News 5/11/16

Top News

NantHealth announces plans to launch the IPO it postponed in November 2015 when it cited poor market conditions, hoping to raise $92 million. The company lost $72 million on $58 million in revenue last year, at the end of which Patrick Soon-Shiong, MD announced a $200 million investment by Allscripts that valued the company at $2 billion. 

Soon-Shiong, worth around $10 billion, earned $150 million in compensation when his NantKwest cancer research firm went public last year.

Reader Comments

From Ricardo: “Re: MD Anderson. Reported a $160.5 million adjusted decrease in income due to Epic. Not surprising given that there were 1,000+ contracted for go-live support. Encore made a killing on this project, although I can’t recall if they ran the selection process, too. I’m surprised this hasn’t received more widespread coverage.” Internal UT documents from a meeting being held later this week indicate that MD Anderson blames Epic-related costs and revenue reduction for its nearly 60 percent year-over-year income decrease, but adds that it had assumed some degree of impact to both from the beginning. 

From Doozy: “Re: trying to get electronic copies of your hospital medical records. Reminds me of this clip from ‘Seinfield’ that aired in October 1996, just after HIPAA was enacted.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor HBI Solutions. The Palo Alto, CA-based company offers predictive analytics and performance analysis solutions to providers, payers, HIEs, and technology vendors. Its Spotlight Data Solution uses real-time (not historical) clinical, billing, and claims data to provide risk models, dashboards, reports, and scorecards to support population health management, risk management, readmission management, and quality improvement. Its work has been vetted both in peer-reviewed research articles and by providers in the field. The system fits into any BI, EDW, EHR, or interoperability environment, using HL7 and 837 feeds, CCLF files from ACOs, EMPI, and natural language processing to extract data from non-discrete data types such as care summaries. According to customer Todd Rogow, SVP/CIO of the New York’s Healthix HIE, “HBI’s comprehensive suite of predictive analytics solutions enable Healthix to be responsive to the needs of doctors and nurses in an environment of shifting models of care. Real-time patient risk stratification and population and event based predictions will give healthcare organizations real-time, actionable information to help them deliver preventive, proactive care and reduce unnecessary utilization.” You probably know some of the company’s executives from their experience with Stanford and Eclipsys: Bruce Ling, Eric Widen, Frank Stearns, and Karl Sylvester, MD. Thanks to HBI Solutions for supporting HIStalk.  

Here’s a just-published video I found on YouTube in which St. Joseph Healthcare (ME) talks about its use of real-time population health alerts from HBI Solutions.

Ms. H from New Jersey says the two iPad Minis and accessories we provided in funding her DonorsChoose grant request have been valuable not just for research, but also because students are getting to work with technology they’ve seen that their families can’t afford. She also adds that her inner city male students are more likely to be kinesthetic leaners and she can meet their needs by assigning them hands-on iPad exercises.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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

Acquisitions, Funding, Business, and Stock

Humana makes an unspecified investment in Glen Tullman’s chronic disease management technology company Livongo Health, closing its Series C round at $49.5 million and increasing its total to $82.5 million.

Patient satisfaction technology vendor Lumin Medical acquires patient feedback technology from Implementing Technologies, which it will add to its PatientTrak patient experience solution. The system steers patients to sites where they are urged to leave four- and five-star reviews.

Sales

Southeast Health (MO) and Missouri Delta Medical Center (MO) choose Cerner Millennium, replacing Siemens Soarian at both. Searching the HIStalk archive turns up a March 2015 mention that Southeast Health was getting hammered by high costs and erratic billing from Soarian and planned to move to Cerner. I also wrote in 2012 that these two competing organizations were sharing the data center and Siemens licensing costs in forming a new company called Servir. Sometimes I forget how valuable the information in old HIStalk posts can be.

Boca Raton Regional Hospital (FL) selects Cerner Millennium. I believe it was a McKesson Horizon shop. 

For-profit Ardent Health chooses Epic for its 14 hospitals in Texas, Oklahoma, and New Mexico (including Lovelace Health System), replacing McKesson Star and Horizon.

UCHealth (CO) chooses LeanTaaS for predictive analytics to improve OR utilization.

Greater Oregon Behavioral Health (OR) will use data aggregation and analytics technology from Arcadia Healthcare Solutions.

People

UTHealth’s School of Biomedical Informatics names Ivo Nelson as the first recipient of its John P. Glaser Health Informatics Innovator Award.

Announcements and Implementations

Walgreens collaborates with Mental Health America to add mental health resources to its website, offer access to MDLive’s behavior telehealth solution, and provide mental health training programs to its pharmacists, nurse practitioners, and physician assistants.

The IT department of Children’s Hospital of Philadelphia (PA) wins a local award for developing an app that tracks patients and employees to reduce wait times, alerts staff when a patient hasn’t been seen for a long period, and identifies occupied treatment rooms.

Government and Politics

ONC offers $1.5 million in interoperability standards grants.

HHS calls for entries for a challenge to simplify patient bills, with $5,000 prizes for the winners.

The government of China orders search engine company Baidu to change its search results presentation following the death of a student who used it to seek questionable cancer treatment from a paid hospital advertisement. The government’s Internet regulator has given the search engine three weeks to display results based on credibility, to limit the size of the ads it presents, and to filter unauthorized providers from the search results. Baidu says it will comply and claims it has already removed 126 million ads from its site. The hospital is being investigated separately for illegally outsourcing its services and for running false advertisements. The Chinese government blocks access to Google via its so-called “Great Firewall,” but the student asked a US friend to do a Google search for him right before he died, only to find out that the treatment he had received had fallen out of favor years ago due to poor results in clinical trials.

CMS Acting Administrator Andy Slavitt says in his remarks to his final Health Datapalooza conference (his job, along with many in HHS, is a political appointment) that, “Physicians are baffled by what feels like the physician data paradox. They are overloaded on data entry and yet rampantly under-informed. Physicians don’t understand why their computer at work doesn’t allow them to track what happens when they refer a patient to a specialist when their computer at home connects them everywhere.” He observes that people got distracted by the Healthcare.gov debacle and missed the successful implementation of real-time insurance sign-up, a marketplace that has reduced insurance prices, and matching consumers to health plans that meet their needs. He cites HHS’s user-centered policies as:

1. Releasing of CMS databases.
2. Changing provider payment incentives to emphasize quality and care coordination.
3. Rolling out a single set of core quality measures.
4. Requiring open APIs and exposing data blocking practices.
5. Proposing the replacement of Meaningful Use with quality measures that “put the needs of the users – clinicians and patients – back in the center.”

Other comments from Slavitt:

Physicians don’t need to get pushed into using technology with incentives to show they’re clicking. They are pulled in because they need collaboration tools. The purpose of new payment models is to give care providers the freedom to do what they think is right. Your opportunity is to allow it to happen. Go find them and talk to them– design for them … If you want to lead the way with innovations that help consumers, great. If you want to follow by using established standards for data and measurement and technology, also great. If you have a business model which relies on siloing data, not using standards, or not allowing data to follow the needs of patients, pick a new business model or pick a new business. What Vice President Biden said should stick with us– as taxpayers, we did not spend $35 billion so companies could build their own silos.

Slavitt specifically listed practices that everyone should follow:

• Eliminate contract language that prevents systems from being plug and play.
• Put machine-readable data on edge servers so it can be used to answer questions.
• Give physicians real-time data inside their work flows, not through a vendor’s portal.
• Use APIs.

