Monday Morning Update 9/12/16

Top News

In England, 12 NHS trusts will receive up to $13 million each from the government as “global exemplars” that will lead the way for innovation, while another 20 will be given $6.6 million each as “national exemplars” to improve their own digital technologies. The announcements follow publication of an NHS digitization recommendations report created by an advisory board led by UCSF professor Robert Wachter, MD.

Health Secretary Jeremy Hunt also announces an expansion of NHS’s 111 non-emergency line to include triage service, publication of an NHS guide of approved health apps, re-launching the NHS Choices patient services website as NHS.UK with a new capability for patients to download their own records in a Blue Button-like fashion, and publishing trust performance data for specific health services.

Reader Comments

From Recent Epic: “Re: Epic’s succession plan. It’s for the best that Carl has taken over, although whether he has any desire to stay remains to be seen. Judy’s leadership is becoming increasingly erratic as she advocates finding ways to charge for APIs and web services, has wild swings of opinion on hosting services, makes rash decisions in trying to make international deals, pushes salespeople to start cutting deals on previously principled pricing and contract provisions, and most disturbing for the direction of the company, spends an increasing amount of time on buildings and events.” Unverified.

From Datapref: “Re: HIMSS Analytics. MU attestation made it easy to find out who has installed which products, with higher quality. Their ‘Logic’ rebrand intentionally makes it hard to export mass data and the UI is a mess. They have a long lag time (3-4 months) getting financial data updated after it’s been published by CMS, while Definitive, Billian’s and even AHA are less than one month.” Unverified. HIMSS Analytics still has the massive competitive advantage of being owned by HIMSS and thus being able to dole out to its paying customers HIMSS points that earn better exhibit hall booth locations. Personally, I’m not in favor of well-funded, theoretically non-profit member organizations recruiting corporate members while also selling them services and in some cases competing with them. I would be interested in seeing the latest 990 tax forms from HIMSS to see how much HIMSS Analytics brings in, but I haven’t found its latest filing so far.

From Pippi Longstocking: “Re: Bob Wachter’s UK digitization report. His only informatics credential is having written an awful and extraordinarily slanted book, cherry picking information to fill in a predefined narrative. The UK report seems to be mostly written by consulting firms. I find it odd that Ross Koppel speaks to informatics, Christine Sinksy to burnout, Deborah Peel to privacy, Julie Adler-Milstein to safety, and now Bob Wachter to success.” It’s interesting to me that in the “Look Inside” preview of his book on Amazon (since I haven’t bought or read the book), Wachter says that David Brailer, MD, PhD, the first National Coordinator who was appointed in early 2004, hinted that President George W. Bush’s push for EHRs came about only because he was jealous of the billions England’s Tony Blair was spending on the ultimately failed NPfIT program. Wachter also says Brailer wasn’t in favor of creating the very ONC he was later tapped to lead, worried that the federal government’s smothering bureaucracy would stifle innovation. I don’t know about Wachter’s informatics expertise, but he’s a good writer.

From Bunchy Donovan: “Re: iPhone announcements. Removing the headphone jack has healthcare consequences since that’s how some device-attached apps use it as a connector.” The change may well put some minimally successful app vendors out of business, which might be a good thing in a herd-thinning sort of way. Meanwhile, Apple will offer an alternative to those $4 non-Apple earbuds I use at the gym — the wireless and surely easily lost AirPods, which will cost $159 and will make the wearer look as douchebaggy as those people whose Bluetooth headsets are permanently implanted in their ears. I assume the AirPods came from the Beats by Dr. Dre line that Apple (over)paid $3 billion to acquire in mid-2014. Apple has transformed itself from solving problems I didn’t know I had to solving problems that  I actually don’t have at all. Your life is pretty darned good if you can allocate $159 (plus the cost of a new and barely improved iPhone) to solve the crisis of tangled earbud wires.

From Silver Spoon: “Re: hospital administrative residencies. Would you recommend them?” They’re great if you can get chosen for them. The faith-based national system I worked for placed only well-connected graduates of their low-ranked religiously affiliated schools in those jobs even though 99 percent of our patients did not practice that religion and in most cases weren’t even aware of the connection. Not surprisingly, the chosen ones were usually fast-tracked in the “people like us” leadership model. I passed up an early-career option of working a stint in the Middle East after hearing a friend’s report of being culturally insulted and professionally disrespected as though he were a mercenary shoeshine boy there, a situation my hospital system colleagues and I found ourselves in without the long flight.

HIStalk Announcements and Requests

Insurance companies offered the poorest customer service experience to respondents to last week’s poll, while lab companies and dentists caused the fewest problems. Hospitals ended up mid-pack, but Beebob shared recent ED visit experience that included lack of wristband checking, nearly being administered morphine despite his or her clearly recorded allergy, employees never washing their hands, and doctors and nurses leaving their EHR sessions active when leaving the room so that anyone could have clicked through patient lists and charts, all of which were reported by letter to their CEO and safety VP with no response.

New poll to your right or here: what should be the key healthcare issue in the presidential election? “Key” means you have to choose the single most important issue instead of yearning for a lazy “all of the above” option that would relieve you of your responsibility make a decision.

I’ve received several emails weekly from investment companies (both in the US and elsewhere) wanting to talk to me about publicly traded health IT companies. I get those all the time, but the volume has picked up, which isn’t a problem for me since I just delete them without responding. They must have a good business model in getting free advice and reselling it as their own insight. Just about everything I know is right here on the HIStalk page for anyone to read anyway. 

Last Week’s Most Interesting News

• CMS offers providers four “pick your pace” options for 2017 MACRA/Quality Payment program participation in 2017.
• Device maker St. Jude Medical sues a security firm and an investment research company for manipulating its share price and profiting from short sales via the issuance of questionably accurate security vulnerability reports.
• In England, a health IT committee issues its digitization recommendation report.
• Epic asks the US Supreme Court to review a lower court’s ruling that the company can’t force employees into arbitration to block class action lawsuits over employment disputes.
• UCSF will lay off 17 percent of its IT staff and offshore their jobs to India after its IT expenses doubled from 3 percent of its operating expense total to 6 percent in the past five years.
• A tiny, AMA-sponsored observational study finds that ambulatory practice doctors spend twice as much time working on the computer and doing desk work than seeing patients.
• Apple toughens up App Store standards for health-related apps to increase review of those that provide inaccurate data and to limit drug dose calculation apps to approved healthcare entities.

Webinars

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

View previous webinars on our HIStalk webinars YouTube channel.

People

Stephen Ondra, MD (Health Care Service Corporation) joins open source data management vendor Amida Technology Solutions as chief strategy officer.

Announcements and Implementations

USC’s family support center and gerontology school provide family caregivers with support resources (care planning, reminders, task management, and self-care content) via an app developed by Los Angeles-based Care3. The three founders have experience that includes working in Aetna’s Healthagen technology businesses.

A new Peer60 report compares Epic and ChipSoft in the Dutch EPR market. Interesting factoids: (a) no ChipSoft hospital reported an improvement in financial outlook, while a fair number of Epic respondents did; (b) Epic scored considerably higher in enhancing patient engagement; (c) Epic scored much better in improving user workflow; (d) Epic’s “would recommend” scores are hugely higher; and (e) nearly half of the users of both systems say their projects ran over budget. The report contains a lot more interesting detail. All I know about Amsterdam-based ChipSoft is that they used to give out cool clogs from their booth at the HIMSS conference, but I stopped asking about them years ago because their booth people (who you might expect to be rosy-cheeked and happy if your only cultural reference is a Dutch Boy paint can) were always eye-rollingly surly in insisting that you put them on right there instead of packing them away for later.

Privacy and Security

This promotional email from Healthcare Informatics seems to miss the obvious fact that if you’re pitching an advertiser’s ransomware material, you should probably not use a gibberish link that the recipient won’t click on if they are even vaguely aware of phishing practices. 

From DataBreaches.net:

• The political team of a British member of Parliament tweets out a photo of the candidate cold-calling supporters that also included in the background a whiteboard containing the telemarketing system’s clearly visible (but since changed) log-in credentials.
• Appalachian Regional Hospitals, whose systems are apparently still down following a ransomware attack several weeks ago, threatens to sue the local newspaper for asking questions about the situation and for publishing “statements that defame ARH or cast it in a false light.” It’s an interesting by-product of gaining public exposure for cybersecurity weaknesses or breaches that the affected organization often lashes out legally at the messenger (since the perpetrator isn’t handily available) in trying to protect their public image. 
• The FBI charges two young men with using social engineering to hack the Internet accounts of several senior government officials that include the CIA director and Director of National Intelligence, using the information to harass them and to download sensitive information that they posted on the Internet. They gained access to the master federal law enforcement computer system, listened to the voicemails of senior officials, took control of their TVs, harassed them and their spouses by phone and email, distributed their contact lists, and fooled their spouses into providing their log-in credentials by claiming that their passwords needed to be reset.
• Researchers warn that it would be easier for hackers to disable the country’s 911 emergency call systems by overloading their limited incoming lines with automated spurious calls from malware-infected mobile phones, estimating that 6,000 infected phones could disable an entire state’s 911 system and 200,000 could take down the entire national system.

Other

Three academic psychiatry authors write in their JAMA editorial that it’s not ethical for EHRs to flag frequent ED flyer with an airplane icon, saying it’s disrespectful and that such labeling may impede good diagnostic decision-making.

Dartmouth-Hitchcock Medical Center (NH) will lay off up to 460 employees in the next few months following a $12 million loss in the fiscal year ending June 30. The hospital’s billing-related expenses increased by $115 million as it changed billing and revenue management systems — which caused a $40 million revenue overestimate – and outsourced its RCM activities to Conifer Health Solutions. According to the CEO, “Other great organizations are experiencing similar downturns with the implementation of new systems and rising expenses.” DHMC implemented Epic at a cost of $80 million in 2011, after which its bond ratings agency attributed its weak operating performance to reduced state funding and its Epic costs.

Examples abound around the world where a single, dramatic photo engaged a previously indifferent public and turned a magnifying glass onto the society we’ve created. This Ohio police stop photo of two West Virginia adults zonked out in a heroin-induced stupor as the woman’s four-year-old grandson looks on just might do it in forcing us to examine our drugged-out society and the impact of only-in-America drug marketing and pricing decisions (over-marketed and thus overprescribed OxyContin whose high prices moved addicts to cheap but notoriously impure heroin freely entering the country after a failed war on drugs, with overdose victims sometimes revived as they were in this case with overpriced and thus less-available naloxone). Both adults have prior records for DUI, drug possession, resisting arrest, and other offenses. You are wrong if you think the epidemic can’t affect you or your family beyond being robbed by drug-seekers – this guy was driving on public streets seconds before this photo was taken, having just missed rear-ending a stopped school bus as he tried to take the woman to the hospital before being stopped by an off-duty officer from the East Liverpool Police Department.

Vince and Elise review the comments received about Black Book and KLAS from my reader survey in Part 6 of their “Rating the Ratings” series.

Here’s one of the most brilliant and hilarious TV ads you’ll ever see, a new Cigna public service message from the “TV Doctors of America” advocating annual physicals that many of their real-life counterparts don’t feel are medically indicated.

Sponsor Updates

• T-System will exhibit at ENA Emergency Nursing 2016 September 14-17 in Los Angeles.
• Crain’s features TeleTracking Technologies in its coverage of New-York Presbyterian’s new mission control center.
• Valence Health will exhibit at Further 2016 September 14-16 in Chicago.
• Frost & Sullivan recognizes Validic for the 2015 North America Frost & Sullivan Award for Visionary Innovation Leadership.

Blog Posts

• IT has a central role to play in managing population risk (Advisory Board)
• Small Hospitals are a Big Deal: The Challenges of Implementing Large Scale EHR’s at Smaller Organizations (Impact Advisors)
• Achieving Patient Flow Outcomes through Collaboration (TeleTracking)
• Disaster Recovery-as-a-Service is a Cornerstone of the Cloud (TierPoint)
• Nothing Spurs Fitness Programs Like a Little Healthy Competition: Part 1 (West Corp.)
• Illinois Mandates Sepsis Protocols with Gabby’s Law (Wolters Kluwer)
• The Tyranny of the Three I’s: Incomplete Information, Inaccurate ICD-10 Coding and Insufficient Documentation (ZirMed)

Contacts

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

Morning Headlines 9/9/16

Plans for the Quality Payment Program in 2017: Pick Your Pace

CMS announces four different timeline options for participating in the MACRA Quality Payment Program, each of which will allow providers to avoid penalties, and many of which would include positive payment adjustments.

Making IT work: harnessing the power of health information technology to improve care in England

In England, Bob Watcher, MD co-authors a Department of Health report on moving the NHS forward with health IT adoption.

