News 1/4/17

Top News

An excellent Black Book survey of 12,000 consumers finds that:

• 57 percent are skeptical of patient portals, mobile apps, and EHRs because they don’t think providers can protect their information from hackers.
• Nearly all respondents express concern that information about their prescriptions, mental health, and chronic conditions is being shared with retailers, employers, and the government.
• A startling 89 percent of respondents withheld information from their providers during their 2016 encounters.
• The percentage of people who distrust health IT has jumped from 10 percent in 2014 to 70 percent today.
• 92 percent of patients who are discharged from hospitals under 200 beds don’t understand how to use the patient portals, engagement tools, and monitoring systems that hospitals provide, with 94 percent of nurses in those hospitals saying they don’t have time to add technology literacy to their discharge planning.
• 94 percent of doctors aren’t interested in reviewing data from patient wearables or fitness and nutrition apps.
• 82 percent of doctors report that some patients bring so much information from their web searches that they don’t have time to review it during the short time allotted for office visits.
• Nearly all respondents who use health improvement apps and devices say their PCP ignores their technology, with 24 percent of those respondents saying they may choose a more tech-savvy doctor as a result.
• 94 percent of providers think the government should pay for patient technology literacy training.

I’m not sure it’s quite the “digital divide” that Black Book calls it, though, since both consumers and providers struggle with technology, aren’t well trained to use it, and worry about breaches (both internal and external). “Divide” suggests some consumers benefit more than others and I’m not sure that’s the case. There’s not a lot of difference between not having the means to use apps vs. not having the interest or confidence to use them.

The most interesting thing about these results is that surveyed consumers nearly always, (a) claim they are in favor of something that sounds innovative, but (b) say their technology fears override everything else (even as they are spewing masses of personal data via Facebook and are willing to provide whatever information companies require to access free games or prizes). In this case, they have nothing positive at all to say about consumer health IT. You would expect similarly low usage of those products, which taxpayers have richly funded.

Reader Comments

From Cornichon: “Re: NextGen. Filed an SEC 8-K form giving shares to leadership, many of them vesting only based on the passage of time and not performance. The vesting is accelerated if the company is sold, which has been a topic of speculation for months. The executives also got new change of control benefits for those let go in conjunction with any sale.” CEO Rusty Frantz gets shares worth $850,000 for sticking around for four years plus another potential $472,000 for company performance, plus accelerated vesting if the company sells out. He also gets 150 percent of base salary and bonus, 18 months of health insurance, a pro-rated current year bonus, and outplacement services if he leaves after a sale. The other execs get a similar deal with 100 percent of base salary and bonus. QSII shares have taken a long slide down since mid-2011, now trading at 2005 prices and valuing the company at $840 million. Founder Shelly Razin, who lost his board chair seat in late 2015, holds more than 10 million shares, worth a cool $138 million although that’s a horrifying $358 million less than the same number of shares were worth a handful of years ago.

From Retired HIT guy: “Re: Summa Health (OH). It replaced its five-hospital ED staffing on January 1 with a company owned by the husband of Summa’s chief medical officer, with just 36 hours’ notice. Staff wondered how staffing would work given the weeks-long credentialing process and the lack of familiarity with the computer systems used.” The new company apparently realized the challenges facing it since it offered the existing ED  docs a $100,000 incentive bonus and an extra $75 per hour join their company, with no takers. The hospital denies employee reports of long ED wait times and patients leaving without being treated.

From Marketing Slick: “Re: CommonWell. Cerner claims it was a founder of Carequality even though it fought it as a CommonWell competitor. All Cerner did was buy Carequality participant Siemens Health Services.”

From Connective Tissue: “Re: Carequality and CommonWell connecting their systems. I agree it’s the golden spike. Some backstory: Epic and McKesson were in a lawsuit over MyChart, as MCK wanted Epic to use RelayHealth. There was also an Epic concern that CommonWell might create a patient portal that would compete with those of providers. Cerner realized that with the VA deal on the table, they needed to get on board because the government supports Carequality. The question was over who charges who – for example, disability and life insurance companies pay the customer because it saves them paperwork. CommonWell wants to charge fees, but Epic wanted Carequality to be free for patient record exchange involving for care coordination. The agreement was for CommonWell to create a record locator service that they can charge for, while Epic agreed to support it for their interested customers (Surescripts offers the only national locator service – the rest are regional ones offered by HIEs). This agreement is like that of cell carriers in that Carequality and CommonWell can charge only their own customers, not those of the other service, and thus Cerner and Epic can’t charge each other. Since multiple participants are involved, rather than calling it a golden spike between two participants, perhaps the agreement could be better described as the linchpin in the nationwide ATM for healthcare.” A few folks who were involved have told me about the April 1, 2016 meeting that was brokered by Micky Tripathi, CEO of the Massachusetts EHealth Collaborative. There’s also that unverified rumor that Cerner is interested in acquiring RelayHealth, but I don’t have a solid source on that even as MCK sheds its other health IT assets and announces no plans for the best one (Relay).

From Unbalanced Sheet: “Re: R&D accounting. I would be surprised if Epic doesn’t use GAAP accounting like most large companies, but it’s never an apples-to-apples comparison. The question is how much R&D is capitalized and thus ends up on the balance sheet vs. expenses that are flushed through P&L. Aggressive companies like Cerner have capitalized 35 percent or more over the years, which allowed it to report higher earnings than more conservative companies. Management has a great deal of discretion over things like that that go toward quality of earnings.” I read somewhere that software companies must now treat R&D as an expense as it is incurred unless they can prove that the investment has a quantifiable future benefit. For software development, I was thinking that the only opportunity to capitalize R&D is the time between technical feasibility and GA, meaning you have to expense a product’s cost once it is released. However, the definition of “product” and “GA” may be squishy.

HIStalk Announcements and Requests

Your chance to weigh in:

• HIStalk reader survey 2017
• HISsies nominations (to those who asked to see Donald Trump, Barack Obama, or Microsoft CEO Satya Nadella on stage at HIStalkapalooza – sorry, but I don’t expect that to work out).

I applied matching money to Vicki’s donation to my DonorsChoose project to fully fund these teacher grant requests:

• A math fluency activities bundle for Mrs. M’s elementary school class in Fairfield, OH
• A document camera and interactive whiteboard system for Mrs. W’s middle school class in Middletown, OH
• Composition books and math games for Mrs. D’s elementary school class in N. Little Rock, AR.

Mrs. M reports that her Virginia students are surrounded by technology that they don’t always get to use because of economic circumstances, adding that the kids have jumped in to create a plan of how they will use the two tablets we provided in funding her DonorsChoose grant request.

HIStalkapalooza

HIStalkapalooza sign-ups are open. The usual rules apply:

• Everybody who wants to come has to sign up on this form (even me) – nobody gets invited automatically.
• Each person who wants to come has to sign up separately even if they’re a guest of someone else (because we use an automated check-in system with individually barcoded tickets),
• Signing up doesn’t guarantee that you’ll get an invitation since that depends on how many people I can invite, which is based on how many sponsors I get. Invitations will be emailed in three weeks or so.
• We pay per click of the House of Blues turnstile and thus close the doors early in the evening since someone swinging by for a late-evening beer still costs many dozens of dollars. If you can’t attend the whole event, please don’t take up a slot.

Thanks to our HIStalkapalooza sponsors who are graciously making the industry’s most talked-about event possible. I’ll have a write-up on each company leading up to the event, which is less than seven weeks away.

I need another couple of sponsors to hit the break-even point on HIStalkapalooza. Companies that want invitations to give out, recognition, and even to have their CEO welcome guests on the red carpet should contact Lorre. She will get creative in finding something fun — for example, HOB offered the idea of outfitting every server with a tie with a sponsor’s logo. I joked that it should be like Nascar where they wear fire suits plastered with logos, to which our HOB contact responded with a dry, two-syllable ha-ha before moving on to something important like the food options.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Acquisitions, Funding, Business, and Stock

Xerox completes its spinoff of its 93,000-employee business process services company Conduent, whose shares trade on the NYSE as CNDT.

Kaufman Hall acquires contract modeling, budgeting, and decision support software vendor KREG Information Systems.

Israel-based “smart shirt” company HealthWatch Technologies raises $20 million from a China-based drug company for its 15-lead, hospital-quality sensor garment.

People

Vocera hires Ben Kanter, MD (Extension Healthcare) as CMIO.

Announcements and Implementations

EHNAC releases 2017 standards for its 18 accreditation programs for electronic healthcare data exchange.

University of Vermont Medical Center files a $112 million state certificate of need to extend its Epic implementation.

United Healthcare will expand its wearables program to allow employees of some companies for which it provides health insurance to allow their employees to use their own wearables, connected via Qualcomm Life’s 2net connectivity platform. Employees can earn up to $4 day in credits for meeting walking goals involving frequency, intensity, and tenacity.

Government and Politics

Senate Republicans introduce an aggressive timeline for dismantling the Affordable Care Act on their promised first day of the new Congressional session. They are using a budget reconciliation resolution that can be passed with a simple majority vote in the Senate (the GOP has 52 seats) vs. the the usual 60-vote legislation approval level. The resolution was introduced by Senator Mike Enzi (R-WY), who says the ACA caused “skyrocketing premiums and soaring deductibles” while driving insurers out of the market.

Privacy and Security

A New York Times op-ed piece on healthcare cybersecurity co-authored by Eric Topol, MD calls for health systems to stop storing and owning patient health data, instead making patients responsible for storing their own information in the cloud or a digital wallet – possibly using blockchain technology – and deciding for themselves who to share it with. He adds,

We cannot leave it to the health record software companies — the Cerners, Epics and Allscripts of the world — to bring about the needed changes. Their business is to sell proprietary information software to health systems to create large centralized databases for such things as insurance reimbursements and patient care. Their success has relied on an old, paternalistic model in medicine in which the data is generated and owned by doctors and hospitals … Patients have shown an overwhelming willingness to share their information for altruistic reasons (which far exceeds the track record of doctors and health systems when it comes to sharing data).

US Special Operations Command in Florida is investigating a claim by security researcher Chris Vickery that he was able to breach the database of a company that provides healthcare workers for one of the group’s programs. Vickery has found several hundred unsecured MongoDB installations, at least some of which have been breached by a hacker with their data held for ransom. A security expert recommends blocking access to port 27017 or limit server access using binding local IPs, then restart the database with the –auth option after assigning user access. The no-SQL MongoDB is used to run big data analytics.

Other

Eric Topol, MD pans the apparently successful “Pure Genius” TV series in which a young technology billionaire creates a hospital that uses cutting edge technology to treat patients that other hospitals can’t help. He not only notes medical mistakes (calling a stroke a heart attack), but questions the show’s premise:

Patients are cured, their lives are saved, or they have dramatic responses to unproven, otherwise unavailable treatments. And in each case Bell, without any medical training or background, makes the critical clinical decisions: “Best idea wins,” he says at the series’ beginning, and they’re usually his. He meets directly with patients and their families, makes extraordinary promises, dresses in scrubs, and uses technology that has never been applied to human beings. When the amnestic police officer does not respond to what the show calls neurostimulation, Bell blurts out, “I’ve always wanted to reprogram someone’s brain” and administers some form of optogenetic intervention that partially restores his memory. The notion that a medically untrained tech billionaire walking around in casual clothes and flip-flops can make life-and-death decisions for people using far-fetched, unchartered therapies is preposterous.