Privacy and Security

Mental health provider Bay Area Children’s Association (CA) reports that hackers loaded malware onto its EHR via credential theft and acquired an unknown number of patient records. BACA uses the PrognoCIS EHR from Bizmatics, which announced a breach of its systems last month, so I assume BACA is just one more Bizmatics customer that was affected.

The UK information commissioner fines an NHS trust $260,000 after its HIV clinic sends its 800-patient email newsletter using CC: instead of BCC:, thereby disclosing the identities of the recipients to each other.

The Atlantic says ransomware was first distributed in 1989, when a biology researcher sent 20,000 copies of an AIDS survey to researchers around the world whose computers would be seized the 90th time they were booted afterward. The ransomware demanded that a cashier’s check for $189 be sent to a PO box in Panama. The biologist was arrested and charged with blackmail, but claimed he was planning to donate the money to AIDS research (despite speculation that he was upset about being passed over for a job with the World Health Organization). The UK jury found him mentally unfit to stand trial and instead deported him to the US, where he died nearly 20 years later after creating a New York butterfly conservatory and naming it after himself.

Technology

The team that developed Siri demonstrates Viv, which adds artificial intelligence to speech recognition in discerning the user’s intent and in integrating with apps via an open ecosystem. The demonstration involved placing a complicated pizza delivery order by voice alone, without scripting. Experts note that mobile device users have lost their enthusiasm for apps that use up cell plan data, require logon credential maintenance, and send useless notifications, with most of them settling on just a handful that they use regularly.

Other

A Time article says Apple created the Apple Watch because Steve Jobs, who was dying of pancreatic cancer, wanted to empower patients and improve the healthcare system. It’s not especially convincing speculation, but it’s a convenient excuse to reflect fondly on Steve Jobs.

Insurers are sharing information gleaned from past medical malpractice cases to help providers develop new protocols and strategies, such as requiring doctors to examine every wound treated in the ED to make sure  no foreign bodies or tendon injuries are present.

I’m surprised at the poorly worded, error-filled writing I see on the websites of newspapers all over the country that should know better, although maybe they’re losing so much money they can’t afford decent writers. For example, you might expect the Richmond paper’s headline writer to have noticed the 10 correct spellings of “Novant” in the article he or she was summarizing that were not in concordance with his or her version.

Weird News Andy notes that the Panama Papers have a medical connection, naming New York University School of Medicine and at least one of its doctors (neurosurgery professor Patrick Kelly, MD) as having offshore accounts. I found a searchable database of the information online, which lists several US doctors as well as some medical companies suspiciously headquartered in the Caribbean.

Sponsor Updates

• Clockwise.MD will exhibit at the NAHAM patient experience conference from May 24-27 in New Orleans.
• AirStrip releases a video on how it helped an academic medical center improve early detection of potential hemodynamic instability.
• Aprima will exhibit at the American College of Obstetricians & Gynecologists Annual Meeting May 15-16 in Washington, DC.
• Advanced Data Systems will offer its EHR customers Chronic Care Management technology and services from CareSync.
• Besler Consulting releases a new podcast, “Common Mistakes Associated with Physician Documentation.”
• Boston Software Systems launches a Podcast Resource Center.
• CoverMyMeds will exhibit at the American Psychiatric Association Annual Meeting May 14-18 in Atlanta.

Blog Posts

• Using Telemedicine in Your Independent Practice (AdvancedMD)
• CMO Challenge: Multiple Payors, Multiple Quality Measures (Arcadia Healthcare Solutions)
• 4 PHI Marketing Special Cases (Catalyze)
• National Nurses Week: RN shares her nursing career from detective to designer (CapsuleTech)
• Healthcare’s Cybersecurity Mandate (Caradigm)
• Using Technology to Promote Shared-Decision Making for Neoadjuvant Breast Cancer Therapy (Carevive Systems)
• What’s Next for Meaningful Use (CTG)
• Empowering Patients (Culbert Healthcare Solutions)

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 5/10/16

NantHealth, Soon-Shiong’s personalized medicine company, files IPO

Healthcare billionaire Patrick Soon-Shiong, MD files IPO paperwork ahead of plans to take his healthcare business, NantHealth, public. The company delayed earlier IPO plans, citing adverse market conditions, and continues to operate in the red.

FBI Cyber Division Chief Advises Companies Not to Pay Ransom for Release of Data

Speaking at the Center for Long-Term Cybersecurity at UC Berkeley, FBI Cyber Division Assistant Director James Trainor says that businesses should not pay the ransom if they are the victim of a ransomware attack, and reiterates that while the attacks will continue to be a threat for years, “Ransomware is about backups, more so than anything else.”

A Comprehensive Strategy for Primary Care Payment Reform in Medicare

Farzad Mostashari, MD, Bob Kocher, MD, and Mark McClellan, MD, PhD co-author an opinion piece on the implications the recently announced Comprehensive Primary Care Plus model will have on ACO participation, calling for consideration of a CPC+ACO pilot program.

HHS announces challenge to redesign the medical bill for patients

During the Health Datapalooza conference, HHS Secretary Sylvia Burwell announces an innovation challenge soliciting designs for medical bills that are easier for patients to understand.

HIStalk Interviews Drew Schiller, CTO, Validic

Drew Schiller is CTO and co-founder of Validic of Durham, NC.

Tell me about yourself and the company.

I’m the co-founder and chief technology officer at Validic, the leading platform for directing patient-generated health data from digital health apps, wearables, and in-home medical devices into the healthcare system.

What is the level of interesting in integrating patient-generated information with enterprise systems?

The level of interest is really strong. In fact, it has been growing quite substantially over the last 12 to 18 months. There has been, in general,, a lot of questions around the usability of the data. Now we’re starting to see a lot of great use cases and examples, which is driving further interest in the market.

Is collecting the data a given and now it’s more of a matter of deciding what the business rules should be to use it?

That’s exactly correct. Getting the data from all the disparate sources is a known quantity. There are places like Validic where you can go and access data from many different sources. Now the question is, how do I get the right data at the right time in order to inform the right action to take for better patient care?

We’ve been very fortunate from a timing perspective. We started with a lot of traction in the wellness space, more the preventative health space. Now we’ve been moving in to more of the traditional healthcare system, along with patient care, remote patient monitoring programs. Also into the clinical trials space and the pharmaceutical market.

Capturing fitness tracking information hasn’t been valuable, but is the next level of maturity patient engagement and chronic disease management, to capture a more complete picture of someone’s health?

That’s exactly right. Fitness trackers are still interesting. They will become more and more relevant as the device manufacturers start to incorporate new kinds of data. For example, most of them now contain heart rate information. I know a lot of them in the future are looking toward other types of data they can collect that are more clinical in nature. But Validic also connects with blood pressure monitors, glucose meters, pulse oximeters, weight scales, a lot of other devices that can be used for chronic disease management as well.

Would the company have an interest in integrating information that doesn’t necessarily originate on a phone app, such as critical patient monitoring?

I look at the phone as a gateway or a hub. You can connect devices through that portal in a variety of ways. Through a Bluetooth connection, you can connect devices like blood pressure monitors.

