News 7/8/16

Top News

England’s NHS scraps its plan to create Care.data, a huge national database of patient information that was to be extracted from provider EHRs.

NHS planned to sell the partially de-identified information of patients who didn’t opt out to drug companies and other willing purchasers, but decided to end the program after two commissioned reports criticized its opt-out and consent policies as being less than transparent.

Reader Comments

From Jolter: “Re: Athenahealth. The company is not immune to the same challenges as competitors, as feedback on this software rating site about their Streamlined upgrade says. I had caught wind on their last investor call that Streamlined isn’t well regarded within their customer base. Instead of worrying about unbreaking healthcare, they should be unbreaking AthenaClinicals.” Physician customers say Streamlined has changed Athenahealth’s EHR into a click-intensive “opaque, cumbersome product” that “has made a mockery of the Athena system” that is now “the worst system I could have ever imagined,” with Athena’s support reps blaming Microsoft or whatever browser the customer is using for their many problems. A pulmonologist says Athena is “crippling my practice” and claims the company is censoring its client forum. Athenahealth is also getting publicly ripped by many customers on Facebook over the forced upgrade. One doctor summarizes Streamlined as, “When it works, it stinks. When it does not work, it really stinks.” It’s tough to keep riding the “disruptor” horse when you’re a publicly traded company worth $5.5 billion, have an installed base of customers to maintain, and need to fawn to impatient investors who constantly demand improving profits. Imagine the outraged fun Jonathan Bush would have with this seemingly major stumble if he ran Epic or Cerner. Athena has quite a few product and acquisition balls in the air, so this is where they get to prove that they earned their seat at the Wall Street table as something more than a future-promising puppy nipping at the heels of dowdier but much larger and experienced competitors.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mrs. D from Nevada in providing math learning games for her kindergarten students. She reports, “As I pulled each math activity out of the box, they cheered, begging me to open it! …  the students thought it was ‘amazing’ and ‘so cool’ that a complete stranger would give us math games … The real gift within that box was the gift of knowledge and understanding. For some of my students, these math games are more than just math games, they are clarity and a road to success and confidence. I have witnessed so many ‘light-bulb-moments’ while using these games. Knowing my students are grasping complex mathematical concepts (for their age) is the greatest experience!”

This week on HIStalk Practice: Sciton gets into practice support. MyIdealDoctor adds behavioral health to its telemedicine services. VITL presses for a less burdensome patient opt-out policy. HHS ramps up opioid prevention efforts, including mandatory PDMP use at FQHCs. Urgent care clinic closes in the face of telemedicine competition. AAPS caves to Brexit clickbait.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Scotland-based Craneware announces record sales for the year ending June 30, with revenue rising 60 percent on $58 million worth of contracts.

Sales

UC Irvine Health (CA) chooses Infinite Computer Solutions and Optimum Healthcare IT for EHR migration.

People

Nat’e Guyton, RN, PhD (Trinity Health) joins Spok as chief nursing officer.

Bob Sullivan (IBM Watson Health) joins interactive patient technology vendor Sonifi Solutions as GM of its healthcare division.

Bob Kyte (Adventist Risk Management) replaces the recently retired Don Kemper as CEO of Healthwise.

Announcements and Implementations

Validic joins SAP’s Connected Health ecosystem, offering users of SAP Health Engagement the ability to integrate patient-generated health data.

Government and Politics

ONC issues a white paper contest for the potential uses of blockchain in healthcare, with submissions due July 29. Up to eight winners get their  travel expenses paid to present their paper at a NIST-hosted workshop September 26-27 in Gaithersburg, MD.

The government of South Australia finally funds the initial planning project for the migration of SA Health’s long-sunsetted patient administration software. The system’s vendor, Global Health, sued the government for breach of contract after it repeatedly refused to stop using the 1980s-era system, of which it is the only remaining user. The SA government has been focused on its troubled Allscripts EPAS rollout, but the state’s rural hospitals aren’t included in the implementation plan and also haven’t committed to upgrading to the current Global Health product.

Peer60 is doing research on Brexit’s impact on England’s NHS. I was curious about its preliminary results even though they’ve surveyed only 80 hospital leaders so far (out of 200+ responses expected). Respondents offered some interesting comments:

• “Prior to the referendum, both campaigns threatened Armageddon if we left/stayed in EU. They both also said we’d each receive a puppy and have champagne for breakfast if we left/stayed in EU. We’d also be better looking and lose weight if we left/stayed in the EU. None of these have come true. The distinct lack of definitive outcomes, even now, make it difficult to have an opinion, apart from the long-standing one that Westminster is full of liars and has absolutely no interest in the well-being of UK citizens.”
• “Welcome to the third world.”
• “More likely to have positive impact as will help with controls re: EU residents who do not pay UK national insurance and taxes from using NHS resources –  this service will need to be funded in the future. We can work through the staffing issue by working differently, researchers will find ways to continue to collaborate. Impact is in needing to find work around and other change.”

John Halamka suggests that CMS eliminate existing EHR certification requirements and instead require vendors to demonstrate only five specific EHR capabilities:

• Use OAUTH2/OpenID to verify trusted exchange partners.
• Use a FHIR-based query to request an electronic endpoint address.
• Use a RESTful approach to push data to an endpoint.
• Use a FHIR-based query to request the location of a patient’s records.
• Use a FHIR-based query to exchange a common data set of key elements.

The Federal Trade Commission drops its anti-trust challenge of the proposed merger of the only two hospitals in Huntington, WV following the state’s passage of a law that was intentionally written to shield hospital mergers from federal scrutiny. The FTC walks away with a warning that hospitals can work together to deliver clinical integrated care without buying each other in reducing competition, noting specifically that while it rarely intervenes in such hospital mergers, its quality and cost red flags were raised in the Huntington market.

The independent Commission on Care, established by Congress to review the VA following the wait times scandal, includes among its recommendations that the VA replace its “antiquated, disjointed clinical and administrative systems” with commercial software products and that it establish a VHA Care System CIO position reporting to the chief executive. The chair and vice-chair of the commission are both CEOs of provider organizations that use Epic (Henry Ford Health System and Cleveland Clinic).

Privacy and Security

A federal appeals rules that anyone who shares a password may be violating the Computer Fraud and Abuse Act, which is intended to address hackers. The case in question involved an employee who gave his company password to former employees, but the ruling could technically allow people to be prosecuted under federal law for sharing their Netflix log-ins.

Innovation and Research

NIH awards $55 million in precision medicine grants to study the self-contributed data of 1 million volunteers, with the lead recruiting centers being Columbia University Medical Center (NY), Northwestern University School of Medicine (IL), the University of Arizona (AZ), the University of Pittsburgh (PA), and the VA. Vanderbilt, Verily, and the Broad Institute will provide data analytics. In addition, Scripps Translational Science Institute and Eric Topol, MD (whose summary of the project is above) will  get $120 million over five years to develop apps, sensors, and processes to recruit the “citizen scientists” and give them the ability to share their collected information with their physicians. The scientist in me loves the idea, but the public health angel on my other shoulder wishes we would focus on the less-sexy blocking and tackling of reducing infant mortality, managing expensive chronic conditions, addressing social determinants of health, and resolving the ugly dichotomy of expensive “healthcare” vs. “health” in applying equal vigor to chasing goals that move the overall health needle further without having as their primary motivation the eventual lining of someone’s pocket.

Technology

The Wall Street Journal suggests that Apple fanboys resist the urge to pounce on the just-released public beta of iOS 10, warning that it’s buggy (not surprising for a beta release) and a pain to revert back to the prior version if things go wrong. The article tries to talk up a few new features, but they seem lame.

Other

Mylan Pharmaceuticals has jacked up the price of decades-old emergency allergy auto-injection EpiPen to nearly $600 per two-pack over the past few years, giving cash-poor, high-deductible insurance consumers and public service agencies the choice to either go without the drug or draw up the much-cheaper generic ampules into syringes as needed for emergency doses. The drug was prescribed 3.6 million times last year as Mylan turned its 2007 acquisition into a billion-dollar product that provides 40 percent of its profits, pushing federal legislation that encourages schools to stock the injections and to recommend two doses instead of one per allergic episode. Mylan, which has a market cap of $22 billion and makes a lot of money selling drugs to the federal government via Medicare, shifted its headquarters offshore in 2015 to dodge US taxes.

The number of HIEs has dropped from 119 to 106 as federal funding ended, a study finds, with half of the surviving ones reporting that they are not financially viable. The most prevalent HIE problems include lack of a sustainable business model, the inability to integrate HIE information into provider workflow, and lack of funding.

Another study in Health Affairs that reviewed AHA’s IT survey data finds that hospitals that use their area’s dominant EHR (usually Epic or Cerner) engaged in a lot more data exchange than their competitors that run other EHRs, which the authors speculate is because it’s easier to exchange information with other Cerner or Epic shops and that those vendors will help make it happen. My takeaway is that hospitals in a mostly-Cerner or mostly-Epic region that use different EHRs have to spend more money to exchange information and are thus less likely to do so, especially if their competitors are indifferent or hostile to the idea.

AdvancedMD tweeted out this photo of their team-building Lego derby. It’s always fun to see the folks in the trenches.

Smokers are less likely to buy health insurance than non-smokers, apparently because they are unwilling or unable to pay the higher smoker premiums allowed by the Affordable Care Act. The penalties levied for not being insured don’t seem to be working, especially when they represent only a small fraction of the cost of insurance.

I’m not entirely convinced that this Microsoft email is genuine even though he company has apologized for it, but it’s still funny to picture some low-level, corporately oppressed recruiter (whether it be at Microsoft or Epic) trying to relate to the kids he or she is recruiting by inviting them — in their cringe-worthy, baby-talk vernacular – to stop by for “hella noms” and  “dranks” just like someone’s white bread mom scanning Urban Dictionary looking for hip phrases to drop at the most embarrassing moment possible.

Sponsor Updates

• Aprima announces that its EHR/PM meets MACRA/MIPS requirements.
• ID Experts will present at the SANS Data Breach Summit August 18 in Chicago.
• Navicure will exhibit at Mississippi MGMA July 13-16 in Biloxi.
• Experian Health will exhibit at the Nebraska Association of Healthcare Access Management July 14-15 in Grand Island.
• The SSI Group will exhibit at the FSASC Annual Conference & Trade Show July 13-15 in Orlando.

Blog Posts

• Owned Media is the Best Media (Influence Health)
• What Does a Radio Shack Ad from 1991 Have to Do with Healthcare Payments? (InstaMed)
• This Isn’t “Logan’s Run” (Orion Health)
• Freedom (but no fireworks) for Physicians (PatientKeeper)
• 3 “must haves” for simplifying complex clinical communications (PerfectServe)
• Five Irresistible Reasons to Choose PeriCalm (PeriGen)
• What is a Provider to You? (Phynd Technologies)
• There’s a FHIR in the House, Don’t Get Burned (Summit Healthcare)

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 7/7/16

The Independence Day holiday is understandably one of my favorites. It had a lot more meaning to me this year and I have my clients to thank for it.

During the last 12 months, I’ve had the privilege of performing consulting engagements in locations key to our nation’s history. I started in Boston, followed by Philadelphia, then Washington DC, and back to Philadelphia. For someone who is a bit of a National Parks junkie, it was like winning the lottery.

Fortunately, many of the monuments are open late. If you hit Independence Hall at the end of the day, there’s an “express” tour that doesn’t require tickets. You don’t get to see everything, but when you’re on site with a client and trying to squeeze in some sightseeing before your flight, you take what you can get.