DeepMind’s first NHS health app faces more regulatory bumps

Google’s AI company DeepMind will suspend the use of an acute kidney injury detection app that it co-developed with the NHS until the software is approved by the UK’s medical device oversight regulatory agencies.

Arizona’s Pinal County Gains Health-Law Exchange Insurer

Blue Cross Blue Shield of Arizona has agreed to offer public exchange plans in Pinal County, which will prevent the county from being the first with no ACA plans available to its residents.

News 9/9/16

Top News

CMS offers providers four “pick your pace” MACRA/Quality Payment Program options for 2017:

1. Submit test data only, which avoids a negative payment adjustment.
2. Participate for part of the calendar year, which qualifies for a small positive payment adjustment.
3. Participate for the full calendar year, which qualifies for a modest positive payment adjustment.
4. Join an Advanced Alternative Payment Model, which qualifies for up to a 5 percent incentive payment.

The AMA has already issued a statement saying it “strongly applauds” the change.

Reader Comments

From Concerned Longtime Customer: “Re: Epic’s succession plan. I don’t see how Carl won’t succeed Judy. He’s who you go to with big problems and he and Judy have similar gravitas in communicating a future direction in an artful way. I had not considered the Sumit possibility, but I see a clear drop-off since he speaks in buzzwords and cliches about how things are going to be ‘cool,’ ‘awesome,’ and I think he even pulled out an ‘insanely great’ one time. He impressed me as someone trying to play the part of Steve Jobs who doesn’t have an authentic vision of his own that reflects our needs. I have concerns about how much longer Carl will last than Judy and hope very much that Epic’s bench is deeper than I’ve seen.”

From Hissing Viper: “Re: a new nurse poll. It finds that 92 percent are dissatisfied with EHRs.” It’s always a good idea to check sources when reading health IT articles written by freelance, newly graduated authors who also craft beauty and fashion pieces.

• It’s not a new poll. The information is from 2014 and has been amply reported previously.
• The site you cite (no pun intended) says the survey was performed by Adventist University of Health Sciences. That is incorrect — the school simply turned existing surveys into a dumbed-down infographic as a marketing piece for its RN-to-BSN program. Using an infographic as a news source is just ridiculous.
• The site takes 18 paragraphs to explain the infographic in failing to note the original survey source, which was Black Book.
• Black Book still sells the old report (and thus the methodology from which it was derived) for $3,495. The number of respondents is ample, but unstated is how those respondents were selected, the respondent demographics, and the exact wording of the poll (since wording has a huge affect on how respondents answer questions).

HIStalk Announcements and Requests

[Caution: geek alert]. Several readers reported that the main HIStalk page wasn’t displaying my most recent posts due to what appeared to be some sort of caching problem, which started happening all of a sudden even though I hadn’t changed anything. I spent a ton of time trying to figure it out, working with my web host, the virtual firewall company, and an offshore guy I hired for $30. Nobody could determine what was happening, although I could see “Cache-Control:max-age=172800” headers being generated by my server from somewhere. I finally lost patience and brute forced a fix by adding “ExpiresActive Off” to the .htaccess file. I don’t like adding fixes that I don’t fully understand to address a problem that I also don’t fully understand, but at least it seems to be working.

This week on HIStalk Practice: Sahali Health Clinic implements Kannact real-time blood glucose monitoring. Cross Country Healthcare expands Boca Raton headquarters. EyeCrave Optics rolls out virtual eye exams with help from Smart Vision Labs. MMC Anesthesia Group signs on with Zotec Partners. E-MDs joins CommonWell. MarijuanaDoctors.com launches telemedicine portal.

Webinars

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

View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

For-profit hospital operator HCA will acquire Mobile Heartbeat, whose clinical communications technologies it had previously piloted. The company will continue to operate as a wholly owned subsidiary of HCA.

Allscripts announces eRecruit, which connects Allscripts-using providers to ePatientFinder’s clinical trial patient recruitment service. 

In what surely must be one of the oddest acquisitions by a health IT company, health coaching chat vendor Grow Fit acquires nutritional beverage vendor Drink King (I’m not sure if the pun is intentional). Both companies are in India.

Online doctor advice vendor HealthTap expands to Great Britain.

Google acquires API vendor Apigee for $625 million in cash. One of the company’s customers is Walgreens, which uses Apigee’s technology for ordering photo prints and managing prescription refills and transfers. Other healthcare users are McKesson, Humana, and Kaiser Permanente.

Medical device manufacturer St. Jude Medical sues medical security vulnerability vendor MedSec and investment research firm Muddy Waters for share price manipulation. St. Jude says Muddy Waters conspired with MedSec to short-sell St. Jude’s shares before MedSec’s critical security report was published. St. Jude also says the vulnerability report is wrong because MedSec used poor testing methodology on outdated versions of its software.

Sales

In England, North West London Pathology Consortium signs a $19 million contract with Sunquest Europe for a hosted laboratory information system. The pathology operation is a shared service among several NHS trusts.

LA County Department of Health Services (CA) chooses Cerner’s HealthIntent for population health management.

Inova (VA) selects clinical decision support and analytics from Stanson Health to provide patient- and context-specific evidence-based recommendations at the point of care. 

Announcements and Implementations

Optimum Healthcare IT expands its Epic Community Connect practice and hires two executive directors to run it, Jon Straffon and Kelli Mangino from Cleveland Clinic.

Surescripts announces Medication History for Panel Management, which supports population health management by connecting health systems, ACOs, and analytics vendors to the medication data of 14 nationwide pharmacies.

Apple announces yet another annual round of marginally improved iPhones that will inexplicably create Apple Store lines of fanboys desperately seeking personal validation via loss of their headphone jack , the addition of waterproofing, and slightly less crappy cameras, none of which are compelling reasons to replace my iPhone 5. The company will also offer Pokemon Go for the Apple Watch, pairing a rapidly fading star with an already-faded one. The company once known for universe-denting innovation is now milking the cash cow via planned obsolescence and piling on pointless features hoping to entice overly loyal fans to ante up yet again in Apple’s form of hardware annual subscription pricing. The iPhone holds only 15 percent of the world smartphone market and these dull announcements aren’t likely to boost that number. Apple announced nothing for the ancient Mac product line. It sounds like the company is perfectly suited for its rumored entry into healthcare.

Cerner opens a clinic and health center for the 2,200 employees of its Bangalore, India campus, which technically gives the company its first Millennium client in that country.

Imprivata adds clinical speech recognition from Nuance’s Dragon Medical One to its Cortext secure communications platform.

Government and Politics

Blue Cross Blue Shield of Arizona steps in to offer an ACA insurance plan in Pinal County, AZ, saving the federal government the embarrassment of having one US county in which consumers have no Healthcare.gov coverage option. However, the insurer also warns that, as the only company offering plans in 13 of Arizona’s 15 counties, the government needs to stabilize the market. BCBS of Arizona has lost $185 million in the past two years selling ACA plans and isn’t thrilled about coming back to Pinal County. A study predicts that people in 31 percent of US counties will have only on ACA insurer to choose from, while another 31 percent will have only two.

The UK’s Department of Health publishes its IT advisory committee’s report on how to spend the $5.6 billion that has been earmarked for NHS digitization that the committee says should be complete by 2023. It attempts to answer the question of whether the UK has the money (especially after recently blowing $15 billion on the overly ambitious and mostly failed NPfIT project) with, “The one thing that NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.” Their report calls for the government to:

• Stage digitization efforts within trusts that are ready rather than trying to bring them all along at once.
• Expect the short-term return on investment to be in the form of safety and quality improvements rather than financial.
• Create and enforce national interoperability standards.
• Give patients full access to their electronic information, including clinician notes.
• Create a national chief clinical information officer (CCIO) position that will oversee the project and then appoint a clinician-informatician to serve as CCIO within each trust who will oversee at least five clinicians with advanced informatics training.

The UK’s report was written by UCSF professor, best-selling author, and medical malpractice insurance pitch man Bob Wachter, MD (asked by Secretary of State for Health Jeremy Hunt to chair the group) and his journalist wife. It not only reflects his personal feelings about US healthcare IT efforts, but also manages to promote his own book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.” His bio doesn’t list any informatics education, training, or job responsibilities, although he’s a paid board member of some health IT vendors. The committee’s participation was in the form of nine, two-hour teleconferences and a two-day meeting.

Privacy and Security

From DataBreaches.net:

• The information of 43,000 patients of Baltimore-based substance abuse treatment provider Man Alive is listed for sale on the Dark Web, stolen by a Russian hacker who sent an employee a phishing email containing a macro-loaded Word document. The hacker reports that he has already sold some of the information following the facility’s refusal to pay him $9,400. Interestingly, DataBreaches.net notified the FBI that the information was listed for sale and they declined to do anything, including letting the facility know.
• CHI Franciscan Health Highline Medical Center (WA) notifies 18,000 patients that their information was exposed in the same error by R-C Healthcare Management that affected 655,000 patients of Bon Secours Health System (VA). The difference in this case is that R-C Healthcare Management hadn’t performed any work for the hospital since 2014, so the information exposed was old cost-reporting data. R-C Healthcare Management misconfigured its network in April 2016, exposing the files it contained to the Internet.

Technology

An article in Nature reviews pharmacogenetics, the science of using a patient’s genetic profile to choose optimal drugs and doses. The article notes that only a handful of tests are being used and that the real value can be delivered only if patients are tested proactively instead of after they’ve had problems. Evidence from randomized clinical trials is not compelling, but advocates say the genetic tests are being held to an overly high standard.

Maritime connectivity vendor Marlink announces a telemedicine solution that includes a central unit, touch screen, HD camera, ECG monitor, blood pressure monitor, pulse oximeter, and several other optional medical sensors. The system provides 24/7 consultations with on-shore doctors and includes a secure web portal for patient medical information. The announcement notes that emergency ship re-routing for a medical emergency costs around $180,000, making the company’s fully managed telemedicine service cost effective. 

University of Washington researchers develop a smartphone app that can detect anemia by measuring blood color by shining the phone’s flash through the subject’s finger. Possibly aware that earning FDA approval is likely to be challenging, the researchers say the best use of HemaApp would be for screening before performing more expensive tests in “limited-resource environments,” i.e. not in the US.

Other

In England, Google-owned DeepMind Health halts use of its Streams kidney injury detection app pending its approval by the UK’s version of the FDA. That means the company and NHS were using the app on hospitalized patients as an unregistered medical device.

Epic petitions the US Supreme Court to weigh in on a lower court’s decision in May that the company cannot require employees to arbitrate employment disputes individually instead of by filing class action lawsuits.

UCSF will lay off 17 percent of its IT staff, blaming reduced hospital payments under the Affordable Care Act and the doubling of IT expenses from 3 percent of the operating budget to 6 percent in the past five years (they went live on Epic in June 2012). The laid-off employees will be expected to train their India-based replacements from University of California system contractor HCL.

A study in Health Affairs finds that while hospital charge masters were supposed to become obsolete with the implementation of DRGs in 1985, hospitals are still using them to increase revenue and to force insurance companies to include their facilities in their networks using the threat of high list prices if they don’t. The authors suggest that legislators require more markup transparency to protect patients who have zero negotiation power with hospitals when faced with excessive charges.

A Florida TV station covers the local hospital’s use of Natus Newborn Care’s Nicview, which allows parents of babies who are in the NICU to view streaming webcam video and nurse messages.

A woman bitten by a stray dog while traveling abroad is given the same rabies drug at four locations in three countries and is shocked by the price variation: $125 (Cambodia), $18.50 (Thailand), $5,255 (a US hospital, that required an ED visit), and $427 (a US medical group). Her travel insurance covered the cost, but her husband, a former CFO, said that of the four providers, only the US hospital sent a bill that was not itemized and was impossible to understand. Healthcare economist Uwe Reinhardt offered a comment for the article:

It’s obvious that our system is unlike any other health system. Other systems were set up to care for patients. Ours was set up by the providers — the hospitals and drug companies — for their own benefit.

The New York Times notes that it’s hard for any of us – including presidential candidates — to assemble our medical records from a lifetime of providers (some probably retired or dead) who used their individual paper or electronic systems. The exception was presidential candidate Senator John McCain, who was able to release his 1,000-page medical record only because it had been assembled for a military study in which he participated, but later he was treated at Mayo Clinic and his campaign had to postpone the release of his records because they couldn’t collect all his records from several Mayo doctors. The article puts forth an interesting alternative to assessing health via old records: have each candidate examined by an independent physician panel hired by the federal government.

Voluntary reports from Kentucky hospitals indicate that 15 people overdosed on heroin over the Labor Day weekend, with 12 of them dying. This follows reports of a mid-August weekend in nearby Huntington, WV, population less than 50,000, where 26 heroin overdoses were reported in just four hours, tying up every ambulance in the county.