We also have a product called VitalSnap that works with legacy medical devices. These are devices that people traditionally use in the home to monitor conditions like type 2 diabetes and hypertension. One of the problems that we found was that when physicians want to measure and monitor patients with these chronic conditions is that a lot of the devices that the patients were using are not connected. That’s why I call them legacy devices. 

VitalSnap enables us to grab — using the camera on the phone — a digital image of the reading from the device, turn that into a digital asset, and deliver that through our system to the healthcare provider. That enables real-time data transfer for even these legacy devices.

Where I see the industry going in general is very much toward a patient-driven, remote patient monitoring, disease management future where you’re only going into the hospital to see the provider for regularly scheduled appointments or for acute management of conditions.

What are the secrets to motivating consumers to take measurements like weight and blood pressure and then report them back?

Consumer engagement is going to continue to be a real struggle. One of the more interesting things is that we have big players from the consumer electronics space entering the health market. We have Apple, Google, Samsung, and Microsoft all entering the health market in a very real way. 

What these companies excel at is consumer engagement. There’s a real opportunity for us in healthcare to leverage the engagement that these consumer electronic companies know how to create with their consumers. We can create a more engaged healthcare consumer by leveraging the fact that maybe these consumer companies are able to engage the patients in a way we’ve never been able to before. That’s a really interesting trajectory that I see the market taking.

What do you think about Nokia acquiring Withings?

I think it’s phenomenal. It’s a sign of the maturation of the industry. Nokia was sitting there trying to understand how they could get into healthcare. Withings is a very solid, stable player in the market. They’re going to be able to do even better things with the power of Nokia behind them.

The only brands I recognize in the consumer area are Withings, Omron, and Philips. Will the big players look at what Nokia did and worry that all the good consumer digital health assets are are being grabbed?

There’s still a number of good assets out there. IHealth is a great company that does work in that space. There’s a company out of France called BewellConnect that we work with that’s really good. There are a number of newer device companies that are coming out that are OEMing blood pressure monitors and weight scales and blood glucose monitors as well. The connected health ecosystem is expanding daily. It’s certainly not consolidating.

For consumers using multiple Validic-integrated devices, would you aggregate the information or package it up in some way?

If the patient connects multiple devices for the same healthcare organization, we can certainly package those three data streams up and provide as much context around that as we can. Really we view our job as, first and foremost, being the data conduit. But then additionally, providing the ability to understand and contextualize the readings that are made available. We don’t make the decisions on the data, but we want to make the data more actionable.

What are drug companies doing with patient-generated data?

Pharmaceutical companies are really interested in collecting more data during the drug development process in order to prove efficacy of the drug. It gives them one more feather in their cap to show that the drug had a certain effect.

Another thing that’s very interesting is that there are current things going on in healthcare, such as remote patient monitoring, that can provide drug companies with new avenues for research. For example, if you have a number of hypertensive patients going through a remote patient monitoring program, it’s very possible that a new drug to treat hypertension can then be used for a certain percent of that population. You have a built-in control. You can start to see if this new drug is effective or not for these people. There are number of opportunities in the clinical trials space for digital health.

What about continuous monitoring of patients?

Patients are very willing to do things that are unobtrusive to their lives. If all the patient had to do was put something on their wrist and wear it, or put on a patch and wear it, they could go about their lives normally otherwise. They would be very interested in doing that. One of the biggest challenges that we see with consumer engagement is that we’re asking consumers to modify their behavior outside of something they typically do. That’s where we  see challenges with engagement.

What are you hearing about ResearchKit and CareKit? Will those products affect your business?

It’s not having any effect on our business. In fact, it has jump-started a number of conversations. I think it’s fascinating. First and foremost, by having the world’s largest consumer electronics company in the healthcare space, and continuing year after year now for the last three years to double down, is a huge asset to everybody who’s trying to improve patient care. It’s driving better consumer awareness, which is awesome.

In terms of ResearchKit, it’s a phenomenal jump-start kit for getting informed consent into an iOS app for a research trial. CareKit is another really interesting tool. If you are building an app for remote patient monitoring, it’s a very, very good framework for jump-starting that process on iOS.

Do you have any final thoughts?

I see Validic as fundamentally being the fabric through which digital health data flows. What we’re trying to do is become the network to act as the future of digital health. 

Where I see this industry going is that it’s not enough to just have the data. We also need to be able to provide context and be able to show the right information to providers at the right times to take the right actions. The future of our company is going to be built on is being able to provide that context.

Curbside Consult with Dr. Jayne 5/9/16

John Halamka’s discussion of the MACRA NPRM was the topic of conversation at the client I was visiting last week. I’m working with them on a strategic planning engagement and am primarily in contact with senior clinical and operational leaders. People kept referencing it throughout our meetings on Friday and I saw the email link go around at least three times. You can always tell who works their email from oldest to newest and who works the other way by how they forward things that many others have already commented on.

In non-written discussion, it was interesting to see how the content of the blog morphed as it was passed from person to person. By the end of the day, Halamka was alleged to have made a call for physicians to boycott Medicare or quit practicing altogether. He didn’t exactly say this, although he did say, “There are probably only two rational choices for clinicians going forward – become a salaried employee delivering clinical care or become a hospital-based clinician exempted from the madness.”

Having been a salaried employee trying to run a primary care practice within the health system’s model, I’m not sure the former choice is entirely rational. Being employed isn’t always the answer. I have worked with physicians at health systems whose conservative and risk-averse nature caused them to significantly over-interpret the requirements of Meaningful Use to the point where practices were collecting completely unneeded information that no one ever looked at. Physicians in employed models often have little control over things like staffing ratios and productivity expectations, which frequently leads to physicians doing busy work because they are either inadequately staffed or have the perception of inadequate staffing.

As someone with experience in the DIY realm, I appreciated his analogy that, “Sometimes when you remodel a house, there is a point when additional improvements are impossible and you need to start again with a new structure.” That analogy should extend past MACRA and MIPS, however, to our entire healthcare delivery system. I do think we’re reaching the point where we’re spending such a high proportion of our resources on a system that isn’t delivering for our patients. Taking a 20-pound sledgehammer to it might not be such a bad idea.

Although Halamka wasn’t making a wholesale call for people to quit practicing medicine, he did say that, “As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.” I agree with him that it will be nearly impossible for organizations, whether small or large, to implement the rule as written on the timeline that is proposed. Having a final rule come out in November for implementation the following January with a full-year reporting period is absurd. How long did we give merchants to make the switch to chip-enabled credit cards? How long did we give states to implement the provisions of Real ID?

I’m eager to see the comments that are submitted regarding the proposed rule. Many physicians are finally feeling like it’s time to start fighting back, but others are selling their practices or just leaving. I spent most of my family’s Mother’s Day gathering hearing from relatives that aren’t happy that their physicians have retired, with one commenting that a successor physician “doesn’t have the knowledge in his whole hand that Dr. X had in his thumb.” Another lamented that her physician had joined a practice doing some “double billing,” which turned out to be provider-based billing because the physician’s office is considered an outpatient department of the hospital.

I also heard yet again about poor quality care being delivered because a physician is treating statistics rather than treating the patient. I’d love to call my grandmother’s physician and ask him exactly why he thinks tight glucose control with multiple meds is the right thing to do for a nearly 90-year-old patient who recently developed diabetes. Rather than sending her to the specialist to work up a possible inner ear cause of her dizziness, maybe he should have listened to her history of low blood sugars as a potential cause.

