hospital’s bottom line by reducing adverse events. The Ivenix Infusion Management System measures and adjusts IV flow rate in real time and supports mobile viewing of infusion status and alarms, integrating with the EHR to auto-program and auto-document. Adaptive technology eliminates the need for ongoing calibration, while software and security updates along with drug library updates are delivered without removing devices from the floors. Ivenix addresses the challenges of increasingly complex dosing regimens, the demand for EHR integration, and infusion technology-related patient safety issues. Thanks to Ivenix for supporting HIStalk.

I found this video that describes the benefits of the Ivenix Infusion Management System, including eliminating nurse time spent manually documenting IV pump information in the EHR.

Last Week’s Most Interesting News

• Epic announces a number of new offerings and initiatives at its annual user group meeting, which attracted 18,000 attendees.
• The Chan Zuckerberg Initiative donates $3 billion to “cure, prevent, or manage all diseases by the end of the century.”
• Private GPs in England offer third-party video visits as an alternative to long appointment wait times, with NHS footing the bill.
• The entire board of Cairns Hospital in Australia resigns following an unpopular and over budget Cerner rollout.
• Appalachian Regional Healthcare (KY and WV) brings the computer systems of its several hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by a malware attack.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Blue Cross Blue Shield of Nebraska pulls out of the federal health insurance exchange, leaving Nebraskans with extremely limited purchasing options when open enrollment starts November 1.

TierPoint will spend $20 million to build the first phase of a 90,000 square-foot data center in Dallas.

Announcements and Implementations

Canopy Health, an accountable care network formed out of an affiliation between California-based UCSF Health and John Muir Health, selects financial risk management and population health services from Conifer Health.

Sydney-based Macquarie University’s MQ Health campus partners with Emory Healthcare (GA) to launch the country’s first remote intensive care unit monitoring program using technology from Philips.

Technology

MSN Healthcare Solutions incorporates SyTrue’s NLP OS operating system and AdvancedBI’s business intelligence tools into its new NLP-based analytics offering for radiologists.

VitreosHealth adds predictive risk models for identifying gaps in care, mental health conditions, and patient motivation to its population health management analytics engine. Models for palliative care will be rolled out towards the end of the year.

Research and Innovation

AHRQ looks for peer-reviewed, patient-centered outcomes research findings related to geriatric care shown to have improved patient outcomes for potential investment in broader dissemination and implementation. 

I missed this a few weeks ago: The National Science Foundation awards Rice University mechanical engineer Marcia O’Malley a $1 million, three-year grant to develop a tool that will track the movement of a surgeon’s operating tool and emit a vibration if his or her technique is deemed too rough. (No details are given as to how “rough” will be determined.) O’Malley says the tool will combine virtual reality with real-time touch feedback that will hopefully make the process of learning how to perform delicate surgeries easier.

Privacy and Security

Care New England Health System pays a $400,000 HIPAA fine for neglecting to update its BA agreement with Woman & Infants Hospital (RI), for which it provides IT system technical support and information security. The lack of updated documents came to light when WIH reported the loss of unencrypted backup tapes containing the PHI-filled ultrasound studies of 14,000 patients. WIH ended up paying a $150,000 fine for its role in the breach.

Other

Iliuliuk Family and Health Services, the only clinic serving Alaska’s extremely remote Unalaska Island (which also happens to be one of the country’s busiest commercial fishing ports), launches virtual consults via satellite technology with Anchorage-based providers at Providence Alaska Medical Center. The local news reports that the service will connect mainland ED physicians with clinic staffers to treat injuries “among the Bering Sea crabbing fleet made famous by the Discovery Channel show ‘Deadliest Catch.’”

Sponsor Updates

• Experian Health will host its Financial Performance Summit October 5-7 in Nashville, TN.
• Patientco releases its annual State of the Industry Report.
• PatientMatters will exhibit at the Arkansas Hospital Association Annual Meeting & Tradeshow October 5-7 in Little Rock.
• PerfectServe will exhibit at ANCC 2016 October 5-7 in Orlando.
• Lexmark Healthcare submits a formal pledge of commitment to interoperability.
• Sagacious Consultants makes a charitable donation to Tri 4 Schools to help extend its Exercise to Achievement after-school program.
• The SSI Group will exhibit at the AAHAM ANI 2016 conference October 5-7 in Las Vegas.
• Summit Healthcare and ZeOmega will exhibit at InSight 2016 September 27-30 in San Antonio.
• Sutherland Healthcare Solutions will exhibit at the HFMA NJ National Institute October 5 in Atlantic City.
• Navicure receives number-one rankings in client satisfaction and client loyalty across three Black Book RCM survey categories.
• Valence Health will exhibit at the Georgia Society for Managed Care Conference October 5-7 in Young Harris, GA.
• ZeOmega releases a video, “SignalHealth Deploys Advanced Care Directives Repository Through Jiva HIE.
• ZirMed ranks first for end-to-end RCM in the 2016 Black Book Report for the fifth consecutive year.

Blog Posts

• Healthcare & Kitchen Table Economics (PatientPay)
• What testing an airplane & obstetrics have in common (PeriGen)
• Back to School – PMD at Academic Institutions (PMD)
• Common FWA Overpayments Your Automated Claim Editing System May Miss (Verscend)
• What You Need to Know: Proposed Federal Fiscal Year 2018 ICD-10 Code Updates (VitalWare)
• Headsets in healthcare? It’s virtually guaranteed. (Voalte)
• Our unconquerable soul (Xerox)
• Avoiding Waste: Practicing at the Top of Your License (Zynx Health)

Contacts

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

Morning Headlines 9/23/16

Epic Systems’ ‘wonderland’ includes humanitarian pursuits

A local paper covers Epic’s annual user group meeting, which drew a crowd of 18,000 attendees.

Digital Hospital resulted in “significant adverse impacts” upon patient safety in Cairns

In Australia, the entire board of Cairns Hospital resigns following an unpopular and over budget Cerner rollout. A staff survey included complaints that the system was “convoluted and time consuming, with significant adverse impacts on patient safety and care.”

Mamba Ransomware Encrypts Computer Hard Drives, Rather Than Data

A new ransomware called Mamba now encrypts the entire infected hard drive, rather than just specific files.

New board headed by McNeil

In England, the newly formed Digital Delivery Board will be overseen by NHS England’s new chief clinical information officer Keith McNeil.