Sponsor Updates

• InstaMed Senior Vice President of Product Management Jeff Lin will keynote the NTC Healthcare 2016 Symposium October 19 in Irving, TX.
• InterSystems will exhibit at the HIMSS-NCA monthly education meeting September 15 in Arlington, VA.
• LiveProcess will exhibit at Emergency Nursing 2016 September 14-17 in Los Angeles.
• Ability Network is named as one of the world’s top 100 private cloud companies.
• Access launches a newly redesigned website.
• Aprima recaps its first-half 2016 success.
• MedData will exhibit at the 2016 TAHFA & HFMA South Texas Fall Symposium September 11-13 in San Antonio.
• EMDs joins the CommonWell Health Alliance.
• BizTech Magazine features Navicure IT Director Donald Wilkins.
• Santa Rosa Consulting assists King’s Daughters Medical center (MS) with its migration to Meditech 6.15.
• Spok partners with Australia-based unified communication solutions integrator Progility Technologies.
• Meditech’s Catherine Campbell is elected quality measurements vice chair of the HIMSS EHRA.
• NTT Data Healthcare Technologies will host its annual client conference September 11-14 in Newport Beach, CA.
• NVoq will exhibit at the AAFP Family Medicine Experience Annual Meeting September 16-24 in Orlando.
• Obix Perinatal Data System will exhibit at the Summit of the Southeast September 14-15 in Nashville.
• Meditech posts a case study titled “Valley Hospital Identifies and Prevents Infections with Meditech Surveillance.”
• Experian Health will exhibit at HFMA Northern California September 15-16 in Concord.
• PatientMatters will exhibit at the Illinois Hospital Association Leadership Summit September 15-18 in Lombard.
• PatientPay will present at the 2016 Council for Entrepreneurial Development Tech Venture Conference September 13-14 in Raleigh, NC.
• The SSI Group will exhibit at the NTT Data Client Conference September 11-14 in Newport Beach, CA.
• Streamline Health will host its annual client conference September 11-13 in New York City.

Blog Posts

• Strategic Defense: Taking the ROI out of Cyber Crime (ID Experts)
• More EHR Disillusionment Data (PatientKeeper)
• 3 things you can do right now in Epic to kickstart your population health journey (Nordic)
• Impact Advisors Creates a Culture of Caring (Impact Advisors)
• 2016 SHSMD Connections: 4 Reasons I’m Excited (Influence Health)
• The Value of Becoming 1 in a Million – the Mental Health First Aid Movement (Netsmart)
• Hello, Canada! (NVoq)
• The Skeleton Key for Personalized Medicine (Orion Health)

Learn More

Frost & Sullivan calls Validic the de facto standard and industry leader in patient-generated health data interoperability. The company’s digital health platform connects providers, pharmaceutical companies, payers, wellness companies, and health IT vendors with data harvested from 300 in-home clinical devices, wearables, and consumer health apps. It reaches 223 million lives in 47 countries and delivers the insight needed to improve health outcomes, population health, care coordination, and patient engagement. Validic helps healthcare companies accelerate their strategic business initiatives. Learn more on the company’s website.

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 9/8/16

I recently received two pieces of paper correspondence from the Drug Enforcement Administration. In following up on them, I was surprised to find that the DEA had become a bit more tech savvy than some of the other federal agencies I interact with.

The first piece of mail addressed a then-upcoming change to its websites, requiring browsers to support a particular level of Transport Layer Security starting August 31. The letter also contained a helpful link to test your browser to see if it was compliant. I was most impressed that the DEA sent the letter more than four months prior to the requirement, which is refreshing considering the number of federal agencies that either don’t give adequate notice or continue changing the requirements down to the wire or after the bell. (MU or MACRA anyone?)

The second piece of correspondence was the renewal notice for my DEA registration, which is required to prescribe controlled substances. The letter stated that most people renewing online are able to complete the renewal within six minutes and print their new certificate immediately. I decided to time myself and am happy to report that as long as you have the required paperwork ready (including state license data and state controlled substance data) that you can definitely do it within six minutes. The only issue was that the receipt didn’t clearly show that I paid my $731, which I’ll need for tax purposes. I’m not about to try to hunt it down with them, so I’ll likely just attach my credit card bill to the sketchy receipt, earning me an eye-roll from my accountant but saving untold time.

Oregon Health & Science University has received a grant from the Office of the National Coordinator for Health IT (ONC) to offer a free course for informatics clinicians and professionals. Update in Health Information Technology: Healthcare Data Analytics will be offered in two-month blocks from October 2016 through May 2017. The course includes 14 modules that will take approximately 18 hours to complete and is offered online. Registration is open and took about a minute to complete. Topics include extracting and working with healthcare data, population health, identifying risk and segmenting populations, big data, interoperability, privacy/security, and natural language processing. It also provides the Maintenance of Certification credits that many of us need to keep our Clinical Informatics certifications.

My virtual inbox contained an update from CMS on their State Innovation Model (SIM). The goal of the SIM initiative, which started in 2013, was to support states in being “catalysts for healthcare transformation and the value of CMS’ collaboration with states.” The strategy is to change healthcare “to have a preponderance of payments to providers from all payers in the state be in value-based purchasing and/or alternative payment models.” States are encouraged to “use their policy and regulatory levers to accelerate” the change from volume to value. It went on to discuss the usual transformation strategies, such as moving primary care practices towards patient-centered models, integrating primary care with behavioral and social programs, community-based population health, and of course “payment reforms.”

I’ve been following many of these projects for years. They all use some combination of bonuses or penalties or regulations to try to drive behavior. They all seem to rely on the practice to figure out how to deliver, despite physicians not traditionally being trained in how to do these things or in how to really run a business. Many are based on payments related to a per-member, per-month calculation that changes as patients enter and leave the practice, which makes it difficult to adjust staffing. This in turn drives physicians to look at third-party firms who provide the services based on a PMPM calculation. Although this shields the physician from risk, it introduces outsiders into patient care, which may not be well-received by patients.

I had my own private practice for several years and wish CMS and other well-meaning organizations would talk more to actual in-the-trenches providers and less to academics and large institutions. Know what would have increased my propensity to perform care coordination? A grant to cover the salary of a care coordinator, not some shifting PMPM payment amount that came long after the fact. Not busy enough to justify a care coordinator for your solo practice? Set up practice-share arrangements between groups to cover the split FTEs. How about a public health nurse that can be embedded in community practices to address the complex psychosocial needs that many physicians don’t have time to address in a six-minute visit?

There has to be an answer other than, a) providers selling out to large medical groups or to hospital systems; b) providers retiring or leaving to do non-patient-facing work; or c) providers opting out of Medicare prior to the biggest boom in its utilization.

The SIM models look at “engaging and supporting providers that have not typically been connected to health IT” through required system implementation/data reporting, interoperability, and analytics. In Round 1 of the program, six states participated – Arkansas, Massachusetts, Maine, Minnesota, Oregon, and Vermont. Findings from Year 2 of the program include:

• Increase in Medicaid primary care provider participation in patient-centered home models (Arkansas)
• Alternative Payment Model participation approaching 50 percent of the state’s total population in Minnesota and Vermont
• Alternative Payment Model participation approaching 80 percent of Medicaid population in Oregon and Vermont

Multi-payer efforts have been used to address payment and delivery system reforms, but I wonder how much of the provider participation has been because providers actually want to participate and feel it’s in the best interests of the patients, or because of de facto coercion by payers and regulators? What do the actual quality numbers show? Is this truly improving care or just changing the cost of care? Do patients have greater access to providers who are adequately addressing their needs or just shuffling them through in order to meet the numbers?

The CMS blog cheerleads its way into saying it is “too early to attribute specific quantitative results directly to the SIM Initiative,” although overall states are reducing emergency department visits and inpatient readmissions through other models that pre-date SIM.

In the reality in which I practice, I still can’t see basic health information for patients who turn up at my urgent care except for pharmacy fill history, which we receive from a pharmacy benefit manager. This of course doesn’t help patients who pay cash for their medications or who are surviving on samples from their doctors’ offices. I practice in a major metropolitan area, for which there is no functional health information exchange and in which several major health system players compete to keep patients in network and have no incentive to share data. None of them are willing to partner with my practice (the largest urgent care provider around by volume) to share data or reduce costs.

Of the last 100 patients I saw, the vast majority of them had concerns that would have been best addressed by a primary care physician. Many patients didn’t have a PCP, and those who do reported access issues. We constantly trim our PCP referral list because physicians are closed to new patients. It drives me crazy that I’m personally contributing to the healthcare mess in my clinical practice while I work to clean it up in my informatics practice.

For the clinical informaticists out there, do you see the same kind of fractured healthcare continuum? Email me.

Email Dr. Jayne.

Morning Headlines 9/8/16

Q&A: ‘Always put the consumer and consumer protection first’

In a Modern Healthcare interview, outgoing National Coordinator for Health IT Karen DeSalvo, MD reflects on her time leading ONC, saying “We shifted focus away from the electronic health record and on to the data….The work we did to unlock that data is going to create unlimited opportunities for entrepreneurs and for consumers to have access to information.

Electronic health records ‘inflict enormous pain’ on doctors. It’ll take more than stopwatches to learn why

In a Stat News editorial, Athenahealth CEO Jonathan Bush reacts to the recent Annals of Internal Medicine study finding that physicians spend about half their work hours on EHRs. He divides blame for the state of physician dissatisfaction with health IT software between the ONC and EHR vendors, suggesting that the first unintentionally limits private sector innovation while the second fails to embrace modern user-centric design processes.

Percentage of Uninsured Historically Low

The percentage of uninsured US adults continues to drop, hitting 8.6 percent in 2016, down from 9.1 percent in 2015.

Startup CEOs and Investors: Bruce Brandes

Why Pokemon Go is More Important to the Future of Healthcare Than Your EMR
By Bruce Brandes (with Charlie Martin)

Over a year ago, I completed an HIStalk blog series entitled “All I Needed to Know to Disrupt Healthcare, I Learned from Seinfeld.” Now we have a new pop culture phenomenon from which our industry has much to learn.

At a recent conference, keynote speaker and legendary healthcare services entrepreneur Charlie Martin made the following proclamation to a ballroom full of healthcare IT leaders: “Pokemon Go has more to do with the future of healthcare than your EMR.” 

I’m pleased to collaborate with Charlie through this column to illuminate how a free gaming app will have more of an impact than the billions of dollars spent on an array of electronic medical record systems over the past couple of decades.

Who Cares About Your EMR?

When you are at home, do you celebrate your plumbing or electricity? Were the type of pipes or wires used in the house a factor in your decision to buy your house? Certainly being able to have light at the flip of a switch and taking a shower are foundational requirements in any home, expected to always work and not be the cause of problems. 

Similarly, the EMR is not a reason a patient selects a hospital or physician. Patients assume and expect you to give them the right drugs, monitor their lab tests, and perform clinical procedures according to best practices. Please keep your Epic go-live parties (and the disproportionate financial investment you’ve made) in perspective. 

Moreover, not only does a patient not care about which EMR you use, here’s another potentially shocking revelation. Apart from delivering a baby, no person ever really wants to be a patient in a hospital. The healthcare system of the future aligns incentives and engages people to be healthy and avoid the hospital if at all possible. 

That is where Pokemon Go becomes more meaningful than your EMR. As our industry clamors to advance initiatives such as population health, consumer engagement, and virtual care to move from a sick-care system to a health-care system, there is much to learn from the example set by Pokemon Go. 

What Pokemon Go Has Done in 30 Days that EMRs Couldn’t Do in 30 Years

• Attracts 21 million users and 4-5 million new downloads a day.
• Users spend an average of 45 minutes per day finding Pokemon (and get exercise by walking or running as a byproduct).
• Seven of 10 users who download the app return the next day.
• With a free application, Pokemon Go has generated $1.6 million in revenue per day.

Key Takeaways from Pokemon Go for Healthcare

Gamification and augmented reality drive real “meaningful use.” If Pokemon Go can get people moving worldwide in 30 days, just think about how we can extrapolate the platform from here. We are exponentially expanding the number of people who are exercising without realizing they are exercising. How can this concept be applied to drive healthier eating, medication compliance, and preventative screenings?

• No boundaries. Virtually every individual carries a powerful computer in their pocket in the form of a smartphone. Pokemon Go meets people where they are — in their home or office, on their schedule, and at their convenience.
• So simple your kid or your grandma can use it. No friction to drive viral use. No cost (freemium model to revenue). Very obvious to understand how to download and use. No implementation or training required. 
• Free. In order to get rapid adoption, do not create friction by charging users to engage. In addition to Pokemon Go, few people would have ever used applications such as Facebook, LinkedIn, TripAdvisor, Yelp, etc. had there been a cost to participate. That said, these companies have figured out how to subsequently monetize from third parties that derive benefit from the resulting widespread engagement of millions, without infringing on the value and trust experienced by all those free users.