A life insurance company in Japan replaces 34 of its claims adjusters with IBM Watson Explorer, which will analyze hospital records to determine insurance payouts. The company expects the investment to pay for itself in less than two years in replacing employee salaries with much-lower maintenance fees. The article succumbs to the sensationalistic “rise of the robots,” but it is inevitable that companies will replace expensive human labor with technology (both manufacturing and information), which is great for shareholders, at least until the customer base evaporates due to unemployment.  

A Texas couple sues Apple after a driver distracted by using FaceTime on the highway caused an accident that killed their 5-year-old daughter. The couple says Apple should have warned users not to FaceTime while driving and should electronically prevent them from doing so (it would be interesting to see how Apple could distinguish a driver from a passenger).

Weird News Andy titles this story “Pean pain paean” (hint: “pean” is a type of surgical forceps). Surgeons in Vietnam remove surgical forceps left in a man’s stomach for 18 years, ironically in the same hospital that apparently left them there in the first place. The hospital only keeps medical records for 15 years, but says it will try to locate the surgical team even if they have retired to let them know they messed up.

Sponsor Updates

• CTG employees support the Family Justice Center with donations of food, toiletries, and gift cards.
• AdvancedMD compiles its most popular e-guides and videos from 2016.
• Aprima employees donate over nine tons of food to Dallas-area families in need through Metrocrest Services.
• Besler Consulting releases a new podcast, “A brief history of healthcare reform in America.”
• CoverMyMeds will sponsor and present at CodeMash January 10-13 in Sandusky, OH.

Blog Posts

• Elderly Health and Prescription Data Islands (Arcadia Healthcare Solutions)
• Is the US Healthcare System Meeting Patient Needs? (CareSync)
• Dynamic Community Services – A Year of Giving (Dynamic Computing Services)
• Top 5 Blog Posts of 2016 (Dimensional Insight)
• Three Memorable Moments in 2016: Bundled Payments, MACRA, and of course, Donald Trump (ECG Management Consultants)
• Top 4 Takeaways from the Low Country (Evariant)
• A Look Back at FormFast’s Top 8 Blog Posts from 2016 (FormFast)
• Assessing the Past and Predicting the Future for 2017 (Galen Healthcare Solutions)
• Digital Insulin Management Cuts Hospital Readmissions for CV Patients (Glytec)
• 2017 Predictions From Healthcare Leaders Across the Country (Hayes Management Consulting)
• Top 10 Most Popular EHR Blog Posts of 2016 (HCI Group)
• The Revolution in Healthcare Consumerism (Healthgrades)

Contacts

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

Morning Headlines 1/3/2017

Digital health investment reaches $7.9B across 585 companies in 2016

Digital health startups raised $7.9 billion in investments in 2016, with startups focused on improving the patient experience raising the most, at $2.8 billion.

Doctors are starting to let patients read their notes

Modern Healthcare covers the growing popularity of the OpenNotes project as UCHealth (CO) prepares to expand note sharing to include all of its mental health services.

2016 in Review

John Halamka, MD publishes a top 10 list of notable healthcare IT breakthroughs from 2016.

ACA Pregnancy Termination, Gender Identity Protections Blocked; Wellness Program Incentives Survive

Health Affairs reviews which ACA rules go into effect on January 1, which were challenged in court, and which were ultimately blocked.

Curbside Consult with Dr. Jayne 1/2/17

It’s the time of year when many of us are making resolutions around how we want to change things in the coming year. I was struck by a recent Washington Post piece about “busyness” being a new status symbol. It mentions that marketers have picked up on the concept as a hook to push items that promote multi-tasking or help people continue to manage time constraints. One Columbia University profession who researched the issue found that people with leisure time were not perceived as having as high a social status as those who worked more.

I see this playing out in a couple of different ways in my consulting work. One is the way mentioned in the article, where people embellish their busyness as a way of trying to look like they’re working harder or more than their colleagues. I recently had to do a workplace intervention with a client whose employee would repeatedly take vacation time, then work on his vacation, and expect it to be credited back to him. (It still surprises me that they needed a consultant to help with that conversation, let alone a physician consultant, but it does pay the bills.)

The employee had a somewhat misplaced sense of loyalty to his customers, defining his worth by his ability to be at their beck and call. He also exhibited a lack of trust in his peers and also his supervisor, refusing to list anyone on his out-of-office message and therefore forcing himself to be permanently on call. He also had no sense of work-life balance and didn’t understand that the company values people taking time off to recharge and refresh.

As someone who has done a fair amount of employee counseling, I have to say it was a pretty bizarre conversation with this guy. He was certainly at the extreme, but I see all kinds of examples of people on this spectrum. Many people have convinced themselves that they’re the only person who can possibly handle a client. As a student of human (and client) behavior, I would argue that if you have clients that fall into that bucket, there is a certain amount of co-dependency going on and a team approach is going to be helpful for everyone and likely better for the client long term. Others tend to fall more into martyrdom mode, keeping toxic projects, clients, or co-workers on their own radar so that they don’t impact others. Although this kind of busyness seems altruistic, it can be harmful in the end.

Another way I see this playing out is when people really are hyper-busy, mostly due to poor management. I have one client who constantly cranks out executive status reports listing how far off the mark their projects are, but there is never any mitigation. When 60 percent of your teams are not meeting production goals due to resource constraints, it might be a good idea to address those constraints.

I see some groups throwing more bodies at the problem without understanding that sheer numbers might not be the answer. I see other groups who won’t add more personnel because of a perception that it would take too long to ramp up workers who can take on the totality of the stalled tasks. So they choose to do nothing, instead never catching up or sometimes falling farther behind. The morale in the trenches on these teams is abysmal because they’re being constantly told they’re not meeting expectations, but they are largely powerless to create change given their current corporate culture.

With as lean as healthcare organizations are trying to be in the face of constant downward payment pressure and regulatory burdens, I continue to be surprised at the lack of accountability of management in many organizations. If a manager can’t articulate his or her resource constraint along with a request for mitigation, then they don’t need to be managing. As companies reduce head count, I see people given management responsibilities who have no business being there and no support to try to learn how to manage.

Just because you’re the best on a team doesn’t mean you’re cut out to be a manager. And often people thrust into those positions try to continue doing their previous jobs because they’re not comfortable managing, which puts things even farther in the ditch. It’s not the employee’s fault, though – the people above them put them in that position, and that’s where the accountability needs to live.

I see people routinely working 50- and 60-hour weeks because they have to in order to keep up with the demands placed upon them. Given the job market for many workers, employees are not empowered to say no to ongoing demands. I have a good friend who works for a global company and works in multiple time zones, which translates to a 15-hour work day much of the time. His company has had multiple layoffs in the last few years and he’s a single parent to kids approaching college age, so his willingness to say no is directly proportional to his perceived ability to find an equivalent position should he be let go. Especially in healthcare and with companies supporting healthcare, this should not be acceptable.

I also see people working those types of hours because they’re cobbling together multiple part-time jobs to make ends meet. Maybe they’ve had a medical bankruptcy, are dealing with family members impacted by drugs or incarceration, or have other significant challenges. Maybe they lost their job and are trying to stay out of debt while getting their kids through school. There should be no negative thoughts on that level of busyness and the rest of us that aren’t in that situation should consider ways in which we can steer our society to reduce the need for it.

I’ve written before about the work habits in different countries and some of our uniquely American work habits. Interestingly, the Columbia University professor did a similar study looking at the perception of busyness by Italian subjects. They ranked being busy at work as having less status than being able to have leisure time.

Having lived in the stress of a high-productivity physician culture and then in the corporate culture and now in the self-employed culture, I’d definitely rank the ability to have more leisure time as one of the key reasons I left traditional practice. They money I made as an employed physician wasn’t worth the fact that I had no life and was constantly on call. Not everyone has the opportunity or ability to make drastic changes, however, especially at mid-life. But we can support each other in making small changes that enrich our workplace and help each other out.

For those of us that are working crazy hours because we can (not because we have to), let’s not fall into the trap of equating busyness with self-worth. Let’s look at how we can address workplace culture, strengthen management, and raise accountability to improve our working environments. For those who have figured out this workplace equation, let’s see how we can improve our communities and our country to meet the need of our fellow humans. Here’s to a 2017 where we’re not busy just to be busy.

Email Dr. Jayne.

Monday Morning Update 1/2/17

Top News

Eric Topol, MD lists his “10 Tech Advances That Can Change Medicine.”

I have to be a quibbler in suggesting that changing “medicine” is far less important than changing “health” – none of these advances would move the needle on the overall health of the US population very much, although listing magic technology bullets makes for sexier reading than advocating exercise, dietary changes, and the other health determinants that drive 90 percent of health and quality of life.

We don’t really need wearable sensors or increasingly sophisticated diagnostic tools to tell us what people could do to improve their health the most, but Topol’s world view is as a cardiologist, technologist, and geneticist rather than that of a frontlines generalist. Telling people to use their own intelligence instead of being overly enamored of the artificial kind doesn’t earn many grants, procedure payments, or technology board seats.

That said, Topol isn’t the only one with the “I have a hammer, so everything looks like a nail” problem. Hospital people mistake their often clumsy episodic interventions as the most important aspect of health.

In both cases, the fact remains that the most significant health decisions are made when people are far away from their providers and the bustling business of healthcare services delivery, often when they are in fact alone. For that reason, maybe health charge should be led by public health marketing people rather than providers whose education and experience causes them to overestimate their importance to health.

Reader Comments

From Lucid Moment: “Re: patient privacy. Patients do not realize that they give up their HIPAA rights when they use an app or system that connects to an EHR via an API. CMS requires providers to send patient information to any application that patients want to use. If a patient clicks ‘I agree’ on the usual multi-page terms of whatever app they’re using, the app vendor will gain access to their data under the FTC’s minimal privacy rules rather than HIPAA’s. Google and Microsoft will benefit because they can read patient data for choosing ads to display. That’s always been the case, but new phone access to data such as through the new Apple services opens the pipe for them.” Interesting. The above is from CMS’s November 2016 update on patient access to health information.

