HHS announces a $3.2 million penalty against Children’s Medical Center of Dallas (TX) following two separate PHI breaches, one stemming from a stolen laptop and another stemming from a lost blackberry, both were unencrypted.
Meditech reports Q4 and FY16 results: revenue dropped 2.8 percent to $462 million. Net income climbed four percent to $73 million, EPS $0.62 vs. $0.52.
Children’s Medical Center of Dallas (TX) will pay $3.2 million to settle HIPAA charges related to the loss of an unencrypted BlackBerry in 2010 and theft of an unencrypted laptop in 2013.
The organization failed to encrypt all PHI-containing devices as recommended by two consulting firms that had performed security gap and vulnerability analyses. It had also allowed its biomedical department to inventory its own IT equipment, causing the IT department to miss those devices in enforcing its security policies.
HHS OCR says Children’s practiced “non-compliance over many years with multiple standards of the HIPAA Security Rule.”
Pam Arora, SVP/CIO of Children’s Health since January 2007, was named last month by CHIME and HIMSS as their John E. Gall CIO of the Year.
Reader Comments
From Deranged Bunny: “Re: mistakes in the HIMSS-owned publication. Here’s one from the first sentence in their lead story today.” Re-wording a press release into a “story” should have been easy for their writer since all the words were right there. For the record, “Purdue” pushes OxyContin, while “Perdue” sells chicken.
HIStalkapalooza Sponsor Profile
InstaMed, healthcare’s most trusted payments network, delivers secure and fully integrated patient payment solutions to the largest health systems, children’s hospitals, and provider organizations across the US, processing billions of dollars in healthcare payments per month. Connect with InstaMed during HIMSS17 at booth 609 to chat about the healthcare payments experience your patients are demanding, the need for integration of patient payments into EHR/PMS, and the increasing pressure on security and compliance, including PCI scope. Plus, we are hosting an evening of conversation, food, and drinks on February 19 after the HIMSS17 opening reception. Learn more.
HIStalk Announcements and Requests
I still have seats available for our CMIO lunch at the HIMSS conference, Tuesday, February 21 at noon, conveniently located just off the exhibit hall and paid for by me. CMIOs can sign up here. Our 20 or so CMIO attendees will enjoy a great buffet lunch and casual peer-to-peer conversations – the only non-CMIO attendee will be Lorre, who is hosting. Everybody has to eat even with all the conference hustle and bustle, so a relaxing lunch with peers is a nice way to escape the neon jungle.
We funded the DonorsChoose grant request of Mrs. W from Arizona, whose elementary school class is using the document camera we provided for reading and phonics skills along with their sections in science, math, and social studies.
This week on HIStalk Practice: Family Choice Urgent Care implements Practice Velocity software. ATA asks for comments on pediatric, mental health, stroke guidelines. MediSys adds Alpha II PQRS capabilities. PatientClick launches telepsychiatry service. DrFirst acquires VisibilityRx. Das Health develops online mental health assessment tools. Greenwood Genetic Center’s Michael Lyons, MD discusses GGC’s decision to add telemedicine capabilities.
Welcome to new HIStalk Platinum Sponsor Siemens Healthineers. The company’s product lines include medical imaging, laboratory diagnostics, and point-of-care testing. Imaging and IT offerings include PACS, RIS, image sharing, clinical data management, software for multi-modality reading, cardiovascular care software, and enterprise imaging, workflow, visualization, and archiving. Diagnostic products include data and workflow management systems, diagnostics system remote monitoring, and laboratory inventory management. Nine out of 10 US hospitals depend on the company’s solutions, including every hospital listed on the US News & World Report Honor Roll. Siemens Healthineers and IBM Watson Health are working together to develop and deploy new population health management products and services to help providers transition to value-based care with analytics and patient engagement. It will offer IBM Watson Care Manager, a cognitive solution that supports nurses and other care managers as they monitor and counsel people with chronic conditions. See them in HIMSS Booth # 2323. Thanks to Siemens Healthineers for supporting HIStalk.
Here’s a Siemens Healthineers intro video I found on YouTube. It’s from May 2016, when the company announced its name change from Siemens Healthcare.
Listening: new from Horisont, fantastic 1970s-sound prog rock that’s actually from a fairly new band from Sweden (think Kansas meets Deep Purple in Uriah Heep’s basement). Speaking of which, RIP John Wetton, whose long career as a prog-band bassist, singer, and songwriter included stints with King Crimson, UK, Uriah Heep, and most notably Asia. Asia’s tour starts on March 15, but Wetton had already bowed out due to his chemotherapy treatments, replaced by Yes’s Billy Sherwood, who previously replaced another deceased legendary prog bassist, Chris Squire of Yes.
Webinars
February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Meditech announces Q4 results: revenue down nine percent, EPS $0.62 vs. $0.52. For the year, revenue was down 2.8 percent as product revenue slipped 15 percent, having declined by 38 percent since 2014. The privately held company’s net income was $73 million in 2016, up 4 percent from last year but down 41 percent vs. 2014’s total.
DrFirst acquires VisibilityRx, which identifies and recruits patients for clinical trials.
Athenahealth reports Q4 results: revenue up 12 percent, adjusted EPS $0.62 vs. $0.45, beating earnings expectations but falling short on revenue.
Sales
George Washington University (DC) chooses Castlight Health’s employee health benefits management platform.
Announcements and Implementations
Catholic Health Services (NY) rolls out Uniphy Health’s mobile collaboration app to its providers.
Jupiter Medical Center (FL) will go live in March 2017 on IBM Watson for Oncology, the first community hospital to do so following the system’s “training” at Memorial Sloan Kettering Cancer Center. It presents individualized, evidence-based treatment options to oncologists in drawing information from 15 million pages of text from medical journals and textbooks.
UCHealth (CO) announces technology-related developments that include virtual visits, online scheduling, a new app, and adoption of the OpenNotes standard.
Government and Politics
A Florida urologist will pay $3.8 million to settle False Claims Act charges that he ordered medically unnecessary lab tests. Meir Daller, MD ordered 13,000 FISH bladder cancer tests of questionable medical value on Medicare patients who were steered to a lab owned by his employer, who then paid the doctor $2 million in bonuses. The assistant US attorney says the doctor would look at paper-based urinalysis results but then throw them away so he could enter whatever he wanted into the EHR, often falsely recording that blood was found in the patient’s urine to justify ordering the test. The practice’s owner, 21st Century Oncology, previously paid $20 million for its role in over-ordering the $1,000 tests for Medicare patients. The company, which operates 180 cancer treatment centers, also reported an October 2015 breach of its systems that exposed the information of 2.2 million patients.
USA Today reports that shares of McKesson were among the healthcare-related investments made by HHS Secretary nominee Rep. Tom Price (R-GA) since 2012 that appear to be improper. Price bought MCK shares in March 2016, McKesson warned investors in early May that Medicare’s reduction in medical equipment payments could hurt its bottom line, and Price introduced legislation to cancel the cuts on May 12.
Privacy and Security
In England, an analysis of the four-day October downtime of three-hospital Northern Lincolnshire and Goole NHS Foundation Trust finds that it was caused by a misconfigured firewall that allowed ransomware to penetrate its systems.
President Trump’s long-time doctor Harold Bornstein, MD lists the president’s medical conditions and prescriptions in a New York Times interview, raising the question of whether he violated HIPAA in doing so.
Other
HRH Princess Haya of Jordan, the junior wife of UAE’s prime minister (she’s the second of his five wives), addresses the Arab Health Exhibition and Congress in Dubai:
I have already alluded to the difficulty faced in embracing new technology in healthcare. To ensure successful adoption, we need to equip the physician, the patient, and the system with the right tools and knowledge. We also need to improve medical training to ensure future generations of doctors are proficient in the use of technology, social media, and digital platforms. This is my point. This is where the balance lies. We have seen all kinds of machines and technologies that have created the architecture, but in the end, it was for the benefit of the people, to give them a home for the future. This same balance needs to be struck between innovation and medicine.
An interesting article lists the biometric measurements that will soon allow police to identity suspects in ways that go far beyond fingerprints. They include signature recognition, typing pattern recognition, recognizing patterns used in reading predefined passages aloud, eye movement tracking, gait analysis, and identifying people by their body odor. Facial recognition systems are already in place, with the FBI having stored the images of half of Americans in its databases. The article notes that President Trump’s executive order on immigration calls for expediting the use of biometric screening at the US border.
Sponsor Updates
Kyruus will present at the Harvard Healthcare Business Conference February 4 in Boston.
ZeOmega’s Jiva 6.1 earns ONC Health IT 2014 Edition Modular EHR certification.
Learn on Demand Systems releases details about its invite-only Launch event in March for customers and partners.
LiveProcess releases a new case study, “Communication During a Cyberattack.”
MedData will exhibit at the HFMA NENY Women in Leadership Conference February 9 in Clifton Park, NY.
Medecision releases a new video, “Aerial Powering Population Health Success.”
Meditech will exhibit at the AHA’s Rural Healthcare Leadership Conference February 5-8 in Phoenix.