There is a new wave of healthcare innovations which strive to incorporate the principles above into their new solutions. 

Among them, I’m sure you’ve noticed that Apple has set their sights squarely on impacting the healthcare industry. Healthcare has taken note of Silicon Valley’s track record of creating new businesses which have put many entrenched institutions out of business. Apple clearly appreciates the foundational value of the electronic medical record, but sees it as a commoditized base from which real value will be created. Apple CEO Tim Cook recently commented regarding its healthcare aspirations:

We’ve gotten into the health arena. We started looking at wellness. That took us to pulling a string to thinking about research. Pulling that string a little further took us to some patient care stuff. That pulled a string that’s taking us into some other stuff. When you look at most of the solutions — whether it’s devices or things coming up out of big pharma — first and foremost, they are done to get the reimbursement, not thinking about what helps the patient. If you don’t care about reimbursement, which we have the privilege of doing, that may even make the smartphone market look small.

What might he be referencing regarding thinking about what helps the patient?

Lead an active lifestyle. Eat natural, whole foods. Rest. Care for those in your community. These are many of the basic principles on which people have lived since the beginning to time, at least until recently. Proven choices that lead to health, enhanced and exacted by an explosion of promising digital health solutions, are perhaps our path back to the future of healthcare. 

Established healthcare organizations – providers, vendors and supportive third parties alike — need to think differently, collaborate in new ways, and be a meaningful part of embracing and accelerating innovation. Pokemon Go represents a step (or 10,000 steps per day) in the right direction.

Bruce Brandes is founder and CEO of Lucro. Charlie Martin is chairman of Martin Ventures. 

HIStalk Interviews Jeff Zucker, CEO, MyDirectives

Jeff Zucker is CEO and co-founder of MyDirectives of Richardson, TX.

Tell me about yourself and the company.

The company is formally known as ADVault. The AD stands for advance directive. We are singularly focused on the world of digital, emergency critical and advance care planning.

We started in 2007 and stayed in stealth mode for about five and a half years, doing a lot of research, development, and pilot testing inside hospitals and community centers and with off-the-street consumers to zero in on this fundamental challenge that’s existed for over 40 years – the desire for everyone to have an advance care plan when they need them and where doctors can find them.

We often put a lot of pressure on a very tense situation in emergency rooms by trying to get patients to create plans when it’s a little too late. That creates additional stress and strain on the patient, family, and care team that’s trying to serve them. We’re focused on giving consumers confidence that they can digitize their voice and have their advance care plan heard anywhere in the world, at any time.

While the healthcare world talks about patient-centered care, we say consumer-centered care because none of us really know when we’re going to become a patient. We want to live with confidence that, if and when we become a patient, our voice and plan can be found. That the medical teams will have some insight into our preferences, values, and care goals, and that that can contribute to a better medical experience that will value and honor the wishes of the consumer.

Our consumer-facing platform, MyDirectives.com, went live in 2012 and now has users in all 50 states and in over 30 countries just through word of mouth, the social media tree, and the health insurance and hospital ecosystem partners that have jumped on board since we started.

We went live a year ago with MyDirectives mobile, and that’s exclusively with the folks at Apple. We felt confident in the stability and the consistency of the Apple platform, and the fact that Apple let us give consumers confidence that, for example, in a cell phone environment, even if their phone was locked, they have the option to put some key information about their emergency care plan in front of the lock screen on their phone. Paramedics and ER doctors can push a button, communicate with your legal healthcare agents, and get access to your care plan. We have been very pleased with the early reaction from consumers to MyDirectives mobile.

How else have you marketed the service?

Our marketing is broad-based and multi-faceted. There’s no one way to communicate with every consumer, so we have to rely on consumers talking to other consumers. We have to rely on doctors and nurses. We use the hospital administrative ecosystem. We rely on health insurance plans to make it clear that the creation of an emergency critical advance care plan is a great way for the plan to help their beneficiaries’ voices be heard if there’s an emergency. Health plans are usually contacted by hospitals for insurance verification and it’s a great opportunity for the health plan to say, “Hey, Jeff has a plan. We suggest you go find it and use it.”

We have to bring in all the stakeholders in order to make a big change. Our view is that if this were an easy solution, it would have been done already. The problem is a 40-year-old problem. The first living will was created in 1969 and it’s been a social problem ever since. Because it’s been a problem for such a long time, it can’t be solved overnight. Our view is that we need all these stakeholders to spread the word. It’s the payers, the providers, the consumers themselves, and forward-thinking technology companies like Apple that are finding new ways to normalize a concept. We are very excited by the reaction, but recognize we have a long way to go.

How many users do you have?

The easy answer is we don’t have enough. There are 190 million people in America over the age of 18 and we want every one of them to have a plan and, more importantly, live with confidence that they won’t be a stranger if they have an accident sometime, somewhere. None of us know when we might have an accident, or where that accident will occur, and so it’s a very logical concept to say, “Responsible adults plan.” I don’t think when we went live that we expected the social tree to extend around the world as quickly as it did. We’ve tracked it and see friends and family signing up across the globe. The organic growth has been a great way for us to have a real world focus group, if you will.

How has the federal push towards greater patient engagement helped?

It’s an exciting time to be in the digital health space. We’re at the convergence of a consumer-driven digital world and a healthcare public policy world that’s forced into reform and innovation. We’re at the intersection of the two with a very important voice, the voice of the consumer.

Regardless of the administration in power, I think all of our elected leaders and the administration that supports them have realized that the more meaningful the healthcare experience, the better the outcome. The government has created some ways, some of them better than others, to try to encourage a very slow-moving industry to adopt innovative healthcare technology much more swiftly.

The federal government’s been great at pushing that. As with most things, the government responds to advances in the private sector, and then the private sector responds to advances in the legislative world. The combination, the iterative parallel processing of the two, is incredibly important and we’re very excited about what we’re seeing in 2016 and what we hope to see in the next few years. The Meaningful Use rules, specifically, have been very good at focusing attention and opening people’s minds to the fact that there might be a better way to do something.

How have providers reacted?

The providers that we have talked to, as you would expect, fall along a continuum. No one hospital moves in lockstep. They’re made up of great people with varied backgrounds. Some of them adopt innovation faster than others and so every organization has a challenge to move at a pace. The fact is that, because this is the only thing that we do as a company, we are crystal clear and incredibly focused on some very simple concepts. Every consumer deserves to live with confidence they can have their voice heard if they have an emergency, and most people don’t have a problem with that statement.

If you don’t have a problem with that statement, then the question becomes, how do you go about giving every consumer confidence that in your particular hospital, or the 15 million beneficiaries in your particular health insurance plan, or the 300,000 employees at your company that have self-funded insurance, how does your population live with confidence that they can get their voice heard?

We use technology to solve that problem. We don’t go into a room and force technology on people and say take it or leave it. We go into a room and explain that we have this human interest goal to enable people to live with confidence that they won’t be a stranger, to get rid of that fear that somehow they’re going to get sucked into a system and someone else is going to make decisions for them and they’re going to lose control in an emergency. We know that the number of people that are admitted into hospitals that have a degree of impairment in decision-making capabilities is significant. The inability to communicate or understand creates a situation where mistakes can be made, confusion can be had, and people aren’t on the same page. We know that’s not efficient. It’s also just not great outcomes.

How does your technology integrate with EHRs?

We have a variety of different integration protocols that a hospital can use to touch our database to find the digital care plan a person may have created in advance. If the person has created it, we digitally send a secure link that is populated into the EHR for that hospital.

There are a variety of integration paths that conform to global standards that hospitals can choose from. We don’t tell them what to do, obviously. We are ubiquitous. We don’t really care what EHR platform they’re on and we don’t care which integration method they use. We’re very intently focused in making sure that we don’t burden the EHR platforms. They’ve got way too many things to do as it is, so we take on that work for ourselves. We are the only MU-certified advance care planning module certified to be in an EHR.

Our singular goal is that hospitals have access to the plans created by consumers and that they open them, access them, and use them in a way that respects the preferences, values, and care goals of that consumer. If the person doesn’t have an advance care plan, then we offer hospitals the opportunity to use our system to help consumers create them. Instead of the labor-intensive process and the costly process of counseling and advising people on site in a stressful situation, we can email them or text them a link and they can create it at home. One of our advisors, former Senate majority leader Bill Frist, MD — who as a cardiologist has seen lots of trauma around the world — perhaps put it best when he said, “These issues are kitchen table issues more than they’re operating table issues.”

How does your technology stand up against the typical complaint about advance directives; i.e. that nobody in the hospital knows about them and the family doesn’t know where they’re kept?

Those complaints are real. The research on advance directives and the problems with advance directives have been very well documented and they’re multi-faceted. We’re very proud of the fact that the HIS world and the digital technology world has, in the case of emergency critical and advance care planning, allowed us to bring a solution to market that’s not just the digitization of a paper form. So much of the early wave of the Internet was, let’s just cut down the bricks and mortar and do online the stuff that we did and we’ll scale it faster. That wasn’t enough for us. The entire experience needed to be recreated. The entire context in which you asked it needed to be recreated. Our solution has innovation in not just technology, not just the clinical experience, not just in marketing, not just in the family experience, but in all those areas.

We recognize that people in the paper-based world have challenges with paper-based documents. We encourage them to try the digital experience, and if they think their paper-based document is better, keep it. We want everyone to live with confidence that their voice can be heard, so we’re thrilled if you’ve got a paper-based document that you love and can be easily accessed. We’ll even help you. You can attach it to a digital account in our system and we’ll do our best to help get that into the hands of the hospital if they need it.

We encourage you to try to answer our questions and personalize it with some video messages. It will help others know that it’s you that did it, that you were in your right mind and you weren’t under stress. That you were clearly acknowledging that these were your preferences, values, and goals of care, and these are the people that you want to speak for you. The digital world gives us time- and date-stamping opportunities and markers so that there’s no question of when you made your wishes known. It’s a much more clear and convincing process.

What will the next five years hold for the company?

In the near future, our strategy continues to be focused and simple — to make sure the technology we’ve already deployed is safe and secure, meeting or exceeding the expectations we’ve put on our hospital and consumer partners. We’re trying to raise the bar even more and excite the consumer marketplace with even more fun features that will give them the confidence that their emergency critical advance care plan is a thorough and accurate reflection of their preferences, values, and goals.

We work very hard to add hospitals and do that in conjunction with the HIEs, ACOs, and EHR platforms that serve them. We are aggressively working to integrate into the healthcare system so that providers can pull the plan if the consumer can’t push it.

With all of the innovation that’s happened in the last few years in healthcare as a whole, and the phenomenal success that cloud computing has brought to innovation in healthcare, it’s amazing to me to even start to think about what healthcare will look like three to five years from now. The cloud, for example, was around in a lot of industries before it hit healthcare. We’ve been at the forefront of the effort to try to push comfort in healthcare with cloud technology, especially with regard to its safety and security. There’s got to be efficacy around the information and the data that we share, and complete transparency to the consumer so that they know they’re in charge of their plan.

It’s important for us that the cloud continue to succeed and grow, and help normalize behavior in healthcare so that we don’t go through the expensive process of siloing data, replicating in hundreds of places the same information, which creates versioning problems, unnecessary paperwork and regulations, and wastes the time of doctors and nurses. We’re trying to make things easier and if we continue to focus on the fact that what we are doing helps ensure that a consumer’s voice can be heard if they have an emergency, then everything else becomes pretty clear.

Do you have any final thoughts?

We continue to challenge the leaders in healthcare that use the phrase “patient -entered healthcare” to back it up with the rules, regulations, policies, procedures, and workflows that reinforce that. It is fundamentally important that we practice what we preach. If we truly care about the voice of the consumer, then we have to do everything we possibly can to make sure that we’re hearing that voice, that we’re asking people to digitize that voice well in advance, because obviously the most chaotic part of the healthcare continuum is when you’re in an emergency situation where you probably can’t communicate.

Have we done anything in society to make sure that the Terri Schiavo situation can’t happen again? We don’t think society has done enough to make sure that experience doesn’t happen again. We can ensure that experience can’t happen again if we have confidence that every decision-making adult has created a plan, shared it, updated it, and verified it. We trust the medical community to take that information and create the treatment plans and protocols to meet those goals. The Terri Schiavo situation was terrible for everyone involved, but the only person who never had an opinion they could express about it was Terri herself. We’re not so focused on what her outcome was or wasn’t. We’re focused on the fact that she didn’t get her voice heard and it was her life.