From Spoon Bread: “Re: misused words. This article list some good ones.” Indeed it does. Some good examples that I’ve seen:

• adverse (harmful) vs. averse (not willing)
• bemused (bewildered) vs. amused (entertained)
• disinterested (unbiased) vs. uninterested (not interested)
• flaunt (show off) vs. flout (disregard)
• opportunistic (exploiting a situation immorally), confused with taking advantage of an opportunity
• simplistic (oversimplifying a complex issue to the point of being misleading) vs. simple (an issue that is uncomplicated)
• tortuous (twisting) vs. torturous (involving physical torture)

HIStalk Announcements and Requests

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

Poll respondents are slightly negative on using scribes to free doctors up from doing EMR data entry work. Linda is concerned about the wide variability in scribe training and their lack of certification, while Furydelabongo says scribes are like transcriptionists who can create a standardized narrative in the absence of a usable EHR (which he or she says is at least two generations away). Frank says having the most expensive labor unit – doctors – entering data is inefficient, no different than if hospital VPs were required to enter transactions.

New poll to your right or here: Should physicians be held accountable for patient satisfaction survey results? Your thought process would interest the rest of us, so click the Comments link after voting and explain it.

Here’s a last chance to participate:

• HIStalk reader survey 2017 (enter your email for a chance to win a $50 Amazon gift certificate)
• Poll: Would you regularly read a daily email containing expanded HIStalk headlines?
• HISsies nominations are open

We funded Mr. C’s “Art of Science and Performance” video equipment grant request through DonorsChoose. He checks in from California to say that the class has recorded a school production so that everyone could watch it and will next make a San Jose Tech Challenge film as its keystone project.

I had some final site upgrade work performed over the holiday weekend. Let me know if you see anything that’s not working.

Last Week’s Most Interesting News

• President-elect Trump meets with the CEOs of several large health systems, with privatizing some aspects of the VA being a rumored topic of discussion.
• A study reports the benefits of adding EHRs as a topic in a hospital’s daily executive safety huddle.
• The local paper reviews a patient death at St. Charles Medical Center (OR) in which an IV error was not caught, partly because the hospital had turned off its IV checking system after finding that it wasn’t compatible with its EHR.
• The New York Times profiles the failure of a North Carolina physician group to move to an ACO model, with physicians who left for higher-paying hospital jobs and a big investment in technology forcing the group to sell out to a large health system.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Acquisitions, Funding, Business, and Stock

Here’s the 2016 stock performance of some publicly traded health IT companies. It obviously wasn’t a great market year for them, even as the Dow rose 15 percent, the S&P 500 ended up 11 percent, and the Nasdaq increased 10 percent. Cerner shares, for instance, are trading at their March 2013 price, with their longstanding steep climb up having ended in March 2015 even before its July 2015 DoD contract win was announced.

Castlight Health – up 19 percent
Premier – down 14 percent
Aetna – down 14 percent
Cerner – down 19 percent
Quality Systems (NextGen) – down 22 percent
McKesson – down 28 percent
Allscripts – down 29 percent
Athenahealth – down 34 percent
Medical Transcription Billing – down 34 percent
Inovalon – down 39 percent

The Philadelphia paper profiles Forerunner Holdings, which offers software that helps hospital pharmacies track prescription drugs through the supply chain to detect counterfeit medications. The company has 50 hospital customers who pay around $5,000 per year to connect with the fulfillment systems of drug wholesalers and manufacturers. The 14-employee company, which is about to launch a $10 million Series A funding round, plans to add a drug shortage warning app and a system to allow hospitals to share access to expensive, rarely used drugs such as antivenin. The company CEO and CTO both came from a Germany-based analytics software vendor and this is their first company.

Fortune magazine profiles investors in “fake it till you make it” startups (of which Theranos is provided as an example) who refuse to believe their companies are doing anything unethical to provide the false appearance of growth. The article ponders whether startup culture has changed now that “the Valley looks as crooked and greedy as the rest of the business world.” The magazine proposes a Startup Scandal Scale that rates companies “on a scale of one to Theranos.” It summarizes,

Some founders grow into talented CEOs. Most don’t. That’s an inevitable by-product of Silicon Valley culture, where everybody fetishizes engineers, designers, and inventors while managers get little respect. “We have an epidemic of bad management,” says Phil Libin, a partner at venture firm General Catalyst. “And that makes [bad] behavior more likely, because people are young, inexperienced, and they haven’t seen the patterns before.” So inexperienced people are handed giant piles of money and told to flout traditions, break rules, and employ magical thinking. What could possibly go wrong? “We hope that entrepreneurs bend the rules but don’t break them,” McClure says. “You know the saying ‘There’s a fine line between genius and insanity’? There’s probably a fine line between entrepreneurship and criminality.”

Other

Someone tweeted about Crohnology, a “patient-powered research network” in which people with Crohn’s disease are invited to contribute information about treatments they’ve tried so that the collective experience can be shared with all participants. It’s still in beta testing after several years, but it’s a great idea.

The New York Times profiles the rapidly increasing world of “fake academia,” where shoddily produced but impressive-sounding journals and conferences feed the “publish or perish” needs of academics – many of them from third-world countries – who pay for the privilege of adding substandard articles and presentations to their CVs. An India-based company runs several of its conferences simultaneously from the same hotels in resort destinations; another’s 17 journals are published by one guy sitting in his apartment; and a third company warns prospective authors that its journals don’t accept papers longer than six pages. One journal accepted for publication a professor’s manuscript that contained one sentence: “Get me off your &@$! mailing list.”A company that the FTC has charged with deception offers the 4th International Conference on Biomedical and Health Informatics in Chicago and other informatics conferences, described with sometimes hilariously fractured English and illustrated with badly resized photos.

Bill Gates warns that the misuse of antibiotics has raised the odds of a pandemic spread by resistant bacteria. 

Connecticut home care agencies worry that the January 1 implementation of a Medicaid fraud prevention system will cause claims processing problems. The electronic visit verification system requires home care workers to call a centralized telephone number upon entering and leaving the client’s home. The agencies also complain that the state chose as its single vendor Sandata, requiring interfacing and loss of functionality. One agency already has a similar system in place that’s integrated into its EHR, but the change will require workers to go through the verification steps a second time just for the state’s records. An agency with 1,500 Medicaid clients says it won’t use the state’s system and will stop serving those patients if the state insists.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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How My 20 Predictions for 2016 Turned Out

Here’s what I predicted on December 28, 2015 and how right or wrong I turned out to be.

Cooled-off funding markets will leave unprofitable startups struggling, IPOs will be postponed, but Health Catalyst will go public.

It’s hard to say whether my first two predictions were correct, but I was wrong about Health Catalyst – they weren’t as anxious or as prepared to go public as I expected. I was right in predicting a poor 2016 IPO market as successful companies in all sectors seemed to prefer increasing their private valuations instead of going public. SEC filings suggest that the trend will continue into 2017. I’m guessing many startups are indeed struggling, mostly because of their own shortcomings. Without the Health Catalyst miss I would have given myself a solid checkmark.

Healthcare costs will be a contentious point in the presidential election, provider mergers will continue, and at least one presidential candidate will timidly suggest cost controls.

Seems right to me. Hillary Clinton touched lightly on cost controls and certainly the cost and premium aspects of the Affordable Care Act became a campaign issue.

Consumers will lose interest in fitness trackers.

I’ll give myself a check even though “lose interest” may or may not be broadly accurate (perhaps, to quote Spinal Tap manager Ian Faith, their appeal is just becoming more selective.) The Apple Watch flopped and some fitness tracker companies sold out or shut down.

The CEOs of Epic, Cerner, and Meditech will start to pull back from day-to-day company involvement as they approach retirement.

This is a toss-up. Epic’s Judy Faulkner is actively involved but talking more about a succession plan because people keep bugging her about it, Cerner’s Neal Patterson was sidelined temporarily by cancer but plans to come back in a few weeks, and I don’t really know about Meditech’s Howard Messing but he seems to be active. I’ll compromise by giving myself an X despite being “directionally correct.” It’s not like they’re just going to disappear while still holding the title, so only Epic and Meditech insiders would know how actively involved their executives are, unlike the publicly traded Cerner who has to be more transparent about what’s going on and Neal has made it clear he’s phasing himself out. In any case, all three companies are likely be replacing their longstanding top executive (and founder in two of those cases) within a few years, introducing the possibility of change.

ONC and Meaningful Use will become increasingly less relevant and more contested as ONC replaces Karen DeSalvo with a new National Coordinator who lacks her experience and bipartisan support.

Meaningful Use was replaced with MACRA while ONC’s influence is debatable – 21st Century Cures gives it more scope. I could score this one either way. Certainly the “more contested” part is true as healthcare member organizations constantly issued press releases and letters complaining about everything MU-related.

Several mid-tier consulting firms will be downsized or acquired as their implementation and advisory business dries up.

I should know better than to make predictions that are hard to quantify. Some companies certainly did cut back or sell out although obviously their reasons for doing so weren’t publicly announced. Like a vendor’s crafty RFP respondent, since I can’t definitively say “no” I’ll go with “yes” since that’s to my advantage.

At least three big health systems will be breached in exposing the information of 100,000 or more patients. The government and organizations like HIMSS will try to help providers share information.

The 100,000-patient number seemed huge a year ago, but breaches of that size are unfortunately not uncommon these days.

The VA will announce plans to eventually replace VistA with a commercial product.

The VA hasn’t specifically said, “We’re dumping VistA,” but their RFIs and conceptual descriptions – not to mention Congressional pressure — clearly suggest such a direction.

At least one customer each from Epic and Cerner will switch to the other’s product to get a better deal on maintenance fees. Epic will expand its hosting service to better compete with Cerner.

I’ve given myself a check on some debatable predictions, so I’ll assign myself an X here even though hospitals have certainly switched both ways between Epic and Cerner and Epic is indeed expanding its hosting services. Most of the swaps were probably related to acquisitions and Soarian customers who were pushed into RFPs that sometimes went Epic’s way, so I don’t have proof that anyone replaced a product just because its ongoing cost was too high.

The terms “telemedicine” and “mobile health” will become antiquated as they simply become another accepted aspect of care delivery. “Information blocking” will also fade away as a hot term when everybody realizes the concept involves speculation without proof.

The terms “mobile health” and “mHealth” are getting long in the tooth and irrelevant since everything is mobile to some degree, but “telemedicine” lives on and “information blocking” is still being thrown around indiscriminately to describe unproven shady behavior by EHR vendors and providers. I was quite wrong in thinking the accusations about information blocking would fizzle due to lack of evidence proving intention. I still haven’t seen the evidence, but the accusations are still flying but with no change in the status quo for patients.

IBM Watson will continue to produce mostly hype. No convincing studies will demonstrate its value, but newly announced, high-profile partnerships will keep IBM shareholders hopeful.

I grade it as all hype so far.

The dark horse publicly traded company best positioned to succeed in health IT and related areas without a lot of fanfare will be Premier.

I didn’t see much of a health IT splash from Premier and its shares are down on the year.

Athenahealth won’t get much inpatient traction with the former RazorInsights and BIDMC’s WebOMR.

It seems logical in hindsight that Athena would need more than a year to become a significant inpatient player if indeed it ever does, but a lot of post-acquisition hype was flying a year ago and this prediction was bolder than it seems now. ATHN share price has dropped 33 percent in 2016.

McKesson will consider packaging and divesting its many health IT offerings as non-core business.