Of all the monuments and memorials, my favorite is the National WWII Memorial in Washington, DC. During the day, you can often catch an Honor Flight group visiting. It’s certainly something to see the veterans reacting to their memorial. Sometimes I can’t turn off the physician side of my thought processes – not only did they survive the war, but they’ve experienced first-hand many of the medical advances of the past century. Things we completely take for granted were revolutionary during their lifetimes. At night, the Memorial takes on a supernatural quality. Each of the memorials has its own special quality, but for some reason, this one particularly resonates with me.

As much as many of us feel we are living in a word full of turmoil, thinking about what we’ve been through as a society during the last 200+ years puts it somewhat in perspective. Although we may be dealing with crises in healthcare delivery that consume us on a daily basis, we’re not dealing with smallpox, polio, or whooping cough. Many of the diseases we’re fighting are somewhat self-inflicted. We don’t need a so-called “moon shot” to cure them, but rather could make a huge difference with public health initiatives, preventive services, and individual lifestyle changes.

Population health has a lot of promise, if you can get through the hype. The ability to reach out electronically to hundreds of patients based on easy-to-access data points is huge. We can do in seconds what it would have taken days to do with paper charts. For most practices, though, the focus is on the sickest of patients because we’re targeting costs as a primary indicator. We’re trying to manage the top 10-15 percent but are losing sight of the rest of the population. For those organizations that have figured out how to expand their reach into the next quartile, the long-term returns on health promotion and disease prevention could be tremendous.

As a young physician, I used to rail at the fact that Medicare would pay for insulin but didn’t have adequate coverage for diabetic education. It felt like we were spending our money in the wrong place. We also weren’t paying for preventive services, but were happy to pay when people were sick. The Affordable Care Act has changed that for the better, as has the push to look at value rather than volume.

I’d like to see it go even farther, though. Rather than focusing primarily on diabetics with the worst control, how about we focus more on the pre-diabetics and newly-diagnosed individuals who we can truly impact? It may not bend the cost curve in the short term, but it certainly will in the long term. I think organizations are trying to move in that direction, but it’s hard to find the right mix of patients to target given the typical resource constraints in care management.

There are some solid programs to look at how we do this. I’ve been following the Comprehensive Primary Care Initiative (CPCI) and its evolution into the CPC Plus program. It’s been great to see the way they looked at the program and how it worked and are now creating two different paths moving forward. Hopefully we’ll have enough practices truly embrace the program that we will be able to see how effective the different approaches are in achieving health outcomes. I’m eager to see what regions will be chosen, what payers will participate, and whether any of my clients will decide to move forward with the programs. I’d love the opportunity to be hands-on with the next generation of comprehensive care.

One of the reasons I think programs like CPCI work is that they’re voluntary. Practices self-select if they want to be a part of it — they know from the beginning what they are getting into. They’re not doing it because they feel pressured or because they’re trying to avoid a penalty, and I think that’s the point we’ve collectively missed with Meaningful Use and now MACRA/MIPS/ACI etc. We all understand the psychology of the carrot and the stick, and even though we know some people will never get moving until the stick is approaching, the carrot is a more powerful motivator for many. Programs like CPC+ also speak to the reasons why physicians went into primary care in the first place.

As we all wait for the MACRA final rule, many organizations are trying to figure out their strategies for the next few years. Do we want to be the kind of practice that just aims to check the box, or do we want to try to do more? How can we get our nation’s best and brightest focused on solving these complex healthcare problems? Can we start to focus on the patients in front of us as much as we’re focusing on scores and numbers?

Unfortunately, these aren’t easy questions to answer. Eventually we will get through all of this, much as our forefathers have gotten through so many other challenges that were different and yet the same. Although it may not seem easy, we’re fortunate to live in a time and place where there are many opportunities to make things better for the people we serve.

Rather than focusing on the daily chaos that surrounds us, let’s remember to think about the promise that our technology holds. Who’s with me?

Email Dr. Jayne.

Morning Headlines 7/7/16

Legal (Fraud and Abuse) Barriers to Care Transformation and How to Address Them

An AHA report suggests that the Stark Law is becoming an impediment to care coordination and the expansion of value-based payment adoption, arguing that “The risk of overutilization, which drove the passage of the Stark Law, is largely or entirely eliminated in alternative payment models.”

Island Health presses ahead on electronic record system in Nanaimo

In Canada, Island Health’s $174 million Cerner implementation moves forward amid a unanimous no confidence vote from representatives of the health system’s medical association.

HealthyCT crumbles under ACA risk adjustment charges

HealthyCT, Connecticuts co-op insurer, will shut down because it is unable to pay a $13.4 million ACA-mandated risk adjustment payment.

Valeant’s New CEO Brings Familiar Prescription

The Wall Street Journal recaps the past business decisions of Joseph Papa, the new CEO of Valeant Pharmaceuticals, as he works to turn around falling stock prices without resorting to drug price gouging.

The House Call Comeback

HIStalk looks at the resurgence of house calls, aided in part by government-sponsored value-based care programs, a need for increased market share, and growing consumer demand for app-enabled convenience and pricing transparency.
By @JennHIStalk

In today’s technology-driven society, the concept of the house call may seem quaint, evoking Norman Rockwell-esque images of the neighborhood physician toting his black bag down Main Street to Grandma’s house. Mobile health tools, however, are turning that image on its head as providers look to increase market share by increasing patient access points.

While house calls have always been around to some degree, digital health startups like Pager, Heal, and PediaQ are putting a new spin on what it means to “go to the doctor.” Even more traditional home care companies like Visiting Physicians Association are placing more emphasis on the role technology plays in caring for the elderly and chronically ill, often with the aid of government-backed incentives.

This new era of house calls is not without its detractors, however. Some physicians are quick to point out that patients can’t establish a true, trusting relationship with this new generation of house-call providers, and that care coordination will suffer. Others, especially those in more metropolitan areas, point to struggles for market share between the local health system, urgent care centers, and app-based house call companies.

Consumers will likely have the last word, as their increasing insistence on convenience and easy access, plus heightened awareness of healthcare costs, leads them away from higher-priced health system monopolies into the arms of the more tech-savvy (but somewhat unproven) competition.

Smart Phones Make the Difference

Dallas-based PediaQ has made technology a core part of its business model. Founded in 2014, the app-based pediatric house call provider has raised $6.4 million to date and has already expanded beyond Dallas to three additional cities in the Lone Star state.

“PediaQ has been developed as a function of change in our culture towards on-demand services, as well as innovation in creating new access points for health systems that are expanding their networks to capture market share,” explains CEO Jon O’Sullivan, adding that the cultural shift to making purchasing decisions via smart phone played a big part in PediaQ’s decision to steer clear of brick-and-mortar locations. “I’ve been on the business strategy side of provider services in healthcare for over 25 years now, and for much of that time I worked with health systems that sought to expand their market share through their provider networks. Throughout that time, I’ve watched the healthcare market evolve to a much more consumer-driven equation.”

While PediaQ’s funding seems to indicate investor confidence, O’Sullivan points out that building trust with customers and the surrounding healthcare community has taken time. “Initially, like any new brand, we had to spend a majority of our resources on consumer education,” he says. “However, once parents started using PediaQ and were able to experience the ease and comfort of a house call for a sick child, the results were nothing short of phenomenal. The main catalyst for our consumer activation and expansion very quickly became the users themselves.”

When it comes to perceived competition with local PCPs, O’Sullivan points out that the company sees itself as an augmenter and supporter of the relationships its customers have with their PCPs. “We’re not out to replace that relationship,” he says, “which is reflected in the fact that PediaQ focuses on after-hours care and ensures that the medical record from the visit is delivered to the PCP the next day.”

Easier Access, Less Windshield Time

Aside from apps, telemedicine has probably had the biggest impact on the resurgence in house calls. It has certainly given companies like Aspire Health and MedZed an edge over more traditional home care companies, especially when it comes to “windshield time.”

Technology has been crucial to the nascent success of Atlanta-based MedZed, which identifies itself as a telemedicine-enabled home care company that provides “21st century house calls” for high-risk and needy patients.

“We decided we had to go into the home in order to service these people,” says MedZed co-founder and chief medical officer Neil Solomon, MD. “We were also well aware that it’s very expensive to pay a doctor or even a nurse practitioner to drive all over the place, especially in certain geographies that are either very spread out or have heavy traffic, like Los Angeles. You can only do maybe four or five visits in a day if you’re driving. It’s inefficient. Plus, there aren’t enough doctors to do this in order to scale this kind of business.

“Our model utilizes telemedicine to make the delivery of care much more efficient,” Solomon says, adding that the first half of a MedZed visit is spent between a care provider and patient going over medications, screenings, and assessments, while the second half is spent on remote consult with a physician, all of which is documented in MedZed’s Drchrono EHR.

“All of our care providers can see the same notes in our EHR,” Solomon explains. “We can export those notes in a fashion that other EHRs can read. We can import laboratory and pharmacy data from other sources so that we can see the full picture of the patient.”

MedZed seems to have distinguished itself from other modern-day house call companies in that it has written its own software for HIPAA-compliant video conferencing and logistics.

“Writing the logistics software was challenging,” Solomon admits. “It helps determine where to send each care provider during the course of the day, figures out drive times, and interfaces with the PM systems of MedZed-affiliated physicians so that they can easily access our video consults. We couldn’t find software on the market that could do all of that.”

Palliative Care Made Easier

Founded in 2013 with high-profile help from former Senator Bill Frist, MD, Nashville, TN-based Aspire Health incorporates telemedicine as well as a number of other technologies into its business model, which focuses on home care for seriously ill and end-of-life patients. Aspire Health Chief Medical Officer Andrew Lasher, MD has seen technology make a tremendous impact on the company’s ability to provide compassionate palliative care to its patients in 11 states and Washington, DC.

“Patients and families are more connected than ever,” he points out. “Secure video conferencing can be an incredible adjunct to high-touch care at the bedside, and in some cases can act as a stand-alone visit. Much of what we do at Aspire is communicate – clearly and compassionately – with vulnerable patients and the people who love them. These family members often live far away, and we can use telemedicine to bring a distant family member to the bedside. There are also medical conditions that can be evaluated perfectly well with video, and many patients will tell you that the conversations they have with a doctor or nurse practitioner through telemedicine is every bit as sacred and impactful as the ones they have in person.”

“There are a number of other technology supports that can support care of the seriously ill,” Lasher adds. “We’re only just beginning to scratch the surface with remote-monitoring devices that help keep track of blood sugar, blood pressure, and that connect isolated patients to Aspire and community-based resources in moments of crisis. We’re seeing that these sorts of devices can integrate fairly seamlessly and in no way hurt the patient experience. Patients can often be reassured through technologic connection, and it only makes the care we provide more personalized.”

Aside from telemedicine, the Aspire team is also looking at solutions around the storage and transmission of advance care-planning documentation, solutions around immediate notification of when patients go to the ER or hospital, and placing tablets in patient homes that enable Aspire caregivers to monitor symptoms and needs on a daily basis. “Anything that helps us relieve a patient’s suffering or avoid an unnecessary and dangerous hospital stay is something we’ll investigate,” says Lasher. “I expect that we’ll be doing more with technology in the next year as the evidence base increases and the offerings improve.”