Whether you have a car accident and you’re in the hospital for a couple of days and just want to go home sooner, or you’re in a chronic situation, or you’ve been recently diagnosed with something that’s incredibly serious, or you have an accident … we should not live in fear that somehow we’re going to lose control of our care.

Morning Headlines 9/7/16

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties

The Annals of Internal Medicine publishes a study measuring how outpatient physician’s use their time, finding that only 27 percent of a physician’s day is spent engaging with patients, while 49 percent of their time is spent in EHRs.

How Elizabeth Holmes’s House Of Cards Came Tumbling Down

Vanity Fair covers the rise of Elizabeth Holmes who, in the absence of working technology, raised $700 million in VC investments on the idea of revolutionizing healthcare, until Pulitzer Prize-winning journalist John Carreyrou dismantled the company’s false claims, resulting in the downfall of the business.

How the CIO of a $39 billion pharmaceutical company is quietly changing the tech-startup world

Merck CIO Clark Golestani discusses the need to reinvent a successful organization as a digital enterprise, and how he encourages his team to work with promising startups to deliver new technology faster.

SEC Form 8-K: McKesson Corporation

McKesson discloses in an SEC filling that the Department of Justice is investigating anti-trust concerns with its planned health IT divestment.

News 9/7/16

Top News

A  tiny AMA-sponsored time and motion study finds that ambulatory practice doctors spend almost twice as much time working on the EHR or performing other desk tasks than seeing patients, with the observed physicians spending only 27 percent of their available time in face-to-face contact with patients.

Physicians spent only around half of their exam room time directly interacting with the patients in front of them, with most of the rest consumed with EHR and desk work. The doctors studied also spent another 1-2 hours past their quitting time doing clerical catch-up.

It’s a very small study, both in numbers as well as the breadth of specialties, practice settings, and geographic areas that were observed. It also contains subjective interpretation of what constitutes non-patient time, in that doctors may be discussing health issues with patients or reviewing information on the screen while using the EHR since those activities are not necessarily mutually exclusive. It also doesn’t address the fact that EHR time may not necessarily be wasted depending on the situation, any more than arguing that radiologists spend too much time looking at PACS images or that anesthesiologists should pay more attention to patients and less to their monitors.

The study also does not compare the time doctors spend using paper charts or the benefits of EHRS while obviously trying to make the AMA’s point that EHRs – and not the healthcare system doctors created in voluntarily accepting checks from insurance companies and the federal government and thus being required to meet their documentation requirements – are responsible for their unhappiness and lack of productivity. I don’t like the tax system, but I don’t blame TurboTax.

An accompanying Annals of Internal Medicine editorial touts the AMA’s STEPS Forward program and concludes, “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the healthcare system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”

Reader Comments

From Voice of Reason: “Re: Epic’s succession plan. As a former Epic employee, the whispers I heard during my time there was that Sumit Rana was going to take over as the next CEO once Judy steps down. The recent piece on HIStalk on Epic’s board of directors corroborates this – he and Stirling are the only two members other than Judy/Carl that work at Epic. Ultimately, I think Sumit will get the nod over Stirling since Sumit has much more visibility within the company and he is a developer whereas Stirling is a TS – there’s an unwritten rule that people defer to developers within the company.” Sumit went to work for Epic in 1998 immediately after he graduated from Delhi College of Engineering and has worked his way up to SVP. Note: I don’t usually correct reader comments, but as other readers have noted and his LinkedIn profile clearly states, Stirling Martin’s background is as a developer (going back to June 1997) and he has never been a TS.

From Former Epic: “Re: Epic’s succession plan. Unless things have changed since I worked there (about three years ago), Judy is very tight-lipped about how things will work after she’s gone. She addressed it once to my knowledge, and all she said was ‘There’s a plan in place.’ As far as the qualifications of her children to run the company, Judy herself wasn’t necessarily qualified back in 1979, so I don’t see that stopping them. At this point, I think Carl Dvorak is the real brains of the operation.” The challenge might be that while the second generation of family business owners usually are much more trustworthy than the third generation, there’s still the issue of mixing founder offspring and business, especially when company ownership is turned over to a foundation. On the other hand, Judy has shown remarkable talent and focus in taking Epic where it is today, so I’m sure she is not oblivious to the challenges and will make every effort to mitigate any threat to the company’s current state. A success story to be emulated is S.C. Johnson & Son, the cleaning supply company (also based in Wisconsin) that’s in its fifth generation of family ownership and leadership with 12,000 employees and $7.5 billion in sales.

From Super Bill: “Re: Epic. Suing one of its customers. Perhaps they don’t want anyone to know how Epic forces smaller regional hospitals and independent practices to enter into agreements with larger players to help with interoperability issues. See this filing.” Epic attempts to block University of Iowa Hospitals and Clinics from complying with an open records request from an unidentified individual who seeks information about services provided by KLAS. An Epic employee sent the health system a KLAS report covering EpicConnect and included attachments that Epic doesn’t want released. Epic argues that the attachments are not public record and are proprietary. I can say from first-hand experience that Epic fights tooth and nail any attempt to obtain contract records from tax-supported organizations that are required by law to provide them to anyone who asks, apparently requiring in their sales contract that the health system send such requests to Epic’s team of lawyers that will use every available company resource to keep the information private in the ultimate form of information blocking.

From What Would HIPAA Do?: “Re: security. I work for a vendor and one of our practices is being forced our EHR after joining a local healthcare system. The new vendor gave us access to an SFTP site to transfer the practice’s data. When we logged in, we could see the data from another 4-5 practices sitting there in plain view. We reported this to the vendor and they said they aren’t worried since they only give the log-in to people they know. Should we report this or formalize our complaint to the vendor? Are we overthinking this?” I’ll invite readers to respond. Personally, I would let your customer know and let them decide how to proceed since any complaint directly from you as a competitor would look like sour grapes, not to mention that there’s no upside to your involvement. It’s always touchy to report a potential security issue that (a) does not and could not affect you; (b) is purely theoretical; and (c) risks having the insecure (pun intended) vendor file an FTC or other form of complaint claiming that you illegally accessed the information of their clients, hoping to deflect the potential damage to the messenger as has been done in several recent health IT examples.

From Will Eye Am: “Re: the magazine that always features men on the cover. Why would you question their choice of featured subject if it’s mostly men in CIO roles?” Mostly because the magazine is produced by an India-based company, and in my admittedly limited experience, it’s more culturally acceptable there than here to treat women as less than equals. Perhaps I’m jaded by my first hospital job in a rural, for-profit hospital that was a veritable Statue of Liberty for the unskilled medical huddled masses yearning to bill Medicare, where our multicultural medical staff insisted (and hospital policy mandated) that female nurses hug the hallway walls with eyes reverentially downturned as they passed. Companies can do whatever they want, but as such shouldn’t be insulted if I report the percentage of non-white men on the boards or leadership teams or, in this case, note that the magazine can’t seem to find anyone other than white men for its covers.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

3M acquires Switzerland-based semantic coding vendor Semfinder.

McKesson discloses in an SEC filing that the Department of Justice has requested information about its previously announced divestiture of its IT business to a new entity created in a venture with Change Healthcare. DOJ is reviewing the proposed plan for any antitrust concerns.

In Scotland, Craneware reports an 11 percent increase in first-half revenue to $67 million, with pre-tax profit of $19 million.

CompuGroup Medical acquires Italy-based pharmacy software vendor Vega Informatica e Farmacia S.r.l.

Vanity Fair runs a fascinating summary of the Theranos debacle and CEO Elizabeth Holmes that includes interesting observations:

• Holmes mimicked Apple to the point of wearing Steve Job-like black turtlenecks, forbidding company teams from communicating with each other about their projects, and emphasizing the company’s “story” instead of its actual technology.
• The Wall Street Journal reporter who broke the story was surprised that Holmes, who micromanaged every company decision, could not explain how its technology worked.
• Company insiders urged Holmes to rebut the damaging initial WSJ report by enlisting scientists to endorse the company’s work, but that wasn’t possible because Holmes hadn’t allowed scientists to publish peer-reviewed papers about it.
• The company’s chief scientist could not make the product work even as Holmes touted it to a widening audience, leading to his 2013 suicide.The company’s response upon being told that he had died was to demand that his widow return the company’s confidential information and later to threaten to sue her for talking to reporters.

The author summarizes the Silicon Valley mentality that created Theranos as:

The venture capitalists (who are mostly white men) don’t really know what they’re doing with any certainty—it’s impossible, after all, to truly predict the next big thing—so they bet a little bit on every company that they can with the hope that one of them hits it big. The entrepreneurs (also mostly white men) often work on a lot of meaningless stuff … [they] generally glorify their efforts by saying that their innovation could change the world, which tends to appease the venture capitalists because they can also pretend they’re not there only to make money. And this also help seduce the tech press (also largely comprised of white men), which is often ready to play a game of access in exchange for a few more page views … In the end, it isn’t in anyone’s interest to call bullshit.

People

Culbert Healthcare Solutions hires Nancy Gagliano, MD, MBA (CVS Health) as chief medical officer.

Announcements and Implementations

Uniphy Health announces GA of its Sentinel sepsis alerting platform.

MedStar Health (MD) delivers patient education delivered using the technology platform of local startup Mytonomy.

Privacy and Security

In Scotland, an environmental activist sues Donald Trump’s Aberdeen golf course, charging its employees with violating the Data Protection Act by using their phones to film her peeing behind a dune on the course. The course admits that it did not register with the data protection regulator despite running at least nine security cameras that were recording guests who weren’t warned that they were being filmed, but says that’s irrelevant because those weren’t the cameras used to record the alfresco urination.

Technology

Microsoft, which decided against offering $8 billion for team communications app Slack, is reportedly working on a similar Skype product called Teams, which will offer chat room-like channels, private direct messaging, and Facebook-like threaded conversations.

Other

Franciscan Alliance will rename the 13 of its 14 hospitals that are named after saints to new names that reflect “Franciscan Health” plus their city name, effective next week.

Business Insider profiles the CIO of drugmaker Merck, who believes that companies must undertake digital transformation or die. The CIO says it’s a change in operation that doesn’t necessarily increase IT spending. Merck gets its CIO involved with technology VCs to get early access to startups, encourages its IT employees to find interesting startups and work with them on technology, and allows its developers to create software and sometimes helps them turn it into a startup.

A study finds that the US has the second-highest maternal mortality ratio among 31 developed countries, with Texas recording alarmingly high numbers of women who die during and after pregnancies mostly due to state government decisions about healthcare funding and access.

ED doctors treating an Arizona man‘s small facial cut are shocked to find that it’s the entry wound for a four-inch piece of a broken chopstick lodged deep in his brain. The man reported that he had grabbed his brother from behind in a Chinese restaurant and his brother stabbed him with the chopstick over his shoulder. He’s OK. Googling  turns up other examples of chopstick-related violence, such as a prisoner who killed himself by stabbing himself with a chopstick and a more recent example in which a man confessed to killing his elderly father during an argument by stabbing him in the throat with the wooden utensil. The National Chopstick Association has not yet invoked the “chopsticks don’t kill people” argument.

Sponsor Updates

• PatientPay will present at the CED Tech Venture Conference next week in Raleigh, NC.
• Aprima will exhibit at the Arizona State Physicians Association meeting September 15-17 in Scottsdale.
• Audacious Inquiry Senior Manager King Yip is named a finalist in ONC’s Blockchain in Healthcare Challenge.
• Bernoulli Health pledges to share its data as part of the Patient Safety Movement.
• Besler Consulting releases a new podcast, “Live from HFMA Region 3.”
• Boston Software Systems releases a new podcast, “Improving Clinical Workflow at Patient Discharge.”
• CoverMyMeds will exhibit at the American Society for Pain Management Nursing Annual Conference September 7-10 in Louisville, KY.
• Cumberland Consulting Group will exhibit at the Healthcare Executive Group Annual Forum September 12-14 in New York City.
• Elsevier Clinical Solutions will exhibit at the Emergency Nursing Association annual conference September 14-17 in Los Angeles.
• EClinicalWorks will exhibit at International Vision Expo West September 15-17 in Las Vegas.