That’s exactly what is happening as the company prepares to create a new, publicly traded company with Change Healthcare and is shopping its Enterprise (Paragon) business around without any takers so far.

Epic will not join CommonWell, but will leapfrog its competitors in offering APIs and slowly building a carefully controlled third-party ecosystem.

I’ll give myself a check since Epic didn’t join CommonWell, but I’m not so sure that Epic has leapfrogged Cerner in offering APIs.

Software for population health management and analytics will enter Gartner’s Trough of Disillusionment as providers implement it poorly and without a commitment to truly change their profitable business models.

I wasn’t speaking literally about Gartner’s hype cycle and I can’t say if population health management software is on it since I don’t subscribe to Gartner, but I think it’s generally true that providers are struggling to wean themselves off fee-for-service business and haven’t done a whole lot with the many software and analytics products that are being sold. You could make a convincing case that I’m wrong, however.

Cerner and Epic will continue to poach the business of Meditech, CPSI, and best-of-breed vendors whose small-hospital customer bases are being acquired by larger health systems.

This is true, although it wasn’t really a bold prediction since the trend was obvious even a year ago.

“Big data” will support a few meaningful clinical studies performed using only aggregated electronic information, but “little data” will provide more impressive but less-publicized results as doctors design the treatments of individual patients by reviewing the outcomes of similar patients.

I’ve given myself some checks for predictions that were partially correct, so I’ll balance it with an X here even though I still believe in the “little data” concept. Certainly some big data-driven studies have turned up some interesting and useful clinical information, so in that regard it probably contributed more than I expected. I could have given myself credit for foreseeing the precision medicine movement that was announced a few weeks after my prediction, but I’m undeserving — that’s really based more on genetic information instead of the “patients like this one” small-scale aggregate data analysis by an individual provider.

Consumer healthcare apps will continue to be plagued by inconsistent use, questionable design, and an unremarkable impact on health or outcomes.

This is another accurate but not especially bold prediction. FDA crackdowns were obviously coming and app vendors rarely bothered to prove that their products influenced patient outcomes.

CHIME and AMIA will follow the HIMSS model of increasing conference attendance and revenue by catering to high-paying vendors willing to buy access to prospects.

I’ll give myself an X since I’m not involved with either organization and thus can’t say how much influence vendors are able to buy. I haven’t heard of any egregious behavior by either organization.

Morning Headlines 12/30/16

Trump Said to Discuss Veterans’ Care Overhaul With Hospital CEOs

President-elect Trump is meeting CEOs from Mayo Clinic, Johns Hopkins Medicine, Partners Healthcare, and Cleveland Clinic to discuss the possibility of allowing veterans to go to any hospital for care, instead of just VA facilities.

Safety huddles to proactively identify and address electronic health record safety

A JAMIA study evaluates the benefit of including EHR safety concerns on daily safety hurdles briefings, concluding that doing so “could potentially serve as an important methodology for institutions to identify, understand, and address the complexity of EHR-related patient safety concerns.”

Use of Secure Text Messaging for Patient Care Orders Is Not Acceptable

Joint Commission revises its position on text-based orders, clarifying that sending patient orders over secure text message platforms is not acceptable.

US Spending on Personal Health Care and Public Health, 1996-2013

A JAMA study stratifies health care spending growth by condition, age, sex, and type of care.

News 12/30/16

Top News

President-elect Trump meets with the CEOs of Mayo, Hopkins, Partners, and Cleveland Clinic, with the topic speculated to be changing the VA to allow veterans to seek care at any hospital.

There’s also the strong possibility that the group tried to convince Trump to leave intact those parts of the Affordable Care Act that boosted the profits of big health systems by insuring people to whom they would otherwise be required to treat free.

Cleveland Clinic CEO Toby Cosgrove, MD, who is a Vietnam War veteran, is rumored to be on Trump’s short list to run the VA.

Also among the pod of rich, white males was facial plastic surgeon Bruce Moskowitz, MD (who founded the non-profit Medical Device Registry for reporting problems with surgically implanted devices) and the reclusive CEO of Marvel Entertainment, who had previously donated $50 million to the cancer center of NYU Langone Medical Center that is now unsurprisingly named after him and his wife.

Reader Comments

From Meltoots: “Re: readmissions article. It ignored the data showing that hospitals simply shifted readmissions to observation beds. Plus, the CHF death rate actually increased over the past several years as hospitals are penalized less for a death than a re-admit. It’s silly talk that the ACA reduced readmissions.” The readmissions penalty was too specific to have a predictably positive impact on patient care, being a primarily financial, incidentally clinical carrot (like other major payment methods that are driven by the patient’s midnight location). Providers have learned to play the Medicare shell game well, always finding a new way to preserve profits when the government removes one. Here’s one I was involved with at my health system. We quietly bought up some oncology practices, then made their patients come to the hospital to get their chemo infusions because it paid us better and we could milk the government’s 340B program to wildly increase drug margins. The patient, however, had to drive to our hospital (which had the usual stress-inducing lack of parking), pay a co-pay since they were now reclassified as hospital outpatients, deal with our often-indifferent registration people and financial counselors, and endure the bustle created when we funneled all those folks into hastily created infusion rooms that resembled happy ending-type massage rooms rather than places of healing. I would not have liked it as a patient — just being in a hospital would make me feel sicker and less hopeful than getting treatments in a quiet, pleasant doctor’s office. Our execs loved the idea, though, since it swelled our bottom line, which is the biggest ego stroke (other than erecting phallic, lavish buildings) that a C-level hospital executive can get.

From The Truth: “Re: Mercy Hospital in Des Moines. Fined over a million dollars for patient safety scores and that doesn’t make HIStalk? C’mon man.” I’m constantly surprised when readers complain that I haven’t mentioned some story that is unrelated to health IT and thus amply covered elsewhere. I guess I should be honored that folks expect or encourage me to write about other topics. The hospital gets three stars from CMS, a D from Leapfrog, and poor patient satisfaction scores, so naturally they announce that all of those measures use flawed data that underreport its medical pre-eminence.

From AnonTip: “Re: Deborah Heart and Lung RFP. I worked on it as a vendor. Some of the RFPs ran 800 pages as they demanded extensive screen shots of workflows and details, then required three days of on-site demos and then site visits. [Vendor’s name omitted] bid $40 million for the 89-bed hospital. They ended up choosing Meditech Web Ambulatory and 6.1, so they will probably dump Allscripts Touchworks at some point.” Unverified. They must have hired consultants to lead their search since it seems like overkill for a tiny hospital that has been using Meditech for decades, although maybe the threat of bolting gave them a stronger negotiating position. The hospital’s 2015 financials show patient service revenue of $163 million and expenses of $166 million, so I can understand passing on the one vendor’s $40 million bid.

From State-Sponsored Actor: “Re: Joint Commission. They’ve flip-flopped again, now declaring that providers can’t send patient orders via secure messaging.” Joint Commission first banned sending orders via secure text messaging in 2011, then decided in May 2016 that it was OK as long as the messaging system met specific requirements. Since then, Joint Commission met with CMS and now declares, “The use of secure text orders is not permitted at this time” because its impact on patient care is unknown, specifically:

• How much nurse work is required to transcribe those orders into the EHR.
• The asynchronous nature of orders sent via text message requires extra steps to clarify and confirm.
• The transcribing nurse has to deal with any clinical decision support messages and relay them to the ordering provider.

From Kilt-Lifter: “Re: DonorsChoose. Do you personally fund the projects you mention?” Not usually. I mention projects in which readers decide to donate through me to enjoy the collective good will created when I share the stories of how the projects I funded with their money (and matching funds) turned out. There’s nothing in it for me and my personal donations are separate.

From Lookie Here Now: “Re: HIStalk email updates. I’m no longer receiving them.” This happens all the time as companies ramp up their protective defenses against spam and my email system cancels the recipient as “bounced.” Just sign up again since that often works.

HIStalk Announcements and Requests

I’ve opened my once-yearly HIStalk Reader Survey. Like last year, I’ll randomly draw respondents for a $50 Amazon gift card. I was surprised in looking over last year’s responses how many reader-suggested changes I have since put in place, although some were just too ambitious for my energy level and capabilities and the #1 response by far is always “don’t change anything.” Some good suggestions from last year and my comments:

• Improve the site search. That’s always a challenge since Google Site Search doesn’t allow date filters, which would be really cool.
• Find an inside-the-Beltway anonymous writer. I’m not super-interested in government and politics, but I’m open to the idea if someone is interested.
• Write less about HIMSS (which is for vendors) and get provider input from AMIA. I don’t really have contacts in AMIA other than I was a member for a while, so I don’t have much to add there except occasionally mentioning something published in JAMIA that someone sends me.
• Get more input from “small people” like analysts or support desk people. I would love to, but vendor executives are paid to write guest articles and otherwise contribute visibly, while those in the trenches don’t have the time or the approval of their employer to participate. I wish that weren’t the case since I suspect they are at least equally interesting.
• Get more contributors. As in the item above, it sounds great, but even well-intentioned contributors quickly drop off as they realize the time required. One of my favorite sayings is, “I hate writing, but I love having written.”
• Do more polls. I will consider that.
• Send the morning headlines via an email update. I keep thinking I should do some sort of daily email update, perhaps using a separate mailing list so that it doesn’t bug those readers who aren’t interested. Given the previous suggestion, here’s a poll: Would you regularly read a daily email containing expanded HIStalk headlines? Last year, the most-loved HIStalk element was news, but clustered tightly in the next three spots were humor, rumors, and the morning headlines.
• Cover more conferences like CHIME’s spring and fall forums, ACHE, AMDIS, RSNA, and JP Morgan. Sounds good on paper, but I don’t get invited to these meetings and I don’t really enjoy attending conferences. The only one that’s appealing is JP Morgan and I’m pretty sure my low BS threshold would be overwhelmed by all the besuited money guys running around leaving an olfactory wake of expensive cologne and self-importance.

Reader Ed donated generously to my DonorsChoose project, allowing me to fully fund these teacher grant requests with double impact from matching funds provided by my anonymous vendor executive:

• Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
• A Chromebook and supplies for Mrs. I’s high school class in Orangeburg, SC
• Math kits for Mrs. V’s elementary school class in Norfolk, VA
• A library of 45 science and environment books for Ms. H’s third grade class in Anchorage, AK
• Two Chromebooks for the high school health education classes of Mr. S in Bay Shore, NY
• Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
• Shot puts and relay batons for the track team at Mr. H’s middle school in Las Vegas, NV
• Five sets of headphones, an electric pencil sharpener, and a programmable robot for Ms. S’s second grade class in Gladstone, MO

Ms. S replied this morning to the news that her project was funded with, “Thank you for kicking off our return from break in a great way! I can’t wait to share with the class that, because of generous people like you, we will now have some much-needed tools in our classroom. It is an amazing thing to be supported! It reminds us how valuable we are and impacts student motivation for reaching their unique potential.”

