News 1/17/18

Top News

Hancock Health (IN) pays a hacker’s demanded four bitcoin in ransom – worth $55,000 at the time of payment — to regain access to its systems. The health system’s CEO says it made business sense to pay the hacker instead of taking weeks to recover its systems.

Once paid, the hackers restored the hijacked files within two hours, allowing the health system to bring its systems back up Monday after four days’ of downtime.

Hancock Health says the hacker penetrated its systems via its remote access portal — using the login credentials of one of the health system’s vendors — to manually deploy the SamSam ransomware. That same malware took down Erie County Medical Center (NY) in May 2017 and Hollywood Presbyterian Medical Center (CA) in early 2016, both of which also paid the ransom.

Hancock Health  did not mention the attack on its website or social media until after it had recovered its systems, with the announcement saying nothing about paying ransom. The explanation is ironically positioned on its website right above the hospital’s press release touting its award for “Most Wired.”

Reader Comments

From Watcher of the Skies: “Re: tax reform’s pass-through provision. I’m wondering if more health IT consultants are setting up shop as independent contractors rather than consulting firm employees?” Readers, please weigh in. The tax bill slashed corporate tax rates from a maximum of 39 percent to a flat 21 percent. Congress then added the pass-through tax to provide similar benefits to small businesses such as sole proprietorships, partnerships, LLCs, and S-corporations, giving high earners who pay individual tax rates of up to nearly 40 percent an incentive to pass that income through a lower-taxed business entity they control. 

HIStalk Announcements and Requests

You can join my Rolodex if you’re willing to provide occasional reaction to news items and to give me ideas about things I should write about. I won’t spam you and I’ll use whatever method of communication you prefer. Example: suppose the VA announces something about Cerner – I would go to my Rolodex to see who might knowledgably comment (anonymously or not) for my write-up. Thanks.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

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

Acquisitions, Funding, Business, and Stock

Nordic acquires the revenue cycle transformation practice of The Claro Group. which says it will refocus on its core businesses of disputes, claims, and investigations.

People

Mon Health (WV) hires Mark Gilliam (Owensboro Health) as CIO.

Sam Adams (Image Stream Medical) joins Patientco as chief growth officer.

FormFast hires Art Nicholas (NoteSwift) as chief revenue officer.

Announcements and Implementations

EHNAC releases its 2018 accreditation criteria for electronic data exchange.

In China, Amcare Women’s & Children’s Hospital’s Wanliu Campus goes live on InterSystems TrakCare.

Government and Politics

Politico says the DoD is placing its MHS Genesis Cerner project on hold for eight weeks because of a large number of open problem tickets and doctor complaints about poor workflows that those doctors say were copied directly from fellow Cerner customer Intermountain Healthcare. I don’t understand Politico’s statement, however, that further installations won’t go forward until fall – the DoD’s project plan had already called for no further implementation beyond the four initial sites until late 2018 pending completion of the required independent review of cost and suitability.

Gallup finds that 2017’s 1.3 percent increase in the number of uninsured Americans is the largest single-year jump since it starting tracking the number in 2008. The number, now at 12.2 percent, peaked at nearly 18 percent in January 2014 just before the ACA’s individual mandate and Medicare expansion took effect. Subgroups with the highest rate of uninsured include Hispanics, people in households with incomes under $36,000, and those aged 26-34. The percentage of people who bought their own insurance plans – such as through exchanges – dropped 1 percentage point in the past year, the first time that number has gone down since the ACA was enacted.

Other

The CEO of Fairview Health Services (MN) tells a healthcare CEO panel that Epic is an “impediment to innovation” and calls for customers to “march on Madison.” The Twin Cities business paper quotes James Hereford as saying,

I will submit that one of the biggest impediments to innovation in healthcare is Epic, because the way that Epic thinks about their [intellectual property] and the IP of others that develop on that platform. There are literally billions of dollars in the Silicon Valley chasing innovation in healthcare, and yet Epic has architected an organization that has its belief that all good ideas are from Madison, Wisconsin. And on the off chance that one of us think of a good idea, it’s still owned by Madison, Wisconsin … There is an opportunity for us to go to Epic and say, look, you have to open up this platform. It’s for our benefit in terms of having an innovative platform where all these bright, amazing entrepreneurs can actually have access to what is essentially 80 percent of the US population that is cared for within an Epic environment. I would love for us to get together to see how we march on Madison.

Amazon posts a job for HIPAA Compliance Lead for “a new initiative,” listing among its preferred qualifications experience with FDA’s medical device approval process.

Coalinga State Hospital (CA) – a 1,500-bed, state-run psychiatric hospital for repeat sexual offenders who are receiving extended treatment — goes on lockdown when inmates riot following the hospital’s ban on electronic devices that can play media from sources other than commercially produced CDs and DVDs.

Fans watching the dramatic finish of Sunday’s Saints-Vikings football playoff game say their Apple Watches warned them they might be having heart attacks. Previous studies have proven that rabid fans, especially those with coronary artery disease, are more likely to have heart attacks when game intensity hikes their pulse rates by as much as 100 percent. Maybe people who are bored by watching sports should tune them in to lower their pulse and BP as they nod off in front of the TV.

Sega announces Two Point Hospital — a hospital management simulation game from the creators of 1997’s Theme Hospital — with a funny, infomercial-like video teaser.

Sponsor Updates

• Audacious Inquiry will exhibit at the DVHIMSS Winter Symposium January 18 in Philadelphia.
• Besler and Culbert Healthcare Solutions will exhibit at the MA/RI HFMA Revenue Cycle Conference January 18-19 in Foxborough, MA.
• Iatric Systems will exhibit at the HCCA Charlotte Regional Conference January 19 in North Carolina.
• InstaMed will exhibit at the MA/RI Chapter HFMA Revenue Cycle Conference January 18-19 in Foxborough, MA.

Blog Posts

• 2017 Brings Strong Momentum and Growth for MEDITECH (Meditech)
• The Two-Pronged Approach towards Effective Healthcare Recruiting and EHR Adoption (Leidos Health)
• The Case for Continuous Clinical Surveillance (Bernoulli)
• 6 Healthcare Trends to Watch in 2018 (Datica)
• Blockchain Healthcare: Patient Medical Records, Health Data, and More (CareSync)
• Bridging Population Health Management and Clinical Interoperability (Casenet)
• Joint Commission: Citing of Hand Hygiene Noncompliance (CenTrak)
• Why AI by Any Name is Sweet for Radiology (Change Healthcare)
• New Year’s Resolution (CTG)
• Wellness in the Workplace (Direct Consulting Associates)
• Healthcare Consolidation: What to Watch for in 2018 (Dimensional Insight)
• “They have their little phones!” (EClinicalWorks)
• 3 Key Planning Steps to a Smooth IT Transition (Hayes Management Consulting)
• Prepare and Prevent Common Due Diligence Issues in Health IT Transactions: Human Resources Considerations (Healthcare Growth Partners)
• TEFCA in a Nutshell (Impact Advisors)
• Imprivata’s cloud-based products achieve SOC 2 certification (Imprivata)
• Five Guideposts for Transforming Healthcare Systems – Part II: Centralize Governance (Ingenious Med)
• SEO for Doctors (Influence Health)
• From Barefoot to Broad-Based: How Information Management is Changing Care in China (InterSystems)
  

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Contacts

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

Morning Headlines 1/16/18

Memorial resumes regular operations following last week’s flooding

MaineHealth’s Memorial Hospital (NH) gets key IT systems – including its three EHRs – back up and running after last week’s plumbing-related flood.

CHIME and HIMSS Name Randy McCleese CIO of the Year

The boards of HIMSS and CHIME award Methodist Hospital (KY) CIO Randy McCleese the the 2017 John E. Gall Jr. CIO of the Year award.

State Requests Lawsuit Against 62 Hospitals Be Dismissed

Indiana Attorney General Curtis Hill will not pursue litigation against 62 hospitals named in a lawsuit that contends they falsified records in order to qualify for Meaningful Use incentives of up to $300 million.

Curbside Consult with Dr. Jayne 1/15/18

Wintery weather has snarled my travel plans somewhat. I’ve been feeling a bit like the characters in “Planes, Trains, and Automobiles” having to cobble together various arrangements to get from point A to point B.

My laugh of the trip occurred after dealing with a canceled flight from Chicago’s Midway Airport. Fortunately, I was able to quickly book a rental car, then grabbed some caffeine at a local restaurant and headed on my way. Since I was in a hurry to get ahead of traffic, I didn’t look at my receipt in detail until I was several hours away, snug in my hotel and working on my expense report. Apparently Diet Coke is now a “sweetened beverage,” at least according to this charge under the Cook County Sweetened Beverage Tax. I did a quick Internet search to see if it applied to all soda or just drinks with sugar and found out that the tax has been repealed and actually expired December 1, 2017. I guess a software update is in order for this point of sale system.