I’ve offered multiple times to go with her to her appointments, but she refuses, partly because she doesn’t want to inconvenience me, but partly because she’s of a generation that doesn’t dare question the doctor. Knowing the group he’s a member of, I can bet that the fact that his bonus rides on patient lab values might be playing a role in his decisions with her. Of course, he could exclude her from the calculations, but again knowing the group and their EHR, that would probably take too many clicks if he even knows how to do it.

It’s a fairly depressing time to be in medicine. I enjoy seeing patients and am lucky to work for a great group, but overall, morale is at an all-time low. More than half of the physicians that were in my residency class have left primary care. Most of those that have remained have changed employers at least a couple of times. Everyone seems to be looking for something better, but they don’t seem to be finding it.

There is one little ray of sunshine in the proposed rule, but I didn’t really process it until I read Dr. Halamka’s summary. That’s the change in wording from Eligible Professional to Eligible Clinician. At least someone, somewhere, remembered that those of us that are actually caring for patients are clinicians rather than just nebulous “professionals.” I like it. It also identifies the broadened scope of professionals covered by MIPS, although it’s not catchy enough for me to change my Friday post from EPtalk to ECtalk. Whenever I hear “EC” together, I think of the E-C clamp technique that you use when you’re using a bag-mask to ventilate a patient. That’s just another sign of how doctor brains work – only one of us would think of something like that.

What caught your eye in the proposed rule? Email me.

Email Dr. Jayne.

Diagnosing Primary Care’s Identity Crisis

Faced with increasing pressures related to government mandates, decreasing reimbursement, workforce shortages, and keeping up with the technology Joneses, primary care and family medicine physicians look for relief in new business models.
By @JennHIStalk

It’s a tough time to be in primary care. PCPs and their family medicine counterparts are faced with a barrage of competing interests that, at first glance, would seem to leave little time for face-to-face patient care. Meaningful Use, MACRA, MIPS, ACOs, PCMHs … the list of acronyms and the public and private payer programs they stem from seem to get longer by the day.

As Dr. Jayne mentioned in a recent post, “In the provider space, there is a tremendous amount of chatter about [the proposed rule for MACRA] being the last straw for small or independent practices. The requirements are daunting, especially for practices that haven’t been at the forefront of payment reform efforts. Just trying to read and understand all the rules and keep track of all the FAQs we’ll undoubtedly see could be a full-time job.”

Even Beth Israel Deaconess Medical Center CIO John Halamka, MD, in his analysis of the proposed rule, seems to have finally thrown in his usually optimistic towel, concluding that physicians at this point really have only two choices – take a hospital job or become employed. “As a practicing clinician for 30 years,” he adds, “I can honestly say it’s time to leave the profession if we stay on the current trajectory.”

It’s a trajectory that, while filled with good governmental intent, has become bloated with oversized expectations and expense related to technology and resources. While Halamka’s list of options is certainly short, it leaves off one route that has become increasingly attractive to fiercely independent physicians – direct primary care.

Understanding Direct Primary Care

The DPC model, though still in its infancy, has grown exponentially in popularity over the last several years as PCPs and family medicine practitioners look for creative ways to stay in business without being shackled to fee-for-service care models and third-party administrative burdens. As the Direct Primary Care Coalition stresses, DPC is “an innovative alternative payment model in primary care …. In DPC, unwanted fee-for-service incentives are replaced with a simple flat monthly fee. This empowers the doctor-patient relationship and is the key to achieving superior health outcomes, lower costs, and an enhanced patient experience.”

“DPC is very popular among a small percentage of our members who practice it, less than two percent, although many want to learn more,” says American Academy of Family Physicians President Wanda Filer, MD, a family physician in York, PA. “Those who are in it love it and are very enthusiastic. They cite not being torn away from patient care to do non value-added tasks such as checking boxes, answering prior authorizations, or other administrivia. They are able to get off the hamster wheel driven by fee-for-service and inadequate payment from payers. They have more time to spend with patients and morale across the office staff seems to be very high, as well as quality metrics.”

Jack Forbush, DO, who practices DPC at the Osteopathic Center for Family Medicine in Hampden, ME, believes the interest in DPC is the result of the de-specialization of family medicine. “Until recently, family medicine was the end-all and be-all of medicine,” he says. “It encompassed obstetrics, pediatrics, internal medicine, gynecology, and hospital medicine. Family medicine physicians aren’t even called physicians any more, but rather providers or practitioners. Do you have heart issue? Go see a cardiologist. Do you have a concerning mole? Go see a dermatologist. National organizations have dropped the ball at maintaining the identity of family medicine. Those physicians in practice have allowed it to happen.”

Forbush also attributes the identity crisis to attempts by non-medical entities like public health officials, administrators, and policy makers to formalize and quantify medicine through programs like Meaningful Use and patient-centered medical homes. “Family medicine has always done what PCMH programs now demand practices do, but now they have to do it and prove it through metrics,” he explains. “Meaningful Use has been a colossal failure and cost practices millions of dollars. One such example is a colleague of mine who, despite complying with the MU mandates, has been fined $18,000. Payment is, of course, expected immediately. MU bonuses were potential bonuses issued after a year of doing the work. What other industry would tolerate this? Decreasing reimbursement rates for primary care in addition to the increasing financial demands placed upon family physicians via technology mandates and  MU mandates continue to squeeze the lifeblood out of primary care.”

Maribel Aviles, MD faced similar frustrations in July 2014 when she decided to leave the Medicare HMO clinic where she was working to open Orlando’s first DPC practice. “When I entered medical school back in 1985, I did it with the mission of being a team member in the patient-doctor relationship,” she explains. “Little did I expect that 20-plus years later I would be subjected to heavy administrative and regulatory burdens. Now we are called providers instead of doctors. These days, family docs can be replaced by almost any PA to decrease medical costs. To top it all off, we’re expected to address the needs of our patients within an allotted time and at a set fee, which we’re often not immediately privy to as it varies by insurance. In a nutshell, I have seen my profession as a family medicine physician shift towards this new image of a servant to government regulations and insurance administrators instead of to our patients. I’ve even been compared to Dr. Google.”

Staying in Control

In moving to a DPC model, Aviles and Forbush have attempted to retain their identities as physicians and seem to be enjoying a renewed sense of independence. “Without a doubt, models like DPC definitely help physicians retain their sense of identity and control,” Forbush says. “The more popular model of being a network physician for an insurance company is essentially allowing yourself to be a slave to someone else’s ever-changing rules, regulations, and expectations. The DPC model frees the physician from unnecessary administrative burdens and decreases the financial expenditures associated with running a practice. For example, you save perhaps eight percent by getting rid of the billing company and your RCM timeframe becomes much closer. Rather than waiting 30, 60, or 90 days to be paid for a service provided today, patients in a DPC model either pay you the day of or via a membership model.”

Aviles expresses similar administrative sentiments, adding that she enjoys no longer having to wrangle with third-party administrators over what tests to order for her patients. “I also don’t have to hire additional personnel to deal with extra administrative burdens, and as a result, can pass along those savings to my patients. I have a renewed sense of control over the treatment of my patients. I feel I am a doctor again, able to contribute significantly to someone’s life and to the system in general.”

“I want to see my colleagues enjoying their profession again,” she adds. “We must continue looking for ways to accomplish this goal. Happier doctors will definitely make happier patients.”