All the recent celebrity deaths made me envious of artists whose work lives on forever and finds new fans year after year, unlike the rest of us charge-leading foot soldiers who are simply replaced by the next warm body when we fall without leaving much of a non-family trace. I suppose the consolation is that it doesn’t really matter anyway once you’re dead.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Government and Politics

@Cascadia notes the existence of the Plum Book, which identifies presidentially appointed federal positions. Those marked NA are non-career appointment, CA is career appointment, and SC is a Schedule C listed appointment. Obviously it’s not quite up to date with correct names despite a December 1 publication date. Former National Coordinator Karen DeSalvo, MD, MPH, MSC is Acting Assistant Secretary for Health, which is noted as a PAS (presidential appointment with Senate confirmation) and she was never confirmed by the Senate, but I haven’t seen her officially say she’ll be leaving by January 20.

Privacy and Security

From DataBreaches.net:

• Brandywine Pediatrics (DE) is hit by ransomware, but recovers from backups.
• Desert Care Family & Sports Medicine (AZ) remains down from a ransomware infection that occurred in August.
• The Dark Overlord hacker who breached several healthcare systems earlier this year penetrates a precast concrete vendor and releases information that includes contracts, a dump of a manager’s cell phone that includes photos of his children, and video of an apparently fatal workplace accident. He or she is demanding extortion payments to leave the remaining information private.
• A hospitalized psychiatric patient breaches systems run by New Hampshire’s Department of Health and Human Services using a computer in the hospital’s library and posts some information of 15,000 people to social media.
• A hacker breaches the paging system of Providence Health & Services, posting some of the organization’s pager messages on the hacker’s website.

This ZDNet security editor is trying to contact a New York hospital to tell them that a network-attached storage device is open to public FTP, with no luck so far. Update: Saint Joseph’s Medical Center has taken the device offline, he reports.

Technology

A journal article describes how scientists use the workplace messaging tool Slack, which a geneticist user says is better than email that is “disastrous for group communication.” They’re using it to work on research papers, discuss conferences, monitor experiments via device integration plug-ins, create custom apps, award points for collaborative activity, create to-do lists, and train new members. Slack offers a free, endless trial, with regular packages priced at either $7 or $13 per user, per month. There’s also an open source, self-hosted alternative that offers a free team edition or an enterprise version for $20 per user, per year.

Other

A JAMIA-published study describes the hospital-reported benefits of adding an EHR topic to daily executive safety huddles. EHR safety issues made up 7 percent of the safety concerns discussed in one year.

A study published in JAMA finds that US healthcare and public health spending increased significantly from 1996 to 2013 — now accounting for 17 percent of the economy – with the biggest costs involving diabetes, ischemic heart disease, and low back and neck pain. The biggest spending jumps were in emergency care and prescription drugs. The only injury that made the top 20 spending list was falls. Government public health spending accounted for just 2.8 percent of the total. It’s interesting that females incurred significantly higher expense – sometimes more than double – for all age groups over 15 in 2013, with their extended longevity and thus higher numbers incurring $130 million in the 85-plus age group vs. just $51 billion for males (although per-capita spending in that group was also 29 percent higher for females at $31,000 – maybe due to loneliness?). Overall cost ramps up smoothly until ages 65, which the jumps start to get dramatic and the challenges in funding Medicare in a mostly cost-unconstrained model become obvious, although the cost-benefit ratio of applying all those expensive treatments – not only to longevity, but also quality of life – is decidedly less certain. An accompanying editorial notes that the largest public health expense category is HIV – which kills comparatively few people – but little money is spent to address lifestyle conditions, some of which involve consumer products that are backed by massive advertising campaigns.

England’s Secretary of State for Health Jeremy Hunt touts the benefits of barcode-tracking and identifying patients, staff, and equipment that can prevent harm and provide data for studies.

A Harvard Business Review article asks, “Are You Solving the Right Problems?” and questions whether frameworks like Six Sigma and Scrum or even root cause analysis and 5 Whys cause people to “overengineer the diagnostic process.” The answer, it observes, is often not a solution to the stated problem, and problem-defining technology or checklists can be “the subtlest of traps.” Sometimes Disney can’t speed up the ride wait, so it just entertains those waiting.

The Watertown, NY town ambulance service blames a computer upgrade for the inability of crews to open its narcotics lock boxes for several days. Ambulances from the next town over were called in when the drugs were needed. They probably could have just asked around since most towns have plenty of people stockpiling opiates.

A social worker fired by Erlanger Health System (TN) for not knowing how to call a Code Blue sues the health system. A nurse trying to revive an inpatient who had hanged himself in his bathroom asked the social worker to call a code. She says she had not been trained to do so and instead rushed to the nurses station, but found only a clinical documentation improvement employee there who didn’t call the code. She finally found five on-duty nurses in the break room, but they didn’t call the code, either. The hospital fired her for failing to call the code, for spreading rumors that the nurses were goofing off, improperly documenting the incident, and missing a meeting in which the incident was reviewed. The social worker claims racial discrimination since everyone who was involved except her is white and nobody else was fired.

In Germany, an unimaginative (and, much to my surprise, sober) 22-year-old imitates a viral YouTube video in trying to scare a sleeping friend by thrusting a running chainsaw near his head. The 18-year-old victim might want to find smarter friends – the chainsaw prankster missed that part of the video in which the saw’s chain was removed, leaving his unintended victim with a nearly amputated hand.

Odd: the HR director of home health software vendor Axxess Technology Solutions sues a company called Dicks By Mail (whose founder claims to have made millions from the insult-oriented business), seeking to learn the identity of the anonymous individual who sent her a box of penis-shaped candies. She thinks it may be the same unknown person who keyed her car and posted phony Craigslist ads about her. Ordinarily I would suggest that surely she must already know anyone who hates her that much, but then I remembered that she’s in HR.

Sponsor Updates

Blog Posts

• 2017 Healthcare Trends Forecast: Spok Leaders Weigh In (Spok)
• Specific HIT Provisions of the 21st Century Cures Act (Impact Advisors)

Contacts

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

EPtalk by Dr. Jayne 12/29/16

I’m happy to report that organizations seem to be getting the message that it’s a bad idea to wait until the end of the year to prepare for quality reporting. I’ve already had nearly a dozen clients sign contracts for assistance with quality reporting and similar initiatives in 2017. That’s a big change from last year, when many of my clients didn’t start getting serious about it until after the end of the first quarter.

One of the barriers in 2016 was lack of vendor readiness. It’s hard to get excited about working on metrics when your vendor hasn’t released their reports yet. Even though the changes are usually small and it’s possible to use the previous year’s reports as a proxy, there seems to be a psychological barrier to doing so. Regardless, most of my clients are on systems whose vendors are already prepared for 2017 reporting, so I’m grateful.

For those clients eager to wrap up 2016, CMS released its attestation worksheets for eligible professionals and eligible hospitals. The attestation system opens January 3 and will be accessible through February 28. If you haven’t started gathering your data, it’s time to start, and the worksheets allow organizations to make sure they have dotted the I’s and crossed the T’s before accessing the online registration system. It’s also a good time to test your logins as well as make sure your registration information is correct.

Even if you don’t plan to complete your attestation until the end of February, fixing issues early is definitely the way to go, although the system will be down this weekend for updates prior to the opening of the attestation period.

Still, many organizations aren’t ready to go quietly into 2017, with the American Hospital Association calling for President-elect Trump to put an end to what is still being referred to as Meaningful Use 3. The organization cites concerns over hospitals spending significant amounts of money to upgrade their systems to the point of compliance. They also requested support in avoiding anti-kickback provisions in the event that providers compensate each other as part of value-based care initiatives. Any modifications to the anti-kickback rules would require Congressional intervention.

The hospital trade association is also seeking a streamlined process for reviewing hospital mergers. The current process has different review criteria for the Federal Trade Commission and the Department of Justice to challenge mergers or acquisitions and there is hope that Trump’s past business deals will set the stage for a relaxed climate in the future.

A friend who works in the process improvement space sent me this LinkedIn article by David Feinberg, president and CEO of Geisinger Health System. It discusses his goal to eliminate waiting rooms in the next two years. It’s a fluffy piece with a lot of discussion of patient-centric care, which aids in getting people on the bandwagon. But as a practicing ED physician, I think it misstates some issues or misses them entirely.

“A waiting room means we’re provider-centered – it means the doctor is the most important person and everyone is on their time. We build up inventory for that doctor – that is, the patients sitting in the waiting room.” Sometimes having a waiting room means that many patients showed up at the same time, or that patients are too sick to be quickly dispositioned. Maybe there just aren’t enough rooms for the patient demand. But the mere status of having a waiting room doesn’t mean we’re not patient-centric.

My current practice situation is the most patient-focused organization I’ve ever been in. Nearly 95 percent of our patients are treated and released in less than an hour, including pharmacy services. Nearly 98 percent of our patients are roomed immediately on arrival. But yes, we have a waiting room, and sometimes it is full. Recent weather events prevented patient travel during a 12-hour ice storm, which led to tremendous volume once the roads became passable. You can’t necessarily design processes around mother nature, but we had some in place. We flexed staffing and worked as quickly as possible with scribes and other supports.

“For starters, treatment will start the moment patients enter the emergency room because remember, it’s an emergency.” This statement is a great emotional appeal, but it’s not the reality of what many of us are seeing in emergency facilities around the country. I would wager that nearly 80 percent of the patients I see do not represent a true medical emergency.

I understand that the nature of an emergency is somewhat in the eye of the beholder, but having the sniffles for one day is not an emergency. Nor is being sunburned while drunk in Cabo San Lucas and then coming to the ED two days later when you arrive back in the States. Also, “I can’t be sick for the holidays because I have 20 people coming over” is not an emergency, either. But it’s the reality for many of us in the trenches. And if you have five people that arrive at the same time, I’m going to treat the one with chest pain or a stroke before I treat the person who cut their finger two days ago and is just now coming for stitches because their mother told them they had to. Yes, my comments are emotional appeals also, but hopefully the point is made.

He goes on to say “our industry is ripe to be disrupted,” which jumps on the overused disruption bandwagon.

Let’s talk about what else the patient care industry needs. First, we need to sink resources into greater patient education and health literacy so patients know what is and is not an emergency. I spent some time in the UK, and they’re really great at this, running ad campaigns to educate patients. They have multiple versions of the same theme and make it clear that people who don’t need to be in Emergency are causing delays for those who do need to be there. We don’t see that in the US because we’ve swung the patient-centric bar too far in some cases as we continue to pursue patient satisfaction scores, sometimes at the expense of quality.

We need more primary care physicians who are compensated at a level where they want to stay in practice and not retire or go part-time or switch to urgent care. We need to incent them to provide after-hours care and keep their patients out of the ED. We need to help them put systems in place that protect them from burnout. We need to reduce the burden of legal-driven care interventions so that physicians can trust in multidisciplinary teams without the constant threat of lawsuits. We need to incent them to deliver low-intervention care when it’s warranted, and help them educate patients away from the “you have to do everything” mentality.