Navicure will exhibit at the 2017 Healthpac Annual Users Meeting February 10-12 in Savannah.
Nordic will sponsor the inaugural Epic North Carolina Users Group Meeting February 8-9 in Greensboro.
February 2, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 2/2/17
It’s increasingly difficult to keep up with the literature when there is so much coming out and the pace of change is so rapid. This article in PLOS One regarding influenza vaccination for healthcare workers caught my eye. It looked at vaccination statistics in long-term care facilities and whether the “number needed to vaccinate” in order to prevent patient death was in alignment with what had been predicted based on previous data. Rather than the previously predicted number of eight vaccinations needed to prevent a single patient death, the number was calculated at somewhere between 6,000 and 32,000. Authors concluded that the four studies supporting enforced vaccination for healthcare workers “attribute implausibly large reductions in patient risk to healthcare worker vaccination, casting serious doubts on their validity.”
This is a great lesson in small data vs. big data and the need to keep questioning and keep researching as the healthcare knowledge base continues to expand. Through the magic of eBay, I once purchased a set of medical student notebooks from the 1920s. They’re half-legal sized bound notebooks that flip at the top, and it’s amazing to see what is written and what we knew then. My favorite page starts with the statement, “There is so much we still do not know about the thyroid.” I wonder what that medical student would think of our current knowledge base? Those notebooks also make me wonder what physicians will think of us 80 years in the future, especially given the current wrangling over whether we as a nation are committed to ensuring medical care for all.
I recently posed the question to my readers about what would their ideal jobs would look like.
From Sunshine State: “An optimal role would be leading several business units from a COO or similar position, with a focus on solving problems in our industry in a fast-paced and dynamic environment. A level of risk is attractive — as John Paul Jones stated, he who will not risk cannot win. How do we shrink an industry and not put people out of work while advancing care? With a generalist background, a greater contribution is possible with coordinating resources and goals across groups rather than leading a specific business unit or department requiring specialized skills.” I agree that the idea of having more than one business unit at your disposal might make it easier to solve problems creatively without the distraction or bottlenecks that occurs with more siloed organizations. There’s a temptation for leaders to protect their own rather than stepping out of their comfort zones in an effort to solve the bigger problem. Certainly figuring out how to reduce cost, increase quality, and maintain jobs is a challenge, even more so when you have limited financial or personnel resources.
From At Bat: “Funny you should ask about the perfect job because I happened into it several years ago. I worked at a large hospital for 30+ years in direct patient care, managed care, the physician organization, the health plan, patient safety, and at the last part of my career in evidence-based medicine. I’m not technical, but was involved system-wide in various projects. I was contacted by the executive for our data warehouse asking if I would speak at a conference on a particular topic. I replied, ‘No problem, any opportunities?’ and after a whirlwind of phone interviews and a quick meet-up at HIMSS, I was offered my dream job helping health systems with analytics initiatives. I have to honestly say that if you gave me a pencil and paper and said to write down the perfect job, this would have been the result. I work from home when I am not traveling, and while I do get a tad lonely, it is the most rewarding job I have ever held. I am slowly getting used to working in the for-profit vs. non-profit world.” The ability to wear fuzzy bunny slippers to work cannot be underestimated. It can be a drag, though, when you realize you’ve been wearing pajamas all day and have been so busy working that you’re not even sure you brushed your teeth today. I’m always happy to hear when people find something that really clicks and hope that it lasts for them.
From What The?: “I wrote you a couple years ago about the perfect job and thought you might appreciate an update. I had decided after being a healthcare IT consultant that I knew without a doubt that I wanted to be a doctor. I have a liberal arts degree and zero science background, but seeing how people like you approach healthcare convinced me that this was something I needed to do. I was accepted to my medical school of choice last fall and am doing contract HIT consulting work to save up money until I start classes. I just got an email about my white coat ceremony in July and could not be more excited about the opportunities ahead.” This put a big smile on my face. Although sometimes those of us in the profession knock it due to the hours, the stress, the external pressures, and more, being a physician is still one of the greatest privileges any of us can have. For patients to trust us in their times of vulnerability and weakness is truly something special. Even though there are tens of thousands of “healthcare IT people” who never go anywhere near a patient, we need to continue to remember why we are doing this. It’s about our grandmothers, brothers, sisters, and everyone else who relies on the systems we use to make decisions and deliver care.
Senate HELP committee chairman Lamar Alexander (R-TN) suggests that stabilizing the individual marketplaces should come before efforts to reform Medicaid or roll back expansion.
The Wall Street Journal reports that Tom Price, President Trump’s nominee to run HHS, was offered a privileged opportunity to buy stock in a biomedical company at a special discount, despite confirmation hearing testimony to the contrary.
Biomedical engineer and MIT professor Robert Langer, recognized as the most-cited engineer in history, invents a long-acting pill that would release a steady dose of a drug for weeks.
February 1, 2017Readers WriteComments Off on Readers Write: The Patient Experience Is Clinical
The Patient Experience Is Clinical By Mark Crockett, MD
As quickly as healthcare began to focus on patient experience, the law of unintended consequences kicked in. While well received as a tool to help improve care, this situation unintentionally gave rise to a consumer culture around patient treatment. Today’s value-based care arrangements call for providers to take a fresh look at patient experience.
While patients certainly deserve to be treated with dignity and listened to carefully, the top patient experience expectation is receiving safe, quality care. “Patient experience [is] not about making patients happy over quality,” says James Merlino, MD of the Association for Patient Experience. “It’s about safe care first, high-quality care, and then satisfaction.”
The best way to deliver on this expectation is for providers to view these issues of safety, risk, and compliance as a cohesive whole, thus enabling patients to receive the safe, quality care they expect, in the caring and supportive environment they deserve.
The Beryl Group defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influences patient perceptions across the continuum of care.”
That’s a big job. Most providers lack the tools to make that happen. Where to start?
It begins with developing provider/patient and provider/organization relationships that encourage collaboration.
In 2013, a British Medical Journal review of 55 studies found that patient experience is “positively associated with clinical effectiveness and patient safety, and supports the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.”
What the BMJ study revealed, and my own anecdotal evidence bears out, is that if a patient experience is positive, the patient feels empowered and can enter into a therapeutic “alliance” with the provider. Patients are motivated to follow treatment plans and are less likely to withhold information if they don’t feel intimidated—or worse, ignored—by their provider and the hospital where treatment was rendered. This supports swifter diagnoses and improved clinical decision-making and leads to fewer unnecessary referrals or diagnostic tests.
Many hospital CFOs don’t need the BMJ study to know a positive patient experience is a clinical indicator that ties to financial outcomes. As outlined in the chart (Figure 1), patient experience is directly associated with a hospital’s Star Rating and patient outcomes:
Creating a positive patient experience, and better clinical outcomes, begins with an understanding of what patients expect from providers. The primary expectation of any patient is, first and foremost, safety. To the unfamiliar, hospitals are scary places. Patients no doubt have read or heard stories (or watched doctor shows on TV) of medical errors and medication mix-ups or of being treated by an unqualified caregiver. Hospitals and other healthcare settings must communicate clearly that theirs is a safe place where patients can trust their caregivers.
If patients believe they are in a safe, trusted environment, their next expectation is, of course, to get better. To be healed. This requires consistent excellence across a wide variety of performance areas. Finally, patients expect to be treated with courtesy and respect.
How do we establish patient experience as one of the pillars of quality healthcare? Not surprisingly, it’s a judicious combination of technology, effective communication, and employee engagement and physician alignment.
Most patients assume all clinicians are highly qualified and fully credentialed. A robust credentialing platform helps providers deliver on that assumption. Other examples of technology impacting patient experience is the ease of electronically submitting information to a Patient Safety Organization. Participating in a PSO not only enables federal protection under the Patient Safety and Quality Improvement Act (PSQIA) but enables the organization to share and learn from peers as it relates to patient safety initiatives that most certainly impact patient experience.
Effective communication improves not just patient satisfaction, but also physician satisfaction. It boosts patient adherence and compliance and reduces medical errors and malpractice claims. The benefits of a culture that encourages open, honest, and direct communication among patients, providers, and staff go directly to the heart of patient experience.
There is a tremendous benefit to incorporating digital rounding (levering mobile technology to gather information in real-time during the rounding process) into a health system’s employee engagement strategy to generate information from patient rounding, safety rounding, and leader rounding. There is much to be learned from the voices of providers, patients, and employees.
For example, although nurses and physicians generate an equal number of complaints, nurses are three times more likely to have positive reports as compared to MDs. However, physician complaints have higher severity and fewer resolutions.
Patient feedback gathered through a rounding process identifies critical focus areas including peer review events, compliance events (particularly in infection control), and patient and employee safety issues.
For one healthcare system, more than 50 percent of all peer review cases at its 30 facilities actually began in patient relations. In addition, validation audits from compliance organizations (specifically CMS) often stem from a patient complaint. Another reason to centralize data gathered from the feedback of patients, providers, and employees is to identify patterns that allow organizations to transform risk management from a reactive process to a proactive component of healthcare delivery.