Blog Posts

• The 2016 Aprima User Conference: Another Great Meeting in the Books! (Aprima)
• Take Full Advantage of EPCS (AdvancedMD)
• Why do Healthcare Information Systems Account for $40+ Billion? (Catalyze)
• Sometimes, You Can’t Take “No” for an Answer (CareSync)
• How Does Your Data Grow? (Spok)
• From Clinician to Consultant: A Different Way to Care for Patients (ECG Management Consultants)
• Reducing Patient Fall Risks with Comprehensive Bed Exit Alarms (Extension Healthcare)
• Top 5 HIE Participant Onboarding Considerations (Galen Healthcare Solutions)
• The Importance of Optimizing Operational Business Processes (Hayes Management Consulting)
• 8 Strategies for an Effective EMR Go-Live (The HCI Group)

Contacts

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

Morning Headlines 9/6/16

Medlio Wins Allscripts Open API Patient Engagement Challenge

Allscripts names digital health startup Medlio the winner of its patient engagement FHIR API contest. Medlio is building an app that “enables users to check insurance benefits, such as status and deductible accumulators, in real-time.”

Epic and Cerner link information exchanges

In England, West Suffolk NHS Foundation Trust will interface its Cerner system with Cambridge University Hospital’s Epic system to being exchanging patient data across different EHRs, a first in the UK.

Demonstrating the relationships of length of stay, cost and clinical outcomes in a simulated NICU

Researchers investigate the relationship between length of stay, cost, and clinical outcomes in a simulated NICU environment, concluding that “reducing LOS does not uniformly reduce hospital resource utilization.”

CMS starts search for HealthCare.gov eligibility vendor

CMS is searching for a small business that has the capabilities to help manage back-end eligibility and support for people who buy plans through Healthcare.gov.

Morning Headlines 9/5/16

Apple will now start screening medical and health apps more closely

Apple updates its App Store Review Guidelines with new, more stringent language that confirms the company will begin scrutinizing apps that offer inaccurate medical advice or diagnostic tools.

EDPA names 2016 Alabama Innovation Awards winners at state conference

The Economic Development Partnership of Alabama names Birmingham-based digital health startup IllumiCare as its Innovator of the Year for developing an EHR hover bar that gives physicians real-time, patient-specific risk and cost data.

Computer hackers demanded ransom payment from Derriford Hospital

In England, Plymouth Hospitals NHS Trust’s Derriford Hospital is hit with ransomware.

Monday Morning Update 9/5/16

Top News

Apple cracks down on questionable health app vendors in tightening its App Store Review Guidelines, saying it will increase its scrutiny of apps that provide inaccurate data, will ban marijuana-related apps and sleep apps that require placing the iPhone under a pillow, and will accept drug dose calculation apps only from approved healthcare entities.

Apple also announces that it will start removing outdated and technically obsolete apps from the App Store prior to the rollout of iOS10 this fall.

Reader Comments

From Mayor McCheese: “Re: Healthcare Tech Outlook. That publication in India that misspelled HIPAA last year is at it again. Our company got the same email saying we’ve been shortlisted to be in the Top 10 list and can be included in their publication for $3,000.” The magazine contains CIO-written vanity pieces, fluff articles that confuse health IT and healthcare technology, and vendor pitches that sometimes misspell the paying company’s name (examples above) and mangle the English language in amusing ways. The magazine, along with CIOReview and others, is published by SiliconIndia, an India-based professional networking site. CIOs must be desperate for an ego stroke to have their work featured there. I also note that  the covers of 17 of the previous 18 magazine issues prominently feature a male subject. The one that highlights a female also includes an inset photo of a male who appears to be peering over her shoulder, the only time they’ve used a second photo on the cover.

From Chiari Malformation: “Re: Epic. Anyone know how Epic will be run post-Judy? She funds a lot of charities that seem to be run by her kids that don’t seem to have significant assets or Epic shares yet. How will these foundations control Epic’s stock to keep the company private? If her kids will be the controlling shareholders, are they qualified to lead the largest medical records company in the country? Maybe this is an academic discussion since there’s no evidence that Judy has followed through on her much-ballyhooed pledge to give away 99 percent of her wealth.”

From Zipty Dudah: “Re: ONC High-Impact Pilot grants. We didn’t hear anything by August 29 notice date. Anybody else?” ONC announced in May that it would fund 3-7 interoperability-related High-Impact Pilots and announce the winners August 29.

From The PACS Designer: “Re: ICD-10 on FHIR. With the coming addition of ICD-10 Procedure Codes to daily clinical use, the next major change to be looking for is the Fast Healthcare Interoperability Resources (FHIR) release. With ICD-10 on FHIR (pun intended) being an upgrade for HL7, we’ll have the opportunity to raise the efficiency level of healthcare practices to a much higher level.”

HIStalk Announcements and Requests

Insurance companies are the #1 bad guy when it comes to high healthcare costs, according to responses to my poll, with providers and patients earning little of the blame.

• Ashter calls for cost controls like most other countries have since taxpayers are paying for the majority of care.
• Cynic says the only answer is a rational single payer system that has no chance of being implemented.
• Furydelabongo says he’s most responsible because he expects medical miracles to protect him from his irrational behavior.
• Frank says we’re unwilling to do as other countries have done in answering the question of “what price life?”
• Observer says only insurance companies have seen little fluctuation in their profits because they keep adding profitable products and abandoning unprofitable ones. He has worked in the insurance business and says companies care only about signing up big employers with zero regard for the members as customers.
• Lee says insurance companies just pay claims that are driven by an electively unhealthy population while delivering margins much lower than those of drug and device companies.

New poll to your right or here: Which organization provided the poorest customer service in your recent personal experience? Mine is a new PCP who I haven’t even seen yet. It’s a one-doc practice and it took forever to get an appointment; I showed up and filled out a mountain of paperwork only to be told by the front desk people that the doctor was out for the day and they should have let me know before I drove in. I came back a week later to see the NP (the only rescheduled appointment I could get) and they had lost the mountain of completed paperwork and I had to scale it again. Maybe worst of all I found out later that the awful front office people weren’t even relaying my questions or needs to the doctor when I called. The doc said later that her office people – all young, inexperienced, and unmotivated — are terrible and that I should call just after the 5:00 closing time and she would pick up directly, neatly dodging the question of why she hires and keeps employees who she knows are incompetent and thus puts the burden on me to avoid dealing with them.

This is the last day of my Summer Doldrums Webinar Special, for companies interested in doing a webinar. It’s also HIStalk Pledge Week for new sponsors and they get a deal, too. Contact Lorre.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Last Week’s Most Interesting News

• The Department of Defense announces an unspecified delay for its first Cerner go-lives that were scheduled for December 2016.
• Athenahealth acquires Patient IO.
• ONC announces 15 white paper winners of its Blockchain Challenge.
• ProMedica and MD Anderson attribute their poor financial performance to the cost of implementing Epic.
• Medscape’s physician EHR survey provides good news to Epic and VistA, bad to NextGen and those who think EHRs boost efficiency.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Consulting firm Health Data Specialists buys a stake in IT staffing and consulting firm Realistic Resources.

Medical imaging cloud vendor DICOM Grid renames itself to Ambra.

Privacy and Security

In England, Derriford Hospital is hit with ransomware. The local newspaper notes that 28 NHS trusts have seen ransomware infections.

A hospital employee using a pregnancy tracking app receives a company’s congratulatory card and baby formula samples right before her due date even though she had miscarried months earlier. The app vendor had sold her data to a company that apparently did not notice that she had updated her status as “miscarried.”

Innovation and Research

IllumiCare wins an Alabama innovation award for its EHR-hovering Smart Ribbon that displays real-time analytics information. It requires no EHR integration and costs $10 per admission for the Pro package that covers observation status, medications, labs, radiation, and cost.

Other

Executives of drugmaker Mylan – which raised the price of EpiPens 15 times over seven years in a 400 percent increase — will earn $77 million in bonuses if they hit share price targets. CEO Heather Bresch, best known before the EpiPen price scandal as the daughter of West Virginia’s then-governor (now senator) who was given an unearned MBA from West Virginia University (later rescinded, after which most of the politically appointed WVU administrators were fired), could see her compensation jump from $13 million to $28 million under the pay-for-performance program that provides ample incentives for robbing patients.

Odd: 40 middle school students are treated and five are hospitalized after eating ghost peppers at lunch on a dare from a classmate who brought them in. “It was really hot. We drank like 10 cartons of milk,” reports one capsaicinized lad, while another had trouble seeing and two vomited up their high-Scoville fruits.

Also odd in an “only in America” sort of way: a man shoots himself in the hand in the dentist’s chair when, under the influence of a nitrous oxide high while getting a filling, he thinks he hears his phone ringing in his pocket but instead whips out his loaded pistol.

Vince and Elise continue their “Rating the Ratings” series with Part 5, which describes the results of my reader survey. I’ll flag their summary with an asterisk in the interests of transparency, however, in noting (as I would hope the ratings firms would do with their surveys) that the sample size was small (74 responses); respondents were self-selected and not validated statistically as being representative; and while I assume the responses were honest, they might not necessarily be correct as evidenced by a couple of comments where the respondent’s memory about specific details might have been fuzzy.

Sponsor Updates

• TeleTracking partners with The DAISY Foundation to establish The DAISY Award for Extraordinary Nurses in Patient Flow.
• Valence Health will exhibit at the 2016 Accountable Care & HIT Strategies Summit September 8-9 in Chicago.
• ZirMed will exhibit at CASA 2016 September 7-9 in Carlsbad, CA.

Blog Posts

• Disaster Recovery, Business Continuity and Hurricane Season – Part II (TierPoint)
• Best Practices to Drive HEDIS Success in 2017 (Verscend)
• Clearing roadblocks for our Health Unit Coordinators. (Voalte)

Contacts

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

Morning Headlines 9/2/16

Technical problems delay rollout of DoD’s electronic health record

The DoD will delay the go-live of its first Cerner implementations, noting that the current schedule may not be realistic. A new go-live schedule will be published within the next 30 days.

Insurers Move to Limit Options in Health-Care Exchange Plans

A McKinsey analysis of the insurance plans that will be available in 2017 across 18 states finds that 75 percent will likely be HMOs or similar plans with narrow provider networks.

King’s College Hospital launches Allscripts Sunrise

In England, 950-bed King’s College Hospital goes live on Allscripts Sunrise.

UK: Data security incident trends

An analysis of data security breaches in the UK finds that the health sector generates the greatest number of breaches.

Workplace Wellness Programs Are a Sham

A Slate article arguing against employee-sponsored wellness programs reports that they “promote medical tests of dubious value, encourage unnecessary doctor visits, and collect sensitive health information despite often extremely lax privacy policies, with little to no evidence that they improve health outcomes.”

News 9/2/16

Top News

The Department of Defense will push back the first go-lives of its MHS Genesis EHR project, according to a reader-forwarded announcement from Thursday. The DHMSM project management office declined to give specific dates, saying only that initial rollouts will be moved back “a few months” and that it will issue a new schedule within 30 days.

DoD had originally announced deployment of the Cerner system to sites in the Pacific Northwest beginning in December 2016. It reiterated that the original schedule was “aggressive, but achievable” in early August 2016 despite a May 31, 2016 DoD OIG report warning that the date “may not be realistic for meeting the required initial operational capability data of December 2016.”

The military is already taking longer and spending more than it expected long before the first go-live. The project awarded Cerner a no-bid, $74 million hosting add-on contract in July, far above DoD’s original self-hosted cost estimate of $50 million over 10 years. DoD said at that time that the extra spending would not raise the project ceiling.

A consortium led by Leidos won the $4.3 billion project bid in July 2015. Leidos and its spinoff SAIC have been paid billions to develop and maintain the DoD’s current EHR, AHLTA. Some experts estimate the total taxpayer cost for AHLTA — which was just voted in a physician survey as the worst available EHR –  could be as much as $20 billion.

Reader Comments

From Sturges: “Re: Epic. A big pro for public vs. private companies is transparency. John Touissaint at ThedaCare publishes all the time, but never mentions that he’s on Epic’s board. The boards of both Epic and Meditech will be a big deal in the coming years, particularly in terms of succession planning and how Epic will operate as a foundation once Judy turns it over as a charitable donation.” I edited Epic’s board and director list in the corporate document above to remove addresses since some of them are of private homes (including the shockingly modest residence of Judy Faulkner). John Toussaint is a former CEO of Epic customer ThedaCare (WI) and is CEO of the ThedaCare Center for Healthcare Value. The board members who aren’t Epic employees as far as I can tell from their names alone (which is all that’s on the state filing) are:

• Roger Hauck. I assume it’s the one who’s on UW Medical Foundation’s board.
• Leonard Mattioli. There’s an owner of a closed chain of Wisconsin appliance stores with that name.
• Nicholas Seay, VP/CTO of Cellular Dynamics.
• Paul Kundert, president and CEO of the UW Credit Union.