The Other Side of the Coin

While Filer and the AAFP recognize the value DPC models have, especially when it comes to relieving physician burnout, she is focused on helping those physicians who have decided to stick with Medicare and Medicaid programs. “I really do not see an identity crisis. Quite the opposite,” she says. “Family medicine has been asking for some time to be recognized for the cognitive work that we do. We know that the work that we do has immense value that is currently under-recognized and dramatically undervalued. Worldwide and in the US, locations with a higher percentage of healthcare dollars spent on primary care have significantly better patient outcomes at a lower total spend. The reverse is not true for specialty care. Policymakers have finally come to recognize this. The shift to value-based care is aiming to strengthen primary care at last.”

“For the first time in my 25-plus year career,” Filer adds, “I think we have a shot at getting US healthcare where it needs to be – meeting the Triple Aim of lower healthcare costs, improved population health outcomes, and better patient experiences. Stronger primary care is the only proven path. We are working to invert the current pyramid of healthcare spend. Many PCPs are caught in the midst of this immense, chaotic change, but understand that the previous system was unsustainable. It will be critical to give family physicians new resources very quickly. They need time with patients, staff to delegate tasks to and to support patient needs, and better EHRs.”

The Effect of MACRA

Filer believes MACRA to be a step in the right direction, albeit one that will require additional resources (a notion seemingly at odds with the love Aviles and Forbush have for the DPC model, which requires fewer resources). “We are launching a large campaign for members called MACRA Ready to get their questions answered and to position them for success in the new value-based payment models,” she says. “Interestingly, one member survey suggests that 40 percent are already doing some value-based contracting.”

Filer doesn’t shy away from the fact that physicians who move to value-based contracting are appropriately cynical about new government programs like MACRA and the Comprehensive Primary Care Plus program. Given their cynicism and Halamka’s gloomy analysis of attempts to replace Meaningful Use, one has to ask if physicians aren’t simply trading one hamster wheel for another.

“Meaningful Use in its old iteration was destructive to morale, patient-physician face-to-face time, and trust that government could get it right,” Filer says. “Under MACRA, it is my understanding that MU will be retained as the name, but that many programs will be streamlined into one set of requirements. Done correctly, the new MU should use the Core Collaborative Measures that CMS, AAFP, AHIP, and others worked diligently to define for primary care. This is a much shorter set of measures. They are focused on patient care and evidence-based. They can be culled from the EHR and, over the next couple of years, can be adopted by most if not all payers in the US, thereby letting everyone compare apples to apples. These streamlined measures should help family physicians feel more like physicians who care for people rather than box-checkers.”

Optimism Despite Shifting Identity

No matter the label physicians give themselves, Filer believes joy can be put back into the practice of primary care and family medicine. “It is my belief that eliminating administrivia, substantially improving payment, getting them off the hamster wheel of volume, and giving them more time and resources to spend on patient needs can make family medicine the first choice of at least 40 percent of students, which is what the US requires for a patient-centered, efficient healthcare system.”

“I think the future of primary care/family medicine is incredibly bright,” she adds, “but fundamental US system changes and graduate medical education reform are critical. Frankly, this country can no longer afford to do business as usual. We are long overdue for this shakeup.”

Morning Headlines 5/9/16

American College of Physicians: Sylvia Mathews Burwell

In a speech given at the 2016 ACP Internal Medicine Meeting, HHS Secretary Sylvia Burwell assures providers that Meaningful Use complaints are being taken seriously and that the department is “working to address things like burdensome reporting and inflexible requirements.”

Saint Agnes Medical Center victim of data breach

Hackers running a phishing scam steal the W-2s of 2,800 Saint Agnes Medical Center (CA) employees.

Cerner (CERN) Q1 2016 Results – Earnings Call Transcript

During its Q1 earnings call, Cerner President Zane Burke reports that the company has reached an all time win rate against competitors, primarily Epic, driven by software improvements, lower cost of ownership, and open platform capabilities.

Allscripts Healthcare Solutions (MDRX) Paul M. Black on Q1 2016 Results – Earnings Call Transcript

During its Q1 earnings call, CEO Paul Black notes that the company is building a precision medicine hub, “bringing together clinical, genomic, and consumer-based information to a centralized database.”

Monday Morning Update 5/9/16

Top News

HHS Secretary Sylvia Burwell tells the American College of Physicians that not only do some EHRs lack interoperability, but health systems sometimes don’t want to share information and providers aren’t paid in a way that rewards information sharing. She acknowledges that Meaningful Use has been hard on doctors with its “burdensome reporting and inflexible requirements.”

Burwell says HHS will set common interoperability standards, chane the culture in hospitals and practices regarding the right of patients to access their own information, and make sure its rules and regulations support the smooth movement of healthcare data.

Reader Comments

From Frank Poggio: “Re: MACRA. Dr. Halamka’s assessment isn’t surprising. The federal government’s objective is to control healthcare costs even though most of the escalation is due to societal failings like obesity and smoking. The provider is stuck in the middle and the middle gets squeezed every time. Providers play ball with payers and government trying to keep impending regulations from going off the track, and when the changes don’t meet the cost savings goal the feds sold to Congress, the bureaucrats have no choice but to go off track, blaming it on providers and promulgating even more onerous rules (remember that HITECH was supposed to pay back $800 billion over 10 years). This bureaucratic insanity will continue as the government continues to ignore the basic issues that drive healthcare costs. Unfortunately, that guarantees there will be many versions of the good Dr. Halamka over succeeding decades.”

From Skitch Henderson: “Re: medical error deaths. How many of those were IT-related, I wonder?” We in healthcare unfortunately kill some patients with the best of intentions but the worst of execution, but nobody really knows how many, much less how those deaths break out by individual cause. Keep in mind that the widely-quoted recent study (with obligatory clickbait headlines, including that of the Washington Post above that inserts the incorrect “now” in falsely suggesting a fresh trend) doesn’t represent new information or signify a rising trend – the authors merely used a different calculation method to create a new estimate from old data using massive extrapolation. Even the authors seem embarrassed that their results have been so overblown in trying to put a new number on an old problem using questionably useful methods. We simply don’t know when medical treatment causes a patient’s death – you can bet that a lot of death certificates say “heart attack” only because nobody knows for sure.

HIStalk Announcements and Requests

Two-thirds of poll respondents think MACRA’s Advancing Care Information is better than Meaningful Use. Meltoots says it’s just more of the same for physicians who are already burned out, adding new measures that haven’t been proven to improve care, cost, efficiency, safety, or interoperability. New poll to your right or here: who is most responsible for physician dissatisfaction? Like those dissatisfied physicians, I am interested in your personal narrative and not just your check-the-box answer, so click the poll’s Comments link after voting to document your story.

It occurs to me that the acronym-obsessed healthcare industry hasn’t yet abbreviated the new program, so I hereby dub it MACI (MACRA Advancing Care Information). You are welcome.

Mrs. R from Ohio says her third graders ask every day if it’s a tablet day, referring to the iPad Mini and case we provided in funding her DonorsChoose grant request. Her students are using it to practice their math skills, perform research, and teach each other to use the iPad.