We also need streamlined data exchange so that the ED isn’t in the dark because a rival health system is engaging in information blocking. You know who is responsible for ALL the information blocking in my area? The hospitals and health systems themselves. Not the EHR vendors. Every system in town has great exchange capabilities, but the hospitals put up faux HIPAA blockades around my ability to find out whether the patient has just had labs drawn.

They’re also engaging in care blocking, as I recently learned when they refused to accept the printed labs and CT scan on a CD that I sent with my patient during his transfer, instead requiring everything to be repeated in-house for liability reasons. That is insane and needs governmental regulation more than EHR vendors do. The same hospital also removed a patient’s IV and stuck her again after transfer because they “couldn’t trust the sterility of the original vascular access.” Again, it’s insane to cause a patient discomfort and remove a perfectly viable IV because you’re afraid of the lawyers.

We definitely need change, but it’s more than hiring more doctors or building more exam rooms. We need cultural change that addresses not only patient attitudes, but the reality of resource constraints in the US healthcare system. But “don’t go to the hospital because you are afraid of being sick, but are not in fact sick” is not a sexy, attention-grabbing campaign.

It will be interesting to see where Geisinger is in two years and whether they meet their goals.

What are your organization’s goals for 2017? Email me.

Email Dr. Jayne.

Morning Headlines 12/29/16

Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre–Post Analysis

A study published in the Annals of Internal Medicine measuring readmission rates before and after ACA’s Medicare Hospital Readmissions Reduction Program went into effect, finds a reduction of 60 to 90 readmissions per 10,000 discharges.

Abbott gets FTC approval for $25 billion St. Jude deal

Abbott Laboratories wins FTC approval to acquire medical device manufacturer St. Jude for $25 billion, under the condition that the two companies divest their cardiac device business units.

Value-based insurance coming to millions of people in Tricare

The recently-signed Defense Spending Bill includes a mandate to test value-based reimbursement initiatives stemming from the DoD’s Tricare insurance program.

Trump Picks Thomas Bossert as Top Counterterrorism Adviser

President-elect Donald Trump names cybersecurity expert Tom Bossert as his homeland security advisor.

Morning Headlines 12/28/16

St. Charles dropped med check system before patient’s death

A patient at St. Charles Medical Center (OR) dies after a nurse administers an IV with the wrong medication mixed in. The hospital had stopped using its stand-alone bedside IV administration software when it moved to McKesson’s Paragon EHR, resulting in a safety gap in its medication administration practices.

Postmarket Management of Cybersecurity in Medical Devices

The FDA releases its final guidance on cybersecurity requirements for medical devices.

A disconnect between physicians and laboratory professionals

A CDC study finds that physicians rarely contact laboratory professionals when faced with questions on which tests to order or how to interpret a result.

A Letter to Donald Trump About Health Care

A New York Times opinion piece calls for Donald Trump to stand by his once outspoken support of universal health insurance coverage amid concerns that the GOP will repeal ACA without passing a replacement law designed to expand insurance coverage.

News 12/28/16

Top News

An Oregon district attorney says he was “on the verge of filing criminal charges” against St. Charles Medical Center-Bend (OR) for halting the use of Baxter’s DoseEdge barcode-driven IV checking system, thereby contributing to the death of an inpatient who received a mislabeled and ultimately fatal IV. The DA backed down when the hospital agreed to make safety changes.

The hospital said both McKesson and Baxter promised that Baxter’s DoseEdge system was compatible with its newly purchased McKesson Paragon EHR, but the hospital had to revert to manual medication checks when it found those claims to be untrue.

Hospital employees claim the hospital turned the DoseEdge system off in a cost-saving move and complain that the Paragon equivalent was too slow to be used.

The fatality occurred because of the usual “Swiss cheese effect” of having several safety steps break down sequentially:

• An expert pharmacy technician who had worked at the hospital for 37 years prepared the patient’s IV with the surgery muscle blocker rocuronium instead of the ordered seizure drug fosphenytoin.
• A pharmacist at the hospital didn’t notice the pharmacy technician’s mistake and approved the IV to be sent to the patient’s room.
• A nurse hung the bag even though it was clearly labeled with a “neuromuscular blocker” warning  sticker that she says she didn’t understand.
• The patient was left unmonitored despite her physician’s order for continuous cardiac and pulse oximetry monitoring, which the nurse admitted she ignored.
• The nurse had to leave the patient’s bedside when a fire drill was called right after the IV was started.

The patient was found unresponsive 42 minutes later and was taken off life support two days after the incident.

The hospital has improved its processes, but it still won’t have a replacement IV checking system until it goes live on Epic in April 2018.

Reader Comments

From Ex Epic: “Re: fun with numbers. Epic is replaying the hits related to R&D investment on their site, although they’ve at least left the Google and Apple nonsense out this time. Oddly, the site’s chart doesn’t match the corporate overviews shared across the campus. Epic’s 2014 and 2015 charts showed Allscripts spending more than Cerner, but their 2016 trend line (which includes those years) has Cerner outspending Allscripts. Which is it?” The trend line shows Cerner and Allscripts spending around 22 and 18 percent, respectively, in 2015, while the bar chart shows 19 and 25 percent. I wouldn’t put much faith in the numbers anyway since Epic compares itself with three publicly traded competitors that follow GAAP recognized accounting standards, while privately held Epic is under no such limitation. Companies can also elect to capitalize as R&D such items as allocated indirect costs (such as a portion of expensive office buildings), maintenance costs, support expense, and other gray areas that may provide little customer benefit. The bottom line (no pun intended) is how products perform and are viewed by customers regardless of how the vendor’s accountants book R&D expense, no different than with any other product. McDonald’s supposedly spends a gazillion dollars trying to invent new menu items that never catch on, but that R&D usually earns the company scorn rather than admiration and their food tastes the same regardless.

From Publius: “Re: Toby Cosgrove as a potential VA secretary. Since Cleveland Clinic is an Epic shop, does this increase the likelihood that the VA procures Epic as its commercial EMR solution, or is Cerner a foregone conclusion given the DoD project?” That’s a tough one. The VA and DoD have disdainfully declined to work together in advancing interoperability until mandated by Congress (and sometimes not even then), so while Cerner might make more sense, I would expect the VA to choose Epic just to be contrary. I think it’s a done deal that they will replace VistA with one or the other. Epic must still be stinging after losing to Cerner for the DoD’s MHS Genesis, so I assume they are using whatever DC influence they have (see: Paul Ryan) to bag the VA deal.

From Meltoots: “Re: integrating state prescription monitoring program (i.e., doctor-shopper) databases with EHRs. We asked our EHR vendor and the state of Ohio for this integration 14 months ago. Here is the click-type data entry nightmare we do today. Does anyone understand this?” Meltoots lists the required steps to perform the patient lookup in the PMP database, which might provide its own deterrent to opiate prescribing:

1. Find the PMP’s webpage.
2. Log in using the user name and password that constantly changes.
3. Click OK that you understand this is private info.
4. Click Search.
5. Click and type in first name and last name (spelled perfectly), date of birth, ZIP code, etc., going back and forth locating the information in different EHR areas and then typing it into the PMP’s web form.
6. Click and hope to find the patient.
7. If the patient is listed, download the generated PDF file.
8. Read the PDF and then print it to prove that you read it.
9. Scan the PDF and attach it to the EHR chart to prove that you did it.

HIStalk Announcements and Requests

It’s a dead heat between Epic and Cerner in the admittedly subjective “who gained the most ground in 2016” category.

New poll to your right or here: is the increasing use of medical scribes good or bad? Polls need to be simple by design, so if you feel boxed in by my default answers, feel free to click the Comments link after voting to explain your position.

Fantastically generous donations from Epic Reader, Bucky Badger, Dr. J, Friend at Impact, and Bill – combined with matching money from my anonymous vendor executive and other sources – allowed me to fully fund these DonorsChoose teacher grant requests:

• 3D pens and printing supplies for Mrs. S’s elementary school class in Oakley, CA
• Makey Makey circuit kits for Mrs. C’s elementary school class in Walhalla, SC
• Two Chromebooks for Ms. V’s middle school class in Phoenix, AZ
• Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
• A Chromebook for Mr. S’s second grade class in Buena Park, CA
• 18 sets of headphones for Mrs. F’s kindergarten class in Hampton, VA
• Math centers for Ms. R’s kindergarten autism class in Newport News, VA
• Five Chromebooks for Mr. V’s high school biology class in Lake, MS
• Four science activity tubs for Mrs. B’s elementary school class in Fayetteville, NC
• A document camera, projector, laser printer, and other projection supplies for Mrs. A’s middle school class in Oakland, CA
• 3D printer pens for Mr. C’s robotics competition team in San Jose, CA
• Five Chromebooks and 15 sets of headphones for Ms. K’s fourth grade class in Detroit, MI
• Programmable robots for Mrs. O’s elementary school library maker space  in Katy, TX
• A bamboo building block set for Mrs. B’s kindergarten class in Sumas, WA
• 30 sets of headphones for Mrs. D’s elementary school class in Sumter, SC
• $200 toward getting 10 Chromebooks for Mr. P’s 10th-grade class in Plant City, FL

Ms. L responded quickly even though Detroit schools were closed Tuesday: “I am beyond excited and grateful for your generous contribution! I can’t begin to explain how much these computers, headphones, and Flocabulary subscription will impact my students. We have been struggling with a lack of technological resources that has made it difficult to use the computer programs that are available to us in a meaningful and effective way. Your donation is helping bring up-to-date, WORKING, technology to our classroom. My students and I can’t say enough thank yous!”

Mrs. E from South Carolina says her students are learning from the programmable robots we provided in funding her DonorsChoose grant request. A snip of her email: “Many of the students come from low-income families that would never have had an opportunity to work with these tools if we didn’t have them at school. One of my students wrote in his thank you letter, ‘I have never in my whole life seen or touched a robot. They do really cool stuff.’ You have made a real difference in the lives of these students, not only by your donation in allowing the purchase of these materials, but also that someone cares enough about them to donate.”

Listening: new from 19-year-old Irish singer Catherine McGrath, who seems to be minimally known even though that should probably change. It’s sort of like pop-oriented US country music sung by Dolores O’Riordan of the Cranberries. Also: new from Columbus, OH-based science fiction-themed hard rockers Starset. One more: the amazing Christian hard rockers Skillet. Check out UK-born drummer-singer Jen Ledger, who plays with hair-flying, thrashing joy that reminds me of a female Keith Moon. Skillet’s tour starts January 28 and includes health IT towns like Madison, Philadelphia, and Indianapolis; they have over 1,000 Ticketmaster reviews with a five-star average and I’m pretty sure they would be entirely worth the $30 or so ticket price.