I was immediately missing my other clients who are located in warmer climates, but enjoyed working with a new chief medical officer who wanted an independent opinion of his hospital’s long-range plan. It was a good change to be able to do some forward-looking work rather than the clean-up and troubleshooting involved in some of my engagements.

As more seasoned physicians retire, I’m seeing younger physicians move into leadership positions. These newly-minted leaders may have MBAs or MHAs, but not a lot of experience managing their peers, especially if those colleagues have been on staff for a long time. Larger organizations may have resources in place to mentor these physicians, but others hope they’ll just grow organically into what the hospital needs. I’ve been through enough formal leadership development exercises to know that the skills they will need aren’t going to just appear overnight.

Various organizations including EHR vendors offer “boot camp” programs for new medical leaders. The ones I know of are pretty solid programs, but some of them are expensive and might be only offered once a year. They are generally a couple of days of intense meetings and quite a bit of instruction.

For a new medical leader, it can be a bit like drinking from the proverbial fire hose. Then, when you return to your day job, it can be hard to try to apply some of the strategic concepts that you were presented with when you’re struggling with day-to-day issues. You might also be trying to learn the EHR systems while building a clinical practice. You may also have to figure out the best way to deal with colleagues who are looking to possibly manipulate new leadership into giving in to their demands. We’ve all heard stories of medical members that set upon a new chief of staff or chief medical officer and try to convince him or her that the EHR is the root of all evil and needs to be replaced. Some dive in and investigate before coming to their own conclusions, and others take reports of widespread dysfunction for fact, which can be disastrous if acted upon out of context.

There are many power dynamics at play within the average hospital’s medical staff organization. When new leaders are brought in from the outside, it can create uncertainty, distrust, and in some situations, it might even bring out some underlying paranoia. I’ve worked with clients like that, who have medical staff members who are convinced that new leadership has been brought in strictly for the purpose of shaking things up and that the new CMO or CMIO is going to try to fire everyone.

Although there are certainly situations where some serious housekeeping needs to take place, for the most part, hospital administrators aren’t looking to completely clean house. There may be a few disruptive physicians who need to be dealt with, but it’s not exactly easy to replace an entire medical staff, especially if the physicians are voluntarily on staff rather than employees. One wouldn’t want to lose the referral base that comes with community-based physicians, especially if the facility has a solid referral network that is tied to an accountable care or other risk-sharing platform.

At times I think about going back to the CMIO trenches, but then I’m reminded of how a new CMIO is sometimes treated. I’ve worked in an organization that had a previous CMIO who I replaced and that can be difficult if your predecessor was well liked or if there was very little boat-rocking. I’ve been around when the CMIO position is newly created and that can have challenges as well. Technology leaders can be nervous that the CMIO will meddle in their affairs and operational leaders can be suspicious as well. Other clinical leaders can be worried about losing control of their departments or service lines, especially if the new CMIO is overly enthusiastic.

In my first CMIO position, I was subjected to senior members of the medical staff who demanded referrals, and sometimes not very subtly. It was implied that I’d need to send business their way if I expected their support in medical staff matters.

I had a close friend who became the first CMIO at a large health system. Since he came from the ambulatory side, the hospital medical leaders didn’t trust him. Other ambulatory physicians didn’t trust the fact that he was a generalist. One particular senior cardiologist continuously harassed the new CMIO, telling everyone that he personally would have been better suited for the job even though he had no informatics experience and didn’t apply for the position. The organization’s leadership didn’t do much to help solve the problem, especially the CIO, who was more interested in how the organization appeared on “best places to work” lists than he was in how the clinical and financial systems were performing and whether the health system was receiving solid return on investment.

I’ve looked at some open CMIO positions and it’s hard to think about uprooting yourself and moving to an environment that might not be quite as advertised. I’ve been on site with clients who put on a great show for visitors, then as you become more familiar and they let their guard down, you learn things that want to make you run shrieking away. Several of the positions require candidates who have completed Epic rollouts from soup to nuts, which puts those of us who come from best-of-breed organizations at a slight disadvantage. I’m not thinking about making a change in the near future, but always like to keep my eye out for interesting opportunities.

Looking for a CMIO, particularly in a warm locale that doesn’t have a tax on Diet Coke? Email me.

Email Dr. Jayne.

Morning Headlines 1/15/18

Hospital hit by ransomware: Attackers demand Bitcoin to release control of system

Systems at Hancock Health (IN) go down following a ransomware attack Thursday.

Mediator to help fix problems with Nanaimo IHealth records project

In Canada, a consultant’s report concludes that Nanaimo Regional General Hospital’s over-budget, behind-schedule Cerner rollout has been mismanaged by Island Health and recommends that further rollouts across Vancouver Island be halted until problems are fixed.

SS&C To Acquire DST Systems

SS&C Technologies will acquire DST Systems, which provides technology, consulting, and outsourcing services for finance and healthcare, for $5.4 billion.

Ottawa hospitals upgrade medical record system

The Ottawa Hospital, the Ottawa Hospital Academic Family Health Team, and the University of Ottawa Heart Institute in Canada will replace their 25 year-old medical records system with Epic.

Monday Morning Update 1/15/18

Top News

Systems at Hancock Health (IN) remain down following a ransomware attack Thursday. I saw no patient advisory on the health system’s website or social media accounts, but its patient portal gives a “this site can’t be reached” error.

The health system’s CEO said the attack wasn’t triggered by an employee opening a malware-infected email, adding, “This was not a 15-year-old kid sitting in his mother’s basement.” He declined to disclose the amount of the ransom being demanded.

Reader Comments

From Pulpy Juice: “Re: KLAS. They should separate reports from a provider who has invested in a vendor in a separate category.I know of two companies that fit this situation, where the glowing reports of customers who own a stake in a vendor are folded in with those of real customers that have no financial interest.” It’s the same as site references or visits, where the supposedly objective peer organization is either being paid by the vendor or owns a stake in it. That situation can be somewhat resolved by asking that the provider and/or vendor disclose any relationships that might compromise objectivity, although you have no way to make them do it or to verify their claims. In KLAS’s case, the only solution I see would be to require vendors to disclose any customer ownership, then skip surveying those organization since KLAS has no way to tell whether the interviewee is influence by (or even aware of) that connection.

From Nida Partee: “Re: HIMSS parties. Can you post details of vendor parties that we as providers can be invited to? I think Cerner is having theirs Tuesday night but I can’t find others.” I never get invitations so I don’t know when they are. If you’re a vendor and are OK with providers registering to attend your event, send me the signup link and I’ll run it here. I would be hesitant to mention a “no signup required” party since I have a few dozen thousand readers and you don’t want to be overwhelmed.

From Searcher: “Re: searching HIStalk for keywords and showing the results in chronological order. Can this be done?” Yes. Use the second of the two search widgets, with or without specifying a date range. It’s not as slick as the Google custom search above it since I had some guy create it for me, but it does allow specifying a keyword which then displays the results in date order. It is surprisingly difficult to even display a date on WordPress search results, much less to filter or sort the results by it.

From Born Free: “Re: GLG’s expert network. I’m curious about HIStalk readership from both sides – have you joined this or other network or does your company use one?” Readers are welcome to share their experience. It’s a brilliant business model for sure. I joined GLG many years ago in my pre-HIStalk days, specifying my area of expertise and desired hourly rate. They then emailed me occasionally with opportunities to complete a survey or get on a call with a vendor, although 90 percent of the time, that vendor wanted specific experience I didn’t have (such as working daily in the imaging field). Invoicing and payment was online, which was pretty cool back then. I remember getting on a call with an investment guy looking for health IT stock insight and I concluded that he should just recommend or buy Cerner shares. I should have taken my own advice now that I’ve looked up CERN’s historical share price – had I invested $10,000 on that day, my shares would now be worth $70,000.

From Allspice: “Re: employee leave policies. My employer, a large EHR vendor, says our maternity, paternity, and family leave policies are competitive. New dads get nothing, however, beyond the standard FMLA. I would be interested in what readers or even company spokespeople have to say about family leave policies.” Readers can email me their company’s policies anonymously and I’ll summarize them here. 

HIStalk Announcements and Requests

Poll respondents think a filed lawsuit is newsworthy if it involves a high-profile dependent or makes dramatic claims, although 44 percent agree with me that since anyone can file a lawsuit and make unproven claims, it’s not news until a decision is rendered or a settlement is reached (possibly years later given our constipated, expensive legal system). Furydelabongo says he/she doesn’t care about intellectual property disagreements but likes to hear about those in which there’s an opportunity for public comments. Clustered is interested in lawsuits that resonate with his/her experience or that test some principle, although I would say it’s hard to separate a watershed moment from a plaintiff simply hitching a ride on a popular belief that may or may not be relevant.

New poll to your right or here, as suggested by a reader: do you trust KLAS’s product rankings? Click on the poll’s “comments” link after voting to elaborate further.

Listening: new from Norway’s The Dogs, one of my favorite hard-rocking bands ever.