Analytics and Home Monitoring will be Key to Independence at Home

Home monitoring technologies are also in the cards for the Visiting Physicians Association, a key participant in the Independence at Home program for Medicare beneficiaries with complicated chronic health problems and disabilities. The pilot house call program, now in its second year, helped save Medicare $25 million in its first year thanks to reduced costs associated with improved medication adherence and fewer ER visits and hospital readmissions. Nine of the 14 participating practices, five of which are run by VPA, earned bonuses totaling nearly $12 million.

“VPA has achieved favorable results because of the technology we deployed into the home setting,” explains Dave Viniza, chief information officer of US Medical Management, VPA’s management services organization. “Our Aprima EHR has offline capacity second to none. Our physicians have a full patient medical record regardless of the connectivity of the patient’s home. Because we were searching for consistent, informed, real-time medical decision-making, VPA also deployed StatusScope, a home-grown application that keeps providers informed, during their visits, of recommended disease-driven protocols.”

“VPA has also used predictive analytics to identify the most at-risk patients and prevent unwanted ER visits,” he says. “By reducing those, we reduce unnecessary and unwanted hospitalizations. We’re continuing to develop those analytic tools. We’re implementing an enterprise data warehouse and dashboard analytics system, as well as implementing a care management system that will automate and streamline the development of non-physician care plans and patient management.”

“We’re also investigating appropriate home-monitoring tools for our patients,” Viniza adds. “We would like to marry the monitoring to predictive applications so that we can improve early identification of approaching medical needs. The end goal is to continue reducing ambulatory-sensitive ER and hospital utilization.”

Opportunity Abounds

While there’s no doubt that this new era of house calls is being fueled by technology, the industry-wide shift to value-based care – however slow it may be – is also helping things along.

“Patients prefer to be at home when they can be,” Lasher says. “That’s especially true for patients with chronic or life-limiting conditions. They know that the hospital isn’t always the best place to be, and that the best treatment for them may occur in their home – treatments that can help them live longer and feel better. For Aspire, seeing our patients where they live is a real privilege. Value-based care is such an accurate statement, since, for the vast majority of our patients, their own personal values make it clear what kind of care they want, and how it should be delivered.

“Clearly, there’s a lot of opportunity to expand what can be done outside the hospital or clinic, and to care for people on their own turf, rather than in a medical setting,” he adds. “Black doctors’ bags are going to be back in style, if they’re not already.”

Readers Write: Election 2016

Election 2016
By Donald Trigg

A provocative Atlantic magazine cover this month headlines, “How American Politics Went Insane.” Jonathan Rauch explores our current reality where “chaos has become the new normal — both in campaigns and government itself.”

As we struggle to draw rational signal from the noise, one can’t help but wonder if Trumpian chaos is resident in our favorite podcasts, journals, and websites. Are byzantine rule-makings not regularly bemoaned on HIStalk?  Do we not hear classes of readers singled out (particularly for using HIPPA and HIMMS)? Are we not struck by the rather small hands on the original HIStalk graphic?  

HIStalk has been, all kidding aside, a thankful escape for many of us from a campaign that has been abysmal even by our diminished US standards. Fortunately, there are just 125 or so days left. And with few exceptions, these conversion dates hold.  

Here is the quadrennial cheat sheet.  

A proper understanding of the 2016 election starts with the massive advantage Democrats have in the Electoral College. The Democrats have a safe hold on 19 states (plus DC) representing 242 Electoral College votes. (Note: If you still are suffering under the delusion that the popular vote selects the president, let’s email about a couple of ideas for your trip to the Albert Gore Presidential Library). As a quick civics reminder, you only need 270 Electoral College votes to become president.  

So, with a probable shortfall of just 28 Electoral College votes to get to 270, the Democratic path is far easier. As an indicative example, a Republican could win every “swing” state from Ohio to Virginia, but lose Florida (29 EC) and thereby lose the presidency. It is not quite as challenging as running a health system with an antiquated MUMPS technical architecture, but it is still a daunting task for the GOP.         

The statistician-turned-blogger Nate Silver places the odds of a Hillary victory at 80 percent with one of his two models factoring in GDP (Q1 GDP was 1.1 percent) for a lower 75 percent chance. He probably has that about right and (spoiler alert) decisions like the Trump VP pick aren’t going to radically change that.

No matter the outcome at the top of the ticket, neither Democrats nor Republicans are likely to dominate the breadth of the electoral landscape. Republicans have a fairly solid grasp on the US House (247-188) and they also control 31 governorships. As Barron’s wrote over the long weekend, ongoing divided government will offer a muted welcome to any agenda this January.  

As for healthcare, the issue significantly trails the economy/jobs and terrorism when it comes to top voter concerns. Moreover, opinions are very settled and polarized. Forty-two percent favor the ACA, while 44 percent oppose it.  

Consequently, Clinton and Trump will use talking point level rhetoric, predominately to drive turnout. Hillary will take on big pharma, calling for caps on prescription drug costs. Trump will bemoan premium increases, call for ACA repeal, and assure us he is going to do something “fantastic.” You will feel like you are watching “Saturday Night Live.”

Notably, there is an important piece of emerging voter sentiment that we shouldn’t miss amid the posturing and platitudes. According to the June KFF poll, 90 percent are worried about the amount people pay for their healthcare premiums, while 85 percent are worried about increased cost of deductibles. Consternation over cost is growing and will be reinforced during open enrollment this fall. 

As we look out to first 100 days of the new administration, we will see a level of change on health policy that is more incremental than historic. Importantly, MACRA will continue to advance at the agency level, buttressed by solid bipartisan opposition to fee-for-service. At the state level, ongoing programmatic Medicaid changes move forward. Finally, even with the the Cadillac tax delay, employers experiment further with wellness incentives and alternative (and narrower) network design.  

In the Atlantic, Jonathan Rauch makes a lonely case for a renewed establishment that can impose some modicum of order. Few will like that treatment plan. His Chaos Syndrome diagnosis, however, is inarguable, as is his view that in the near term, “it will only get worse.”  

Donald Trigg is president of Cerner Health Ventures. In a previous life, he worked for President George W. Bush starting on the 2000 presidential campaign in Austin, Texas, and then after a brief Florida detour, in Washington, DC for the first half of Bush’s first term. 

Morning Headlines 7/6/16

Measuring Interoperability: Listening and Learning

ONC will address a MACRA requirement to establish metrics for measuring interoperability by incorporating two new interoperability-related questions into the AHA Information Technology Supplement Survey and the CDC’s annual National Electronic Health Record Survey.

Member Voice: ‘Medical Error’ Study Shows Major Flaws, Should Be Retracted

Neuroradiologist Shayam Sabat, MD calls for BMJ to retract a clickbait paper it published titled “Medical Error: The Third Leading Cause of Death in the US,” which he says a “shoddy piece of scientific and statistical work which cannot stand the close scrutiny of peer physician researchers and professional statisticians.”

Business Associate’s Failure to Safeguard Nursing Home Residents’ PHI Leads to $650,000 HIPAA Settlement

Catholic Health Care Services of the Archdiocese of Philadelphia will pay a $650,000 settlement stemming from a 2014 data breach that left 412 patients information exposed when an unencrypted company-issued iPhone was stolen.

Cluster failure: Why fMRI inferences for spatial extent have inflated false-positive rates

A study investigating algorithms used to process functional MRI results finds that the algorithms used generate false-positive rates up to 70 percent, leading authors to question the validity of 40,000 studies.

News 7/6/16

Top News

ONC will measure MACRA-mandated national interoperability progress using metrics from two existing surveys: the percentage of providers who say they are sending and receiving information (AHA’s Information Technology Supplement Survey) and the percentage who say they actually use the information of other providers to make clinical decisions (CDC’s annual EHR survey).

Reader Comments

From Addison in Madison: “Re: Epic non-competes. Epic’s modus operandi is to demand new agreements with any change in status / business. Your employer has perhaps been steady for a while, so they are operating under an old agreement. It is when something changes that Epic introduces their new demands. What changed for Accenture was the acquisition of Sagacious. Same with Navigant’s Epic-related acquisitions. When that happened, Epic put the agreement back on the table, with the new stipulations. You can expect the same if your firm is ever acquired or does any acquiring.”

From Voice of Reason: “Re: Epic non-competes. The reason Epic might be doing this is because both Sagacious and Vonlay were bought out by Accenture and Huron Consulting Group respectively. Epic might be thinking since Accenture and Huron provide a variety of consulting services, their Epic consulting division might pass on proprietary info to their other divisions that might compete with Epic. I don’t think Nordic has these restrictions since they only deal with Epic consulting.”

From Dr. T: “Re: Epic non-competes. what may happen is when Epic learns of the new facility you are going to, there is a quiet conversation with the old employer. Then they call the new employer and say, ‘We won’t do business with that person.’ Guess what happens? You don’t have a job, you can’t prove who talked to which manager/exec, and you don’t have the deep pockets to fight it. I saw it myself and almost had to get the toes out to keep counting how many times it happened with an old employer.”

From DrM: “Re: Epic non-competes. I predict Epic’s approach to the consultants will be what brings down the whole non-compete house of cards for them. Does anyone else find it strange that, shortly after starting up their own consulting firm, they impose rules on competing consulting firms that will (purely coincidentally, I’m sure) reduce the number of available consultants? Other companies have lost anti-trust suits for doing less. I also hope in the trial they bring up their trade secrets so they can be told the definition of trade secrets, i.e., you actually have to try to keep them a secret.”

From Apt Moniker: “Re: Twitterati. I, too am never sure whether Twitter means anything in real life. However, senior execs often watch their own Twitter accounts, although not the company one.” Twitter, Facebook, and LinkedIn are, at least for individual businesspeople, vanity platforms. Heavy users like feeling followed and it gives them a place to tout their self-perceived wonderfulness in humble-bragging to others who are doing exactly the same thing in a never-ending stream of self-promotion. Twitter in particular is full of updates that are simply links to questionable source material with the apparent goal of being the first to highlight something new or to appear to be better read. My experience is the same as what big web publishers have reported – I can get a ton of tweets and retweets linking to my original HIStalk page and it doesn’t boost site traffic one bit. From that I conclude that the Twitterers are happy just to read that the page exists, but free of the motivation to click the link to see what it actually says.

From See My I/O: “Re: leading CMIOs. Here’s a link to the top 15.” Sorry, that’s just the usual time-wasting magazine crap story, or in this case, a pointless but painful to watch slideshow. There’s no stated methodology behind the list – the magazine apparently just chose some names they recognized and proclaimed those CMIOs as “leading” in trying to amass clicks that advertisers might mistake for influence.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mrs. H, whose Arkansas elementary school science class needed activity tubs for their Friday projects and labs. She reports, “The students really enjoyed the force and matter experiment in which they had to attach a balloon with a straw to a string and release it to see who’s balloon traveled the fastest. The conversations we got from students were amazing and after each group went students discussed what they could do better next time to make their balloon travel quicker. These were some fun times — we are so competitive.”

I pledged transparency to a reader who asked me awhile back to list not just new HIStalk sponsors, but also those companies that don’t renew. I don’t like doing that because I take it as a personal failure, but I promised. With that, I’ll say goodbye and thanks to the following companies with whom I parted ways in the past year because they were acquired, went a different direction, tightened their belts, or lost the employee who was my only contact there.

AirStrip
Anthelio Healthcare Solutions
AT&T
Aviance Suite
Awarepoint
Burwood Group
CareTech Solutions
CitiusTech
DataMotion
Greencastle Group
Greenway Medical Technologies
MBA HealthGroup
McKinnis Consulting
MedAptus
Oneview Healthcare
PDS
Porter Research
Provation Medical
Sensato
Streamline Health
VMware
XG Health Solutions

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Digital pathology startup Proscia raises $1 million. The founder and CEO just earned his BS from Johns Hopkins. I’m amused that the company’s write-up says the team has filed “over eight patents” and been involved with “more than four technology companies,” making me wonder what’s wrong with just saying “nine” and “five.”