Patient experience is clinical. It matters to value-based care and has direct impact on an institution’s long-term financial survival. Organizations that sideline patient experience, or simply meet the minimum standards required, do so at their peril.
Mark Crockett, MD is CEO of Verge Health of Charleston, SC.
Comments Off on Readers Write: The Patient Experience Is Clinical
No Easy Answers For Scheduling Physician On-Call Coverage By Suvas Vajracharya, PhD
Recent criticism of on-call scheduling practices in the retail sector means that it may be time for healthcare operations leaders to review on-call scheduling practices for their physician teams.
In recent weeks, the retail sector has experienced close scrutiny for on-call arrangements with their staff. According to Reuters, New York Attorney General Eric Schneiderman and “his counterparts in seven states, including California and Illinois, have sent letters to a number of companies in the last year requesting information about their scheduling practices.” In response, employers like Aeropostale and Walt Disney have begun discontinuing the practice of keeping hourly workers on call for last-minute shift changes to avoid further legal disputes.
In healthcare, on-call coverage is regulated under the Emergency Medical Treatment and Active Labor Act (EMTALA). Most medical institutions choose to pay on-call physicians to ensure appropriate coverage under these rules. According to a 2012 SullivanCotter report, nearly two-thirds of healthcare organizations provided call pay to at least some physicians, up from 54 percent in 2010. However, the EMTALA regulations are excessively vague and “in a manner that best meets the needs for the hospital’s patients” can be interpreted in ways that leave physicians feeling like they’re receiving an unfair deal.
“In the MGMA’s 2013 Medical Directorship and On-Call Compensation Survey, primary care physicians reported a median on-call rate of $100 to $150 per day,” according to an article in Medical Economics.
From the physician perspective, these rates may not fairly balance the sacrifices they are making to provide on-call coverage during their days off — if they are receiving compensation at all. For retail employees, state officials concluded workers can be harmed by “unpredictable” schedules that can increase stress, strain family life, and make it harder to arrange child care or pursue an education. Fundamentally, to be on call as either a retail employee or a physician requires foregoing activities and flexibility with free time.
With physician burnout on the rise, heavy variation in the frequency of calls and a wide range in the number of physicians participating in call rotation, health leaders should invest proactively in finding fair on-call strategies to ensure the hospital’s access to physicians and to prevent turnover. How do we fairly compensate a physician for remaining in close proximity to the hospital and being physically and mentally capable of providing direct patient care at a moment’s notice? How do we weigh the difficulty of taking calls on holidays or weekends or being on primary call versus backup call?
Providing adequate on-call coverage remains a constant challenge for most healthcare institutions. Making it a program that is seen as fair and respectful of physician staff can be a crucial first step. Using scheduling technology instead of a manual process not only removes the sense that personal bias may be influencing how on-call hours are assigned, but also provides transparency across teams and flexibility for swaps. Scheduling technology with advanced algorithms based on artificial intelligence can also ensure that on-call schedule enforces work patterns in harmony with circadian rhythm of physicians who need to work at any hour.
Healthcare operations leaders should want to follow the lead of companies like Gap, who proactively change their policies to stay ahead of on-call criticism. Small policy changes can dramatically reduce risk for healthcare operations and improve physicians’ professional satisfaction.
Suvas Vajracharya, PhD is founder and CEO of Lightning Bolt Solutions of South San Francisco, CA.
Health information technology (HIT) has made significant advances over the last two decades. While adoption is not necessarily a good marker for successful EHR usage, adoption of office-based physicians with EHR has gone from about 20 percent to over 80 percent and more that 95 percent of all non-federal acute care hospitals possess certified health IT. HIT implementation has led to improvements in quality and patient safety.
However, many of the goals of increased HIT implementation have been stymied by social and technical roadblocks. A “one type fits all” approach may help reduce training and configuration costs, but there are many approaches to patient care and unique workflows between specialties and among individual users.
Most EHRs are burdened with three major legacy issues:
Technology. Present EHR systems are mostly built on what would now be considered old technology. Some of the ambulatory products and small acute care products have moved onto cloud-based architecture, but most are client-server. While hosting instances of a product reduces the technical expertise needed by the client and can lead to better standardization of implementation, it does not necessarily deliver the advantages of a native, cloud-based architecture.
Encounter-based. EHRs have been built on the concept that interactions with patients (or members or clients) are associated with a specific encounter. This functions well for face-to-face visits and for specific events, but is limiting where longitudinal care is required.
User experience. The user experience has for the most part taken a back seat to functionality in HIT software development. A quick view of most HIT systems shows the interface to be cluttered and does not draw the user’s attention to the areas that need the most attention. Most users access only a small percentage of the functionality that is present within the system, but vendors continue to add functionality rather than clean up the interface.
Platforms have revolutionized the way business is conducted in many industries. Numerous examples have made household names out of companies like Airbnb, Uber, Facebook, YouTube, Amazon and many more. A platform is not just a technology, but also “a new business model that uses technology to connect people, organization, and resources in an interactive ecosystem.”
There is a need for a HIT platform that would support the multitude of components necessary to move the delivery of HIT into the next generation. The future health solution needs to use contemporary technology that will have the flexibility to adapt to ever-changing requirements and use cases of modern healthcare. Some of the characteristics of the future health solution are:
Open. One of the biggest complaints of users and regulators is the closed nature of many HIT systems. The future health solution needs to be built as a platform that is able to share and access not only data, but also workflows and functionality through APIs
Apps and modules. A modular structure will enable components to be reused in different workflows and encourage innovation and specialization.
True, cloud-based architecture. Cloud computing delivers high performance, scalability, and accessibility. Upfront costs are reduced or eliminated and minimizes the technical resources needed by the client. Management, administration, and upgrading of solutions can be centralized and standardized.
Multi-platform. Users expect access to workflows on their smartphones and tablets. Any solution must develop primary workflows for the mobile worker and ensure that the user interface supports these devices
Scalable (up and down). To meet the needs of small and large organizations, the future health solutin will need to scale to accommodate changes in client volumes.
Analytics, reporting, and big data. HIT systems have collected massive amount of data. The challenge is not just mining that data, but presenting the information in a way that can be quickly absorbed by the individual user.
Searchable at the point of use. All the data that is being collected needs to be readily accessible. Using universal search capabilities and the ability to filter and sort on the fly will facilitate the easy access to information at the point of care.
Privacy and security. The core platform will need to be primarily responsible for the security and privacy of the data. The other modules built on the platform will need to comply to the platform security and privacy practices, but will not need to primarily manage these issues.
Interoperable. Need to adopt all present and future (FHIR) standards of data sharing. The open nature of the platform will facilitate access to data.
Internationalization and localization. Internationalization ensures that the system is structured in such a way that supports different languages, keyboards, alphabets, and data entry requirements. Localization uses these technical underpinnings to ensure that the cultural and scientific regional differences are addressed to help with implementation and adoption.
Workflow engine. Best practices can change and can be affected by national and regional differences. An easy-to-use workflow engine will be a necessity to help make changes to the workflow as needed by the clients.
Task management. Every user has tasks that need to be identified, prioritized, and addressed. Therefore, a task management tool that extends beyond a single module or workflow will be needed.
Clinical decision support. Increasingly sophisticated decision support needs to be supported, including CDS, artificial intelligence, and diagnostic decision support. These capabilities need to be embraced by the platform, allowing external decision support engines to interface easily with the other modules.
Adaptable on the fly by the end user. Allowing the end user with proper security to make changes to templates and workflows would help improve adoption.
User experience. Probably the most significant barrier to adoption of HIT is the user experience. Other industries are way ahead of healthcare in the adoption of clean, easy-to-use interfaces. It is vital that a team of user experience experts be integrally involved in the development process. All user-facing interactions, screens, and workflows need to be evaluated by user experience experts who can recommend innovative ways the user interacts with the system and how information is displayed.
The HIT industry has hit a wall that is preventing it from developing innovative products that use the newest technology and have an exemplary user experience. A new platform has the potential to support a robust, flexible, and innovative series of products that can adapt to meet the needs of the various healthcare markets globally. Such a project would have to build slowly over time, as does any disruptive technology. The legacy systems and other HIT systems that exist do not have to be excluded, but rather can be integrated into this new platform.
Identifying technology that, at its core, has the privacy, security, data management, and open structure could lead to the next generation of healthcare management systems. While some of these characteristics are obvious to developers and users alike, it is the sum of the parts that is important. Integrating most if not all of these characteristics into a single model is what can lead to enhancing the value of HIT and the delivery of care.
Toby Samo, MD is chief medical officer of Excelicare of Raleigh, NC.
Virginia Governor Terry McAuliffe announces that the state has received a $3.1 million grant from OxyContin manufacturer Purdue Pharma to help it integrate its prescription monitoring program with the EHRs of local providers.
Vox reports that pharmaceutical executives have persuaded President Trump to drop his call for Medicare to begin negotiating lower drug prices, opting instead for a plan that includes lowering drug company taxes and reducing regulations.