What I Wish I’d Known Before …

A reader survey respondent brilliantly recommended a new feature called “What I Wish I’d Known Before …” in which I provide the topic, you provide the answers, and we all learn from them. The first installment will be, “What I Wish I’d Known Before Replacing My Hospital’s Time and Attendance System,” a question you will hopefully answer here. This is a great idea, but it will die quickly if I don’t get enough responses to be interesting.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

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

Acquisitions, Funding, Business, and Stock

McKesson CEO John Hammergren says Change Healthcare, of which McKesson owns 70 percent, may run its IPO in 2018.

Athenahealth will move forward with previously announced plans to expand its Atlanta office by 40,000 square feet at a cost of $2.7 million. The company cut 60 Atlanta jobs in October as part of restructuring and elimination of 9 percent of its 5,500 jobs nationwide.

Decisions

• Ochsner Hancock Medical Center (MS) will replace Evident with Epic.
• Gunderson Moundview Hospital and Clinics (WI) will switch from Cerner to Epic in 2018.
• Animas Surgical Hospital (CO) will switch from Harris Healthcare to Cerner in 2018.

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

Announcements and Implementations

CVS lists a position for senior product manager of its Boston-based digital innovation lab.

Government and Politics

The VA’s Aurora, CO hospital – construction of which the VA has acknowledged to be running more than $1 billion over budget and years behind schedule – won’t have enough positions filled to be fully operational at its planned summer opening and won’t actually be fully completed. The new campus lacks  space for a rehab center, so the Denver hospital that the new one replaces will remain in use for at least three years. Total price for the new 182-bed hospital, originally pitched as $328 million, will exceed $2 billion, or $11 million per bed. The project is being run by the Army Corps of Engineers.

Privacy and Security

Oklahoma State University for Health Sciences (OK) notifies 280,000 Medicaid patients that their billing information has been exposed to an “unauthorized third party” who gained access to network folders.

Other

A frozen parking lot drain causes a sink to overflow in the lower level of an office building that houses the data center of MaineHealth’s Memorial Hospital (NH), causing service interruptions that won’t be resolved until Monday at the earliest when new servers and other equipment are delivered.

A doctor who has studied 757 physician suicides finds that:

• It’s a seven-to-one ration of male doctors to female.
• Anesthesiologists are the highest-risk specialty, most of whom kill themselves by overdose and often in call rooms.
• Outwardly happy doctors often commit suicide to the shock of their co-workers.
• The death of a patient seemed to be a factor in several cases.
• Medical students who failed their boards or don’t get their desired residency have killed themselves.
• Inhumane working conditions and administrative pressure are sometimes mentioned in suicide notes.
• Sleep deprivation is a factor.
• Doctors don’t seek help because they don’t trust that their mental health records will remain confidential.

AAFP offers forms that allow family doctors to screen patients for social needs (aka social determinants of health). I’m not sure how this information could be incorporated easily into an EHR other than by manual scanning, however.

In Canada, a consultant’s report concludes that Nanaimo Regional General Hospital’s over-budget, behind-schedule Cerner rollout has been mismanaged by Island Health and recommends that further rollouts across Vancouver Island be halted until problems are fixed. The report disputes the  perception of the hospital’s loudly-complaining doctors that software is causing patient safety issues. The consultants say the hospital wasn’t ready for go-live, employees weren’t adequately engaged and trained, and the hospital’s toxic climate of distrust made it worse.

Weird News Andy says, “Dr. Ook will see you now.” Researchers from the Borneo Nature Foundation filming orangutans catch them creating a muscle-soothing ointment from plants by chewing them into a paste and then rubbing the paste onto the affected joints, piquing the interest of researchers who wonder if the plant’s anti-inflammatory properties could be used in humans. WNA says it’s weird because they could even use their feet to unscrew medication bottle lids.

Sponsor Updates

• Summit Healthcare will exhibit at the IHE Connectathon January 15-19 in Cleveland.
• Voalte publishes a white paper, “3 keys to patient-centric care team communication.”
• Access will showcase its paperless, web-based eForms, and electronic patient signatures solutions at the 2018 MUSE Executive Institute.

Blog Posts

• University of Iowa Health Care Increases Industry-Sponsored Clinical Trial Opportunities with TriNetX (TriNetX)
• Rx.Health and Redox Partner to Bring Integration-Ready, Evidence-Based Technologies to Healthcare Organizations (Redox)
• Connect with Your Patients Through Two-Way Texting (Solutionreach)
• Defining the Perfect Prescription and Achieving it in Four Steps (Surescripts)
• The Emergence of Choice: Why Consumers Own the Future of Healthcare (Huron)

Contacts

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

Weekender 1/12/18

What the Heck Is This?

HIStalk Weekender is a way to close out the week in a Hawaiian Shirt Friday kind of casual way, free of the limitations of the regular M-W-F news format. It incorporates suggestions from my reader survey, such as:

• Lighten the M-W-F news posts but still run interesting stuff in its own section for reading at less-busy times
• Keep DonorsChoose updates but separate them from the news
• Recap the week’s best reader comments that might have been missed or posted later
• Provide links to the entire week’s posts for those who are catching up
• Queue up items through the week to allow posting Weekender by Friday afternoon

Readers who are of the “just give me the news headlines customized to my personal interests and nothing else” genre can skip these posts and just read the daily headlines, but as I always caution, succeeding in a profession means keeping up with it instead cocooning off Facebook-style or glancing at headlines. I wouldn’t put something on HIStalk if I didn’t think it was important, debatable, or interesting to C-level executives, even if only as watercooler topics.

Weekly News Recap

• Change Healthcare retools its claims management network to use blockchain, the industry’s first high-volume test at 50 million claims-related events each day.
• Allscripts buys Practice Fusion for $100 million in cash.
• ONC’s Genevieve Morris says regulations will be published this spring that will define and regulate information blocking.
• ONC publishes a draft of its Trusted Exchange Framework.
• Cerner hires former Philips North America CEO Brent Shafer as CEO and board chair.
• Wolters Kluwer Health sells Provation MD for $180 million in cash.

Best Reader Comments

Cerner has a gap to close and it would help everyone if the VA pushed them to increase the clinical value of their interoperability to rival Epic’s. (Switch Clicker)

Allowing physicians to run the whole show sounds good, except it led to healthcare being a lagging adopter of technology, unsustainable cost growth, and a 17-year delay (on average) in clinical best practices receiving universal adoption. Healthcare was run like a medieval guild. That’s what physicians running everything led to and leads to. (Brian Too)

With regards to Cerner and the VA, I would agree with you. I, too, am surprised that they didn’t leverage the Leidos relationship and have them act as the primary, similar to what occurred with the DoD. To my knowledge, Cerner, on their largest government contracts, hasn’t been the direct supplier. They won the DoD with Leidos playing lead, and in the United Kingdom, they first were with Fujitsu as the primary before BT took over for Fujitsu. (Associate CIO)

It’s amazing how the ONC thinks that healthcare organizations are adopting FHIR. Not one single EMR, LIS, or RIS vendor in the US utilizes FHIR yet for interoperability. If they really want to invoke change, they need to figure out ways to either force adoption or incentivize it. (Annon)

Eva. Once again, a virtual assistant is given a woman’s name. (HIT Girl)

The amount of times I have sat in a room to have two physicians in the same organization get into a shouting match as to how something should work is uncountable. If you cannot figure out your ideal workflow, how is a vendor supposed to create software to support it? Vendors/developers still need to be in charge of creating software, there simply needs to be more input from qualified clinicians, and less regulation on the specifics regarding clicks and metrics from the government. As someone who has grown up with a laptop in hand, the state of Health IT is atrocious, and the fact that far greater strides have not been made is an absolute travesty. (Seargant Forbin)

Reducing the cost of health care with interoperability, even with the sharing of information, isn’t going to happen until physicians learn to trust the documentation and test results of other facilities. If a CT has been done at Facility A and the patient is then consulted on by Facility B, they are likely to repeat the CT since they trust their technicians. (Barbara)

I see that healthcare is similar, in more ways than clinicians know or admit, to software development in every other industrial sector. Real software solutions are built on a foundation of failure and inadequacy, slowly rising to competence. Fortunes are spent on this process. A few winners emerge over time. Sectors like Finance had the advantage of (far) fewer data elements and strong theory, widely taught (this includes GAAP and goes all the way back to Luca Pacioli). Biology is more complicated but healthcare will get there. The real question should be, why did physicians expect highly competent EMRs to exist when so few physicians bought them, used them, or participated in designing them? A market economy will build what the market supports. Low investment results in sub-par results. Except, sub-par EMRs also discourage physician adoption and chokes off investment. (Brian Too)

Watercooler Talk Tidbits

Ms. C says of the 200 sets of headphones readers provided to her Utah elementary school class in funding her DonorsChoose teacher grant request, “One project for STEAM that we are excited to use these headphones for is studying living and non-living things. We will watch live feeds and videos to see animals in their habitats, write observations, and report on our findings. Our headphones will help us hear these videos, so thank you for donating them!”