UnitedHealth Group sues publicly traded American Renal Associates Holdings for fraud, complaining that the dialysis company convinced its Medicare- and Medicaid-eligible patients to instead sign up for UnitedHealth insurance at no charge, arranging to have their premiums paid by a charity whose funding comes from providers who benefit from having better-insured patients. Government programs pay American Renal Associates about $300 for a dialysis treatment while it can bill UHG $4,000 for the same session, giving the company a profitable loophole in billing more in claims than it costs to pay for the patient’s insurance. The Affordable Care Act requires insurance companies to accept all people regardless of their health, but HHS has been vague on whether it’s OK for charities that receive most of their funding from providers to pay individual premiums directly.

Sales

Mayo Clinic will implement Visage Imaging’s Visage 7 enterprise imaging platform throughout its radiology practices.

Announcements and Implementations

Carefluence earns the first API certification issued under ONC’s criteria, with Carefluence Open API 1.0 earning certification for patient selection, data category request, and data request. I note several misspellings on its home page, including a claim that it was designed to “demistify” interoperability, which suggests fog removal. The company’s website has minimal information (such as location and management team), but it appears to be connected to the equally reticent technology vendor ModuleMD.

Among the winners of MD Buyline’s user satisfaction surveys are Aesynt (pharmacy robotics), CareFusion (pharmacy automation), Epic (EHR), GE Healthcare (cardiology PACS, perinatal information systems, RTLS,and time and attendance), Healthcare Insights (financial decision support), McKesson (staff scheduling), Philips (PACS), Premier (ERP), SCC Soft Computer (laboratory information system), Siemens Healthineers (cardiology PACS), and Vital (3D advanced visualization).

Government and Politics

The government of South Australia continues to defend its over-budget and delayed $315 million EPAS patient care system even as the auditor-general warns that the project is underfunded and unlikely to deliver $113 million in savings. The Allscripts Sunrise system is live at some sites and will be phased in when the new flagship Royal Adelaide Hospital opens.

Privacy and Security

Catholic Health Care Services of the Archdiocese of Philadelphia will pay a $650,000 HIPAA settlement related to the 2014 theft of a PHI-containing, company-issued iPhone that was not password protected. The phone contained the information of 412 residents of the six nursing homes it owned and managed. OCR found that CHCS had not published a policy about taking mobile devices off campus and had not developed a risk analysis and risk management plan. Most interesting is that CHCS was charged as a business associate rather than as a covered entity since it was the corporate parent of the nursing homes and provided technology services to them.

Atlantic Health System (NJ) sends 5,000 randomly selected employees an email saying they’re getting raises, telling them to just confirm by clicking a link and entering their employee ID number, data of birth, and ZIP code. One-fourth of them opened the email and two-thirds of those provided their personal information. The email was actually a phishing test that mimicked known hacker practices such as using an originating email address ending in .com instead of .org. Several employees complained that the promised raise wasn’t real, but on the upside, quite a few reported the email as suspicious and warned co-workers not to fall for the trap.

Innovation and Research

Researchers find statistical bugs in the software that interprets functional MRI results, leading them to question the validity of 40,000 studies.Poor archiving and data sharing practices mean the existing studies can’t be re-analyzed with better software.

Technology

London’s Moorfields Eye Hospital is sharing de-identified eye scans with Google DeepMind, which is developing artificial intelligence for early detection of diabetic retinopathy and macular degeneration.

An Apple iOS 10 update this month will allow iPhone users to sign up as organ donors with the Donate Life America registry and be flagged as an organ, eye, and tissue donor on the phone’s Medical ID emergency information display.

Other

Neuroradiologist Shyam Sabat, MD calls for BMJ to retract the “shoddy science” tabloid-like pseudo-study it published in May that claimed medical errors are the third-leading cause of death in the US. His analysis of the paper finds that four studies were improperly combined into a meta-analysis that really left just one 2004 Healthgrades study of Medicare recipients, which the authors then wildly extrapolated to all inpatient admissions. He concludes,

How a reputed group such as the BMJ could not see through these simple but outrageous statistical blunders is anyone’s guess. Did the overwhelming incentive to get a spice tabloid-type, eye-catching headlined paper prevent the editorial process from taking common sense decisions? The result is that the US medical community is being ridiculed by media and people not only from the US but the whole world who cannot understand how US medical system is so incompetent despite spending the maximum in the world and attracting the best talents from all over the world.

The Boston Globe notes the trend of doctors working night shifts in hospitals, where “nocturnalists” oversee the activities of overworked residents, reduce the number of calls to attendings, and get patients out of the ED and into beds when indicated.

Cleveland stakes its claim as “The Medical Capital” by launching a rebranding initiative, a new website, and a new testimonial video. In other words, you should take their word for it because they blew through a ton of marketing money in proclaiming themselves #1. Maybe it will draw business, but I can recall many weed-infested empty lots bordering desolate highways festooned with signs proclaiming that area to be some town’s “high-tech corridor” that never quite caught on.

Dear naive people who cry foul when drug companies raise the prices of critical drugs for no good reason, saying those companies are “putting profits ahead of patients:” that’s exactly what for-profit companies are supposed to do. It’s unconscionable when health systems and insurance companies hide their huge bottom lines behind non-profit status, but for-profit corporations exist for a singular purpose, to deliver maximal profits to shareholders. The understandable outrage would be better focused on advocating for government-led drug price involvement like the rest of the world uses, which leaves US consumers footing the bill for most drug company profits and research investment.

Powell Valley Hospital (WY), which struggled for years to get its $2 million NextGen hospital EHR working well enough to earn Meaningful Use money, learns that the product’s new owner, Harris Computer Corporation, won’t add MU Stage 3 capabilities to the product. Harris has offered to replace NextGen with QuadraMed for just the installation cost, but the hospital would still need to spend over $1 million. Harris confirmed that it will provide only break-fix support for the NextGen hospital system, saying it acquired the product because NextGen was going to shut it down anyway.

A former naturopath (ND) who left a lucrative practice after observing a colleague administered an unapproved cancer drug says that “naturopathic services are quackery” and scoffs at ND ambitions to be recognized as primary care physicians. She writes,

Essentially, naturopaths want to be allowed to take shortcuts. Instead of attending medical school, naturopaths attend their own, self-accredited programs with low acceptance standards and faculty who are not qualified to teach medicine. Instead of a standardized and peer-reviewed medical licensing exam, naturopaths take their own secretive licensing exam that tests on homeopathy and other dubious treatments. What little medical standards that seem to be tested on the exam have been botched, like the one question in which a child is gasping for air and the correct answer on how to treat is to give a homeopathic remedy.

Sponsor Updates

• Clockwise.MD will exhibit at the UCAOA Regional Conference in Philadelphia on July 14-15.
• Audacious Inquiry comments on MACRA NPRM V5.
• Boston Software Systems launches a podcast series covering EHR migration, system optimization, and the sunsetting of legacy systems.
• CareSync is featured in a USF Health article on Tampa’s digital health opportunities.
• ClinicalArchitecture will exhibit at the Military & Government HER & Health IT Symposium July 13-14 in Arlington, VA.
• Cumberland Consulting Group will attend the 340B Coalition Summer Conference July 11-13 in Washington, DC.
• Elsevier will develop a free benchmarking report detailing the current landscape of cancer research and collaborations as part of the national Cancer Moonshot initiative.
• Healthfinch joins the Athenahealth Marketplace.

Blog Posts

• Meditech 6.x Outperforms Other EHRs on CMS Quality and Value Measures (Meditech)
• Advanced Practice Training: AdvancedInsight Reimbursement Analysis (AdvancedMD)
• Curing Weak Patient Engagement with mHealth Apps (AirWatch)
• Burgers and Fries and Data (Arcadia Healthcare Solutions)
• Live from HFMA ANI 2016 (Besler Consulting)
• MACRA: Reporting for Quality’s Sake (Caradigm)
• Oncology Care Model: 196 Physician Group Practices and 17 Insurance Companies to Participate (Carevive Systems)
• When an EHR Isn’t Enough (ECG Management Consultants)
• Meditech 6.X: Facing Transition Decisions (Galen Healthcare Solutions)
• MACRA 101: 9 Things to Know (Hayes Management Consultants)
• Building Rapport – Relationships for Success (HCTec)
• Go-Live Support: Procedures & Reporting (The HCI Group)
• Declaration of Health Independence (Healthwise)

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 7/5/16

Conflicker Used In New Wave of Hospital IoT Device Attacks

A report from IT security firm TrapX Labs concludes that internet-connected medical devices remain a digital soft spot for hackers attempting to infiltrate networks.

NHS seeks cure for its costly digital headache

The Guardian discusses the need to improve data security as England pushes forward with its plans of digitalizing NHS medical records.

CMS updates rule allowing claims data to be sold

CMS publishes a final rule that will expand access to its claims data through the “Qualified Entity Program,” which grants approved organizations access to CMS data sets that include patient-identifiable claims information.

Here’s How a Hacker Extorts a Clinic

TheDarkOverlord , the anonymous hacker responsible for selling four healthcare databases on the dark web last week, says in an interview that he does not feel bad about what he is doing because he is “furthering the enhanced security and development of new protections.”

Monday Morning Update 7/4/16

Top News

A security firm’s research finds that PCs and servers controlling hospital medical equipment often run outdated operating systems that are vulnerable to old malware such as the Conficker worm, giving hackers an easy back door into the hospital’s network. The report notes that hospitals are usually zealous in protecting end user PCs, but sometimes forget the computers that run CT scanners, dialysis machines, and other FDA-approved medical devices.

A case study involves a top hospital whose X-ray equipment was running Windows NT 4.0, which the security firm observed being penetrated in time to stop it. Honeypots created at another hospital found hackers hitting Windows XP-based systems for radiation oncology and fluoroscopy.

Reader Comments

From Orlando: “Re: Epic’s non-compete provisions. I wonder if they’ll try this in California?” California’s position on non-competes is that anything that restrains competition is automatically void. However, we’re back to the fundamental problem: no matter how questionably enforceable a non-compete agreement is, the employee has to decide whether to sign it and hope it will all work out when they leave because their only other option is to mount a long, expensive legal challenge either before or after their departure. Readers have pointed out that both Epic and Cerner have aggressive, mandatory non-compete agreements with employees but rarely enforce them if the employee leaves in a civil manner. Another challenge is that Epic could kill an employment offer from a third-party consulting firm or a health system by simply placing an off-the-record phone call. “You’ll never work in this town again” is pretty much true if you cross someone at Epic an try to jump ship to work for someone who relies on Epic’s goodwill, regardless of what legal terms you did or did not sign.

HIStalk Announcements and Requests

McKesson’s health IT legacy will be modest, suggest poll respondents who characterize its contributions as poor (45 percent) or fair (43 percent). Commenters blamed disconnected and poorly managed acquisitions, a lack of healthcare IT focus similar to other companies that entered health IT with a big splash and later slunk out quietly (Siemens, GE, AT&T, IBM, and Oracle), and leadership pulled from the sales ranks. New poll to your right or here: which company will benefit most when McKesson sells its EIS business that includes Paragon?