Also checking in is Mr. Willet from North Carolina, who says the faces of his elementary school students light up with pure joy when he brings out the programmable robot kit for his digital lab program, which he says enhances not only their math skills, but their communication and critical thinking. A surprising 15 percent of the students in his school are homeless, so the only technology access many of them have is at school, and quite a few students go home on Friday with donations from the local food bank in their backpacks. It’s interesting that schools are better than hospitals at identifying social determinants of health and connecting those in need with resources.

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

Last Week’s Most Interesting News

• BIDMC CIO John Halamka criticizes proposed MACRA rules, saying that nobody can understand them and that it’s time for physicians to consider leaving their profession if the government’s trajectory doesn’t change.
• Siemens Healthcare renames itself to Siemens Healthineers.
• IMS Health and Quintiles announce plans to merge in creating a pharma services business with $7 billion in annual revenue.
• Joint Commission reverses its 2011 decision that prohibits sending orders by text messaging, provided that the messaging platform meets specific technical requirements.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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

Here’s the recording of a recent Webinar, “Provider-Led Care Management: Trends and Opportunities in a Growing Market.” Our presenter had audio problems during the live Webinar, so we recorded a new version.

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call:

• President Richard Poulton says the Netsmart transaction will allow patients to be managed across acute and chronic illness to health maintenance.
• CEO Paul Black says the company is building a precision medicine knowledge hub.
• Allscripts offers 135 certified solutions in its application store and developers are using its APIs to work on 1,550 applications.
• Black quoted a recent study that found that 87 percent of financially challenged hospitals regret changing IT systems, 90 percent of nurses say EHRs impede their ability to deliver care, 63 percent of executives say their jobs or those of their peers were threatened by an EHR replacement, and 78 of physicians say replacement EHRs didn’t deliver the expected clinical buy-in.
• Responding to an analyst’s question about rumored loss of market share in the independent physician segment, Black said that every vendor has churn but that of Allscripts is within expectations.
• Black expects MACRA to cause some of the nearly 500 certified EHR vendors to leave the market, creating replacement opportunity.
• Asked about the NantHealth partnership, Black says that two or three Sunrise customers will be going live on integrated Eviti protocols soon and that he expects to gain EHR business from the partnership.
• Black says the physician complaints in South Australia got more press than either the client or Allscripts wanted, but haven’t damaged the relationship.

From the Cerner earnings call:

• The company says its win rate against Epic is at an all-time high, which it attributes to product improvements, predictable delivery, lower cost of ownership, population health capabilities, and an open platform.
• Cerner says the number of hospitals moving from the former Siemens products to Millennium is ahead of expectations, while the overall financial and operational objectives of the acquisition are on track.
• The company says its HealthIntent population health management product is a differentiator when competing for new EHR business, with most new customers choosing it.
• Cerner’s go-forward product for patient accounting remains Millennium, but the company will continue to offer the Soarian product to the 25 percent of the market that wants a standalone patient accounting product.

I checked the five-day share price performance of a few companies that recently announced earnings: Cerner (down 4.5 percent), Allscripts (down 1.7 percent), Athenahealth (down 2.8 percent), McKesson (up 0.2 percent), CPSI (down 12.4 percent), and Imprivata (up 0.4 percent).

I’m enjoying the savagely clever commentary about Siemens changing the name of Siemens Healthcare to Siemens Healthineers, as the company apparently intends to spin it off (Siemens says the “eers” part refers to “pioneers” rather than “engineers” like you might expect). Much of the scorn involves an employee-posted video (with 450,000 YouTube views) of the obviously expensive yet hilariously awful employee kickoff event that Siemens held in its home town in Germany, which to many typifies everything that’s wrong with big companies — cluelessness, mandatory employee attendance at morale-boosting events that actually kill morale, spending money on frivolity while laying people off, and inadvertently emphasizing the multi-faceted chasm between the richly compensated executives and the trudging masses who do the actual work. Some of my favorite comments from a Reddit topic titled “Siemens embarrasses 44,000 employees with new ‘Healthineer’ mandatory dance concert”:

• Can confirm – this killed all productivity at our newly-christened Healthineers office today. It was hard to get any work done in between the fits of laughter and moments of dumbfounded shock that anyone, anywhere, thought this was going to be a step in the right direction.
• Siemens made ovens at Auschwitz. I think they will regret this more.
• Hawaiian Shirt Friday.
• Siemens: we’ll lay off 12,000 employees to keep profits up. Now show us how much you love your job! Dance, puppets, dance!
• First, do no harmineering.
• This event was probably a huge success. Nothing brings people together quite like hating something together.
• Look at all those people watching this " concert" in dead silence. That pretty much tells they were forced to attend this s&^%. Besides, this reeks of brainwashing and reminiscent of propaganda videos that dictators release un-ironically.
• When the camera pans across the crowd … wow. It’s like a bunch of KISS fans who accidentally showed up at a gospel festival, or vice-versa.
• After this presentation, Hermann von Siemens was exhumed and charged with war crimes for a second time.
• The balding, middle-aged engineers in the audience seem to be as horrified and bewildered as we are, so we can at least have some faith that the people who do the actual work at Siemens have their s&^% together despite upper management’s cluelessness.
• I was waiting for one of the blue morph suit guys to tear their mask off, revealing a Michael Scott glowing with so much pride it hurt to look at.
• It really pains me to know that this is what our healthcare dollars are being spent on.
• I think the world is finally getting over giggling at the pronunciation of our company’s name. We need to up the ante with something else embarrassing.
• This is great marketing material … for GE and Phillips. How can a company be taken seriously if they are so out of touch to think this was a good idea?
• I feel like there must be some elderly Germans left around who would be more than willing to tell you that this is, in fact, a very clear sign of things about to go very, very wrong.
• It is cringingly awesome how they have the lyrics highlighted as if they thought everyone would want to sing along.
• Suffering through that pap is one thing, but having to tell people who ask that you work for Siemens Healthineers? That’s torture.

Sales

Grace Health System (TX) selects Patientco for its patient-focused payments solution.

People

Imprivata hires Aaron Miri (Walnut Hill Medical Center) as CIO and VP of government relations.

Allscripts hires Tess Coody-Anders (Resolute Health) as SVP/GM of consumer health.

Announcements and Implementations

Centura Health (CO) went live on Epic at five hospitals and their clinics on May 1.

Privacy and Security

A hacker steals the W2s of all 2,800 employees of Saint Agnes Medical Center (CA) when one of them falls for a phishing email.

Other

The Irish government gives initial approval to a nine-year, $1 billion plan to provide all patients with a digital health record. The one-year product selection will start at the end of 2016. The first go-live will be the new National Children’s Hospital in Dublin.

Allegheny Health Network (PA) blames an unexpected operating loss on the one-time costs of implementing Epic.

The local paper notes that St. Charles Health System (OR) will implement Epic, creating 100 jobs in reversing their late-2014 decision to stick with McKesson Paragon. This will be the health system’s fourth EHR, having previously chosen to move from McKesson Horizon to Paragon.

Kaiser Family Foundation tweets out a timely graphic showing the primary role mothers have in keeping their children healthy.