Here’s a welcome video from new Cerner Chairman and CEO Brent Shafer.

Allscripts provided this slide in its presentation at the J.P. Morgan Healthcare conference, describing its role as an “industry consolidator.”

France-based technology company Blade launches a cloud-based, subscription-priced replacement for the PC, with an initial target audience of gamers. PCs, Macs, or mobile devices plug into the Shadow box and app, turning them into a high-powered PC (eight-threaded dedicated Xeon server, 12 GB RAM, 256 GB storage, high-end NVidia graphics card) for an annual fee of $420 in offering “the last PC you’ll buy,” at least as long as your always-on Internet connection delivers at least 15 Mbps.

An excerpt from Genome Mag’s look into the commercial and research implications of DNA theft and health data ownership:

Stanford University Law School professor Hank Greely agrees that human biology does not fit neatly into the property box. “Do you own your kidney?”’ he asks. “Well, kind of. No one can take it from you without your consent, but neither can you sell it.” And, he says, the same awkward fit holds true for data. “I’d like to think that I own my electronic health record, but do I really? I can’t keep the hospital from using it, or sharing it with an insurer, or giving it in de-identified form to a researcher, or giving it to the FBI if the FBI asks.”

Two old-money Kansas City, MO families donate $75 million each to Children’s Mercy Kansas City to form the Children’s Research Institute and to build it a nine-story, 375,000 square foot building that will house 3,000 mostly new employees.

The 15,000 square foot Chicago mansion previously rented by Outcome Health CEO Rishi Shah for $50,000 per month is listed for sale at $9.99 million, down from the previous $15 million. The house became famous when the 31-year-old paper multi-billionaire Shah fled the property OJ-style in a black Escalade to avoid being served a summons related to allegations that the waiting room advertising company misled investors.

A surgeon in England is sentenced to community service for using an argon beam coagulator to burn his initials into the livers of two patients during transplant surgery in 2013. He said it was an attempt to relieve OR tension, but the judge scolded him in letting his “professional arrogance” stray into criminal behavior even though patients weren’t endangered.

Dr. Oz rushes to the aid of a fellow airline passenger and breathlessly recounts his heroic intervention to reporters – he asked the guy to lie down and raise his legs. At least he didn’t shove a weight loss pill down his throat or apply his entertainment-level medical guidance that experts say deviates from accepted medical knowledge at least 50 percent of the time.

In Case You Missed It

• Monday Morning Update 1/8/18
• HIStalk Interviews John Fleming, MD, Deputy Assistant for Health Technology Reform, ONC
• Curbside Consult with Dr. Jayne 1/8/18
• News 1/10/18
• CIO Unplugged 1/10/18
• Readers Write: If I Were the Health IT King: A Royal Perspective on 2018 Trends
• Cerner Names Brent Shafer as Chairman and CEO
• EPtalk by Dr. Jayne 1/11/18
• News 1/12/18

Get Involved

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

Morning Headlines 1/12/18

HIPAA Fee Policy ‘Threatens To Upend’ Records Industry: Suit

Release of information/HIM vendor Ciox Health sues HHS, saying HIPAA’s limitation on how much patients can be charged for copies of their medical records has saddled providers with hundreds of millions of dollars in new costs.

Philips to move company headquarters from Andover to Cambridge

Philips plans to relocate its North American headquarters by 2020, taking 2,000 employees to a new facility in Cambridge.

Army Virtual Medical Center launches at BAMC

Brooke Army Medical Center (TX) launches Army Medicine’s first virtual medical center.

Report ranks software developer as the best job in the US this year

A US News & World Report survey finds that software developer is the best job of 2018, outranking healthcare jobs for the first time.

News 1/12/18

Top News

Release of information/HIM vendor Ciox Health sues HHS, saying HIPAA’s limitation on how much patients can be charged for copies of their medical records has saddled providers with hundreds of millions of dollars in new costs and “threaten to bankrupt the dedicated medical records providers who service the healthcare industry.” 

Ciox Health was recently named, along with several dozen Indiana hospitals, in a lawsuit claiming that the hospitals fraudulently claimed to give patients requested copies of their medical records within three business days 50 percent of the time as HHS requires. The lawsuit also says Ciox Health illegally profited from overcharging patients for their records in violation of anti-kickback laws.

Reader Comments

From Evergreen: “Re: Brent Shafer. I know him and he’s a nice guy, but he doesn’t have much relevant background either as a subject matter expert or as CEO of a publicly traded company.” My reaction to Cerner’s choice to replace the late Neal Patterson:

• Netherlands-based Philips doesn’t have the healthcare cachet of Cerner and Shafer has worked there for 12 years. I was expecting a stronger pedigree, either within health IT or as a publicly traded health-related company’s CEO.
• I’m surprised that running an international company’s US business unit was enough of a track record to justify becoming Cerner’s CEO and chairman.
• Despite Cerner’s insistence upon the death of Neal Patterson that the company’s succession plan would allow it to replace him quickly, it took six months, perhaps raising the question of who else was considered, which of those declined, why internal candidates were ruled out, and what factors landed Shafer the job?
• It’s tough to replace a visionary, passionate founder with a strong will who has held the CEO role since the beginning, rather like Apple searching for a replacement for Steve Jobs.
• Still, Cerner’s board chose Shafer with appropriate due diligence and he has the complete authority to lead the company his way.

From PHG: “Re: Philips. Announced internally that they will shutter their North American headquarters in Andover, MA by 2020, move 2,000 employees to a new facility in Cambridge, and lay off or transition many roles to different facilities.” The story hit the papers late Thursday as you described it, with Philips following other companies that have left suburbia for downtown Boston (Kendall Square in its case). 

From Polite Discourse Please: “Re: CIO/CNIO guest authors. You might get more people interested if you applied a more strict comment policy to avoid some of the reader nastiness that Ed Marx got at times. I suggest either not allowing anonymous comments or approving only professional, respectful responses.” I agree and would be happy to do that. I don’t like censoring people, but on the other hand I’m embarrassed when a guest author gets skewered, even though I can tell when they’ve written something that is likely to raise emotion. Ed told me recently that he wasn’t bothered much by the criticism and in fact got a lot more positive responses offline, such as invitations to events and mentorship requests from some folks all the way to the CEO level.

From Allscripts Watcher: “Re: Practice Fusion. Hearing that part of the Allscripts plan is to eliminate the free model and start charging providers $200 per month.” Unverified, but reasonable, although customer defection is likely to be substantial. I still question how many active users Practice Fusion has (they’ve always been coy about usage numbers) and whether selling patient data and drug company ads brought in much revenue. Allscripts knows, though, and says $100 million is a good deal, presumably in acquiring a marketable product since the customer base is iffy. Allscripts has turned into a health IT mutual fund in buying low with hopes of selling high (in the form of higher share price).

From Duke Hazard: “Re: my 20-bed hometown hospital. Overpaid staff by millions of dollars,  making its providers some of the country’s highest paid. Whether it’s by incompetence or corruption, it’s inexcusable.” Auditors find that the appropriately named Cavalier County Memorial Hospital (ND) has been overpaying two doctors and a nurse practitioner for almost 10 years, totaling $2.5 million and making them among the country’s highest paid. They’re no longer at the hospital, but a new CFO is. I’d put my money on corruption – how can executives miss plowing such a large chunk of their revenue into the hands of just three providers without anyone noticing for 10 years?

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

Wolters Kluwer Health will sell its ProVation Medical gastroenterology software business to Clearlake Capital Group for $180 million in cash. Wolters Kluwer Health says it will focus instead on broad, multi-specialty products.

The Sacramento Bee notes that few people have heard of California’s second-richest company behind Apple – McKesson.

People

Philips promotes Vitor Rocha, head of the company’s ultrasound business, to CEO of North America. He replaces Brent Shafer, who will become Cerner chairman and CEO on February 1.

HHS promotes Kathryn Marchesini to ONC’s chief privacy officer.

Qlik names Mike Capone (Medidata Solutions) as CEO.

Announcements and Implementations

Ochsner Health System (LA) will integrate its Epic system with the state’s prescription monitoring program via Appriss Health’s PMP Gateway service.

A Reaction Data survey of 889 doctors almost evenly split between ambulatory and hospital practice finds that Epic leads all vendors by far in being chosen in system replacements. Dissatisfaction among all EHR users seems to be significant, but in the absence of specific “hate it” numbers, I’m reading between the lines that EClinicalWorks is the least-disliked (maybe or not the same as “most-liked”) vendor, Allscripts finishes worst of all, but ironically 70 percent of the users of new Allscripts acquisition Practice Fusion are advocates of that product.

Sales

Portneuf Quality Alliance (ID) selects population health management technology from Lightbeam Health Solutions.

Springhill Medical Center (LA) will implement Medhost’s EDIS.

DaVita Physician Solutions, affiliated with DaVita Kidney Care, chooses Epic as the foundation for its chronic kidney disease / end-stage renal disease EHR called CKD EHR. The press releases is tough to follow, but Epic will apparently replace its internally developed Falcon Platinum EHR and offer users a migration path.