Last Week’s Most Interesting News

• The Department of Justice gives anti-trust clearance to the creation of a new health IT company by McKesson and Change Healthcare.
• CMS indicates that 171,000 Medicare-eligible providers will receive an EHR Incentive Program downward adjustment in 2017.
• HIMSS announces the retirement of President and CEO Steve Lieber, effective at the end of 2017.
• A JAMA-published observational study involving Medicare ICU patients finds that those overseen by female intensivists experience better outcomes than those with male doctors.
• HHS tweaks the Health Insurance Marketplace rules for 2018, with the most significant changes involving risk pools.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Acquisitions, Funding, Business, and Stock

A business site profiles the South Korea-based hospital-vendor partnership behind Bestcare 2.0, a hospital information system deployed in South Korea and Saudi Arabia that the group hopes to expand into the US market.

Decisions

• Marina Del Rey Hospital (CA) will switch from Cerner Soarian to Epic.
• Virginia Gay Hospital (IA) moved from CPSI to Epic In November 2016.
• St. Mary’s Hospital (CT) will replace McKesson Paragon with Epic in July 2017.

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

Government and Politics

A New York Times opinion piece urges President-elect Trump to follow through on his previously expressed support for universal health insurance, warning him that Republicans in Congress (including his nominee for HHS secretary, Congressman Tom Price, MD) are giving him bad advice in pretending to support such a program while actually pushing “repeal and delay” without any plan of their own to replace the Affordable Care Act and thus driving insurers faced with poor risk pools out of the market. It recommends,

The crucial first step is to avoid repealing the insurance expansion without simultaneously replacing it. The new Congress comes to Washington next week, and its members should know where you stand from the beginning. It won’t work to promise millions of people health insurance on spec. If you avoid this trap, you can then push both parties toward a different version of universal health coverage.

FDA issues final guidance on post-market medical device cybersecurity.

Other

Lisa “Venture Valkyrie” Suennen posts her annual holiday song lyrics parody “Thriving Here in Venture Fundingland,” sung to the tune of “Walking in a Winter Wonderland.” She just took a job as managing director of GE Ventures.

A Black Book poll of C-suite provider executives predicts these trends for the first half of 2017:

1. Hospital IT budgets will remain flat while physician practices will cut their technology spending an average of 13 percent from 2016.
2. Electronic data warehouses will top the list of short-term priorities.
3. Hospital interest in enterprise resource planning systems will be restored in a value-based care environment.
4. Most hospitals haven’t budgeted for projects that would increase interoperability.
5. Large hospital groups fear that cyberattacks will move upstream from the mostly small facilities that were impacted in 2016, expressing concerns about insufficient threat detection systems and the possibility of security alert fatigue.
6. Hospitals are confident about their cloud application strategies even though most of them haven’t bought cloud-based disaster recovery solutions or don’t understand what they have purchased.
7. Small-hospital CFOs will revise their RCM strategies and increase their focus on coding and clinical documentation improvement, with many of them considering outsourcing.
8. Salaries for hard-to-find skills such as healthcare analytics, big data, security, mobile, and cloud technologies will jump as competition heats up and H-1B visa programs could be scaled back.
9. Providers are interested in precision medicine, but nobody’s really buying systems to address it due to expected implementation difficulty.

The New York Times profiles the failed attempt of North Carolina physician group Cornerstone Health Care to transition to an ACO care model. The practice lost a third of its doctors (especially its high-revenue specialists) to higher-paying hospitals such as UNC Health Care; it had to borrow $20 million for capital projects such as new IT systems; and some of its doctors sued it in claiming that their compensation was reduced arbitrarily to cover debts incurred due to mismanagement. The practice ended up selling out to Wake Forest Baptist  Health, which experts say is likely to raise costs as the focus changes from keeping patients healthy to feeding the hospital’s revenue-generating departments.

A CDC survey finds that physicians rarely collaborate with laboratory professionals in the 15 percent of encounters in which they aren’t sure how to order diagnostic tests and the 8 percent in which they received results they don’t understand. The primary barriers are that doctors don’t know who to contact or don’t have the time to do so. Physician respondents suggested adding lab ordering criteria to CPOE systems, publishing mobile clinical decision support apps, and adding lab professionals to multidisciplinary rounding teams.

Medical University of South Carolina will open an Apple-sanctioned retail computer store in its library that will offer discounted Apple and Dell products to students and faculty. It’s also considering using the store to provide health-focused technology, such as healthcare apps, to patients.

Sponsor Updates

• Horses for Sources and its research division cover a patient experience redesign project at Lawrence General Hospital led by  Sutherland Global Services.

Blog Posts

• The New “21st Century Cures Act” Summarized (Impact Advisors)
• Patient Attribution and Care Teams – Managing Side-Effects of Population Health Initiatives (Optimum Healthcare IT)

Contacts

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

Morning Headlines 12/27/16

The Truth About Blockchain

In an interesting but non-healthcare specific piece, Harvard Business Review recounts the 30-year path TCP/IP took to transform business and draws parallels to the pace and transformative nature that blockchain technology could have on business practices in the future.

Fearing Medicaid cuts, states wield health data as a political weapon

CMS Acting Administrator Andy Slavitt is pointing to diagnostic and cost of care data from states that expanded Medicare under ACA to make a case against a full repeal of the law.

Got a chronic disease? There will soon be a prescription app for that

Wired UK covers the NHS program aimed at developing and prescribing apps to help manage chronic diseases.

Morning Headlines 12/26/16

Cornerstone: The Rise and Fall of a Health Care Experiment

The New York Times profiles provider group and accountable care organization Cornerstone Health Care (NC), telling the story of its transition to ACO status and its eventual sale to Wake Forest Baptist Medical Center.

Year in Review: Cerner presses forward despite year of uncertainty

Cerner closes out 2016, a year that brought with it CEO Neal Patterson’s cancer diagnosis, delays on its DoD implementation, and ongoing construction at its new Kansas City campus.

Medical scribes free doctors to spend more time with patients

A local paper reports on the introduction of medical scribes in the CHI Memorial (TN) emergency department, linking the rise of scribes to ARRA and the resulting increase in EHR use by providers.

Morning Headlines 12/23/16

Google Deepmind and Imperial in streams deal

Google’s UK artificial intelligence company, Deepmind, will implement its only non-AI app, Streams at Imperial College Healthcare NHS Trust. Streams monitors clinical information and alerts doctors of deteriorating patients.

Analysis of Nearly 51,000 Geisinger Patient Exomes, EHRs Reveal Actionable Variants, Drug Targets

A study analyzing the DNA and EHR data of 51,000 patients finds that 3.5 percent of the study participants had clinically actionable variants.

Eight More Health Systems Join Growing Support for Surescripts National Record Locator Service

Eight new health systems have joined the Surescripts National Record Locator Service, which runs patient record searches within the Carequality HIE.

UMass Memorial posts $68M surplus for 2016

UMass Memorial Health Care reports a $68 million surplus in 2016, up from $47 million last year, despite $125 million in new debt that it is using to implement Epic.

News 12/23/16

Top News

The Department of Justice gives anti-trust clearance to the previously announced creation of a new health IT company by McKesson and Change Healthcare, clearing the way for the deal to go through as planned in the first half of 2017.

McKesson will own 70 percent of the new company, to which it will contribute most of McKesson Technology Solutions.

Reader Comments

From CCOW, MUCOW: “Re: Meaningful Use penalties. A CMS document says it will apply a downward payment adjustment to 171,000 EPs in 2017 for failing to demonstrate MU.” I’ve long lost interest in Meaningful Use and its offspring. We as taxpayers have paid $35 billion to bribe doctors to use old, poor-selling EHRs they wouldn’t use voluntarily, which is maybe a first in any industry. I suppose that as a stimulus package, it delivered the expected economic benefit (although it was late to the party by the time the details were worked out), but I’m not seeing much difference in cost or quality so far. Maybe it’s a laying-the-tracks sort of thing that will pay for itself downstream. Meanwhile, I read somewhere that ONC now has 400 employees, reproducing itself like typically virulent federal agencies, departments, and offices.

From Piezo DeVoltaic: “Re: equipment. Other than the Wi-Fi adapter you mentioned, what else do you use to write HIStalk?” I have a Toshiba laptop that I got from Office Depot for less than $300 several years ago and a 27-inch Acer monitor that I think cost around $130. That’s it other than keyboards, which I go through frequently due to the volume of writing I put out – I buy the basic Microsoft wired keyboards three at a time since they’re only around $12. Starting on a new keyboard is like a new beginning because I’m always snacking while working due to lack of time, so the crumb load is significant (shaking my keyboard upside down looks like a snowstorm). On the non-work front, I have an iPad Mini and my beloved Chromebook. I also need to replace my iPhone 5 at some point, I suppose, although I can’t get excited about the iPhone 7 Plus that seems like its logical successor.

From LFI Masuka: “Re: article comparing medicine to ‘Moneyball.’ The movie was really about using statistics to better value assets in an environment of limited money to spend on those assets. The vision was not getting the best possible Oakland A’s – it was getting the best Oakland A’s for a reasonable price. The equivalent for medicine would not be best practices – it would be to set up budgeted compensation guidelines to more realistically address those activities that promote long-term health. Getting more bang for our collective bucks. Without the financial aspect, Medicineball is what we used to call ‘science.’” I like that. I would also say that it’s a subtle but important mistake to assume that hospitals are best equipped to do anything more than patch people up and send big bills after they treat ‘em and street ‘em. Somehow everybody just accepts that hospitals are the logical overseers of population health management. I disagree. Most of us see our PCPs a lot more often than we have a hospital encounter, not to mention that hospitals are notoriously bureaucratic and inefficient. Maybe it’s because the doors of medical practices are locked at least 75 percent of the time, sticking hospitals with less-convenient coverage hours but making them the most reliable and accessible provider. I’ve spent most of my career working in hospitals and I would never (a) donate money to them, (b) trust them; or (c) become their inpatient without having someone sitting at the foot of my bed at all times to catch their inevitable mistakes. They’re like universities – too much emphasis on money, overly large employee egos, and an inflated sense of entitlement and global self-importance.

HIStalk Announcements and Requests

Donations from three HIStalk readers, paired with matching money from my anonymous vendor executive, allowed me to fund these DonorsChoose projects:

• An Osmo Wonder Kit for Ms. F’s sixth grade class in Costa Mesa, CA
• Science, STEM, and weather books Ms. H’s second grade class in Fayetteville, NC
• Scientific calculators for Ms. H’s seventh grade class in Indianapolis, IN

Ms. H responded quickly to the news that her project was funded. “I am so grateful that you are helping us out. We do not get a lot of science materials in second grade. This is exactly what I needed for my students when we come back from the winter break. I can’t tell you how much this means to me to give my students the best so they can learn. My kids love science and now you are giving us materials for them to really dig in and learn. You are the best.”

Ms. C sent photos from her California middle school showing the daily news show equipment we provided in funding her DonorsChoose grant request (microphones, a $50 camera-equipped drone, iPhone tripods and clips, and accessories).