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

We funded the DonorsChoose grant request of Mrs. Robles from Arizona, who says the iPad Mini and multimedia receiver we provided to her middle school class has been “a game-changer for all of us” as the students have been more inspired to work harder at math using the lessons and discussions she assigns.

Also checking in is Miss V from Utah, who had said in her grant request that she was “sometimes embarrassed as their teacher because we are a STEM school and yet I don’t have a single math manipulative in my classroom.” We bought her several sets, leading to her update: “The manipulatives you donated are more versatile than I ever thought possible, we use the counters for language bingo, shapes, math, and much more. Since we have received your donation, math in our classroom has become a lot more interactive and hands on. Miss V. and the math detectives will be solving hard math problems for years to come thanks to your amazing gift!”

Here’s how you know you’re in a low-growth geographic area: the clerk at Walgreens asks for your telephone number to look up your Balance Rewards Card and enters it wrong as you’re reciting it because they weren’t expecting a non-local area code. That suggests: (a) the area hasn’t grown enough to need more than one area code, and (b) they don’t get many people moving in since most would keep their old cell number containing their original area codes.

Last Week’s Most Interesting News

• A hacker offers the patient databases of three providers for sale after those organizations decline to pay him or her to keep them private.
• Teladoc announces plans to acquire consumer engagement software vendor HealthiestYou for $155 million in cash and stock.
• AMIA announces the requirements for taking its informatics certification exam.
• McKesson announces that it will divest its Technology Solutions business into a new joint venture company that it will co-own with Change Healthcare and that it will exit the business following the new company’s 2017 IPO. McKesson will also seek strategic alternatives for its Enterprise Information Solutions business, which includes the Paragon hospital information system.
• Allscripts brings back three original executives from its EPSi financial planning business and files a lawsuit against competitor Strata Decision Technology, accusing the company and former Allscripts chief marketing and strategy officer Dan Michelson – hired by Strata as CEO in 2012 – of using confidential Allscripts information to improve the KLAS rankings of StrataJazz in displacing Allscripts’ EPSi from the #1 spot.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

UK-based Network Locum, which matches hospitals with available locum tenens doctors, raises $7 million.

Xerox will lay off 95 employees of its Orlando-based Medicaid administration program due to “the business decision of a single client.” 

Sales

East Jefferson General Hospital (LA) chooses NThrive – the former MedAssets, Precyse, and Equation – for revenue cycle outsourcing.

Government and Politics

The Brexit-induced devaluation of the British pound could leave NHS unable to afford expensive drugs manufactured elsewhere, experts fear.

Go Andy Slavitt. You’re going to miss him when he leaves his federal job soon.

The federal government erases $171 million in loans made to students of bankrupt, for-profit Corinthian Colleges, which at its peak ran 100 campuses serving 75,000 students who received $1.4 billion per year in federal student loans. The students who voluntarily chose the aggressively marketed but questionably useful training programs (some healthcare-related) offered by Corinthian Colleges get to walk away from their debt as does the company itself, leaving federal taxpayers holding the bag for the unwise decisions made by everyone except themselves.

Other

Vancouver’s Island Health will press on with its $135 million Cerner implementation despite last week’s unanimous no-confidence vote by its medical staff, who warn that the system’s electronic order entry is changing, cancelling, and overriding their orders. ED and ICU physicians have already gone back to paper orders after voicing similar patient safety concerns.

Catholic Health Initiatives will get out of the health insurance business after incurring big losses, adding big non-profit health systems to the list of organizations that believed they could compete with much-hated big insurers despite having minimal expertise in assembling a good risk pool and managing member health. 

Endocrinologist Joseph Aloi, MD of Wake Forest Baptist Medical Center (NC) describes in an interview how he uses Glytec’s Glucommander software to manage diabetic ketoacidosis. He notes that the #1 concern in treating older diabetic patients is hypoglycemia and it’s often caused by inpatient transfers out of dialysis, patients who aren’t eating, or NPO patients whose routine insulin dose isn’t adjusted. They’re looking at using Epic as a teaching tool to warn physicians if an insulin drip is discontinued and there’s no order for basal insulin, a practice used successfully used by Sentara.

I was wondering while watching fireworks Sunday night if any NFL’ers blew their fingers with firecrackers off this year.

This is a pretty funny tweet, although I wouldn’t have been as kind in not calling out the fact that there’s no such thing as EST until the clocks move back in November. Why do Americans struggle so much with the simple concept of EST in the winter, EDT in the summer? (or just plain ET year round for those who just can’t keep them straight.) I’m not clear on what the HIT100 is, but it seems to reward and excite the Twitterati. I used to feel proud when a big company re-tweeted me until I realized it was a 24-year-old marketing assistant charged with tweeting something positive about the company. It’s not like Neal Patterson is manning or even reading Cerner’s Twitter since most decision-makers have more important things to do than screwing around with social media.

This must be doubly digital medicine: a robotic rectum developed by Imperial College London for practicing rectal exams.

Sponsor Updates

• Over 500 WeiserMazars employees volunteer at over 20 community organizations in five states during its second annual “Days of Service.”
• ZeOmega receives a perfect SOC 2, Type 2 Report following an audit of its IS services.
• Xerox is named a leading contact center outsourcing service provider in Everest Group’s 2016 report.

Blog Posts

• Improving Hospital Efficiency through Data Driven Analytics (TeleTracking)
• Hybrid IT: It’s About More Than Infrastructure (Tierpoint)
• Go-Live Support: Procedures & Reporting (The HCI Group)
• Busted 2016: Prominent Healthcare Fraud Schemes (Verisk Health)
• Summer’s Health Melts the ICD-10-CM Code Freeze (VitalWare)
• The powerful potential of smartphones. (Voalte)
• 5 Steps Towards a Modernized Healthcare Contact Center (West Corp.)
• 5 Reasons You’ll Want to Attend this Year’s ZirMed User Group Conference (ZirMed)
• Dynamic Diagnostic Support (Zynx Health)

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 7/1/16

Data breach at Mass. General involves 4,300 dental patients

Massachusetts General Hospital informs 4,300 dental patients that their records were exposed after an unauthorized user gained access to records stored by dental practice management software vendor Patterson Dental Supply.

Teladoc to Acquire HealthiestYou in Cash, Stock Deal; Updates FY16 Outlook

Teladoc enters into a definitive agreement to acquire consumer engagement platform vendor HealthiestYou for $155 million in cash and stock.

Eligibility requirements for advanced health informatics certification

AMIA announces eligibility requirements to sit for the advanced health informatics certification examination.

Biden threatens funding cuts for researchers who don’t report clinical-trial data

During a conference at Howard University, Vice President Joe Biden was asked why research grants were being issued to organizations that were not reporting results to public databases in a timely fashion, to which Biden replied "Doc, I’m going to find out if it’s true, and if it’s true, I’m gong to cut funding. That’s a promise."

News 7/1/16

Top News

Massachusetts General Hospital (MA) notifies 4,300 patients that their information was exposed in a February 2016 breach of dental practice systems vendor Patterson Dental Supply. Dental system security guy Justin Shafer notified the company in February that all instances of its Eaglesoft software are insecure because the database uses a default username of “dba” and a password  of “sql.”

The company expressed its thanks in May 2016  by filing a Computer Fraud and Abuse Act claim in which it notified the FBI that Shafer had illegally accessed its server, leading to a pre-dawn raid on his home by a dozen armed agents who hauled him away in handcuffs.

SRS commented on the screenshots I ran showing hacker TheDarkOverlord (who I’ll refer to as “he” even though he or she hasn’t divulged gender) sitting on an SRS EHR log-in screen as he apparently used Remote Desktop Protocol (RDP) to steal their client’s patient data:

Protecting our clients’ patients’ information is a top priority at SRS. Upon receiving notification that patient data from one of our clients may have been compromised, we immediately launched an investigation. While our investigation has concluded that the SRS system itself was not compromised, we are working in partnership with our client to assist in any way we can. At this time, the matter has been turned over to the appropriate authorities.

The hacker published several SRS screen shots showing full patient information. SRS is right, though – accessing a system by breaching RDP isn’t taking advantage of a vulnerability of any system other than RDP. It’s just logging in using someone else’s credentials. The real question is how he obtained the log-in information. RDP can store system usernames and passwords that can be displayed with readily available utilities. It would be interesting to know whether the clinic had set up RDP for its own users or whether a software vendor had configured it for remote support use.

Justin Shafer (see above) speculates that the SRS client is Athens Orthopedic Clinic (GA) based on partially readable information in the SRS screen shots. DataBreaches.net contacted the clinic and received this response from its CEO:

In the last 48 hours, we were made aware of a potential data breach relating to our online patient records. Today, we also received an email requesting that we comply with the hacker’s request (which has been published in various forms online.) We take the privacy of our patients very seriously, as well as the laws that guide patient privacy, and we are investigating what may have happened through the proper channels. When we have more information to share with you and your readers, we will be in touch. Kayo Elliott, CEO, Athens Orthopedic Center.

TheDarkOverlord also named the Midwest provider from whose system 98,000 records were stolen and then listed for sale: Midwest Orthopedic Pain & Spine in Farmington, MO.

The hacker says he contacted each provider and offered to destroy his copies of their records if they paid him, with the alternative being that he would offer their records for sale. All of the providers declined. Note that this is extortion rather than a ransomware attack since he didn’t lock the users out of their own databases – he just demanded money in return for not publishing the records. He also apparently accessed the systems using manual intrusion methods rather than automated malware.

I scoured the Web for how to secure RDP:

• Use strong passwords.
• Keep both client and server versions current since older versions have many vulnerabilities.
• Enable network-level authentication.
• Administrator-level users can run RDP by default, so either remote unneeded administrator access or remove the administrator account from RDP access and add a technical group instead.
• Set a local security polity limiting the number of password attempts.
• Change RDP’s listening port so it can’t be easily seen in hacker network scans.

Here’s a chillingly factual description of how to hack RDP to steal the sysadmin password. The hacker uses address resolution protocol scanning software to find device IP addresses; captures the data stream when an RDP client connects to the RDP server (such as when a vendor connects to provide technical support); and then looks for passwords in the sniffer file, visible as individual user keystrokes (or the hacker can use a brute force password cracker).

Vendors, you might want to give your customers some emergency security guidance about configuring RDP, TeamViewer, LogMeIn, or any other remote support tool your support agreement requires.

Reader Comments

From Green Tomato: “Re: forcing consulting firm employees to sign Epic’s non-compete agreement. Here’s a copy of what my employer insists we sign. Interesting contents: (a) it completely restricts access to Epic code without ‘pursuant to a customer schedule’ language, so the company has already run into engagements that require review of Epic code; (b) it restricts access to the Chronicles database, again costing my company a couple of engagements because they needed to query Chronicles to support a customer; and (c) it includes the hugely overreaching and offensive clauses declaring that we can’t work for an Epic competitor for one year after leaving our current jobs. I’ve heard that other consulting companies have signed agreements without the non-compete clause. I am standing up to my employer in not signing the agreement and will likely lose my job in the next few weeks. Without getting a group together for class action lawsuit, I’m essentially screwed, and even with a group it would be an uphill battle.”I don’t have the expertise to evaluate the legality of a company requiring its employees to sign another company’s non-compete agreement, but firing someone for declining to sign would seem to sit in wrongful termination territory. The fact that your employer even put this in front of you is indicative of just how scared companies are of getting on Epic’s bad side. I invite legal opinion, although I think you are correct that, right or wrong, you would need a lot of time and money to mount a challenge, and by the time you prevail, you will have moved on. You also have the document in Word, so you could add “not” in a key place (such as, “This restriction will not apply to you”), print it, and sign it hoping that nobody notices your edit.