Technology

The Boston Globe highlights the progress EHR vendors are making with embedded virtual assistant technology that resembles Alexa and Siri. EClinicalWorks rolled out its assistant Eva to customers in December, Epic will reportedly launch a virtual assistant next month. and Athenahealth has one in the works.

Government and Politics

Brooke Army Medical Center (TX) personnel launch Army Medicine’s first virtual medical center, which will also serve as a test site for additional centers.

Privacy and Security

Sensato Cybersecurity Solutions and ComplyAssistant develop a scalable medical device cybersecurity operations program for hospitals that includes device monitoring, breach detection, and automated assessment and risk scoring.

Other

A US News & World Report survey finds that software developer is the best job of 2018, The report considered hiring demand, work-life balance, income, and future prospects. Healthcare jobs usually top the list and still hold positions 2-5 with dentist, physician assistant, nurse practitioner, and orthodontist. All the highest-paying jobs are in healthcare, as the jobs tying for first with a $208K median salary are anesthesiologist, OB/GYN, oral and maxillofacial surgeon, orthodontist, and surgeon.

Weird News Andy knew that some hospitals dump patients, but he says it’s still shocking to see it happening on video. A bystander records University of Maryland Medical Center Midtown Campus (MD) security guards wheeling out a patient dressed only in her hospital gown and dropping her off at a bus stop on a 30-degree night. The bystander called police and medics took her back to the same hospital.

Sponsor Updates

• MedData will exhibit at the HFMA WI Mega Healthcare Conference January 15-17 in Wisconsin Dells.
• Nordic releases a new video, “Achieving a return on your EHR investment in 2018 and beyond.”
• Arcadia Healthcare solutions publishes a new white paper, “Building the Successful Accountable Care Organization.”
• NTT Data will offer AI-based solutions from Pieces Technologies to healthcare customers.
• Parallon Technology Solutions will exhibit at the MUSE Executive Institute January 14-16 in Newport Coast, CA.
• Experian Health will exhibit at the HFMA Western Symposium January 14-18 in Las Vegas.
• ZeOmega achieves significant growth and product innovation in 2017.
• Forward Health Group earns the highest score in clinician engagement among population health vendors in the KLAS Research 2017 Population Health Management report.

Blog Posts

• Tech could lower healthcare delivery toil by 50% (LiveProcess)
• Guiding Principles to Consider When Using Cerner’s Model Order Sets (Optimum Healthcare IT)
• Raising the Stakes in 2018, CMS Continues Focus on Appeals and Grievances (Medecision)
• Why you should share notes with patients (Meditech)
• It’s time to embrace a universal identity management system (Experian Health)
• Redox in the New Year: Squeezing into 2018 (Redox)
• Healthcare IT Recovery: 4 Business Continuity Myths Debunked (Spok)
• How Harbor Health Plan Utilizes PatientPing to Improve Member Outcomes (PatientPing)
• GDPR Compliance – What US Healthcare Organizations Need to Do (Impact Advisors)
• Artificial Intelligence in Health IT – Catalyst for Change? (FDB)

Contacts

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

EPtalk by Dr. Jayne 1/11/18

It’s been a while since I’ve shared from the reader mailbag. I have to say it’s been hard to keep up lately. I’ve been filling on an “interim” CMIO engagement that feels like it’s never going to end. The hospital hasn’t taken my advice on productive work and process improvement, so every day is an email battle. Couple that with an increase in spam and nonsense press releases landing in my Dr. Jayne account and it’s a recipe for late night eye-crossing.

From Retail Medicine: “Re: CVS-Aetna merger. I agree with your concerns. I envision their community approach to healthcare being short on care and long on profit. How do we work to protect patients who are not aware that they are not receiving the care that they need and deserve? It is clear that those setting the rules have little understanding or empathy of the situation.” The reader attached a copy of the letter they sent to the CEOs of both companies, which brings up many good points. A significant portion of visits to retail clinics may be unnecessary since they are for upper respiratory infections, sprains, and strains – all of which can be self-managed without clinical intervention using common sense remedies such as rest, fluids, and over-the-counter medications. We see this at our urgent care, where patients come in when they have had symptoms for only a few hours and haven’t tried anything to address the symptoms. Nurse triage lines could help, but many patients aren’t aware of the services their insurance plan offer. It remains to be seen whether higher co-pays for emergent and urgent visits will make a difference with these visits. Other points included the need for retail clinics to coordinate with primary care physicians through a comprehensive communication system.

From Vintage: “Re: smart glass in exam rooms. Sounds like big fins on autos in the early 1960s – eye-catching, but useless and phased out in a year or two. Surely the money paid for smart glass could have been allocated to investments with more direct impact on patient care or improvements to the working facilities of care givers. But it looks cool, I guess.” I suspect another way that cost savings could be achieved would be eliminating the large-screen monitors for so-called transparent charting. I’m sure there are plenty of physicians who don’t want their lack of typing skills or difficulty navigating the EHR to be obvious to patients. There are still too many physicians who fall into those subsets. I work regularly with physicians who have been using an EHR for years, but when you watch them, they navigate as if they have never seen the screens. I wonder if there is a biological condition that inhibits formation of muscle memory in a subset of end users? I’m always amazed when physicians who mastered complex medical disciplines struggle with straightforward actions like entering a chronic condition on a problem list.

From The Field: “Re: observations from implementing Epic. My clinical work is entirely divorced from my IT work – I show up, see patients, and head out, electing not to get involved in a multi-layered bureaucracy. No one thought to ask me to jump in on the rollout. As my clinical colleagues struggled with various issues and just blamed the EHR, I found myself slicing the baloney thinner. Some issues were with software. With a little research and overhearing some scuttlebutt, it became apparently that other issues were because certain modules of the software weren’t purchased. Still other issues involved configuration and some were user –dependent, where users upstream in the flow of clinical information weren’t using the EHR in ways that allowed downstream users to have a flow of data. A year and a half later, I realize that we are really still implementing the system, finally getting back around to fixing things. On another aspect, the support teams could be very enthusiastic but counterproductive. I began to dread calling in a bug because of the time it would take to process it while I was trying to see patients.” There are always rude surprises when end users discover they’re missing critical pieces needed for them to be successful. I see this when practices purchase a laboratory interface but fail to spring for the mapping needed to make ordering tests a seamless experience for clinicians. Or when content is missing for key specialties, or when non-visit but high-volume workflows such as care coordination or telephone medicine are weak. I admire a clinical informaticist who can manage scope well enough to avoid being sucked into a black hole that’s not in his or her sphere of ownership. The point about the help desk is well-taken – the best support systems I’ve seen involve having strong local super users who can quickly document the details of an issue and log it on the clinician’s behalf, allowing patient care to continue.

From Weirder than Weird: “Re: do-it-yourself circumcision kits. Did you see this article?” I intended to mention it, but it was lost in the holiday shuffle. There is a similar listing on the US Amazon site, although the item appears to be unavailable. That has left the door open for plenty of interesting questions, answers, and reviews. It made me curious what other medical or quasi-medical offerings were on Amazon. I was surprised to find biopsy forceps, uterine curettes, prostate biopsy transport vials, and ringing in at $1,400, a positioning kit for breast MRIs. While the “Young Scientist” brain dissection kit is unavailable, you can have a porcine heart or a fetal pig shipped for less than $45. From the comments on some of the listings, there are plenty of families gathering around the kitchen table to learn about anatomy. Apparently you really can get it all on Amazon.

Email Dr. Jayne.

Morning Headlines 1/11/18

Cerner Corporation names Brent Shafer CEO, Chairman

Former Philips North America CEO Brent Shafer will take on his new roles February 1.

Meet Eva, the voice-activated ‘assistant’ for doctors

EHR-embedded virtual assistant technology from EClinicalWorks, Epic, and Athenahealth heralds more productive workflows for physicians.

1Vision Awarded Home Telehealth Contract from the US Department of Veterans Affairs

The VA awards Service-Disabled Veteran-Owned Small Business 1Vision a $260 million contract to provide veterans with home telehealth services.

ONC Appoints New Chief Privacy Officer

HHS promotes Kathryn Marchesini to ONC’s chief privacy officer.

Cerner Names Brent Shafer as Chairman and CEO

Cerner announces that it has hired Brent Shafer as its board chair and CEO, effective February 1. The 60-year-old Shafer had been CEO/EVP of Philips North America from since 2014 and a Philips employee since 2005. Prior to that, he held roles at Hill-Rom, GE Medical Systems, HP, Johnson & Johnson, and Intermountain Healthcare.

Cerner co-founder Cliff Illig, who has held interim roles as CEO and board chair since the death of Neal Patterson in July 2017, will resume his previous role as vice-chairman of the board.