From MT Hammer: “Re: Nuance Transcription Services. Laying off all its California-based employees as of September 30. The layoffs will apparently include both transcriptionists and supervisory staff. Affected employees were informed via conference call on Wednesday, August 31.” Unverified, but discussion abounds on the MTStars message board, where posters suspect that their jobs are being offshored to India. That shouldn’t be surprising given the company’s announcement in January 2016 that it would hire 3,000 transcriptionists in five cities in India, hoping to achieve a 50 percent transcription growth rate there given the inherent time zone and cost advantages. It may not have helped that California is rapidly increasing its minimum wage to $15 per hour by 2022, which is more than at least some transcriptionists are paid as hourly employees.

From Mr. Porky: “Re: Kaiser Southern California. Its Cerner Millennium lab system was down most of Monday and Tuesday due to a server issue.” Unverified.

From Unfortunately Informed: “Re: [vendor name removed]. Their chief growth officer is about to be booted after a short stint following a mass exodus of the sales team and pending lawsuits of harassment.” Unverified. I’ve omitted the company name for obvious reasons, but we’ll see if an announcement is forthcoming.

From Victor Victuals: “Re: the upcoming OCR/NIST HIPAA security conference. Attendees can add lunch and refreshments to their registration fee for $306. The latest GSA for Meals and Incidentals is $69. Wonder what kind of lunch and refreshments they’re providing at that price?” It’s a really bad deal when you look at the registration page to see what’s included – just two continental breakfasts, two buffet lunches, and one afternoon break. The overpriced hotel restaurant (was that redundant?) has a bakery basket or fruit plate for around $10 and lunch items (even steak) for around $20, which would total maybe $60. Perhaps this is a social engineering experiment where NIST wants to see whether attendees will fall for an obvious, phishing-like ruse. I’m trying not to preach about their use of “EST” instead of the correct “EDT.”

From Kitty Has KLAS: “Re: KLAS. Vince is incorrect in saying that KLAS requires vendors to pay. They don’t – they only have to provide a customer list. However, if they want to review the report ahead of time or publicize their rating, they have to pay. KLAS also offers billable consulting services, where they tell vendors where to improve based on the feedback from their customers.”

From Skitch: “Re: KLAS. They’re the Consumer Reports of healthcare IT. Enough said.” No, they aren’t, and they don’t claim to be. Consumer Reports is a publication whose paying customers are readers, not vendors, and trying to assess the quality of a dishwasher is a lot different than rating hospital software based on a few customer reports. Both organizations rate products, but Consumer Reports:

• Is published by an independent, non-profit consumer advocacy group.
• Does not accept advertising or any form of payment from vendors.
• Does not allow vendor involvement in testing products or obtaining customer feedback.
• Performs product testing in its own labs.
• Does not sell consulting services, customized reports, or anything else to vendors and investors in keeping arm’s length from them to maintain objectivity and transparency.
• Does not allow vendors to publicize the rankings they receive.

From Good4U: “Re: patient advocates. Is inviting them to industry meetings the best way to improve the healthcare system?” I don’t think so since there’s no scale or consumer push involved. I would rather invest the time and money to mobilize consumers to understand their rights, instruct them on how to protect themselves or their loved ones as patients, and give them resources to contact when they need help with medical decisions they don’t fully understand. It would be a nice tribute to Jess Jacobs to develop an educational program to help others navigate the indifferent, inefficient, and sometimes life-threatening healthcare quagmire she found herself immersed in since every one of us will face it eventually despite what we know as insiders. We may happily work in hospitals, but deep down we all know that one of the most dangerous places in the world is a hospital bed.

From Spastic Colon: “Re: [publication name omitted]. Check out their top stories.” I get tired of being asked to analyze what other sites run as news since I don’t really care and I don’t read them anyway, so I’ll answer just one last time. The site has 11 “latest news” stories on their home page. None of them contain any actual reporting – they are simply re-worded material they found on other sites (not always credited) in padding out uninteresting items to 10 or more paragraphs. I had already declined to cover nine of their 11 items that I felt weren’t worth the time of HIStalk readers. Of the 11 news items:

• Six are re-worded press releases, two of which have zero to do with health IT.
• Two summarize journal articles, while another re-words a TV station’s story.
• One is a sponsor advertisement.
• One is a slideshow of old news.

HIStalk Announcements and Requests

Grammar gripe: beginning a sentence with the word “there.” It’s easy to instead word the sentence with the usual subject followed by a verb. Instead of “There are many articles covering population health management,” write, “Many articles cover population health management.” Try to determine the subject and verb of each of those sentences and you’ll see the problem with the former. I also continue to be annoyed by listing a physician as “Dr. John Smith, MD” or simply as “Dr. John Smith.” In my experience, the former is usually written by a third-party person of cluelessness or an arrogant doctor determine to shove his or her title down one’s throat twice, while the latter is often employed by those who are at least slightly and illogically embarrassed that they hold non-MD medically-related practicing doctorates such as DNP, DO, DC, MBBS, DPM, DPT, DAUD, or PharmD.

We run a back-to-school type new sponsor special every Labor Day as the industry picks back up, giving new companies extra months for free. Contact Lorre. We’ve had quite a few sign up lately, wisely avoiding the pre-HIMSS rush period that sometimes stymies procrastinators.

This week on HIStalk Practice: NorthStar Anesthesia deploys Plexus Technology Group’s anesthesia EHR. Pennsylvania goes live with ABC MAP PDMP. AMA adds population health data to its workforce mapping tool. Senator Gary Peters includes a telemedicine stop on his statewide motorcycle tour. HHS announces $53 million in funding to help states combat opioid abuse. Falcon Physician adds charting capabilities to its EHR for nephrologists.

This week on HIStalk Connect: DoseMe, Health2Sync raise new funding rounds. NIMA develops gluten-testing tech. Access announces new partnerships. Elementary school student prints prosthetic hand for teacher. My Health Guide App produces new case-study video.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Theranos withdraws its request for fast-track approval of its Zika-virus blood test after the FDA finds that the company’s trials in the Dominican Republic were not overseen by an institutional review board. CEO Elizabeth Holmes used her August 1 stage time at the AACC conference to pitch the test and a new lab analysis machine, neither of which have passed FDA muster to reach the market.

Sales

Sharp HealthCare (CA) will implement Cerner PowerChart Ambulatory for one of its two medical groups, integrated with its inpatient Millennium system.

People

University of Rochester Medical Center (NY) hires Tom Barnett (NorthShore University HealthSystem) as CIO.

Announcements and Implementations

Philips and Qualcomm will use each other’s technologies to offer personalized connected care solutions involving home medical devices.

In England, King’s College Hospital goes live with Allscripts Sunrise.

Government and Politics

A McKinsey analysis of proposed ACA-sold insurance plans for 2017 finds that three-fourths of them will be of the higher-profit HMO type with a narrow network (often just a single hospital system and its affiliated doctors), while only one-fourth will be PPO type plans with broader coverage.

Privacy and Security

From DataBreaches.net:

• Information from ambient light sensors used to adjust smartphone and laptop screen brightness to any website that uses a new API, meaning a website or hacker could use the information to identify a specific user or determine information about their home. I didn’t realize that some retailers adjust their prices based on the user’s device, charging iPhone users more than those shopping with an inexpensive Chromebook.
• In the UK, healthcare represents by far the greatest number of Q1 data breaches, although most of the incidents involved paper rather than electronic information.
• Also in the UK, Wythenshawe Hospital launches an internal investigation into the journal report of “bagpiper lung” cited by Weird News Andy. The deceased patient’s daughter wasn’t told why he died – she learned it only because the journal article contained enough details to make it obvious to her who the case study involved.
• New York State Psychiatric Institute notifies 22,000 patients that its systems were breached this past spring.
• A potential class action lawsuit against Flowers Hospital (AL) involves a now-imprisoned phlebotomist who used information contained in unsecured daily file folders to file fraudulent tax returns.

A DataBreaches.net analysis of the FTC’s case against LabMD notes the “pretzel logic” of going after theoretically exposed data that was viewed only by a vendor trying to sell security services to LabMD. It calls out the lack of FTC definition of acceptable security standards and the FTC’s subjective interpretation of risks that might reasonably cause consumer harm, which should interest every healthcare provider since FTC is getting more active in healthcare security. It concludes,

If one government agency – HHS – that is the premier agency for protecting patient privacy and data security didn’t even consider this incident a reportable breach under HIPAA back in 2008, then doesn’t it strike anyone else as a bit absurd that the FTC would turn around years later and claim that this incident was not only “likely” to cause substantial harm, but did cause substantial harm – even though they didn’t interview even one person whose data was in the errant file? For the FTC to declare by fiat that consumers experienced substantial harm in this case is just over the top.

Innovation and Research

NIH profiles AiCure, a medication adherence app whose further development was funded by NIH’s National Center for Advancing Translational Sciences. The company’s app uses facial recognition and motion-sensing smartphone sensors to visually verify that a particular med was taken as prescribed, specifically targeting clinical study participants (and obviously hoping to tap into the always-popular and cash-flush drug companies as customers). The New York company has raised $12 million.

Other

A Slate article declares that workplace wellness programs are “a waste of time and money, they don’t improve health outcomes, and they’re a front for shifting costs onto employees.” The article adds that such programs promote questionably useful tests, encourage unnecessary doctor visits, and collect health information using sloppy security policies. It cites the 2009 claim of grocery store operator Safeway that its wellness program (optional, but employees had to pay higher insurance premiums if they opted out) helped hold its healthcare costs flat, when in fact only 14 percent of its employees were even eligible to participate and the way Safeway kept costs down was to raise insurance deductibles. The company’s questionable wellness program results led to the so-called Safeway Amendment to the ACA that allows employers to shift more premium costs to employees who fail wellness tests.

A smartly written editorial by a surgeon criticizes a Texas district attorney who continues to publicly declare that vaccines cause autism and who appeared in a trailer for the movie “Vaxxed.” He summarizes by comparing the respective burden of proof required by the court system and the FDA:

The video in which he appeared is so much like anti-vaccine videos I’ve deconstructed over the years and suffers from the same confusing of correlation with causation. LaHood himself views the movie like a trial against vaccines and seems quite impressed by the “evidence” it presents. Unfortunately, as tempting as it is for a lawyer and DA to see everything in legal terms, science doesn’t work that way. He goes on and on about how children seemingly regressing after vaccines is “strong circumstantial evidence.” Yes, perhaps, but in science, circumstantial evidence … is what we in the medical biz call anecdotal … the weakest form of evidence.

A reporter from the Boston business paper tweets out while visiting Steward-owned New England Sinai Hospital that computers on wheels were jamming up family waiting areas because employees had limited wall sockets available for charging them. Hospital executives responded by saying the carts had been moved, which is good since it means that someone at the hospital follows Twitter, although that doesn’t seem to address the problem of needing to charge them somewhere.

Columbus-based Big Lots donates $50 million to Nationwide Children’s Hospital (OH) and will get naming rights to the clinical department and a planned pediatric psychiatric hospital. Even though I’ve bought stuff at Big Lots (while overlooking piles of junky merchandise and the occasionally troubling behaviors of my fellow bargain-seeking shoppers), I don’t know that I’d want to be admitted to a hospital named after a company selling closed-out distress merchandise out of previously abandoned stores in dying strip centers. The NYSE-traded retailer is worth $2.2 billion on $5 billion in revenue, while recent tax forms show that the hospital made $244 million on $1.4 billion in revenue. 

Sponsor Updates

• Influence Health will exhibit at SHSMD Connections September 11-14 in Chicago.
• Ingenious Med and Obix Perinatal Data System will exhibit at the Georgia HIMSS annual conference September 7 in Atlanta.
• Illinois Senator Dick Durbin visits the Intelligent Medical Objects office.
• Live Process will exhibit at the Nevada Hospital Association Focus on the Future conference September 7-9 in South Lake Tahoe, NV.
• MedData will exhibit at the Texas Society of Anesthesiologists Annual Meeting September 8-11 in San Antonio.
• Meditech representatives discuss interoperability at the 2016 KLAS Cornerstone Summit.
• PatientMatters will exhibit at the Kansas Hospital Association Fall Conference September 8 in Overland Park.
• PaymentsSource profiles PatientPay’s healthcare “paper fix.”
• Forbes names Red Hat as one of the world’s most innovative companies.
• The SSI Group will exhibit at the CASA 2016 annual conference and exhibit September 7-9 in Carlsbad, CA
• IT Business Edge covers SyTrue’s partnership with IDS.

Blog Posts

• Patient Engagement, You’re Doing it Wrong (Influence Health)
• VCISO Answers Barriers in HIMSS 2016 Cybersecurity Study (Orchestrate Healthcare)
• What is The Ideal Team Player? (Nordic)
• No Doctor Beats Machine Learning: A Startling New Challenge to an Old Approach (Orion Health)
• Security Q and A with Grace Hua (PatientSafe Solutions)
• The influencers: How will nurses change the landscape of healthcare? (PeriGen)
• Walking the Walk with Unparalleled Customer Service (PMD)
• Five Steps to Managing Patient Movement Success (Sagacious Consultants)

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 9/1/16

I completed my HIMSS registration this week. This year’s registration has a space for attendees to list their Twitter handles so that they appear on registration badges. I don’t remember seeing that last year. I was sorely tempted to appropriate someone else’s handle just to see if anyone noticed, or to see if hilarity ensued. But alas, I went the conservative route and just signed up as myself.