In Massachusetts, Lahey Health and Beth Israel Deaconess Medical Center announce merger plans. The combined organization would include eight hospitals, 29,000 employees, and $4.5 billion in annual revenue.
OxyContin manufacturer Purdue Pharma will give the State of Virginia a $3.1 million grant to integrate its doctor-shopper prescription drug monitoring database with provider EHRs.
The state will use the PMP Gateway of its Appriss Health NarxCare system, which uses two years of prescription data to visually represent a patient’s usage patterns and to present a calculated risk score. Beyond claims and EHR data, it can incorporate information from EMS and criminal justice systems.
NarxCare offers prescribers a Medication-Assisted Treatment locator map and patient information handouts.
The 450-employee, Louisville-based Appriss Health says its systems process 25 million database inquiries each year. It also offers law enforcement, public safety, and Medicaid fraud detection apps.
Reader Comments
From Firing Line: “Re: HIStalk. I have followed you since I worked at a big health IT vendor, where it was a fireable offense to read your blog back in the early days.” I’ve heard that about a few companies, which encourages me since I must be doing something right if they want to ban employees from reading what I write. I also enjoy hearing from readers who apologize for not evangelizing HIStalk because they consider the information they gain to be a personal competitive advantage.
From Spatial Orientation: “Re: [EHR vendor name omitted]. Has informed users that they are able to supply QRDA III reports but not QRDA I reports, meaning they are in violation of ONC’s certification requirements.” Unverified. I’ve invited the company to respond but haven’t heard back. I’ll repeat this item including their name in Thursday’s post if they don’t respond.
HIStalkapalooza Sponsor Profile
Spok, Inc., a wholly owned subsidiary of Spok Holdings, Inc. (NASDAQ: SPOK), headquartered in Springfield, VA., is proud to be the global leader in healthcare communications. We deliver clinical information to care teams when and where it matters most to improve patient outcomes. Top hospitals rely on the Spok Care Connect platform to enhance workflows for clinicians, support administrative compliance, and provide a better experience for patients. Our customers send over 100 million messages each month through their Spok solutions. When seconds count, count on Spok. For more information, visit spok.com or follow @spoktweets on Twitter.
HIStalk Announcements and Requests
I’m getting swamped with HIStalkapalooza emails from people who don’t appreciate the fact that I have around 50,000 readers and I have maybe 1.5 FTEs total other than me to do everything HIStalk-related, of which party planning represents about 0.01 FTE. My plea is this: come if you received an invitation, don’t come if you didn’t, and don’t email us either way because it’s the busiest time of year for us and throwing a free party isn’t our most pressing priority. To summarize the oft-stated rules: (a) don’t ask if I have extra tickets since I’m already turning people away who signed up due to a shortfall in sponsorship funds, so I certainly won’t be inviting someone who didn’t even register; (b) you’ll need to complete your registration online from the email link and bring your barcoded invitation to the event; (c) I can’t help you fix your company’s spam filter that didn’t let your invitation through; (d) you can’t bring a guest if you didn’t register them; and (e) wear whatever you want, but go big if you want to have a shot for the “best shoes” and best dressed” awards. There’s an exception to (a): get your company to sign on as a sponsor of the event and your CEO can come after all — it’s nearly always CEOs who neglect to sign up and then dispatch an underling to demand an exception, usually from vendor companies that don’t support HIStalk in any way.
Dear HIMSS-owned publication: hi, it’s me again. Thanks for fixing the story you ran over the weekend that I called out, in which you mistook a January 2016 press release for January 2017 and splashed it out as breaking news. I won’t quibble with the fact that you just changed the story to hide your mistake without acknowledging it. On that topic, please note that there’s no such company as “Optum Healthcare IT” that you reference in your list of KLAS winners. What you meant to say was “Optimum Healthcare IT.” At least your HIMSS peer at Healthcare Finance also screwed up the same name, calling it “Optimum IT.” Don’t worry, I don’t read your site, so I won’t be catching your mistakes regularly (but hopefully your readers will!)
We provided strategic thinking and economics games along with general supplies for Ms. D’s middle school class in Arkansas in funding her DonorsChoose grant request. She reports, “My students have played rounds of critical thinking games every week since we have received the package. This is their favorite time of the week and can’t wait to figure out what new game we are playing. After learning about Milton Bradley and Henry Ford, the students have started creating their own strategy games.”
Webinars
February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.
February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.
Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.
Acquisitions, Funding, Business, and Stock
Thoma Bravo is soliciting bids to buy its supply chain management company Global Health Exchange for up to $1.3 billion, Reuters reports. Thoma Bravo bought GHX in 2014.
A private equity news site says health information exchange platform vendor Vyne has hired a merchant bank to explore a sale of the company.
Big Massachusetts providers Beth Israel Deaconess Medical Center and Lahey Clinic announce plans to merge to better compete with the huge (and hugely expensive) Partners HealthCare, which also recently announced its own plan to acquire the Massachusetts Eye and Ear specialty hospital.
Sales
Geisinger Health System (PA) will implement Stanson Health’s clinical decision support and analytics to add real-time, patient-specific intelligence to its EHR.
In England, King’s College Hospital NHS Foundation Trust chooses Cerner Millennium EHR and revenue cycle for the 100-bed hospital it will build in Dubai.
MedEvolve hires Jenny O’Pry (MedSynergies) as SVP of RCM and Matt Seefeld (NantHealth) as SVP of business development.
Announcements and Implementations
Healthcare Growth Partners publishes its amply-researched and well-written HIT Market Review, which includes M&A, valuation, the year in review, and thoughts about the impact of the new administration.
A new Black Book report finds that population health management technology is a fast-growing sector even though providers are forging ahead using only stopgap tools from their EHR vendor, they’re dealing with community HIEs that offer poor population health modeling data, and they have limited data availability beyond their own EHR’s health snapshots. Hospitals report that they will need new PHM and IT talent, but shortages may limit availability. The top three best-of-breed vendors were IBM Watson Health, Evolent Health, and The Advisory Board Company, while the top three PHM and value-based care consultants were Premier, The Advisory Board Company, and Evolent Health.
Government and Politics
Vox reports that President Trump has abandoned his campaign promise to reduce drug costs by allowing Medicare to negotiate prices, changing his mind after meeting with pharma lobbyists to now favor drug company tax reductions and deregulation.
Privacy and Security
I’ve seen several recent articles on Cambridge Analytica, the “behavioral microtargeting” analytics firm that was involved (to an arguable degree) with both the Brexit and Donald Trump wins that pollsters failed to predict. The company’s work is relevant to healthcare because: (a) it sounds a lot like how HIMSS describes its new service that will target vendor sales prospects using their personal information; and (b) it could be more positively used for public health in areas such as depression. Either way, lax US personal data laws are making us all targets of companies that train their analytical firepower to profitably sway our decisions. Cambridge Analytica, of which White House advisor Steve Bannon is apparently a board member, mines Facebook data via those mindless quizzes that bored people inexplicably take, thus giving the company access to their Facebook profiles. The company’s technology supposedly requires just 68 of a user’s “likes” to accurately predict their skin color, sexual orientation, political party affiliation, and use of drugs, alcohol, and cigarettes, while it just 10 “likes” allow researchers to “know” a Facebook user better than their work colleagues. The company combined that information with commercially sold personal information databases to develop psychological profiles on every American. It then buys Facebook ads that it micro-targets to individual personality types, which some experts say was the key to the unexpected and lesser-funded campaign victories of Donald Trump and Brexit:
On the day of the third presidential debate between Trump and Clinton, Trump’s team tested 175,000 different ad variations for his arguments, in order to find the right versions above all via Facebook. The messages differed for the most part only in microscopic details, in order to target the recipients in the optimal psychological way: different headings, colors, captions, with a photo or video. This fine-tuning reaches all the way down to the smallest groups … In the Miami district of Little Haiti, for instance, Trump’s campaign provided inhabitants with news about the failure of the Clinton Foundation following the earthquake in Haiti, in order to keep them from voting for Hillary Clinton … These “dark posts”—sponsored news-feed-style ads in Facebook timelines that can only be seen by users with specific profiles—included videos aimed at African-Americans in which Hillary Clinton refers to black men as predators, for example.
The St. Louis Cardinals will give the Houston Astros $2 million and their two top draft picks as cybercrime compensation. The former director of baseball development for the Cardinals was sentenced to 46 months in prison and a lifetime MLB ban for accessing the scouting reports, contract information, and internal emails of the Astros using passwords he had guessed.
Officials in Missouri, the only state that doesn’t have a doctor-shopper prescription drug monitoring database, are still arguing over privacy requirements and which state agency should oversee it.
Other
Sites are slinging around news headlines saying that medical residents spend half of their time working on the computer, but they fail to note the deal-breaking limitations of the just-published study they reference: it was performed in Switzerland with unknown applicability to the US and it was an observational study (which has unavoidable bias) of only 36 internal medicine residents in a single hospital. There’s probably also the fact that residents are often expected to remain in the hospital outside of normal working hours, so it’s questionable whether EHR usage required extra time or whether they were stuck in the hospital without much else to do anway.