Illig said in a statement, “Brent is a proven chief executive who has helped lead the growth and strategies of a complex, multinational organization over a number of years. He is committed to innovation, with extensive knowledge of healthcare, technology, and consumer markets and an exceptional skill set that complements Cerner’s strong leadership team. Since our founding, Cerner has used the power of information technology to disrupt and improve healthcare. The addition of Brent to our leadership team positions Cerner well for our next era of growth.”

Shafer said in the announcement, “For decades, Cerner has built its reputation on meaningful innovation and driving client value. This company’s history of remarkable, sustained growth is testament to a strong leadership culture and I’m excited to celebrate many new milestones with Cerner associates around the world. My commitment to Cerner’s clients, shareholders, and associates worldwide is that we will continue to be the catalyst for real and effective improvement across healthcare.”

According to SEC filings, Shafer will earn a base salary of $800,000, will be eligible for a $1.2 million annual bonus, will be awarded $4 million worth of Cerner shares plus a $3.7 million award to replace his forfeited Philips equity, and will be allowed use of Cerner’s corporate aircraft up to $100,000 annually. He will be paid two years’ salary if the company is sold.

Readers Write: If I Were the Health IT King: A Royal Perspective on 2018 Trends

If I Were the Health IT King: A Royal Perspective on 2018 Trends
By Jay Anders, MS, MD

Jay Anders, MS, MD is chief medical officer of Medicomp Systems of Chantilly, VA.

If I were king of health IT, I would find great joy in sitting at the head of a banquet table before all my subjects, casting judgment on the most current health IT trends. Like the king in Bud Light’s recent commercial series, I’d love to lead a hearty “dilly dilly” cheer for innovations that make it easier for physicians to practice medicine, while banishing the less worthy trends to the “pit of misery.”

Health IT king or not, I see the following 2018 health IT-related trends falling into two distinct buckets.

Deserving Dilly Dilly Cheers

Interoperability

At long last, health systems seem to be accepting the inevitability of interoperability. Organizations are resigned to the fact that it’s no longer reasonable to refuse to share patients’ clinical records with cross-town competitors. Instead, everyone needs to work together to make systems talk. The growing acceptance of standards such as FHIR are also helping to advance interoperability efforts. I predict significantly more progress in this area over the next three to five years.

Collaboration with Physicians

More health IT companies are seeking input from physician users as they design, build, and test their solutions. Vendors are realizing that the creation of user-friendly clinical interfaces can no longer be an afterthought and that the delivery of physician-friendly solutions must be a priority. By collaborating with physicians, vendors better understand required clinician workflows, existing bottlenecks, and the processes that are critical to patient safety.

For example, physicians can provide insights into common clinician thought processes and clarify why one workflow may be preferred over another. Physicians understand what tasks are traditionally performed by a medical assistant, how long a particular procedure might take, and when and why a clinician cannot be looking at a computer screen. By embracing physician collaboration, health IT companies are better-equipped to create innovative solutions that work and think like physicians and enhance provider satisfaction.

Shared Chart Ownership

Not too many years ago, most people — including patients — believed that each physician owned his or her own patient charts. That mindset is changing, and today, most providers and patients realize that everyone involved in a patient’s care — including the patient’s family — needs to share clinical data. The growing recognition that information must flow seamlessly between caregivers is a huge step in the right direction and advances industry efforts to get the right information to the right person at the right time.

Banished to the Pit of Misery

Data Dumping

More data is being exchanged between providers thanks to better interoperability tools and growing enterprise acceptance. Unfortunately, many organizations continue to struggle to figure out what to do with all the data. More health systems have the ability to dump buckets of data on providers, yet few physicians have the tools to efficiently organize the data into actionable information that enhances patient care. Don’t look for any widespread fixes in the short term.

Administrative Burdens

Healthcare still has not figured out how to reduce the administrative burdens of practicing medicine. Physicians continue to be frustrated and disillusioned with their careers, thanks to ever-changing regulatory and reimbursement requirements that require adjustments to clinical workflows. Don’t expect big improvements any time soon, nor major legislation that streamlines existing healthcare policies and regulations. Instead, physicians will be forced to continue addressing numerous tasks that distract from the delivery of patient care.

AI Hype

Despite all the hype, don’t look to artificial intelligence and machine learning technologies to solve all the industry’s data and reporting problems. The bottom line is that these technologies are still insufficiently mature for healthcare applications. Providers would of course love solutions that leverage natural language processing (NLP). AI will have the ability to convert dictated chart notes to free text and free text to data that is actionable for clinicians. Unfortunately, the error rates for converting speech to text to data are, at best, between eight and 10 percent. Give these technologies at least two to three more years before they’re ready able to truly enhance clinical decision-making at the point of care and move out the pit of misery and earn dilly dilly cheers.

Ah, if only I were the Health IT King and had the power to fix inefficient systems that impair clinician productivity. I cheer dilly dilly to all who seek to embrace the knowledge and expertise of physicians to deliver highly-usable solutions. I am confident that their efforts will make physicians happier and more productive and enhance the delivery of quality patient care.

CIO Unplugged 1/10/18

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

First Days

This is the second of a four-part series on key considerations and action items during your first 120 days in a new job.

They say the typical executive will switch positions 5-7 times during his or her career. How can you ensure a smooth and effective transition? This series is intended to compliment what others have written over the years with some fresh perspective. This post will begin where the last left.

Below are some ideas to consider from Day 1 to Day 30. A shout out to several peers whose experiences are reflected below.

Welcome

The first day on a new job can be nerve-racking. You typically head straight for orientation or to your new office and meet your manager. One of my colleagues arrived his first day only to have his manager inform him that he was leaving the organization that day. Another met her new manager for the first time since the one who had hired her retired during the recruitment process. Whatever the circumstance, dress the part and take a deep breath.

Manager

Your first priority is to connect well, connect quick. Some managers will wait for your first day to interact. Some prefer to wait days to let you settle. Either way, be proactive to make sure time together is scheduled.

Seek to cover several topics, ranging from performance expectations to preferred routine communications – face-to-face meetings, texts, emails, etc. Ask how they will know they made the right hire.

It’s a careful balance, but I recommend sharing on the personal side, also. We are all human, and the more you know about one another, the better the relationship is likely to be. 

Extra — ensure you have a regular meeting cadence in place and ask for feedback.

Assistant

Your assistant can make or break you. They are a key partner in your assimilation. Your assistant is your front line, the first person your manager, peers, team, and subordinates engage with. Your assistant sets the tone.

This relationship is a partnership. There must be mutual respect and appreciation. If you’re an external hire, an internally-hired assistant who knows the organization well is key. They have in-depth understanding of local politics and know back-channel communication pathways.

Extra — ask human resources to look for proven assistants who are seeking growth opportunities.

Logistics

To hit the ground listening and running, clear all logistic hurdles Week One. Badges, supplies, parking, productivity tools, stationery, cards, etc. Make sure you carve out time to handle personal logistics as well that require weekday attention. With the right assistant, the majority of these mundane tasks will already be handled.

Extra — coordinate with your assistant days before your arrival to develop an onboarding checklist.

Teaming

Have your first team meeting by end of Week One. Ideally, have your initial one-on-one meetings with your directs. As with your manager, it is crucial to bond quickly and well.

Unless circumstances dictate otherwise, move slowly and spend a good deal of time getting to know team members. There is plenty of time for work. Schedule ample get-to-know-you opportunities.

Extra — arrange for a voluntary cookout with families included. This provides an informal way to learn more about one another and to meet partners and children.

First Week Check-In

If you establish a robust manager relationship, select an awesome assistant, complete logistics, and begin developing team relationships, you have an excellent start.

Now, the next three weeks.

Peers

Contrary to common belief, your first obligation is to your peers. You share common management and goals with your peers. Your directs are important, but they come second.

It is key to develop effective relationships with each peer. Try to connect on a personal and professional level. Find common interests. Learn from them. Ask their keys to success. Ask for candid feedback.

Extra — a meal out of office allows ample time for conversation and protects from distraction.

Listening Tour

Identify key formal and informal leaders. Have your assistant make appointments. Visit with all of your division leadership, 2-3 layers down. Dependent on your organization complexity, this is a massive but important initiative.

You must know the voice of the customer. What you learn will help inform quick wins and Day 30-90 objectives. While this is a turbocharged effort to make numerous visits in a short period, the listening tour never ends.

Extra — I always send a same-day, handwritten thank-you card to the person I met.

Quick Wins

Assuming nothing is on fire, develop quick wins with your team. Use information gathered from the listening tour. Low-hanging fruit can be easily accomplished and shows leadership, listening, and action. For you, it also reveals your division’s leadership and bias for action.

Extra – publish your teams’ quick wins initiative and report progress, especially if imperfect.

Observe

Watch carefully. Look for influencers. Look for leaders. Find allies who you can turn to for advice and insights. You will need them in the coming days.

Execution

In a new job, it is natural to want to do more and do more quickly. You have to balance the desire for achievement with precision. If you accomplish a bunch of objectives but do so sloppily, you’ve dug yourself a big hole.