This interesting video shows how Cedars-Sinai is using virtual reality to reduce the boredom of hospitalized patients. I would be happy just to get fast WiFi since my one and only night in a hospital for observation was like spending a night in jail – I didn’t get dinner because they didn’t find me a bed in time and all they had was fruit juice, there was no WiFi, my bed was missing the TV remote/call button combo, and I was in the dreaded “semi-private” room (meaning separated by only a paper-thin curtain that allowed every sound, smell, and silhouetted image to pass freely) with a guy who was a lot worse off than me. I was also awakened frequently by the nurse charged with writing down what the gadgets around me displayed, which must have required a lot of her focus because she didn’t notice that my IV ran dry and didn’t give me the meds that were ordered. This was the hospital that refused to give me an electronic copy of my medical records with the excuse that “we only do that for doctors.”

Here’s Part 3 of Vince and Susan’s vendor review. It’s fact-filled and entertaining as always.

Sponsor Updates

• TeleTracking will host an executive forum on transforming patient access May 10 in Long Island.
• Midmark closes its acquisition of Versus Technology.
• WeiserMazars #BestAdvice campaign wins the Association for Accounting Marketing’s National Social Media Campaign of the Year.
• Optimum Healthcare IT is ranked among the top two Epic consulting vendors for overall broad performance by KLAS.
• ZirMed will exhibit at the Zoll Data Summit May 17-20 in Denver.
• Experian Health will exhibit at the HFMA/MO Joint Conference May 11-13 in St. Louis.
• PeriGen offers a National (OB!) Nurses Week Appreciation Toolkit.
• Streamline Health will exhibit at the 2016 National Rural Health Association Innovation Summit May 10-13 in Minneapolis.

Blog Posts

• Five Ways to Make IT More Strategic (TierPoint)
• What’s Next for Meaningful Use (CTG)
• This May, We’re All About the Historicals (UltraLinq)
• Connecting to an HIE — The Good, the Bad, and What it Means to You (Iatric Systems)
• Time for National Access to a Prescription Drug Repository in the EHR Workflow (First Databank)
• 8 Tips for a Seamless Risk Adjustment Program (Verisk Health)
• ICD-10-PCS Has a Starring Role in the FFY 2017 IPPS Proposed Rule (VitalWare)
• Bots are red-hot. (Voalte)
• Leverage SMS Messaging for Fiesta-Worthy Communication (West Corp.)
• Healthcare’s Strategic Asset: Customer Service (Xerox)
• The Future of Enterprise Mobility is Here: What’s Your Strategy? (PatientSafe Solutions)
• Will Physicians Say #Don’tMACRAme”? (PatientKeeper)
• A nurse’s intuition: Filling the gaps technology can’t (PerfectServe)
• Looking Past the Cherry on Top (PMD)

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 5/6/16

A Deep Dive on the MACRA NPRM

BIDMC CIO John Halamka, MD publishes his analysis of the recently released MACRA proposed rule.

Cerner Reports First Quarter 2016 Results

Cerner reports Q1 results: revenue grew 14 percent to $1.14 billion vs. $996 million during the same quarter last year, adjusted EPS $0.53 vs. $0.45, missing revenue projections. Share prices fell four percent in after hours trading.

Allscripts announces first quarter 2016 results

Allscripts reports Q1 results: revenue grew three percent to $346 million but fell short of projections, adjusted EPS $0.13 vs. $0.08.

Ns1ghter Launches Free and Unlimited Doctor Visits

An Austin-based startup launches offering free, unlimited telehealth visits and free second opinion case reviews.

News 5/6/16

Top News

BIDMC CIO John Halamka, MD dissects the nearly 1,000-page MACRA NPRM and makes interesting points:

• It’s a zero-sum redistribution rather than a stimulus program –  some clinicians will be paid more while others will be paid less based on performance.
• MACRA doesn’t impact hospitals or Medicaid EHR incentive participants. For them, Meaningful Use and quality reporting continue.
• ONC in March gave itself more authority over how EHRs are used in the field, with the proposed MACRA wording requiring clinicians to sign off that they have cooperated with ONC and that they haven’t disabled the interoperability capabilities of their EHRs. He says a lot of people are going to see ONC’s self-proposed surveillance role as overly intrusive.
• Clinicians can meet the secure messaging and view-download-transmit measures by having a single patient participate.
• Clinicians must participate for the full 2017 year, use a 2014 or 2015 certified EHR, and report to either eight Stage 2 or six Stage 3 measures in the Advancing Care Information objectives that replace Meaningful Use.
• Halamka also dryly notes a requirement that clinicians “continue to practice medicine” and that “listening to each patient’s story, being empathetic, and healing are optional.”
• He concludes that “sometimes when you remodel a house, there is a point where additional improvements are impossible” and says that nobody can understand the 962-page MACRA document, concluding that clinicians probably only have two choices – become a salaried employee or take a hospital job to avoid the complexity.
• The usually-optimistic Halamka summarizes darkly, “As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.” That’s a significant development since he called for rolling Meaningful Use into a less-prescriptive quality measurement program, but he’s not happy with how it turned out.

Reader Comments

From EMR Expert: "Re: King Khaled Eye Specialist Hospital in Saudi Arabia. It will become the first hospital in the Middle East to reach HIMSS EMRAM Stage 7.  That’s very good news for InterSystems, hard luck for Cerner and Epic.” Unverified. The InterSystems TrakCare-using hospital, a Johns Hopkins partner, reached Stage 6 in December 2014.

From Compressed Coal: “Re: Quintiles-IMS Health merger. Quintiles acquired Envoy in 1998 to create a competitor to IMS. It didn’t work and Quintiles eventually sold the business to Healtheon / WebMD. Envoy is one of the core assets of Emdeon, which is now Change Healthcare. I guess Quintiles finally got what it wanted all those years ago.” I wince remembering those irrational dot-com days of 2000, when Quintiles sold Envoy to Healtheon / WebMD for $2.7 billion after acquiring it in a $1.4 billion stock swap just a year earlier.

From Chili Dog: “Re: SPARC. CMS has notified the winners of its 10-year, $24 billion Strategic Partners Acquisition Resource Contract (SPARC). Here’s the small business winner list that CMS hasn’t announced yet.” I wasn’t familiar with SPARC, but the RFP description says it’s a multiple award, indefinite delivery / indefinite quantity contract divided into two pools – small business and unrestricted – with a $25 billion ceiling. It is described as, “This contract will provide strategic, technical, and program management advice, guidance, and support services to CMS to facilitate the modernization of business processes and supporting systems and their operations. These systems will include the Federal Healthcare Exchange and Medicare / Medicaid information technology systems. Other Department of Health and Human  Services Operating Divisions (HHS OPDIVs) may place orders under this contract as well.”

HIStalk Announcements and Requests

Mrs. M from Pennsylvania is using the three iPad Minis, cases, and document camera we provided in funding her DonorsChoose grant request to challenge her second graders with STEM skill exercises and games. She adds that the students who don’t have access to technology at home are especially excited about learning and working hard.

Listening: new from reader-recommended Purson, an inexplicably obscure female-led British psychedelic band that sounds like all the best musical parts of the trippy early 1970s (Deep Purple, Jefferson Airplane, and The Doors come to mind). The female lead singer-songwriter, Rosalie Cunningham, can and does shred it on guitar. They just started a small-venue US tour. They are outstanding, including their choice of name.

This week on HIStalk Practice: CMS, AMA offer resources for physicians struggling with MACRA. Jonathan Bush sounds off on Athenahealth’s trajectory, gives thanks for Obamacare. DAS Health acquires EHR/PM assets of Jackson Key Practice Solutions. "HIPPA" loses its luster thanks to a fraudulent letter to patients. Tandigm Health rolls out virtual visits courtesy of TouchCare. Warburg Pincus acquires DocuTap. Dr. Gregg channels Prince in his ode to MACRA.