A TransUnion Healthcare consumer survey finds that three-fourths of respondents would look more favorably on a provider who provides upfront cost estimates, but 43 percent said it was hard to get cost information and another 21 percent said they haven’t even bothered trying.
Authors of a JAMA opinion piece say it’s too expensive for patients to get copies of their medical records since providers widely ignore a 2016 federal law that allows them to charge only direct labor and postage costs associated with creating the paper copy. Only Kentucky requires providers to give patients the first copy of their records at no cost.
Small drug company Kaleo, which makes a recently approved naloxone injector for opioid overdoses, has raised the price of its consumer-usable package of the nearly 50-year-old drug from $690 in 2014 to $4,500 now. The company is donating the product to first responders and drug treatment programs, covering co-pays for buyers with private insurance, and selling it to the VA (which is allowed to negotiate drug prices) at a significant discount, but sticking insurance companies and taxpayers with the bulk of its profits.
In England, a report finds that human error contributed to the failure of the 1980s-era pathology system that delayed surgeries at Leeds Teaching Hospitals NHS Trust. Most of the system’s experienced support employees have left and newer analysts didn’t notice that system backups had grown so large that they were being corrupted.
OB-GYN doctors and nurses at a hospital in Macedonia are fined when a nurse posts Facebook photos of their in-hospital New Year’s celebration that show alcohol, cigarettes, and cupcakes iced to look like vaginas. Photos of the latter item indicate that though their social media judgment is suspect, their eye for anatomical detail is admirable.
A JAMA article addresses the continued problems patients are experiencing when requesting a copy of their medical records, despite the widespread use of EHRs that should minimize the burden and cost of fulfilling these requests.
Fitbit reports that it will miss Q4 revenue estimates by a wide margin, citing declining demand for fitness trackers. The company announces that it will eliminate 110 jobs to reduce costs. Share prices fell 16 percent on the news.
Kaiser Permanente faces $2.5 million in penalties for failing to supply California regulators with properly formatted claims data from its Medicaid managed-care plans. The issue was originally raised in 2016, and a corrective action plan was agreed upon that gave Kaiser until January 1, 2017 to reformat and resubmit its data, but corrected claims were never resubmitted.
Penn Medicine using big data to try and forecast when lung cancer patients will end up in the emergency room. Current algorithms are reportedly able to predict one-third of these ER visits, at which point patients can be called and scheduled for a clinic visit.
January 30, 2017Dr. JayneComments Off on Curbside Consult with Dr. Jayne 1/30/17
I’ve finally started getting excited about HIMSS. On Friday, my MagicBand arrived, personalized and ready for Disney to start transferring cash directly to their coffers. After learning hard lessons in the past about the need to book hotel rooms early, I was able to get a room at my hotel of choice. I planned to spend most of HIMSS with a good friend, but she tried to book a couple of days after me and wasn’t able to get a room. She does, however, have connections at Disney, where we were able to get significantly more posh accommodations for a fraction of what we would have paid at the official HIMSS hotels. Sure, we’ll have to deal with parking and traffic, but I’m looking forward to spending time with friends and getting away from the craziness of the show each night.
I was also excited to get my HIStalkapalooza ticket. Even though I’m guaranteed an invitation, I do have to register for a ticket just like everyone else and it’s always exciting when that email arrives. Now I have to figure out what I’m going to wear and of course find the right shoes, so that will be on my to-do list for the next couple of weeks. It’s nice to have a project to work on that doesn’t involve federal regulations, frustrated healthcare organizations, burned out physicians, or medical practices struggling to survive.
Things have also started to slow down at my clinical practice, with the near-epidemic of influenza finally easing up. Our fiscal year runs with the calendar year. Even though we monitor the numbers closely throughout the year, once we close the books, it triggers detailed accounting reviews and the beginning of discussions on our strategy for managed care and occupational health contracting negotiations. That dovetails with planning exercises and review of our recent growth and whether we should continue with our plans for opening new locations or whether we need to re-evaluate. Fortunately, our price transparency and the boom in high-deductible insurance plans continues to support our planned expansions. We have nearly triple the locations we had when I started, with several hundred employees.
I had an opportunity to sit down with our chief operating officer this week. Part of the meeting was a review of my personal metrics. It’s nice to work at an organization that understands the role of metrics and how to use them drive organizational goals. It’s a bit if a luxury to be able to set our own metrics and not be stuck with what CMS and other governmental bodies think we should use, regardless of whether they impact our internal or community-based goals.
We look at a variety of metrics that impact patient satisfaction, such as wait time, treatment time, appropriate referral for advanced imaging, procedural complications, survey results, and response to clinical follow-up outreach. Those metrics vary month to month, and in this cycle we saw a pretty significant impact due to the rate of influenza, norovirus, and other infectious diseases. At one point in December, we were seeing 50 percent more patients on a daily basis than we had ever seen, so it’s not surprising that patients would be a little less satisfied about wait times or congestion in the office.
We also look at quite a few financial metrics, including charges per encounter and the distribution of E&M codes among providers. As you would expect, most of our visits fall under a subset of codes, but there are some outliers that occasionally over- or under-code, so we have to decide how to deal with them. Is it just a blip or part of a larger pattern? Does it increase our risk for audit? Is someone trying to game the system by getting their charges up without appropriate justification?
We know that the cost of care at our facility is about one-eighth that of care at the area’s emergency departments, so it might be tempting for some providers to upcode. We also look at what the EHR suggested the code be, vs. what the provider or scribe actually clicked, vs. what the internal coders think. There is always some wiggle room depending on whether documentation elements were captured as free text or discrete elements, and our visits occasionally move up or down the E&M code spectrum after coding review.
Not surprisingly, I tend to fall at the lower end of the pack as far as charges per encounter, which makes sense with my primary care roots and all of the managed care red tape I’ve had to deal with. I tend to be less free with prescriptions as well, which is understandable given the risks of polypharmacy with patients you don’t know well. It was interesting to see the comparative data and what some of my colleagues are doing though – I average 0.64 prescriptions per patient encounter, where some of my colleagues are in the 1.6 and 1.7 range. Most of our group is in the 0.85 range, so I’m not that far off the mark. Given the range, though, I recommended that next month we slice that data a little differently and look specifically at newer vs. established colleagues, moonlighting residents vs. midlevel providers vs. supervising physicians, full vs. part-time provider status, and distribution by location.
We look at a lot of our data in aggregate, which makes it interesting when you know you have outlier data. Since we have our own in-house ultrasound and CT scanners, we look at the timeliness of referral for those modalities. Since I only work part time, any fluctuations in my practice patterns show up a bit more acutely than my peers who see many more patients each reporting period. My “timely referral for diagnostics” metric was significantly off from last month, and the COO got a kick out of the fact that I could recite the clinical situations of the patients whose visits drove the numbers. I had a flurry of cases that had to be transferred to the emergency department for higher acuity care (and in two cases had to go straight to the operating room) and let me tell you, those are the shifts you don’t forget.
The urgent care keeps trying to lure me into a full-time role, and it’s getting more difficult to resist its call. We agreed to talk again in a few months. In the meantime, we’ll have to see if HIMSS brings any new and exciting opportunities to light my informatics fire.
If you could have any job in the world, what would it be? Email me.
ACA architect Ezekiel Emanuel, MD, PhD laughs at the idea that Silicon Valley data gurus will ever replace doctors, saying “I am much more skeptical that the computer is going to replace a doctor. That a computer is going to interface with the patient and take care of them. Not gonna happen.” He is also unimpressed with wearables, saying that continuous monitoring generates data that the healthcare industry is not prepared to take action on.
A hospital employee sends the W-2s of 1,400 employees at Campbell County Health (WY) to a hacker that posed as a hospital executive and asked for the forms to be emailed to him.
VoteStand vote fraud reporting app developer Gregg Phillips, who President Trump credits with convincing him that 3 million people voted illegally in the November election (all of them for Hillary Clinton), has a healthcare IT connection – he’s the chairman of AutoGov, a Medicaid eligibility decision support tool vendor. The product’s description suggest that it works similarly to his vote fraud analysis methods, merging databases together to provide a full eligibility picture of Medicaid applicants.
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AutoGov markets its big data-powered system to providers as, “You will be able to decide whether or not to admit a Medicaid patient with just a touch of a button.” It is powered by scoring algorithms that use data from 30 million cases.
Phillips, a former Texas Deputy HHS commissioner, says he augmented a 180 million-row voter registration database with other databases and geocoding data, giving him the ability to verify identity, residency, and citizenship status, although others have questioned his claim. He said in a CNN interview Friday he won’t be able to release specifics for several months given the analysis required and the demands of his day job.
A post-election tweet by Phillips claiming that non-citizens voted was picked up by the then-President-elect, after which an apparently puzzled Phillips told a reporter, “Is a tweet really news? Isn’t everything on Twitter fake?”