Even when done well, ensure that your level of execution is sustainable for you and your team. Does the organization have the capacity to embrace and digest all the change? At what pace? Execute at the intersection of speed, capacity, and quality. Save something for days 30-90 and beyond.

Extra — communicate with your manager and agree on the appropriate work effort and priorities.

Balance

Pace yourself. This is a marathon. Don’t sprint from the starting blocks so that you have nothing left for the race.

Execute quick wins and also think long term. Do the team and I have the energy and time to sustain a sprint? What about our families? They are supportive and understand the increased work hours of First Days, but for how long?

The last thing you can afford to lose at this point is your balance. Do not neglect your fitness, your health, or your family.

Extra — take advantage of holidays and weekends to stay connected to family.

The Next 30 Days

While you are learning the organization and are in relationship development mode, during Days 30-59 your thoughts crystalize and your foundation begins to be laid. I’ll review some key considerations and takeaways in the next post.

Feedback

What other considerations and action items should leaders consider in their first 30 days of a new role?

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

Morning Headlines 1/10/18

Change Healthcare Announces General Availability of First Enterprise-Scale Blockchain Solution for Healthcare

Change Healthcare announces GA of healthcare’s first enterprise-scale blockchain product, incorporating the technology into its Intelligent Healthcare Network for claims management.

President Donald J. Trump Takes Care of Veterans from the Battlefront to the Home Front

President Trump signs an Executive Order directing the DoD, VA, and Homeland Security to develop technology-heavy plans to provide mental health and suicide prevention resources to military personnel transitioning back to civilian life.

Siemens to list Healthineers unit in March: sources

Siemens will take its Healthineers business public in an April IPO that will value the company at $48 billion.

CMS announces new payment model to improve quality, coordination, and cost-effectiveness for both inpatient and outpatient care

CMS launches a new voluntary bundled payment model that allows providers to earn additional money if care expenses meet  a spending threshold that factors in quality.

McKesson CEO Calls Criticism of Company’s Opioid Role ‘Nonsense’

In an interview with Bloomberg, McKesson CEO John Hammergren downplays the company’s role in the opioid epidemic and hints at a possible 2018 IPO for Change Healthcare, in which it holds a 70-percent stake.

News 1/10/18

Top News

Change Healthcare announces GA of healthcare’s first enterprise-scale blockchain product, incorporating the technology into its Intelligent Healthcare Network for claims management.

The company says its use of blockchain will create a single source of truth that will enable greater auditability, traceability, and trust that will encourage creation of innovative services.

President and CEO Neil de Crescenzo said in a statement, “While others are experimenting with use cases, the pervasiveness of our Intelligent Healthcare Network has enabled us to quickly deploy blockchain at scale in addressing a highly administrative process, providing a launching pad for broad adoption. We will continue to leverage blockchain and other technologies to develop additional applications that can make healthcare more patient-centric while addressing cost and quality.”

Change Healthcare’s Intelligent Healthcare Network processes 50 million claims-related events each day using blockchain, which the company says is a successful demonstration of its capability in high-volume transaction processing.

Reader Comments

From Bama Boyz: “Re: Practice Fusion. Revenue of only around $60 million, tried to sell at 4-5 times revenue with no takers, and Allscripts has been trying to build a low-end cloud product that is going nowhere two years in. Allscripts needs a cloud product, Practice Fusion’s investors are tired, and thus the deal makes sense even with no winners.” Unverified, although it’s interesting if a company that offers a free, no-maintenance EHR is making $60 million selling patient data and drug company EHR ads. I observed on November 1 that the previously high-flying Practice Fusion had fallen off everyone’s radar with modest at best EP attestation numbers, especially for a product that’s free and has been around for more than 10 years. The $100 million cash acquisition price doesn’t even cover the $157 million that VCs unwisely fed it. Allscripts adds yet another ambulatory EHR to its fleet, increases market share by buying a questionably quantified customer base that isn’t paying anything, and drops another discounted day-old pastry into its mixed bag of unrelated acquisitions. On the plus side, it gets a market-tested cloud offering for small practices that can be quickly retooled into a licensed product instead of an ad-supported freebie. I don’t know what happened to the somewhat secretive Care Otter/Allscripts development team that was supposed to demo its new EHR at MGMA but didn’t. The challenges for Allscripts will be to figure out how to sell the Practice Fusion product to those small practices (Practice Fusion required only filling out a short registration page) and keeping cross-selling expectations realistic. I’ll also note that MDRX shares are up 44 percent in the past year vs. the Nasdaq’s 30 percent, so the market likes what Allscripts is doing.

From Grapevine: “Re: Philips PHM (Wellcentive). Laid off half their sales force a week before Christmas.” I reached out to the company, which provided this response:

Philips is engaged in increasing efficiencies in its Population Health Management business to meet evolving customer strategic goals, challenges, and needs with agility and focus. The Population Health Management market is a very promising, yet highly dynamic growth market. After careful consideration, Philips undertook a very limited restructuring of specific positions in a number of functions in December 2017, with those positions being eliminated in January 2018. Employees affected by this limited restructuring will be provided with a comprehensive separation package and transition support.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor QuadraMed, Healthcare Identity Experts. The Plano, TX-based company provides award-winning end-to-end healthcare identity management solutions that include enterprise master patient index software, MPI clean-up services, EMPI analytics, and staffing. It can diagnose, treat, cure, and prevent identity issues with 99 percent accuracy. The typical hospital’s 8-12 percent duplication rate – which gets a lot worse after a merger or acquisition — places patients at risk for medical errors, impedes interoperability efforts, hampers ACO operations, and jeopardizes EHR conversions. Simple EHR vendor matching algorithms use a handful of identifiers that require an exact or phonetic match, yielding only 50 percent accuracy and a lot of false matches. QuadraMed’s probabilistic algorithm analyzes many patient demographic data points and tunes out data entry errors to deliver 99 percent accuracy. Customer Newark Beth Israel Medical Center (NJ) reports that it dropped its duplicate record rate from 11.1 percent to 0.2 percent, improving its registrar workflow as well as patient safety. Thanks to QuadraMed, Healthcare Identity Experts for supporting HIStalk.

Mrs. H shared an update from her Missouri elementary school classroom, which is now equipped with STEM books and activities courtesy of readers who funded her DonorsChoose grant request: “When they opened the packages, I had a roomful of students who have never been more excited about creating and taking books with activities home to share with their families. I have a list of students waiting to take home a project to share! Thank you for bringing learning opportunities to my amazing kids and encouraging them to be excited about STEM!”

I’m looking for a health system CIO or IT director who can become a regular HIStalk contributor Dr. Jayne style. I can also use a nurse in a CNIO or other informatics role as a second contributor. Reader survey respondents suggested I add these additional voices and I agree, although I’ve tried before with minimal success — I need expertise, good writing skills, and a commitment to sticking to a schedule. If you’re the CIO/CNIO equivalent of Dr. Jayne, contact me, but don’t be surprised when I ask you to write a sample post – several people have been gung ho until faced with the pressure of that first empty page, causing their sudden disappearance. 

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

Siemens will take its Healthineers business public in an April IPO that will value the company at $48 billion, Reuters reports.

Eric Topol notes that healthcare has for the first time become the #1 source of American jobs, passing the retail sector. The federal government predicts that five of the seven fastest-growing industries over the next 10 years will be in healthcare. Topol concludes, “Human resources are the #1 driver of the $3.4 trillion healthcare expenditures/year; the job growth is unchecked. We watched an industry with nearly six decades of unbridled growth, with poor outcomes relative to the rest of the world, and did so little to alter the course.” I suspect the vast majority of those newly created jobs will not involve actually delivering care.

Sales

Kootenai Health (ID) selects the legacy data archiving solution of Parallon Technology Solutions to allow it to view extracted, self-hosted Meditech Magic data via a viewer.

UCSF Medical Center (CA) will implement IV safety analytics from Bainbridge Health, a spinoff of Children’s Hospital of Philadelphia.

In Canada, Peterborough Regional Health Centre expands its integration relationship with Summit Healthcare to include additional care coordination connectivity and integration with Connecting Ontario.

People

Video visit vendor MDLive hires Rich Berner (Allscripts) as CEO.

Announcements and Implementations

USPTO awards Glytec another patent, this time for personalized, computer-guided selection and dosing of any oral or injectable diabetes regimen.

Government and Politics

ONC Principal Deputy National Coordinator Genevieve Morris says regulations that will define and regulate information blocking will be published this spring. She says providers aren’t always comfortable sharing information with other providers whose security practices are unknown, but adds,

I think some of those trust concerns are used as a red herring to try to limit the sharing of data for competitive purposes. We’ve seen this with HIPAA, where we’ve been told ‘we can’t give that to you because of HIPAA.’ That’s totally misinterpreting HIPAA and these trust issues become a scapegoat for not wanting to share data for competitive reasons. Trying to figure out where that is happening versus real issues with sharing health information is part of the job that we take on.

HHS OIG says Georgia Medicaid made a lot of unallowable payments because the several systems it uses to assign ID numbers can’t detect duplicates.