From ThisChangeIsNotGood: “Re: McKesson and Emdeon. They fall short in integrating acquired products and their customer service lacks. Change Healthcare and Relay have KLAS scores that lag almost 10 points behind their competitors. Why will bringing two challenged organizations together be good for customers? The obvious answer is that it won’t – it’s just a very profitable transaction for Blackstone. They acquired Emdeon for $3 billion and used at least $1.5 billion in debt, so this deal gives them $1.75 billion in cash ($250 million in profit) plus they still own 30 percent of the resulting entity. The release mentions $150 million in cost reductions which has to be mostly employees – the companies are huge cash generators because their customer contracts are old and those customers are drastically overpaying. The question is how long hospital CFOs will tolerate out-of-market prices with mediocre solutions and customer satisfaction.” There’s also the question about the degree of alienation felt by McKesson Technology Solutions customers and whether they see that getting better or worse once they’ve been dealt off to NewCo since, most importantly to McKesson, they buy a lot of non-IT stuff that McKesson actually cares about.

From HIStalkFan: “Re: [vendor name omitted.] VP of operations is leaving after the international sales VP left in the past month as well. The company has fired 20 folks in the past few months and seems to be losing business fast.” I left out the name of the cardiovascular information systems vendor for now since the VP is still listed on the company’s executive page. 

From Luke: “Re: VistA. Says its 40-year-old code is hard to manage, unlike that of commercial products.” Maybe, but Epic has been around nearly that long and Cerner Millennium was built in the 1990s. All three products have been enhanced continuously since they were developed, so it’s not like running an un-updated copy of Windows 3.11. The problem with both the DoD and the VA is that they’re going to hand billions over to contractors no matter what product they use and will probably botch their implementations via poor planning and oversight.

HIStalk Announcements and Requests

Mr. H says his Texas after-school STEM class is “beyond excited” about the STEM kits we provided in funding his DonorsChoose grant request. The students have built a robot arm and analyzed pond water, with one student proudly exclaiming while experimenting with a marble roller coaster, “We are engineers in the making!”

Listening: Gary Clark, Jr., accurately characterized by the reader who recommended him as “born two generations too late, Jimi Hendrix crossed with Stevie Ray Vaughn.”

This week on HIStalk Practice: ManagementPlus launches revenue cycle solutions for eye care practices. Jonathan Bush waxes lyrical about his political plans. Allergy Partners develops app to help its patients track meds, triggers, symptoms. VillageMD partners with New Hampshire-based practices to assist with value-based care transitions. HHS selects 200 physician practices to participate in its Medicare Oncology Care Model. "Dr. Trump" promises perfect healthcare for all.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Marketing intelligence vendor Definitive Healthcare acquires competitor Billian’s HealthData.

Teladoc will acquire telehealth consumer engagement platform vendor HealthiestYou for $155 million in cash and stock. Scottsdale, AZ-based HealthiestYou lost money on $10 million in FY2015 revenue, while Teladoc confirms that it will lose around $50 million in 2016. HealthiestYou offers price comparison and provider search. It seems like a ridiculous multiple for Teladoc to pay for an app that doesn’t seem all that interesting or related to its core telehealth business, but they must know what they’re doing.

Google Capital takes a $46 million position in publicly traded marketplace Care.com, which matches families with caregivers.

Allscripts sues its former chief marketing and strategy officer Dan Michelson – hired by competitor Strata Decision Technology as CEO in 2012 – as well as Strata, claiming that Michelson “has in his possession an external hard drive containing highly confidential and trade secret Allscripts documents and information.” Allscripts claims that Michelson has disclosed its information to Strata employees in violation of his Allscripts employment agreement. The lawsuit also notes that Strata hired several other Allscripts employees, several of whom worked in sales for EPSi, the Allscripts financial planning product that competes with Strata’s StrataJazz. Allscripts contends that it lost the #1 KLAS spot for Decision Support – Business in 2014 to StrataJazz because of the exposed information, causing EPSi to drop to fourth place in the 2015 report.

Sales

GoHealth Urgent Care chooses Orion Health’s Rhapsody integration engine to connect with its health system partners.

Government and Politics

Vice President Biden, questioned at a cancer summit about why medical institutions that receive government grants don’t always publish their research data, responds angrily, “I’m going to find out of it’s true. And if it’s true, I’m going to cut funding. That’s a promise.” NIH Director Francis Collins says the 2008 law requiring taxpayer-funded researchers to submit their clinical trials data to NIH-run ClinicalTrials.gov does not provide an enforcement mechanism, but he expects changes that will allow NIH to levy fines on those who don’t comply or the power to ban them from receiving further grants.

The Wall Street Journal says health insurance deductibles should become the next health policy debate now that 91 percent of the US population has coverage. Since 2004, co-pays have dropped, worker wages have increased modestly, and deductibles have jumped 256 percent to become the #1 health cost concern of consumers as well as the preferred tool for employers trying to rein in annual premium increases.

Congress works on a financial bailout of Puerto Rico, where 9 percent of its population has moved to the US, causing its hospitals to struggle with unfilled beds and an exodus of clinicians that may cause a further downward spiral in employment and business investment. Puerto Rico’s governor observes that its residents pay the same Medicare tax as mainland residents, but it gets less federal funding than the states. Lenders have cut off further loans as debt soars, with one surgeon noting that the hospital’s electricity was turned off for non-payment in the middle of a surgery he was performing.

Other

AMIA announces the eligibility requirements to take the exam for its Advanced Health Informatics Certification, an alternative to the physician-only clinical informatics subspecialty. Until an unspecified time until which the majority of graduate informatics programs are accredited, the requirements are:

• Employment in an operational health informatics role.
• Attainment of a health professions graduate degree plus a master’s in health informatics (for which 36 months of informatics experience in the US or Canada can be substituted). Examples of acceptable degrees are MSN, MPH, NP, PA, DDS, DNP, PharmD, DO, and MD.
• 18 months of informatics work experience.

AMIA’s next steps are to develop the exam’s core content, choose a certifying entity, and launch the accreditation of graduate health informatics programs.

Commonwealth Fund President and former National Coordinator David Blumenthal, MD, MPP says that instead of trying to convince providers to share their patient information, a better way to eliminate information blocking is to put patients in control of their own records as a “consumer-mediated health information exchange.” Patients or their paid vendors would manage and distribute their own information to parties they specify, which could include researchers or public health authorities. Blumenthal says the next steps would be to certify and/or regulate the organizations that will help patients share their information and to give those organizations access to provider EHRs.

Informaticist Harris Stutman, MD ended his “Jeopardy” run Wednesday, earning second place for the day but taking home three-day winnings of $63,500.

BMJ ponders whether it’s OK for conferences to ban live-tweeting of their educational sessions. Arguments for: (a) presentations may include unpublished results and preliminary conclusions; and (b) the presenters may have granted a copyright to journal that is publishing their work. The author suggests that conferences make their tweeting policy clear and that speakers indicate on their title slide whether they are OK with having attendees tweet out photos of their other slides and handouts.

Sponsor Updates

• Audacious Inquiry announces that its Encounter Notification Service is delivering1 million ADT notifications per month.
• Boston Software Systems launches an EHR migration and optimization podcast series.
• Netsmart helps prepare health and human services providers for CARF and The Joint Commission accreditations.
• Representatives from 30 healthcare organizations in Canada visited Toronto’s Humber River Hospital, which claims to be North America’s first full digital hospital, to learn about its Meditech 6.1 system.
• CloudWave is named by Hewlett Packard Enterprise as Preferred Healthcare Network Partner.
• Red Hat will host its annual summit will take place May 2-5, 2017 in Boston.
• Sagacious Consultants releases the June 2016 edition of its Sagacious Pulse newsletter.
• SK&A publishes its annual pharmacy compliance report.
• Sunquest Information Systems hosts a Cancer Moonshot Summit in Tucson, AZ.

Blog Posts

• How Long Should Organizations Take to Notify After a Breach? (ID Experts)
• Earned Media is the Best Media (Influence Health)
• Engineering Solutions to Improve Quality of Care (Ingenious Med)
• The Journey to EMR Adoption: Persistence Pays Off (InterSystems)
• Medical Image Exchange: Which Docs Use it Most? (LifeImage)
• 4 ways to set yourself up for effective data governance (The Advisory Board Company)
• The Biggest Risk of Social Media for Physicians? Not Using It! (Meditech)
• Preparing for the Health System of the Future: 3 Strategies You Should Know (Navicure)
• Managed Services: Your EHR challenges, our solutions (Nordic)
• A Different Kind of Patient Record (Orion Health)
• Re-imagining Healthcare IT (PatientKeeper)
• Is Your Old EMR and Open Door for Hackers? (Mica Health)
• Building an effective care team collaboration strategy: 4 focal points (PerfectServe)
• Addressing the Address Issue in the “Good Neighbor” Policy (Phynd Technologies)
• If You Value Health Data, Set it Free (PMD)
• Spotlight on the Heart of MUSE 2016 (Summit Healthcare)
• Finding Success in Health IT Adoption for LTPAC (Surescripts)

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 6/30/16

Lots of chatter in the physician lounge this week around the installation of the new president of the American Medical Association. Frankly, I haven’t heard physicians discuss the AMA this much in years. The consensus has been that the AMA doesn’t really represent physician interests. Front-line physicians think the AMA has sold them out in a variety of ways.

With that in mind, though, why is the AMA top of mind this week? It’s because new president Dr. Andrew Gurman doesn’t use an electronic health record and is proud to say so.

I think we’re all so subject to the EHR hype and the constant barrage of vendor messaging, that we’ve forgotten that there are a lot of physicians out there who either aren’t using EHRs or who have elected not to attest to Meaningful Use. According to CMS data, only 56 percent percent of office-based physicians had demonstrated Meaningful Use of certified EHR technology at the end of 2015. I couldn’t find all the detailed data for 2015, but looking at 2014 data, there were 17 percent of physicians who hadn’t adopted an EHR at all. Of those non-adopters, 48 percent practice either solo or in groups smaller than 10 physicians.

I’d have been a lot more impressed if the new president was a primary care physician who had opted out of EHR, but Dr. Gurman is a solo orthopedic surgeon who specializes in hand surgery. He admits his practice is just taking the 2 percent penalty at this point. If you’re just looking at a 2 percent penalty, the ROI on opting out is pretty clear, especially if Medicare isn’t responsible for the majority if your patient visits.

I don’t know what Dr. Gurman’s payer mix looks like, but the hand surgeons I know work mostly with younger patients who are likely to have commercial insurance coverage. The opt-out becomes harder as the practice’s population ages (more Medicare) or as economic forces shift (more Medicaid).

Those practices I work with that have yet to implement an EHR are generally concerned about costs. To implement an EHR well costs far more than the incentives that have been available to date, and the penalties are minor compared to the cost. Of course, when you look at the other costs that having an EHR can reduce (chart storage, supplies, staffing for inevitable “chart hunts,” inefficiency) one can make the case for an EHR. It’s when you start adding in provider time that the cost curve can start behaving unpredictably.

In an efficient practice with standardized processes and a commitment to fully support the EHR, the ROI can be tremendous. In a practice where physicians don’t have buy-in or the systems aren’t in place to make the EHR run well, the ROI can evaporate in an instant.