Reader Comments
From Is This Even Still a Thing? “Re: booth babes. I just got this pitch.” An Orlando modeling agency warns HIMSS17 exhibitors of the peril of hiring “below-average young women” to draw traffic, introduce products, and generate leads. I think I should run a honeypot sting operation to focus on the demand instead of the supply, setting up a fake HIMSS booth staffed by an “above-average young woman” from this agency. Each time our booth babe lures a gawking attendee into the booth, I would emerge with microphone in hand like that solemn-voiced talking head Chris Hansen in “To Catch a Predator,” inviting the now-squirming attendee to have a seat and explain to my on-camera audience (and to their colleagues and families) what they hoped to gain.
From Research Expert: “Re: HIStalk. I read it every day and find it extremely valuable. Good thing it’s not more organized or it could put many of the advisory firms out of business. 🙂” Thanks. I’m more of a real-time fire hose since I don’t like to recycle old news just to earn reader clicks while insulting their intelligence, but I could probably get someone to repackage the already-vetted information stream into something that could be useful in a different way. However, my inherent laziness makes that unlikely.
HIStalkapalooza
HIStalkapalooza invitations will be emailed by Monday. Every year we invite people who claim we didn’t, as our email was apparently blocked by their overly aggressive spam filters (the invitation will come from eventbrite.com). Important: you MUST click the link on the email invitation link called “Attend Event” to complete your signup, otherwise the check-in system won’t recognize you at the House of Blues and you’ll be slinking away crestfallen to the sounds of the link-clickers inside slurping down drinks, loading up plates, and performing their pre-dance stretching.
A shortfall in sponsor money means I can’t invite everyone who asked to attend, unfortunately. The pecking order is providers first, then two people from each HIStalk Platinum sponsor, then I just try to choose a good mix of job titles and companies until we hit the number I can afford (since I’m paying thousands out of my own pocket). I’ll ignore emails asking for exceptions, explanations, or anything else event related – it’s just a party and nobody will suffer from starvation, dehydration, or dance deprivation for lack of attendance that Monday evening. Like a concert or sporting event, each person must have an individual ticket that will be scanned at the door.
HIStalkapalooza Sponsor Profile
Cumberland Consulting Group is a leading healthcare consulting firm that helps some of the nation’s largest payer, provider, and life sciences organizations implement and optimize technologies to maximize operational efficiency. Cumberland delivers comprehensive consulting services with a focus on strategic advisory, implementation, optimization, and outsourcing. The firm excels at system selection and planning, implementation project management, system optimization, and performance improvement. In addition, Cumberland offers high-quality, certified resources to support your most complex IT projects. For more information on Cumberland’s services, visit their site.
HIStalk Announcements and Requests
Dear HIMSS-owned publication: apparently you failed to notice that the press release you used as the sole, uncredited source for your just-published breaking news article was dated January 6, 2016. You already reworded that press release in calling it news on January 8, 2016 (although even then your sub-headline made no sense). Could you perhaps apologize to the 400 folks who have shared your “news” so far this week since you’ve made them look stupid in mistaking a year-old announcement for something new? Thank you.
About half of poll respondents reacted negatively to the announcement that HIMSS is starting a conference and media group that will cater to vendor members targeting provider members, while 17 percent like the idea and 31 percent don’t care either way. HIS Junkie sagely comments that if HIMSS were truly member-driven, it would set up a division and conference to teach providers how to negotiate with vendors and to get better contracts, but as he notes, there’s no money in that.
New poll to your right or here: why are you going to the HIMSS conference? (a question I ask myself every year about this time).
Ms. H asked for financial help via DonorsChoose to continue her New York high school’s “Guest Writers” series, which we provided. She says students have enjoyed getting a behind-the-scenes look of how books are written, edited, and published as described by award-winning authors who visit with the students.
Iatric Systems donated $500 to my DonorsChoose project, which with matching funds applied (from my anonymous vendor executive and other sources) fully funded these teacher grant requests:
Two laptops, computer accessories and cases, a document camera, and supplies as requested by high school senior Julie for her Camden, NJ pre-calculus class
An Amazon Fire tablet for Ms. D’s elementary school class in Los Angeles, CA
A Chromebook for Mr. D’s elementary school class in Wichita, KS
STEAM literature for Ms. M’s fourth-grade class in Minneapolis, MN
An activities table for Ms. A’s first-grade class in Manning, SC
Hands-on manipulatives and family interactive learning technologies for Ms. A’s elementary school class in Chicago, IL
Ms. A from Chicago emailed soon after I made the donation to say, “This is beyond heart-warming! I am tearing up and smiling at the same time! The education crisis in my state is threatening more teacher layoffs, furlough days, and shortening the school year. Your donation has uplifted my spirit and brought great joy as finding innovative ways to educate my students and their families is a passion that, I learned today, I do not share alone. ”
Last Week’s Most Interesting News
McKesson announces that it will acquire CoverMyMeds for up to $1.4 billion.
A federal judge rules against the proposed merger of Aetna and Humana, citing anti-competitive concerns.
GetWellNetwork acquires Seamless Medical Systems.
Former National Coordinator Karen DeSalvo, MD, MPH joins her fellow HHS political appointees in leaving government service with the administration change.
Webinars
February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.
Acquisitions, Funding, Business, and Stock
Harris Corporation will sell its government IT services business to Veritas Capital for $690 million in cash, which doesn’t sound like much for a division that’s generating $1 billion in annual revenue.
Hospital staffing firm Jackson Healthcare will build a $100 million, 306,000-square-foot expansion to its Alpharetta, GA headquarters that will house 1,400 new employees. It will include a 39,000-square-foot amenities building modeled after the Colosseum in Rome that will house a gym, pool, restaurant, hair salon, dry cleaner, spray-tanning studio, chiropractor, masseuse, and barber. The company took in $800 million in revenue last year.
Sales
University of Virginia Medical Center (VA) chooses clinical process measurement solutions from LogicStream Health, which it will use to drive evidence-based best practices in managing and improving its EHR’s decision support tools.
Children’s Healthcare of Atlanta selects Voalte Platform for care team communication and alert notification.
CHI Franciscan Health chooses Clearsense analytics to aggregate and organize patient data for clinical decision-making.
Decisions
Memorial Hospital Of Carbondale (IL) will switch from Meditech to Epic in June 2017.
Trinity Rock Island (IL) will replace BD Pyxis MedStation with Omnicell in summer 2017.
Centura Health – Porter Adventist Hospital (CO) replaced Meditech with Epic in October 2016.
Elmhurst Memorial Hospital (IL) went live with Epic in October 2016.
These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.
People
Will Plourde (HealthcareSource) joins LiveData as VP of engineering.
Announcements and Implementations
McKesson’s IKnowMed tops Black Book’s oncology-hematology EHR satisfaction ratings for the sixth straight year.
Privacy and Security
An employee of Campbell County Health (WY) sends the W-2 information of 1,400 employees to a hacker impersonating a hospital executive who asked for all forms for 2016.
Other
A Johns Hopkins Medicine study finds that, not surprisingly, clinic doctors who are running behind schedule unintentionally shortchange patients in trying to catch up.
A woman sues Cone Health (NC) for trying to collect the unpaid medical bills of her deceased husband, seeking class action status under a clause in the state’s constitution that says the property of a woman can’t be attached to pay for the debts of her husband.
ACA architect Ezekiel Emanuel, MD, PhD scoffs at the idea that technology can replace doctors and that wearables can improve health, arguing that the tech sector is missing the point that resolving a technology-identified problem still requires a face-to-face doctor-patient encounter. He says technologists should focus on solving health problems like heart disease and obesity instead of obsessing about new monitoring tools, saying that even a cure for cancer would have a minor impact on life expectancy compared to reducing smoking and high blood pressure.
An Ohio man is charged with arson and insurance fraud after police get a search warrant to review his pacemaker data and find no evidence of heavy exertion at the time he claimed he was quickly packing and lugging heavy belongings out of the house as the fire spread.
A Hauppauge, NY doctor is convicted of selling opioid prescriptions by instructing his assistant to set up phony EHR exam and treatment records for anyone willing to pony up $120 in cash, all while he spent most of his days out of the office playing hockey.
Sponsor Updates
Arcadia Healthcare Solutions wins top honors from Frost & Sullivan for its clinical and claims analytics platform.
PeriGen publishes slides from its presentation on “The New Labor Guidelines: Benefit or Harm” presentation at the Steamboat Perinatal Conference.
Phynd will exhibit at the North Carolina Epic User Group Meeting February 8-9 in Greensboro.
Red Hat technologies support TransUnion’s migration to a new IT environment.
Wharton Research Data Services adds SK&A healthcare data.
McKesson will acquire prescription electronic prior authorization vendor CoverMyMeds for $1.1 billion, plus an additional $300 million in financial performance incentives that would be paid out over the next two years.
Wired covers the expanding role AI will play in healthcare, noting a recent Nature study that tested the accuracy of deep learning algorithms designed to analyze images and identifying cancerous skin lesions and found that they performed as well as 21-board certified dermatologists.