Other

A Tufts analysis finds that the growing volume of data collected in clinical drug trials is increasing drug development time and adding integration challenges since most drug companies and research organizations still don’t collect EHR data electronically.

Sponsor Updates

• Casenet releases version 6.4 of its TruCare care management platform.
• Kyruus will offer its ProviderMatch patient access solutions on Epic’s App Orchard for seamless patient scheduling.
• Boston-based startup news site VentureFizz interviews ZappRx founder and CEO Zoë Barry.
• OpGen and Merck subsidiary ILUM Health Solutions will collaborate in a CDC-funded project to develop cloud- and mobile-base antimicrobial stewardship software for hospitals in Colombia that will support WHO’s WHONET global drug resistance monitoring software.
• Iatric Systems will integrate HealthGrid and Meditech solutions to help Ephraim McDowell Health (KY) with value-based care initiatives. 
• PerfectServe will integrate its clinical communication and care team collaboration platform with Microsoft Skype for Business to allow clinicians to conduct video conversations from within the PerfectServe application.
• Meditech will integrate aggregated data from Arcadia Healthcare Solutions into its Web EHR and analytics product for population health management.
• Besler renews its HFMA Peer Review designation.
• Netsmart will embed the virtual doctor service of American Well in long-term care and behavioral health EHR,  giving patients improved access to professionals and allowing them to obtain services from home.
• Culbert Healthcare Solutions will exhibit at the HFMA Revenue Cycle Conference January 18-19 in Foxborough, MA.
• Dimensional Insight will exhibit at the MUSE Executive Institute January 14-16 in Newport, CA.
• KLAS recognizes Aprima as a top-tier vendor of ambulatory RCM services for the large and small clinic categories.
• Iatric Systems will exhibit at the MUSE Executive Institute January 14-16 in Newport Coast, CA.
• InstaMed will exhibit at the HFMA Western Region Symposium January 14-17 in Las Vegas.

Blog Posts

• You Have Secure Texting…So Why Do You Need Mobile Device Management? (Spok)
• Raising the Stakes in 2018, CMS Continues Focus on Appeals and Grievances (Medecision)
• 2017 Innovator of the Year Awards (AdvancedMD)
• New Year’s Resolutions for the ACO (Arcadia Healthcare Solutions)
• The Case for Continuous Clinical Surveillance (Bernoulli)
• Meeting CMS Guidelines: New Reporting System for the Quality Payment Program (CareSync)
• Utilizing Location Technology to Help Protect Healthcare Staff (CenTrak)
• Hardware Improvements Greatly Improve Practice Functionality (Chart Logic)
• 3 Tricks for a Healthy Approach to Legacy Systems (Leidos Health)
• Why is it Important to Remain Compliant with State Mandates Around Prior Authorization? (CoverMyMeds)
• Set the Stage for Project Success by Investing in Business Analysts (CTG)
• Best Practices for Supporting Old and New Systems (Divurgent)
• Promoting System Efficiency in High Turnover Staff (Hayes Management Consulting)
• CIO Chat – John Kravitz, Geisinger Health System (Huntzinger Management Group)
• GDPR Compliance – What US Healthcare Organizations Need to Do (Impact Advisors)
• What are the conditions for use of secure messaging within healthcare settings? (Imprivata)
• Using Video to Change the Healthcare Consumer Experience (Influence Health)
• What to Expect When Deductibles Reset (and How to Ensure Patient Payments) (InstaMed)

Contacts

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

Morning Headlines 1/9/18

Practice Fusion, once headed for $1.5 billion valuation, ends in ‘disappointing’ fire sale

Allscripts will acquire Practice Fusion for $100 million in cash.

Allianz to invest $59 million in digital US healthcare provider

German insurance company Allianz will invest $59 million in American Well.

State approves UVM Health Network’s $151M records project

Vermont’s Green Mountain Care Board approves a request to implement Epic at four hospitals within the University of Vermont Health Network.

Curbside Consult with Dr. Jayne 1/8/18

I read with interest the news item last week about the Vermont Health Information Exchange. While that state’s exchange is under the microscope for issues with spending and data quality, there are plenty of other HIEs out there that are struggling with being useful at the point of care. Since my work spans multiple states, I’m able to see what is available to clinicians and how well it integrates with clinical workflows. There are variables whether the exchange is truly an exchange – namely whether data can be pushed or pulled or whether it’s little more than a view-only repository.

In the Vermont situation, 91 percent of interviewed stakeholders think that the state needs an HIE, but only 19 percent of interviewees feel that it is meeting their needs. One of the major barriers cited is Vermont’s opt-in policy, which limits the number of patients whose data is present for sharing. At this point, only about 20 percent of patients have opted in.

I had my own adventure with opt-in in my early days as a CMIO, when we created a private HIE to share data among physicians affiliated with our hospital. Although there wasn’t a specific state law that forced us to be opt-in, there were case law citations that prevented us from assuming all patients gave us permission to share data. We were able to maneuver through it over time by having all participating practices add language to their new patient consent forms that permitted sharing through the HIE. The practices also had to go back and have new consents executed for existing patients, and that took time.

Our vendor was subsidizing the interfaces because we were a beta client for their new HIE platform. Our hospital was picking up the rest of the tab, so there was no cost to the community physicians. My staff and I did countless road shows trying to convince physicians that this was a good thing to be part of, but at the same time, our CIO spent a lot of time trying to kill it simply because it wasn’t his idea and it was being executed by clinical leadership rather than IT leadership.

We ended up being live for quite a few years until our state HIE began to take shape. In all, it was an exciting time, but very different from the environment we’re in now, where interoperability is at least a little bit easier.

Despite having been live for several years, my own state HIE still struggles. It doesn’t communicate with our state immunization registry, which reduces its utility for primary care and urgent care physicians. All the immunizations sent to the HIE are strictly added as read-only data element, and there is no mechanism for resolution of duplicates or for reconciling with the immunization registry. A physician looking to validate immunizations on the HIE also has to go to the registry, and since the registry actually functions as a source of truth, why not just go there in the first place?

Our HIE doesn’t store any diagnostic imaging, only PDF report documents. Sometimes these are useful when an existing finding is well described and can help serve as a comparison, but there are entirely too many radiology reports out there with “clinical correlation recommended,” which means the reading radiologist isn’t going to stick his or her neck out by providing a specific diagnosis. When we find unusual things on an x-ray or CT, we’re hard-pressed to understand whether they’ve changed from previous. Instead of being able to provide the patient with immediate reassurance, we’re left giving him or her a copy of our films on a CD for them to take to their primary physician or the pertinent specialist to get it sorted.

The consultants evaluating the Vermont HIE recommended that it provide quality reports to support data-driven care. Our HIE doesn’t do any kind of reporting either, which to me seems a waste of a good population management tool. We’re in the midst of the worse influenza season we’ve seen in the last decade and yet can’t leverage that data for real-time reporting or surveillance. We have to wait for data to be reported to the state health department, then for it to be parsed and sent back to us in static form.

The Vermont HIE review also revealed concerns about patient matching and the function of its master patient index. We struggle with that in my state as well. Our state HIE’s program for identifying potential duplicate patients and merging them feels like it’s virtually non-existent. Since the matching algorithm appears to use address as one of its criteria, when I search for patients I find records that are clearly the same patient but are treated as unique individuals because they have different addresses, even if the rest of the demographics are the same.

We don’t tolerate that level of records duplication in my current practice, and in my former life at Big Health System, we had aggressive policies in place to identify, validate, and merge duplicate patients in our system on a regular basis. There’s no reason the HIE can’t do the same, especially with subpopulations that are known to be transient, such as college students, migrants, and homeless persons.

Another general concern around HIEs that plays out across the country is the sustainability of their funding models. Many are heavily subsidized with state funds and others are cobbled together with a variety of funding sources.

I worked with a practice recently whose HIE is struggling with funding. Practices are either required to do a full integration with the HIE at a cost of more than $40K and then pay a couple hundred dollars per provider per year to stay connected, or if they don’t want to do a full integration, they can pay a steep annual fee for providers to have web portal access. My client’s practice has a residency program with many rotating providers along with a number of locum tenens providers who fill in at their rural clinics. The fee for portal access is strictly per provider, with no regard to resident, full-time, or part-time status. For residents who are only in clinic for a couple of half days a week during a four- to six-month rotation, it’s too costly. For part-time physicians and those who are functioning in a job share situation, it’s not cost effective. We attempted to negotiate a break with the HIE, but were unsuccessful.

In my own practice, where I’m surrounded by Epic hospitals, I’m waiting for the advertised Share Everywhere functionality to start making an appearance. Although it was to be included in their November release for MyChart, I haven’t been inundated with patients whipping out their phones to give me access codes so I can see their records and send a note pack to their Epic-based care team. I’d be interested to hear from anyone who has seen it in the wild or used it to access patient information.

How satisfied are you with your HIE options? Email me.

Email Dr. Jayne.