HIMSS isn’t cheap for “regular” attendees. Even the early bird rate is $785, not to mention the mandatory $199 renewal of your HIMSS membership. I can’t complain too much, though, since it’s one of a handful of places that those of us that are board certified in clinical informatics can get our required continuing education credits.

As I went through the registration process, a couple of things struck me. The first was the addition of the “HIMSS Star Service” option for $149. It’s basically a concierge service offering assistance with booking at the hotels (on a space-available basis, so good luck with that) as well as coat check at the convention center and restaurant reservations. It also offers “help to design your tailored conference agenda, including social events and exhibitor appointments” and “exclusive tours on the exhibit floor based on interest.”

The show floor is already crowded enough with people standing in the aisles oblivious to those around them. I envision a Disney-style guide with a pennant leading a tour group around the hall. Maybe I should put out my shingle and offer “Dr. Jayne’s Tour of Cool Booths.” I already give party planning tips for social events, so it might be a natural next step.

Speaking of party planning, I recently had a negative email from a vendor rep who took issue with the fact that I didn’t mention their company’s upcoming user meeting when I mentioned the events of multiple other vendors. I write for HIStalk on top of my day job of running my own consulting business and my night job of seeing patients. Although I’m pretty good at keeping up with the industry, I don’t keep track of every possible vendor event. The best way to make sure that I know about your event is to tell me – and not with a mass email, but something personalized that shares interesting tidbits about it or helps me understand why it’s noteworthy. For HIMSS, actually inviting me to events exponentially increases the chances that I’ll swing by to visit.

The list of HIMSS events also includes multiple woman-focused events. I’m not sure how I feel about that. Although women are under-represented in many science, technology, engineering, and math fields, organizing events strictly around status as a man or woman seems problematic. Rather than seeing the Women in Health IT Networking Reception, I’d rather see other professional minorities addressed, such as an Ambulatory Informatics Networking Reception or Independent Physician Practice Networking Reception events. The latter is definitely a minority, for sure. There’s also the Most Influential Woman in Health IT Awards Dinner as well as the Disruptive Women Luncheon.

I’m not a fan of the naming of the Disruptive Women Luncheon and would think that its sponsor (a public affairs company that specializes in “creative communication”) could have come up with something better. Disruptive how? In the innovation context? In the grandstanding Jonathan Bush context? In the snapping-your-gum teenage context? In the context I saw this morning, where a disruptive man held an entire meeting hostage and prevented the rest of us from getting through the agenda? “Disruption” is an overused buzzword that needs to go and the whole idea of special women’s events needs to be rethought.

I’ve often joked about putting together a “Textbook of Organizational Pathology” with case studies based on my work life. I’m sure I have enough stories from my time at Big Hospital System to fill at least a dozen chapters, and then there’s the physicians and hospitals I’ve worked with since I started consulting. If I ever write it, there will definitely be a chapter on “The Art of Work Shirking.”

I had a prime example this week when working with a practice support representative at a large health system. The practice support team is charged with fielding questions about EHR use and associated technology that originate from the practices that the health system has gobbled up over the last decade. I’m supposed to be backstopping the department, identifying areas for additional education and assisting in putting together a training program for the new hires.

Due to the group’s growth, some of them are very green, but others are just lazy. I had just done a presentation on HIPAA and the need for appropriate use of secure messaging vs. text vs. email vs. voice mail for the team when I received an email from one of the support reps. She went overboard with praise about my recent talk and then dropped this gem: “I think I’m clear on how to answer the client question below, but wanted to know if you had any additional feedback.”

To be able to provide any “additional” feedback, I might need to know what she planned on advising. However, I suspected her of hoping that I’d just answer the question my own and save her the trouble of formulating a response, so I asked her what her advice was going to be. She responded immediately saying, “I don’t want to bias you with my response, I was just curious what you would advise.” Looking logically at this, I just taught the class on this, which her employers hired me to teach because of my expertise. Yet she thinks my response to a question might be biased by her ideas? It doesn’t even make sense.

I’m happy to help people who genuinely don’t know the answer to a question, who want me to critique their potential response, or who just need help. But then let’s call it what it is, and not try to be coy, using flattery and evasion to cover the fact that either you don’t know the material that was just covered in a class, that you spaced out during said class, or that you’re just lazy. I suspect she was also naïve enough to think I wouldn’t forward the exchange to her supervisor, who was appropriately irritated by her staffer’s actions. I’m continually amazed by the antics people try to pull using email, that I doubt they would try in a face-to-face conversation. They also forget that email is forever and easily forwarded.

What’s the worst example of work shirking you’ve seen lately? Email me.

Email Dr. Jayne.

Morning Headlines 9/1/16

UPMC reports strong year-end financials

UPMC closes its 2016 fiscal year with a positive outlook on its ACA exchange policy, growing its regional market share from 18 to 67 percent. CFO Robert DeMichiei explains, “We did not jump in with low price points. That is what I think happened to the national insurers and to many of the Blues across the country — the idea was to grab market share immediately. We did not do that, and that allowed us to get some clarity about the population and the right pricing.”

The World’s Most Innovative Companies

Forbes names Cerner to its list of world’s most innovative companies, ranking it 37 of 100.

Theranos Halts New Zika Test After FDA Inspection

Theranos withdraws its FDA application for a Zika diagnostic test after regulators found that the company did not include proper patient safeguards during its testing.

Researchers question report alleging vulnerabilities in St. Jude devices

Medical-device manufacturer St. Jude Medical responds to allegations made by investment firm Muddy Waters that its medical devices are vulnerable to life threatening hacks. In a statement released by the company, President and CEO Michael Rousseau says “The allegations made by Muddy Waters and MedSec are irresponsible, misleading and unnecessarily frightening patients.”

Keeping Up with Amazon Alexa’s Healthcare Potential

HIStalk looks at the ways in which patients, providers, and vendors are using Amazon’s virtual assistant technology to improve healthcare inside and outside of the hospital.
By @JennHIStalk

When it first launched in mid-2014, the Amazon Echo looked like nothing more than what many thought it initially was – a voice-enabled wireless speaker that could offer up information via the company’s proprietary Alexa voice assistant technology. Whether it was traffic conditions, weather forecasts, or trivia questions, the Echo at first seemed capable of helpful but extremely basic tasks.

As consumers began to dig into its features and Amazon opened up the Echo’s platform to developers, new capabilities began to emerge, many of which caught the eye of those with a keen interest in the role consumer-facing technologies can play in healthcare.

Straight from the Patient’s Mouth

As with many technologies today, (wearables being a prime example), consumers soon began using Alexa as a personal healthcare assistant. Julie McGovern, CEO of practice management consulting firm Practice Wise, was quick to recognize the value its features could offer in helping her care for her ailing mother. “Alexa has made life easier for my mother on a daily basis,” she says. “Besides medication reminders, which we set as timed alerts, she uses Alexa to add items to her shopping list, get news and weather updates, listen to music and audio books, and amuse herself by having Alexa tell her jokes.”

McGovern has her eyes – and those of her mother’s providers – peeled for new Echo aging-in-place features. She’s especially excited about a new interactive medication management feature that will notify designated family members and caregivers if her mother doesn’t acknowledge to Alexa that she has taken her meds after a certain number of attempts.

From Contest to Market

McGovern and her mother may soon be able to take advantage of just such a feature from DaVincian Healthcare, the Overall Champion of the PYMNTS.com & Amazon Alexa Challenge held earlier this summer. The Austin, TX-based startup created DaVincianRx for the competition, an “interactive prescription, communication, and coordination companion” designed to improve medication adherence while keeping family caregivers in the loop.

The prototype, which took six weeks to create, was developed with the end goal of helping patients become more active in their own care and staying on track with medication plans. “When we combine prescription abandonment and non-adherence costs,” explains DaVincian Healthcare Chief Medical Officer Meredith Porter, MD, “they are staggering. Estimates range around $300 billion every year. Yet even more concerning than the wasted medical costs are the clinical costs – worsening medical conditions, unnecessary appointments and hospitalizations, and poor health outcomes, including death. Out team focused on leveraging Amazon’s Alexa to find a real solution to address this problem, keeping in mind the importance of closed-loop communication between the patient, provider, and family.”

Porter adds that Alexa-enabled tool, which the company plans to roll out through the Amazon ecosystem, is perfectly suited for aging-in-place patients like McGovern’s mother. She also believes that it will do well, “especially with those who feel overwhelmed or isolated when it comes to their health management. Our skills help people stay on track with knowing why and when they should be taking medications; reminding them about new prescriptions or needed refills; and tracking adherence to offer the critical closed-loop connectivity to family members and health teams.”

Bringing Alexa to the Bedside

Providers are certainly aware of Alexa’s potential, perhaps none more so than Boston Children’s Hospital, which developed an Alexa-based app earlier this year that offers parents advice when their child runs a fever. BCH Chief Innovation Officer John Brownstein, PhD attributes the hospital’s interest in Alexa to its well-documented interest in emerging consumer technologies and how they might be applied to healthcare. “As voice-assisted technologies have emerged,” he says, “we began to think about whether or not this could be a new channel through which consumers can receive health information. Echo became a great example for us to choose because it had been such a commercial success, and we had this ability to work within the Amazon environment to build out Alexa-related skills.”

Brownstein has been pleased with reception of the KidsMD app, which has thousands of users. “It’s really a two-way form of communication in that we’re providing useful information to patients and also collecting really interesting data about symptoms that could potentially be used for better understanding things as they’re happening in various parts of the country. That background data can be useful for public health.”

The KidsMD app is just the beginning as far as Brownstein is concerned. His team is busy evaluating a number of other use cases, many of which evolved out of a mini Alexa hackathon held at the hospital in May. “Could you use voice to pull up an image from the EHR while you’re in surgery so you don’t have to scrub out, for example? Can you use it as you’re interacting with a patient to take an image?” Brownstein poses. “We’re really excited about Alexa’s potential in situations where you want to either have the ability to keep working without having to change course,” Brownstein says, “or where you might want better interaction with your patient by not having to turn your back to them and start typing on a computer. Not to mention the opportunities for patients in their rooms. If they need to access information and they’re not mobile, this might also be an opportunity for them to access information or communication. We’re experimenting with all of these scenarios in parallel.”

Brownstein adds that patients invited to BCH’s Alexa brainstorming event were most interested in potential home uses, and his team in turn became interested in the resultant opportunities in collecting feedback and offering post-discharge care guidelines and educational materials. “To be able to get to that level of detail quickly through voice is really interesting,” he says.

Prioritizing Further Developments

BCH hasn’t yet pulled the trigger on formally launching these ideas because of privacy and security concerns. “We’re working with Amazon to figure out HIPAA compliance and better understand what the risks are,” says Brownstein. “We’ve built a consumer version of Alexa with the KidsMD app, so we’re not concerned from that perspective because it’s just providing general information. When you start talking about electronic medical data or interfacing with the hospital system, that’s when you really need to figure out how the enterprise version of Alexa will have to emerge. We’re still working on that.”

Prioritizing internal opportunities also plays a part in BCH’s further development of Alexa-related enterprise capabilities. “Like anything,” Brownstein explains, “it has to be thought of in the context of other efforts and where that should be prioritized. Then, of course, there’s the integration issue. There’s still a challenge to integrate with our existing Cerner EHR. We’ve done a prototype of it, but the integration into the core IT fabric of the hospital will take a lot of work.”

Gauging Real-World Patient Potential

Whether it’s enterprise environments or home-based opportunities, Amazon’s Alexa technology is well poised to impact healthcare delivery and outcomes, not to mention patient satisfaction scores. “I think that any time you make information more easily available to patients, any time you make the experience more enjoyable, more seamless, I think you’ll have a real impact on the overall patient journey,” Brownstein enthuses.

Porter is equally enthusiastic about the innovation Alexa could bring to healthcare. “We recognize that the potential for this technology in healthcare is nearly limitless,” she says, “from health education and chronic disease management to reducing healthcare costs and transforming lives in health.”

The ultimate litmus test for Alexa’s role in transforming healthcare will be conducted in the lives of patients like McGovern’s mother. An enjoyable, seamless, and even humor-inducing experience that results in improved medication management and care coordination will surely help escalate Amazon’s virtual assistant technology to a vital part of the care team.