McKesson will acquire privately held prescription electronic prior authorization vendor CoverMyMeds for $1.1 billion plus another $300 million if the company hits performance targets.
McKesson will operate the Columbus, OH-based company as an independent business unit. Francisco Partners must have made a fortune from its November 2014 investment in the company.
I interviewed co-founder Matt Scantland a couple of years ago, where he explained that drug companies pay for CoverMyMed’s services to avoid unfilled prescriptions. He also agreed then with my assessment that the company was flying under the radar in an obscure niche with $19 million in revenue. That figure jumped to $50 million the same year and $100 million the next.
McKesson also announces Q3 results: revenue up 4.7 percent, EPS $3.03 vs. $3.18, meeting earnings expectations but falling slightly short on revenue. Shares dropped 8.3 percent Thursday on the news.
Reader Comments
From Build That Well: “Re: Becker’s. Changed their story on Erlanger’s loss.” Becker’s focuses on clickbait “10 things to know” listicles written mostly by new liberal arts grads for lazy readers. In this case, they tried to hype Epic as causing Erlanger’s reported loss, but the article they rewrote from the local newspaper didn’t say that at all. Above is the headline before and after. The non-alternative fact, according to Erlanger’s CFO, is that the loss was caused by overtime expense, employee insurance payouts, and drug costs, although he did mention almost as an afterthought that some overtime expense was incurred due to covering employees assigned to the Epic project. Erlanger’s CEO says in another newspaper’s article he’s happy that the hospital is hitting its year-to-date net income targets given that it amortized its $100 million Epic cost over just three years. Erlanger also notes that high-deductible insurance plans and its 33 percent self-pay rate means it can’t collect a lot of what patients owe.
From Clustered: “Re: Epic. I’m not bothered about their position on investment. How many times have there been things truly beautiful, streamlined, and elegant that were designed by committee? Investors are exactly that, collectively — a committee. They dilute decision-making in exchange for access to money and it sounds like Epic already has enough money of its own. Sure, there are things I wish Epic did differently, but I’m not sure inviting a bunch of MBAs and money folks onboard would improve things. Viva la Judy! (disclosure: I don’t work for or with Epic and never have).” Committees are like well-diversified mutual funds – they reduce the chance of both great failure and great success, at least if you’re willing to accept bland mediocrity. The best lessons I’ve learned in writing HIStalk are: (a) people can convey their strong opinion in believing that they represent the majority when in fact they could be dead wrong; and (b) instead of letting a committee tell me what to avoid doing wrong, I would rather just do what I want to do and let readers either come back or move on.
From Silicon Valley Geek: “Re: Stanford Health Care. Since the new CEO arrived in July, the former CIO (who was promoted to chief digital officer last April) is leaving along with the associate CIO. The bloated 700-employee IT department serving a 600-bed hospital and ambulatory network has been seeing layoffs as the organizational struggles to manage operational costs, new construction, and integration of the newly acquired ValleyCare. IT lost over 50 people yesterday as the CEO announced a $100 million savings target for which non-labor cutbacks weren’t enough. Michael Sauk is now interim CIO – he used to work with the CEO at City of Hope and UW.” Unverified, except the part about Mike Sauk since it’s on his LinkedIn.
HIStalkapalooza
I’ve closed signups, so hopefully if you wanted to attend you either (a) got your name on the list in time, or (b) will be sent an invitation from one of the sponsors of the event, who get to invite a certain number of guests.
I’m happy that our Industry Figure of the Year (one of the four nominees above) has confirmed attendance at the event, as has our “when ___ talks, people listen” recipient. I’m trying without success so far to get our “person you’d most like to see on stage” and Lifetime Achievement Award winners to stop by, but you never know.
Thanks to our newly participating HIStalkapalooza sponsors:
HIStalkapalooza Sponsor Profile
PatientSafe Solutions obsesses over the experience of care to help care teams communicate and work together reliably and efficiently. PatientSafe delivers measurable safety and quality improvements through a mobile platform that extends an organization’s EMR, clinical, and communication infrastructure and fits seamlessly into care team workflows. The company’s context-driven PatientTouch platform unifies communication with workflow by consolidating text, talk, alerts, EMR data, clinical workflows, and customizable care interventions, all in one mobile app, on one device. For more than a decade, PatientTouch has helped clinicians both in and outside the hospital streamline care delivery, increase quality, and lower costs.
HIStalk Announcements and Requests
Ms. M in Houston sent photos of her students using the listening center and wipe boards we provided in funding her DonorsChoose grant request.
Welcome to new HIStalk Platinum Sponsor Clearsense. The Jacksonville, FL-based data science company offers a cloud-based analytics solution that works with any data source and can be rolled out in a fraction of the time required for a traditional data warehouse. Its real-time, cloud-based, subscription-priced, scalable system helps healthcare organizations respond to the pressure to use data to make better and faster decisions. Examples: reducing adverse events, improving patient flow, hitting quality and patient satisfaction targets, driving research, and managing cost and payment. Thanks to Clearsense for supporting HIStalk.
I found this excellent YouTube video featuring Clearsense Chief Innovation Officer Charles Boicey MS, RN speaking at the most recent HIMSS SoCal Clinical Informatics Summit.
Readers have been asking for years to be able to search HIStalk articles with a company name and date range and I finally figured out how to do that in an admittedly inelegant but somewhat effective way. The date range search box allows specifying a search word (it works best with a single word) and an optional “from” and “to” date range, then shows the results in context. It’s not perfect, but it’s good if you want to see when I mentioned Cerner, let’s say, in just the second half of 2016.
We like to have cool people hang out at our HIMSS booth since we don’t have anything to sell and are otherwise sitting alone in our microscopic, unadorned space. Contact Lorre if you would like to entertain, amuse, or otherwise engage HIStalk readers for an hour or so – we tend to like people who are funny and don’t take themselves too seriously, which is harder to find in health than you might expect.
Does ICD-10 have a code for repetitive stress injury caused by anxiously checking three news sites every 10 minutes, drawn by a combination of fascination and dread?
This week on HIStalk Practice: Northwest Vein & Aesthetic Center rolls out Oncomfort’s anxiety-reducing VR technology. Employee clinic company OurHealth signs on with Athenahealth. Pediatricians take aim at wearables for infants. Eye Care Leaders adds OptimizeRx to partner EHRs. Winners Circle series launches with MTBC winner and Practice Manager Baqar Naqvi. Stakeholders band together to encourage renewed value-based payment reform efforts. Compulink adds Weave’s patient scheduling tech. Sue Kressly, MD advocates for pediatric-specific functionality in EHRs. Sign up for physician practice health IT news.
Listening: the now-defunct After Forever, since Floor Jansen is in my opinion the best singer (of either gender) in the world and the band was crazy talented, as are many of those in the “Beauty and the Beast” metal genre. Now she sings for NIghtwish, where she’s equally good although with less-demanding material. Floor singing “Leaden Legacy” with AF is about as good as it gets.
Webinars
February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.
Here’s the recording of Wednesday’s webinar, “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.”
Acquisitions, Funding, Business, and Stock
Quality Systems (NextGen) reports Q3 results: revenue up 9 percent, adjusted EPS $0.23 vs. $0.16, beating analyst expectations for both.
Specialty EHR vendor SRSsoft renames itself to SRS Health, unleashing a fury of highfalutin’ buzzwords in which the marketing people congratulate themselves on wresting control of the company’s strategy by turning an orange circle into marketing art whose description will sail right over the heads of customers who squint thoughtfully and say, “I dunno, it just looks like an orange circle to me.” Companies somehow never learn to just make these changes without over-describing them, insisting on involving customers in their contrived logic and convoluted explanation that elicit guffaws instead of praise:
A brand’s logo is its face to the world. Our new orb-shaped visual identity represents the continuum of how we help our clients engage their patients before, during, and after visits. It signifies the perfect balance of improved efficiency with proven outcomes. And it symbolizes the unending dedication of our team to remain in motion as we continue to pioneer the HCIT solutions of the future. The fiery color of our logo was chosen specifically to depict the passion and commitment to client satisfaction of the people who make up the SRS Health team.
Sales
Children’s National Health System (DC) adds Millennium Revenue Cycle to its Cerner EHR.
Local governments in Finland choose Optimum Healthcare IT to staff the 29-hospital Epic implementation of their $615 million Apotti project.
People
Former HHS Secretary Sylvia Burwell is hired as president of American University in Washington, DC. I wondered about her advanced degree and it turns out she doesn’t have one.
Investment banker Jefferies hires Dmitry Krasnik (Houlihan Lokey) to lead its coverage of healthcare IT.
Announcements and Implementations
InterSystems and Clinical Architecture develop a “clinigraphic” graphical representation of a patient’s most pertinent information contained in medication lists, comorbidities, and test results.
The Gates Foundation donates $279 million to University of Washington’s Institute for Health Metrics and Evaluation, which publishes evidence and trends for global population health that includes the annual Global Burden of Disease report.