It’s possible to delivery high-quality, well-coordinated care without an EHR, but it’s definitely a lot of work. I’ve worked with a number of groups that have not only achieved Level 3 Patient-Centered Medical Home recognition using paper charts, but who also have been able to demonstrate higher-quality care than their peers. The reporting requirements for these initiatives can be significant and typically require using other IT systems to document outcomes even if the practice isn’t using an EHR. It’s certainly easier to use an EHR, especially if you have a robust one, but balancing the demands of the EHR with its benefits is a trick that many practices have yet to master.

I’m working with a practice right now that has only a few physicians and no dedicated resources to support their EHR. They are extremely demanding with their vendor, yet refuse to do even the simplest things to help themselves. For example, the physicians refuse to allocate time for staff to attend the complimentary webinars that their vendor offers for upgrade preparation. I suppose they think the staff will learn about the product changes through telepathy.

The managing partner refuses to work collaboratively with the EHR vendor. Today they copied me on an email to their lab vendor where they were completely out of line, making wild accusations about the EHR vendor. It doesn’t seem like they’ve ever heard the old adage about catching more flies with honey.

I’m particularly sensitive to the statistics about practices that have opted out of Meaningful Use since I’m part of one. We’re fortunate that our payer mix tips towards the commercial side, and that we’ve carefully cultivated other revenue opportunities that aren’t subject to the current regulatory environment. We provide comprehensive occupational health services for some local employers and limited services (such as pre-employment physicals and drug screens) for others. We do travel health and have some contracts for specialized medical clearance. We do use an EHR and initially participated in Meaningful Use, but stopped after it became more burdensome than it was worth.

Even though we’re robust EHR users, I wish there were better ways for us to share data with other practices. Since we provide mostly urgent care services, it would be great to be able to access patient records from primary care physicians or from other acute visits, but we really can’t get anything. We can send CCDAs like nobody’s business (and we do), but we rarely receive anything because patients generally don’t anticipate having to come in for pneumonia, bronchitis, or the flu. Our metropolitan area doesn’t have decent coverage by a health information exchange, so really the only information we can pull into the EHR is the medication history from the PBM.

The major health systems surrounding us have absolutely no desire to share information with our practice because we directly compete with their emergency departments, yet the vendors are the ones that get accused of information blocking.

Until the health systems are in some way incented to share data with the rest of us, it’s going to be hard to move forward and get the information we need to provide better care to our patients and our community. Although most hospitals have embraced EHRs, we all know how hard it is for patients to get their own records electronically. Until we start solving that problem, I don’t have a lot of hope for the hospitals sharing with anyone that’s not closely aligned with them.

We’ll have to see if there’s as much buzz around this AMA president at the end of his term as there is at the beginning. Will primary care physicians embrace him and his goals? Time will definitely tell.

Email Dr. Jayne.

Morning Headlines 6/30/16

The Biggest Obstacle to the Health-Care Revolution

Former National Coordinator David Blumenthal, MD explores the idea of giving patients control of their own electronic records, which they can then use to overcome interoperability limitations, a system he calls a “consumer-mediated HIE.”

How IBM’s Watson Supercomputer Is Going to Help 10,000 Veterans

The VA is partnering with IBM’s Watson to bring precision medicine to cancer treatment within the health system. The VA delivers care for 3.5 percent of the US patient population, and the largest group of cancer patients within a single health care group.

But seriously, why did Theranos have just one spokesperson?

Brooke Buchanan, VP of communications and public spokesman for Theranos, has reportedly resigned from her position with the company on Friday.

Why there is no beta in health care

Re/Code examines the “move fast and break things” culture behind many software companies and outlines why it has failed to deliver solutions that address end user pain points in the health IT space.

Readers Write: Who’s On First? Baseball’s Lessons for Hospital Shift Scheduling

Who’s On First? Baseball’s Lessons for Hospital Shift Scheduling
By Suvas Vajracharya, PhD

A single MLB season includes over 1,200 players, 2,340 games, and 75 million fans in stadiums. In just 10 seasons, it’s possible to generate more baseball schedule options than there are atoms in the universe. Yet a full season of baseball scheduling is still far less complicated than just a single month of scheduling for 24/7 coverage shifts in a hospital emergency department. There’s good reason hospital operations teams are stressed about scheduling. Trying to do this manually with paper or a spreadsheet is an exercise in pure masochism.

First, a bit of history. Major League Baseball started out using a guy in the commissioner’s office to set up season schedules. Harry Simmons quickly found the task so overwhelming that he left the office and worked on the schedule as his full-time job (sound familiar?) In 1981, the league assigned the job to a husband-wife team named Henry and Holly Stephenson, who set the schedules for two decades using a mix of computers and manual scheduling.

Tech leaders at IBM, MIT, Stanford, and Carnegie Mellon all tried to unseat these scheduling gurus and failed until 2005, when the league switched to what is called “combinatorial optimization” technology to generate their schedules entirely by computer.

Today, the same applied mathematics technology is used in not just Major League Baseball, but in all sports leagues, airline schedules, and retail stores, too. Any time you’ve got a mix of teams, individuals, holidays, facilities, unpredictable weather patterns, changing demand, and lots and lots of rules that sound straight out of high school word problems … that’s a scheduling job for advanced computing.

Healthcare, as anyone with experience in the sector might guess, is behind the times when it comes to scheduling technology. The vast majority of hospital departments (an estimated 80 percentage) are still setting schedules manually, like our poor old friend Harry Simmons. It’s a problem that can’t be ignored any longer. Not only is manual scheduling a major time sink for hospital operations staff, it also contributes to the already significant issues of professional burnout and physician shortages.

The MLB uses scheduling software in two distinct ways. First, they generate an established schedule for the season using set rules. These include rules designed to prevent player burnout, such as requiring a day off after a team flies west to east across the country or not playing on certain holidays. There are also operational rules, such as not having two home games in the same city the same night or making sure the weekend and weekday games are equally divided among teams.

In healthcare, these established schedule rules include things like not scheduling back-to-back night shifts for a physician, making sure weekend on-call time is fairly distributed, and ensuring key sub-specialists are available 24/7 for procedures. This rules-based schedule serves as the baseline.

After this, a second type of scheduling tool comes into play. These are requests that let the schedule flexibly adapt to changes. When a blizzard knocks out a week of MLB games or they need to cancel a series in Puerto Rico due to Zika concerns, it’s this second set of optimization technologies that reconfigures the schedule to get things back on track for the season.

In healthcare, schedule requests happen any time and all the time. Vacation, maternity, schedule swaps, requests for overtime, adding locum tenens, adding mandatory training sessions — hospital schedules change far more frequently than MLB schedules, adding to the complexity.

A recent study of over 5,500 real medical department physician shift schedules showed that medical department scheduling varies by specialty. Emergency medicine has by far the most complex process with an average of 62 repeating scheduling rules and 276 monthly schedule change requests. Hospital medicine and OB-GYN follow behind and office-based schedules such as nephrology are much simpler but still beyond anything in the MLB. The math on the number of schedules you could generate with that complexity and variability in emergency medicine is mind-boggling. That specialty also just happens to have the highest rate of physician burnout.

It is time for hospital operations leaders to figure out what the MLB discovered way back in 1981: setting complex schedules is a job for computers. Using sophisticated machine learning to balance dozens of rules and to support flexibility for ongoing changes is good practice for baseball players, pilots, and physicians. With the help of technology, hospitals might already have the solutions they’re looking for when it comes to care coordination, physician retention, increasing patient volume, and preventing staff burnout. It’s time for hospital operations to play ball.

Suvas Vajracharya, PhD is founder and CEO of Lightning Bolt Solutions of South San Francisco, CA.

Readers Write: Change Your Change Management

Change Your Change Management
By Tyler Smith

Does your organization have a solid change management system in place? Hopefully for most, the answer is yes. In large-scale IT projects, it is essential that a well-constructed system of checks and balances for each system-affecting change be in place, as well as a forum for the discussion of each change that has a material effect on other pieces of the project.

However, due to overhyped fears of errant build moves, change management often becomes an organizational behemoth, larger and more threatening than the worst government bureaucracy and capable of effectively killing the desire of any analyst to make any change.

When the change control warps to such a state that analysts dread getting up and going to work because they know that every software improvement they make will cost them an exorbitant amount of time in the approval process, the project runs the risk of losing talented staff (if not in body, then in mind).

Having worked on a variety of EMR projects over the years, I have seen everything from no change control to a change ticket process that required a PhD to navigate the nuances and still left no one feeling fulfilled when the update in question eventually reached the live environment. Many times it isn’t just the process — it’s the outdated change management software that is used at these organizations, which causes the confusion and lengthy timelines. I’m not going to name names but anyone who has worked in these projects knows what I am talking about. These ancient enterprise change management software suites make the worst-performing EMR seem user-friendly.

The real loser in this dreaded combination of micromanagement and crappy software is the loss of productivity and creativity. If an analyst spends more time getting a change through than building it, that is not necessarily bad. Some simple changes require lots of analysis to see the broader system impact.

However, if every change requires a time effort 1.5 times or greater than the time spent to perform the actual configuration, that is a serious issue. You are effectively sacrificing productivity out of a fear of your analyst being incompetent or too short-sighted to see/think through the effect of their change. In effect, your organizational policy is stating, “We trust you to make changes in the system, but no we do not think you have any degree of comprehension of what these changes mean.”

Therefore, as organizations stabilize and try to determine how to get the best work from their full-time teams, I would highly suggest taking a look at your change management process and change management software vendor and see if the process and software really align with the other organizational initiatives you promote within your IT team.

Here are a few suggestions for moving forward:

• Simplify. Cut down the change management process and software to the most necessary components. For example, do you really need to have seven different fields where a description is entered? Do the technical specifications ever need to be entered more than once? How long do these meetings need to be and do all changes need to be presented in such a forum? How many people need to attend? Trim the digital and process components. Every step whether in the software or in the change meeting/presentation process is like the dreaded extra click for the provider. Eliminate documentation processes that are redundant, in addition to required fields that do not serve a purpose.
• As you simplify the governing structures, try giving analysts more control and in doing so see how little processes you actually need in place to maintain order. If analysts have the mental capacity to perform build tasks, they can probably handle taking on a degree of higher level organizational thinking regarding the impact of their change.
• Do not allow the change control process to be constantly updated unless those changes are removing redundancies or irrelevant steps. Adding additional rules and processes often confuses analysts and these updates rarely serve their intended purpose.
• Eliminate the standalone change control team altogether and make a committee formed from actual team members. It is OK to have a PM if the organization mandates such a structure. However, analysts who solely sit in a change control cube and who are not building in the system can never have a real world view of the software. These team members are essentially reactive (which means that in order to feel they have a purpose, they need to make the jobs of others more difficult, for better or worse). It may be a stretch to say that a change control team is a form of featherbedding, but the roles within it should be looked at with care as to the greater purpose they serve and their need to be full time.
• Finally, if you can, scrap the medieval change control software and use the most minimally time invasive platform to document and present change and keep a record for the future. An Excel document may be enough. If the change control is linked to the help desk ticketing software this may not be possible without getting a new help desk software, but add this to the analysis.

Reducing change control staff and processes may not be pleasant. However, the long-term gains in efficiency and creativity that you will see in return from your analysts will benefit the end users of the software far more than the negatives of a temporary overhaul.

Tyler Smith is a consultant with TJPS Consulting of Atlanta, GA.

Morning Headlines 6/29/16

About the Proposed Combination

McKesson confirms rumors that it will spin off its health IT business, merging it with Change Healthcare and in the process creating a new company with a combined annual revenue of $3.4 billion.