A TV show is on in the background as I’m writing, in which a limelight-seeking singer is butchering a Christmas carol with overwrought vocal gymnastics in an ill-advised attempt to “make it her own” instead of just singing the damned thing without gimmicking it up. The only worse thing I’ve heard is when a “Nashville recording artist” wearing a laughably misplaced cowboy hat hacks up the National Anthem before a Nascar race, providing 10 bad, rambling notes for every one that was originally written. Even the “artists” who follow the Star-Spangled Banner reasonably well still feel compelled to wing it toward the end, probably in relief for remembering all the words. Apparently they are mistaken in thinking they know better than the composer.

This week on HIStalk Practice: Fallas Family Vision selects RevolutionEHR. Greenwood Genetic Center launches telegenetics program in South Carolina. Michigan will implement Appriss Health’s prescription monitoring program tech. Orthopedic + Fracture Specialists goes with Odoro patient self-scheduling software. MedStar NRH’s John Brickley outlines the challenges PTs face when selecting health IT. Our Children Our Future selects TenEleven Group’s behavioral health EHR. Walgreens looks to Matter for innovation inspiration as it works out Theranos kinks. Palo Alto Networks’ Matt Mellen offers ways to spot spoofing in healthcare emails.

I’m leaning toward taking the weekend off from writing HIStalk, so if indeed I do, have a Merry Christmas or whatever holiday (if any) you celebrate. I don’t gain much wisdom from Facebook, but I liked a quote I saw there: “It’s not what’s under the Christmas tree — it’s who’s around it.”

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Sales

In England, Allscripts PAS customer Dudley Group NHS Foundation Trust adds Sunrise and dbMotion.

Deborah Heart and Lung Center (NJ) will upgrade to Meditech Web Ambulatory and 6.1.

In England, Imperial College Healthcare NHS Trust will implement Google-owned DeepMind clinical deterioration detection system.

Announcements and Implementations

Eight large health systems go live with the Surescripts National Record Locator Service. The company offers EHR vendors free access to the system, which operates under Carequality’s framework, until 2019.

Privacy and Security

From DataBreaches.net:

• A security firm’s analysis finds that the black market price of a patient’s complete medical record has dropped over several years from $50 to less than $10, which has caused cybercriminals to refocus their efforts on spreading the more profitable ransomware.
• Fairbanks Hospital (IN) notifies an unspecified number of patients that their information was visible to unauthorized employees for several years, adding that it’s not even sure who viewed the information.
• Henry County Health Department (OH) alerts 500 of its home health and hospice patients that their information was contained on a nurse’s stolen laptop, adding that it will start encrypting laptops.
• Community Health Plan of Washington notifies 400,000 current and former members that a security vulnerability in the network of contractor NTT Data exposed their information. 

Innovation and Research

A Geisinger study in which patient genomes were matched to their EHR information finds actionable variants for familial hypercholesterolemia in 3.5 percent of those studied.

Other

The $125 million that UMass Memorial Health Care (MA) borrowed for its Epic implementation reduced its fiscal year operating profit, but it still made $47 million vs. $58 million last year.

Saint Vincent Hospital (PA) is forced by the Equal Employment Opportunity Commission to rehire six former employees it fired in 2013 for refusing to take a flu shot and then providing questionable clergy-signed documentation of their claimed religious beliefs. EEOC says the hospital’s requirement constitutes religious discrimination. The hospital must now accept any excuse an employee offers for declining to be immunized.

Denver Health (CO) fires $360,000-per-year pediatric anesthesiologist Michelle Herren, MD for posting Facebook comments about First Lady MIchelle Obama that said, “Doesn’t seem to be speaking too eloquently here, thank god we can’t hear her! Harvard??? That’s a place for ‘entitled’ folks said all the liberals! Monkey face and poor ebonic English!!! There! I feel better and am still not racist!!! Just calling it like it is!" She apologized, saying she didn’t realize “monkey face” might be taken as racist, that her comments were taken out of context,  and that she thinks it’s a double standard that everyone can make fun of Melania Trump but the First Lady is off limits. Unlike Ms. Obama’s degrees from Princeton and Harvard, the exclamation point-shrieking Dr. Herren earned her medical degree from Nebraska’s Creighton University, ranked among the bottom 15 US medical schools.

Weird News Andy offers his Merry Christmas story. New Mexico Department of Health epidemiologists investigate their own agency’s catered holiday lunch after 70 of its employees get sick afterward. I don’t usually worry about catered food, but I’m nervous  about eating at potlucks or picnics, where you can’t verify the food safety standards employed by well-intentioned people who don’t understand that food needs to be refrigerated as soon as it’s cooked and until it’s heated and eaten. Compounding the problem is that hospitals and office buildings don’t always have a real kitchen with big enough refrigerators to hold everybody’s dishes for several hours or a range to heat them up, so there’s always a big line waiting for the cheap, countertop microwave. Think twice before you take leftovers home. Sometimes I think that every American should take a food safety course since it’s surprising how many people leave food out after cooking or after eating, somehow thinking that simply covering it keeps bacteria out.  

Sponsor Updates

Holiday Activities

PeriGen and its new acquisition WatchChild hold their first combined team meeting in Cary, NC, with employees also building 10 bicycles for the local Big Brothers, Big Sisters organization, They were surprised afterward to be joined by the children whose bikes they had just built.

Xerox Healthcare donates gifts to the Northern Rivers Holiday Giving Campaign.

• Consulting Magazine awards Impact Advisors VP Jenny McCaskey a Lifetime Achievement Award.
• Everest Group places NTT Data Services in the Leader quartile for three of the 2016 Peak Matrix Assessments, including the new EHR category.
• PatientKeeper releases a new video featuring customer reviews of their charge-capture solution.
• The SSI Group raises money to place over 400 wreaths on the graves of veterans.

Blog Posts

• Getting nurses back to the bedside (Infor)
• Top 5 Healthcare IT Buzzwords You Need To Know (Access)
• Our Year in Review: What Navicure’s 2016 Surveys Tell Us about Organizational Goals and Achievements (Navicure)
• Get Ready for Blockchain’s Disruption: A HIStalk Blog Recap (PokitDok)
• How to increase the impact of smart mobile devices (PerfectServe)
• The Importance of Longer EFM Views (PeriGen)
• Top Conferences for Healthcare Privacy and Compliance Officers in 2017 (Protenus)
• How Streamline Health is about to change code auditing forever (Streamline Health)
• Summit Provider Exchange – Tips and Tricks (Summit Healthcare)
• Strategic Planning: Rethinking Your Hybrid IT Strategy in 2017 (TierPoint)
• Tips to ensure your quality program actually improves quality (Verscend)
• RSNA in Perspective: Streamlining Workflows, Reducing Costs, Improving Outcomes (Vital Images)
• A Better Contact Center for a Better Customer Experience (West Corp.)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 12/22/16

There has been a lot of information coming out of CMS over the last couple of weeks, and I’m sure some organizations are missing it in the holiday rush. I know I missed some of the announcements when they came out last week. Sometimes I’m not sure whether subscribing to multiple news feeds and aggregators helps me or adds to the issue.

Some of the hottest debate is around changes to the CMS bundled payment programs, including two new mandatory programs for heart attack care and bypass surgery. The other changes are to the hip and knee replacement program. The new programs will qualify as Advanced Alternative Payment Models for the purposes of MACRA. Within the Acute Myocardial Infarction Model and the Coronary Artery Bypass Graft Model, flat fee payments will occur instead of line-item payments for procedure-related services.

These models will launch on July 1, 2017 and run through December 31, 2021. Hospitals from 98 metropolitan areas were selected for participation, which again is mandatory. Any savings during the first two performance years can be kept by the facilities, but starting in the third year, hospitals will be required to repay a portion of the extra costs with a gradual increase in that repayment portion. Bonuses for demonstration of defined quality metrics will be available, starting at 5 percent in the first three years and moving up to 20 percent in the fifth year.

There is also an incentive for providers to refer heart attack patients for rehabilitation under the Cardiac Rehabilitation Incentive Payment Model. Hospitals will receive $25 per service provided to patients post-MI or bypass for up to 11 services per patient. After that, the payment goes up to $175 per service. Cardiac rehabilitation has proven value in the clinical realm, so it’s nice to see CMS putting money in play to incent desired behaviors.

Bundled payments under the Comprehensive Care for Joint Replacement Model are also expanding, adding hip and femur fracture care. The Surgical Hip and Femur Fracture Treatment Model will also count as an Advanced APM under MACRA. CMS webinars are forthcoming and will detail the new payment programs and the hoops that providers must jump through to qualify for bonuses. As is usual for new CMS programs, there will be a flurry of fact sheets and open forums where providers and organizations can ask their questions. Response to the announcement has been mixed, with the American Medical Association in support and the American Hospital Association against, largely due to the fact that participation is mandatory.

Hospitals in the impacted regions have a little over six months to prepare, which isn’t a lot of time when you’re talking about the need to analyze current state and apply interventions to support a new paradigm. Those of us in the consulting space would encourage everyone to start thinking about this, even if you’re not in one of the mandated performance areas, to start making changes as well. It’s highly likely that these programs will expanded and the sooner you prepare, the easier the transition will be.

CMS also announced two new Accountable Care Organizations, one of which is tantalizingly named “Track 1+.” It has less downside risk than the existing tracks in the Medicare Shared Savings Program and is designed to bring smaller practices into the risk-assumption fold. It is set to launch in 2018 and the hope is to bring up to 70,000 providers on board. Smaller or rural hospitals could have less risk than their larger counterparts, which could be attractive to those organizations who are on the fence about being an ACO. Interested groups can submit an intent to apply as soon as May 2017. Whether they’re admitted to the track or not, there is good reason to start preparing now.

The second one, the Medicare-Medicaid ACO Model is designed to address the needs of dual-eligible beneficiaries who are covered under both programs. Although these patients could previously participate in Medicare ACOs, there was no financial accountability for the Medicaid spending for these patients. The new ACO allows for management of both sets of costs. States can submit letters of intent to work with CMS to design the state-specific requirements. Up to six states will be selected with priority given to states with lower Medicare ACO participation. Once states are identified, applications will be released to ACOs and providers.

Regardless of the proliferation of new models, some analysts have suggested that they may not be fully rolled out or may be significantly changed after new leadership hits HHS after the inauguration. That’s exactly the same kind of thinking we’ve seen intermittently over the last decade, where providers wait to take action because they think there’s a chance of change. For some, that has caused a lot of angst when they realized that their watch-and-wait attitude only served to cause a flurry of activity later. I sympathize with their hope that a new administration will come in and wipe the slate clean, but given the continued escalation in healthcare costs and the political pressure to drive them down, it’s not entirely realistic. I still would love to see regulation in the health insurance space but that’s not entirely realistic either.

As of early 2016, nearly 30 percent of Medicare payments were tied to quality and value and the next milestone is to try to tie 50 percent of payments to those parameters by 2018. We’re going to continue to see a proliferation of new programs that can be confusing and maddening. I hope those in the trenches are considering New Years’ Resolutions that promote serenity and relaxation, because it’s going to continue to be a slog.

Have you started thinking about your resolutions yet? Email me.

Email Dr. Jayne.

Morning Headlines 12/22/16

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