Grady Health System (GA) goes live on Glytec’s eGlycemic Management System of personalized insulin dosing, blood glucose alerts, and analytics integrated with Epic as well as glucose surveillance integrated with Grady’s laboratory information system.
Government and Politics
A small survey of PCPs published in NEJM finds that only 15 percent think the ACA should be repealed entirely, with three-quarters of them saying it just needs tweaked (some of their suggestions are above). The doctors mirror the general public in supporting existing policies such as prohibiting consideration of pre-existing conditions, allowing parents to keep their children on their insurance through age 26, offering taxpayer-funded small business tax credits and individual subsidies, and expanding Medicaid. Fewer than half support requiring people to carry insurance, however, thus again raising the all-important question of how insurance companies can create cost-effective risk pools among only self-selectors.
Massachusetts Governor Charlie Baker – a former CEO of insurer Harvard Pilgrim Health Care — defends his call for employers to pay the state $2,000 for each employee who either isn’t offered health insurance or who declines to buy it. The state’s MassHealth program is spending $1 billion per year to subsidize health insurance for low-income, full-time employees who could buy employer-offered plans but instead sign up for MassHealth to take advantage of premium subsidies, which the state says is an ACA loophole. Baker is also calling for limiting provider rate increases, with price hikes of the most expensive hospitals capped at the same level as their Medicare increases. MassHealth’s annual cost of $16 billion accounts for 40 percent of the just-released 2018 state budget.
President Trump says in a TV interview that his replacement for the “disaster” of the Affordable Care Act will offer “a better plan, much better healthcare, much better service treatment, a plan where you can have access to the doctor that you want and the plan that you want. We’re gonna have a much better healthcare plan at much less money.” He also says that he expects everyone insured through the exchange to keep insurance coverage.
Privacy and Security
President Trump’s deportation executive order instructs federal agencies to exclude illegal aliens from the Privacy Act, which prohibits the the disclosure of a person’s federal government-held information without their consent. The Act covered only citizens anyway, from what I can tell, and I’m not sure this order has any direct impact on healthcare. Perhaps the significant result is that agencies would need to know (and therefore ask) about immigration status and systems might have to be modified to record it.
Other
A Wired article notes that improvements in graphics and artificial intelligence technology may render obsolete those doctors who look at an image and then decide what it is, warning that pathologists, radiologists, and dermatologists are at risk of being replaced by machines. It cites the just-published study in which neural networks trained on previous images performed as well as 21 board-certified dermatologists in recognizing cancerous growths.
The Wall Street Journal profiles McKesson Specialty Health’s Practice Insights analytics platform for oncology practices, which extracts EHR information for clinical insight and matches patients with clinical trials.
A patient of a family practice owned by Carolinas HealthCare (NC) complains after noticing that her problem list included “lesbianism.” The health system said the observation was listed there to avoid offending her, but offered to move it to the notes section of her chart. The patient questions why the health system needs to record her sexual orientation at all. I’m not sure I agree since I assume she told them and thus felt they should know, but perhaps the term “problem list” casts an unintended aspersion. This could be a challenge for the OpenNotes movement – recording patient-reported or observed information in a way that patients don’t take as offensive, although this example is less of a challenge than accurately identifying someone as obese, alcoholic, or depressed.
Sponsor Updates
Sutherland Healthcare Solutions publishes a video describing its SmartHealthSolutions analytics platform.
ECG Management Consultants will exhibit at the Summit on Bundled Payment January 25-26 in Atlanta.
The Chartis Group publishes a white paper titled “What does the Trump Presidency Mean for Providers?”
January 26, 2017Dr. JayneComments Off on EPtalk by Dr. Jayne 1/26/17
CMS rolls out the MIPS red carpet for small, rural, and underserved practices with a webinar on February 1. CMS will be discussing eligibility, 2017 participation, data submission, performance categories, scoring, and resources available to practices falling into these categories. Figuring out a MIPS strategy is hard enough for large practices who have relatively greater resources, so I can’t imagine how a small independent rural practice might struggle. I’ve done some engagements with that demographic and many of them can’t even figure out how to afford a reasonably priced consultant given their payer mix (lots of Medicaid) and the challenges of treating the medically underserved.
Whether you’re a cash-strapped practice or not, CMS has also given some confusing messages when discussing the Medicare volume threshold for excluding practices from MIPS. There have been questions about whether providers have to meet the charge threshold AND the volume threshold, or whether it should be an OR function. The answer is that it depends on how you ask the question. If you’re asking who is excluded, it’s providers who Medicare Part B allowed charges are less than or equal to $30K OR if they see fewer than 100 Medicare Part B patients annually. If you’re asking who is eligible, it’s providers who meet the charge threshold AND see more than 100 patients. For those who think proper sentence construction is antiquated: case in point.
I just took a long-term assignment with a client whose basic business processes are in total disarray. They haven’t been looking at their staffing or expenses for months and have dug themselves into a deep hole. Originally, they thought there was some kind of embezzling or theft, but after a thorough investigation, it points to a total lack of management.
Looking at the “at your fingertips” reports available in their online payroll system, I identified a handful of employees who have been logging overtime daily for more than a year. In interviewing the employees and their direct managers, no one has ever noticed it, let alone discussed it or taken steps to mitigate it. When assessing one employee’s daily assignments, it turns out she has been doing various tasks that belong to three other employees and that has been eating up a good chunk of her time. It never occurred to her to discuss this with her manager, which is one issue, but the manager’s failure to notice the overtime is another. And accounting’s failure to notice a significant budget variance is a miss as well as practice leadership failing to notice that accounting didn’t call it out.
We discussed sitting down with the employees and working through their daily tasks to find out what was generating the overtime, but they were uncomfortable leading the discussion. I agreed to work with them, taking the “watch one, do one, teach one” approach to get them to a point where they were at least minimally capable of managing their own resources. It was a painful few days of discussions, coaching, reviewing, role-playing, and revisiting, but we at least stopped the bleeding with a new policy to prevent employees from logging overtime without a direct manager approval that is documented in writing. Although many of the overtime-inducing tasks were administrative, several of them were clinical in nature and we had to make plans to ensure that work didn’t fall through the cracks.
The bigger point here is that if a practice can’t handle Office Management 101, how are they going to handle the increasing data-gathering and reporting demands required as healthcare evolves? And if they can’t figure out how to resource current tasks or how to eliminate non-value-added processes, will the patients suffer? How will they create processes for team-based care, increased coordination with external providers, management of transfers of care, and more? There are plenty of vendors out there pushing technology solutions that will only automate bad processes and it’s challenging to have these hard conversations with organizations about how they do business. If they’re not managing their human resource overhead, they may not be managing their supply overhead, either. And it’s a safe bet that if they’re not on a cloud-based EHR, they’re not managing their servers and hardware, either.
Ultimately some of these practices aren’t going to be financially viable. My primary care physician’s practice recently disbanded. The partners had very different ideas about what “productive” looked like, which resulted in one partner carrying the lion’s share of the overhead. Over time this became untenable, and his aging partners weren’t willing to work harder or longer hours.
My PCP grew increasingly disillusioned and his partners couldn’t afford to buy him out, so they agreed to close. It’s been a culture shock as he moves into the ranks of employed physicians. Fortunately, he didn’t have to join a big health system group, but became an employee of a small independent practice. Based on all the things he no longer worries about, he has more time for patient care, but it’s been an adjustment. We’ve been friends for a long time, so I did a therapeutic intervention and used some of his free time for dinner and a movie. I think we’ll be able to get him through this.
It was interesting watching the wind-down from the patient perspective, however, since I had gotten used to having access to the practice’s patient portal for all my needs. I was glad to see that my records still remain on the vendor portal. They didn’t disable all the features, though, so it still allowed me to send an appointment request, a refill request, and a message to the physician, but I know for a fact that no one is monitoring it because the practice’s servers have been decommissioned and are in a box in his basement. I found the notification that the practice was closed and where patients should contact the physicians, but it was buried three screens deep in an “about our practice” area of the site.
I had taken advantage of their personal health record download functionality after my last visit so I already had what I needed, but it was good to know my records live on with the vendor. My new physician uses the same vendor, so hopefully it will all connect and be good to go.
How portable has your PHI been with system migrations and practice mergers? Email me.
January 25, 2017NewsComments Off on McKesson Will Acquire CoverMyMeds for $1.1 Billion
McKesson announced Wednesday that it will acquire Columbus, OH-based prescription electronic prior authorization platform vendor CoverMyMeds for $1.1 billion plus a potential additional $300 million based on performance.
McKesson announced the acquisition as part of its quarterly earnings report in which it beat earnings estimates but fell short on revenue.
CoverMyMeds is a RelayHealth Pharmacy partner. It will remain an independent McKesson business unit with co-founders Matt Scantland and Sam Rajan staying on.
Comments Off on McKesson Will Acquire CoverMyMeds for $1.1 Billion
Very well said Mike. It was an interesting, albeit abbreviated show. Agentic AI is certainly the new next thing. It…