Jeremy Hunt suggests second EU referendum

In England, “remain” supporter Health Secretary Jeremy Hunt backs calls for a second Brexit referendum or, as an alternative, proposes a general election to establish sensible terms on the UK’s exit deal.

Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction

A study measuring correlations between physician burnout and EHR use found that providers that use EHRs or CPOE report being unsatisfied with the amount of time they spend on clerical work and a higher level of physician burnout.

Patient Payment Responsibility up 13% in One Year

A TransUnion Healthcare report finds that patients experienced a 13 percent increase in both deductible and out-of-pocket maximum expenses in 2015.

News 6/29/16

Top News

McKesson will divest its Technology Solutions business into a new joint venture company that it will co-own with Change Healthcare (the former Emdeon), with plans to take the new company public sometime in 2017. McKesson will own 70 percent of the new company and Change Healthcare will own 30 percent.

McKesson will retain its RelayHealth Pharmacy business as well as its Enterprise Information Solutions division, but will “explore strategic alternatives” for the latter, which includes its remaining go-forward hospital information system Paragon along with less-attractive products like Star, HealthQuest, and OneContent. McKesson seems to have lost most of its Horizon customers to Epic or Cerner after they declined to move to Paragon under McKesson’s Better Health 2020 program, so this latest move will likely cause more defections.

The new company will take on up to $6.1 billion in debt to fund the transaction.

Blackstone Group bought publicly traded Emdeon, which operated under the WebMD name through 2005, for $3 billion in 2011 and took it private in a leveraged buyout. It renamed the company Change Healthcare in September 2015 after January 2015 plans for a $5 billion IPO never materialized.

McKesson struggled from the beginning with its $14.5 billion acquisition of HBOC in 1998, dogged by a massive accounting scandal, the resultant firing of several executives who were involved, aging product lines, and a lack of corporate focus. The company, like several before it, dabbled in health IT dispassionately but with the added baggage of having wildly overpaid for an immediately impaired asset. MCK share price dropped and didn’t recover for 12 years under John Hammergren, who was quickly promoted to co-CEO in the leadership void in 1999, eventually becoming the country’s highest-earning CEO.

This transaction, along with the eventual disposition of Enterprise Information Solutions, will once again remove McKesson from the software business.

… but not the day after the transaction closes.

Your trivia questions for today:

• Who was named as Hammergren’s co-CEO in the 1999 announcement that McKesson Chairman Charlie McCall and CEO Mark Pulido had been fired over HBOC’s accounting irregularities?
• What was the name of McKesson’s short-lived online business that was launched in the heady dot-com days of 2000 and led by Hammergren’s former co-CEO, giving Hammergren full control?
• What accounting company failed to detect widespread fraud as the auditor of both McKesson and Enron?

Reader Comments

From ProGoogler: “Re: Change Healthcare. Blackstone finally dumps Healtheon / WebMD / Emdeon / Change onto McKesson? Surprising that Change would dump all assets into a company they’ll only have a 30 percent stake in. HIStalk followers–what’s the take on this?”

From Silly Boy: “Re: McKesson and Change. Throwing their trash into a doomed-to-fail company, ridding themselves of all liability, and getting $1.5 billion each in cash out of it? Wow.” You forget to mention the advantageous tax accounting McKesson will use to walk away.

From Robert Higgins: “Re: dress while traveling. See this LinkedIn post, which says everybody should dress up while traveling on business because they represent the company and you should be extraordinary rather than ordinary.” I can’t imagine anything more mind-numbingly ordinary than a bunch of mid-level company hotshots wearing suits everywhere they go hoping to impress strangers who apparently value cloth over character. Real power players wear whatever they want (see: Mark Zuckerberg, Steve Jobs, etc.) while their un-creative, lemming-like underlings choke on ties. I’ve attended venture capital sessions at the HIMSS conference and my biggest takeaway was that the real money guys looked like they had just dropped by after a family cookout, while back at work my fellow IT management team members would illogically don their always-handy suck-up jackets for internal meetings or restroom trips.

HIStalk Announcements and Requests

The Tennessee elementary school students of Mrs. Jones have shown “amazing growth” in benchmark assessments, she reports, after practicing reading and math on the the three Kindle Fires we provided in funding her DonorsChoose grant request.

I don’t really do anything with LinkedIn except look up people’s job histories, but you are welcome to join the 2,477 people who have connected with me there, of which 351 have written me really nice recommendations. There’s also the HIStalk Fan Club created by Dann many years ago, now up to 3,617 members, many of them CEOs, CIOs, CMIOs, etc. I might tell my mom about it just to see her puzzled double take since surely she views me fondly and accurately as her low-profile ne’er-do-well.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Ask Lorre about her “Summer Doldrums Special” sale.

This Tuesday’s webinar by West Healthcare Practice drew nearly 500 registrants and will no doubt generate many YouTube page views after the fact. I always give my first-pass critique of our webinars and rarely have any change suggestions for West. Lots of readers are apparently interested in what Henry Ford is doing with contact centers (including me).

Acquisitions, Funding, Business, and Stock

Allscripts acquires RealCost.io — a decision support company founded by former EPSi executives Tim Rutledge, Ralph Keiser, and John Gragg – and will put the three men back on the Allscripts EPSi financial planning product line to serve as chief product architect, CEO, and COO of Allscripts EPSi, respectively. Eclipsys acquired EPSi in 2008 for $53 million in cash, followed by the acquisition of Eclipsys by Allscripts for $1.3 billion in 2010. All three left Allscripts from 2008 to 2011.

VistA vendor Medsphere and ambulatory PM/EHR vendor ChartLogic will merge.

EHR data sharing vendor Medal raises $3.8 million. Co-founder and CEO Lonnie Rae Kurlander is a 27-year-old medical student at Boston University.

MedAssets-Precyse renames itself nThrive. Pamplona Capital Management bought MedAssets for $2.7 billion in November 2015 and combined its RCM business with Precyse, another of its recent acquisitions.

Sales

Mercy Technology Services adds three clients: Riverview Health (IN) for Epic hosting, McLeod Health (SC) for data analytics, and Peninsula Regional Medical Center (MD) for Epic implementation support.

People

Medical informaticist Harris Stutman, MD (MemorialCare Health System) returns as “Jeopardy” champion Tuesday night following his wins on the Friday and Monday programs that earned him $39,700.

Premier promotes Leigh Anderson to SVP/CIO, replacing the departing Keith Figlioli.

Microsoft promotes Simon Kos, MBBS to chief medical officer. It appears he went to work for industry (InterSystems, then Cerner) directly out of residency without actually practicing medicine.

Announcements and Implementations

Analysis by TransUnion Healthcare finds that patients experienced a 13 percent increase in their deductible and out-of-pocket maximum costs in 2015 at $1,278 and $3,470, respectively. “Patients are becoming the new payer,” the report concludes.

Vital IMages launches its application-neutral archive that connects proprietary data sets for interoperability and workflow.

Government and Politics

In England, Health Secretary and “Remain” supporter Jeremy Hunt calls for additional Brexit referendum votes or other “democratic endorsement of the terms” by which the UK will extricate itself from the European Union. He is considering running for Conservative leadership as prime minister, urging full trading access but with immigration restrictions. Hunt said previously that NHS would face budget cuts and staff shortages should the UK exit from the European Union, a statement pro-Brexit supporters characterized as fear-mongering. Meanwhile, “Leave” campaigners appear to be backtracking on their assertion that withdrawing will free up $467 million each week, of which they had promised that a large portion would be sent directly to NHS to improve healthcare services.

Privacy and Security

A hacker offers for sale the records of 655,000 patients from three unnamed US provider databases and reports that some of the information in them has already been sold. DeepDarkOverlord says he or she exploited an unstated vulnerability in RDP (remote desktop protocol) to take control of the provider computers and steal their patient data, after which he or she offered to return the data for a ransom that the providers elected not to pay. The prices range from $100,000 to $411,000 for each of the three databases:

• An Access database of 48,000 patients from an unnamed healthcare organization in Farmington, MO.
• A plain text database of 210,000 patient records stolen from a Midwestern provider
• A plain text database of 397,000 patient records retrieved from an unnamed Georgia provider.

Apparently one of the hacked providers uses the SRS EHR, based on the hacker’s screen shot of  him or her taking over a Windows 2008 server at the unnamed Georgia site.

The same hacker is also offering a 9.3 million patient record database from an unnamed insurance company, stolen using the same RDP exploit. Security researchers tested sample data and believe it’s an old database since many of the telephone numbers and email addresses it contains are no longer valid.

Technology

Comcast Business creates its largest Eastern US network in providing 100 Gbps Ethernet connectivity between the campus of Penn State Health Milton S. Hershey Medical Center (PA) and the university’s data center.

Other

A survey finds that EHR-using physicians are less satisfied and more burned out, with physician satisfaction low for performing both EHR documentation duties and CPOE. Family medicine, ED, and orthopedic surgery are big trouble spots, while surgeons and ever-affable pediatricians are happier. Interestingly, the method of documentation didn’t affect the burnout rate much – it was about the same for dictation, voice recognition, handwriting or typing, and using scribes. Only 36 percent of respondents said the EHR has improved patient care and just 23 percent said it has increased their efficiency.

Bob Wachter, MD cashes in on the success of his book “The Digital Doctor” in hiring himself out as a thought leader and video star to malpractice insurer The Doctors Company, a role he describes as, “My partnership with The Doctors Company will provide its 78,000 members and other physicians nationwide with the tools and information needed to thrive in today’s rapidly changing digital landscape.”

Sponsor Updates

• FormFast publishes a new white paper, “Delivering ROI: The Case for Electronically Capturing Patient Signatures.”
• FujiFilm will exhibit its Synapse product line at SIIM 2016 June 29-July 1 in Portland.
• A study finds that hospitals that use Nuance’s clinical documentation improvement solutions score better in patient mortality ratings.
• Meditech held its Nurse and Home Care Forum June 15-17 in Foxborough, MA.
• Glendora Community Hospital (CA) goes live on electronic forms from Access and signature pads from Wacom in the ED and admission areas.
• Bernoulli CIO John Zaleski will speak at the IEEE Chase 2016 Conference on Connected Health June 29 in Arlington, VA.
• Besler Consulting wins a B2B Marketer Award for Best Contribution to Sales Account-Based Marketing.
• Carevive Systems shares its latest poster presentation, “Implementation of Survivorship Care in a Network Hospital Setting.”
• CTG and Catholic Health Systems will co-host a symposium, “Exploring the Impact of Security Threats: Is Your Organization Prepared,” June 29 at CTG headquarters in Buffalo, NY.

Blog Posts

• A Banner Year for Bundles (ECG Management Consultants)
• Clinical Communication & Collaboration: Tying it all together (Part 5) (Extension Healthcare)
• Innovation Through Collaboration (Iatric Systems)
• Your organization is now live with a new EHR … what about the legacy stuff? (Galen Healthcare Solutions)
• 8 Things About Healthcare Analytics That May Surprise You, Part 2 of 2 (Hayes Management Consultants)
• Advanced Practice Training: AdvancedInsight Collections Per Total RVU (AdvancedMD)
• Gartner: VMware AirWatch Scores Highest in 3 EMM Use Cases (AirWatch)
• What in the Health IT is PQRS GPRO? (Arcadia Healthcare Solutions)
• Smart mHealth Platform Redefines Adherence (Wolters Kluwer Clinical Drug Information)
• 7-Step Technology Checklist for PHI Protection (Catalyze)
• Architecture of Substance Intolerance (Clinical Architecture)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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