You can rekindle your (hopefully) fond memories of HIStalkapalooza in Las Vegas by checking out Elsevier’s great video. Thanks to Elsevier for creating the video, sponsoring the event, and sponsoring HIStalk for several years. I guess I need to decide soon whether to do it again in Orlando since venue booking is always the first step, but it’s also the scary one where I sign on the line which is dotted an agreement to pay many dozens of thousands of dollars in hopes that sponsors will step up to keep me financially solvent.

Webinars

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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

Acquisitions, Funding, Business, and Stock

DocuTap, which offers an urgent care PM/EHR, is acquired by private equity firm Warburg Pincus.

Envero Health, which offers care management and analytics systems, raises $14 million. CEO Dan Neuwirth was previously president and CEO of MedCPU Americas. The company’s website is irritatingly vague and artsy in failing to explain exactly what they’re selling, but a news search turns up its recent acquisition of two other Richmond, VA firms owned by local health systems, one that offers an HIE and another selling call center services. 

McKesson reports Q4 results: revenue up 7 percent, EPS $1.97 vs. $1.69, meeting revenue expectations but falling short on earnings. Technology Solutions wasn’t mentioned much in the earnings call except to say that margins are improving and hospital revenue is decreasing. Stock analysts didn’t even ask any technology questions as they focused exclusively on McKesson’s core drug business.

CPSI announces Q1 results: revenue up 51 percent, EPS –$0.07 vs. $0.49, missing expectations for both with the company blaming the timing of its $250 million January Healthland acquisition closing. From the earnings call, Healthland CEO Chris Bauleke has left CPSI well before the 12 months he agreed to stay on to help with the transition.

Cerner reports Q1 numbers: revenue up 14 percent, adjusted EPS $0.53 vs. $0.45, meeting earnings expectations but falling short on revenue.

Allscripts reports Q1 results: revenue up 3 percent, adjusted EPS $0.13 vs. $0.08, beating earnings expectations but falling short on revenue.

The Advisory Board Company reports Q1 results: revenue up 12 percent, adjusted EPS $0.46 vs. $0.30, beating earnings expectations but falling short on revenue.

The dour German engineers that run the gray metal conglomerate Siemens inexplicably turn their marketing people loose to justify their existence in creating a forcibly fun new identity for the healthcare business, with the end result being that Siemens Healthcare will now be known as – it’s making me retch as I type it – Siemens Healthineers, which sounds overly cheery for a company best known for supporting the Third Reich and bribing government officials. Feel free to sing along with the video above that celebrates the “innovators and family of friends” who mostly seem embarrassed by the corporate misstep that is exploding with mandated joviality around them, with the Disney-esque song running way too long before it finally ends to stunned, half-hearted applause. The only people who seem to be actively engaged in the white-bread proceedings are two on-stage suits, who I assume were in charge since their beaming faces and stiff dancing are the exceptions among an otherwise borderline hostile crowd who would clearly rather be anywhere else. They should have passed out the faux Blue Man Group costumes at the door to prevent the friends and families of employees from recognizing them. Surely the out-of-touch executives that approved the name without thinking it through are horrified by the scorn it is generating, leading to my prediction that it will be quietly retired within a few weeks and everybody who was involved will claim they didn’t know anything about it or were just following orders.

Startup Ns1ghter offers free, unlimited online access to its board-certified doctors. It boasts of a machine learning platform whose contribution is not described, but that appears to be intended for developing care algorithms. The “free” part is made possible by “funding and marketing partnerships.” The choice of name is bizarre without being memorable (they apparently pronounce it “insighter” without acknowledging the presence of the numeral) and the company’s address on its privacy policy page is a residence in Austin, TX.

Sales

Salem Regional Medical Center (OH) selects Meditech 6.1 to replace McKesson Horizon.

People

Rock Health Founder and Managing Director Halle Tecco announces via Twitter that she is leaving the venture capital firm for unstated reasons and destination.

Kaleida Health (NY) hires Cletis Earle (St. Luke’s Cornwall Hospital) as VP/CIO.

David Chou (University of Mississippi Medical Center) joins Children’s Mercy Hospital (MO) as VP/CIO.

Announcements and Implementations

Optum, Medecision, and TriZetto launch a set of software and service offerings for state Medicaid Management Information Systems, taking advantage of a CMS change that provides federal funds for states to modernize their Medicaid enrollment, eligibility, and claims systems incrementally.

Government and Politics

Farzad Mostashari tweets out this CMS actuary’s graphic that shows the expected impact of MACRA on physician payments, which he describes as “financial suicide” for small practices. It suggests that 87 percent of solo practices will be paid $300 million less, or about $3,400 less per doctor. It’s interesting that the bigger the practice, the lower the expected rate of negative adjustment (dropping to just 18.3 percent for practices of 100 or more clinicians). The inevitable consolidation might sound like a good thing economically, but note that hospital consolidation has raised rather than reduced prices and patients are dealing with an even larger indifferent bureaucracy.

Privacy and Security

A hacker called “The Collector” offers 1.7 billion email passwords for sale, stolen from all of the most popular online email services. The hacker is selling the entire package for $1, asking only that positive reviews be posted on a hacker forum. Experts recommend changing passwords for email as well as any other sites where the same password was used.

Privacy advocates question Sharp Grossmont Hospital’s (CA) use of OR video surveillance in trying to determine which team members were stealing drugs. The hospital hid motion-activated cameras inside the computer monitors of anesthesia machines, thereby capturing video of every delivery and tubal ligation over a year without patient consent. The hospital says the videos show the doctor they suspected pocketing drugs, but the doctor says he was just keeping them handy and other videos show the doses being used on patients. The hospital doesn’t want to give the doctor’s lawyers access to the videos, saying they would invade the privacy of Sharp HealthCare, employees, and physicians.

Other

The mainstream press picks up an FDA MAUDE database adverse event report filed by Merge Healthcare in which an unnamed hospital customer ignored the company’s antivirus configuration instructions for its Merge Hemo cath lab documentation system, failing to exclude huge medical imaging and data files. The hourly scans caused an incident described as, “A customer reported to Merge Healthcare that, in the middle of a heart catheterization procedure, the hemo monitor PC lost communication with the hemo client and the hemo monitor went black … there was a delay of about five minutes while the patient was sedated so that the application could be rebooted.”

A TransUnion Healthcare survey finds that three-quarters of consumers are worried about increasing healthcare costs as they watch their premiums, co-pays, and deductibles increase even before the 2017 rate increases. I have to assume that the 25 percent who don’t care about healthcare costs are funded in some way by taxpayers who do.

Study authors determine that medical mistakes kill more Americans than all other causes except heart disease and cancer. The study involves quite a few assumptions since death certificates don’t include codes for medical errors and BMJ seems awfully promotional in touting the article, but regardless of methodology, all of us working in healthcare know that patients die because of our screw-ups. Still, it’s hard to say definitively that a given medical error killed a patient, just like it’s hard to say that a given patient died of cancer rather than of chemotherapy complications.

An LA Times investigative report finds that Purdue Pharma, which has sold $31 billion worth of the narcotic OxyContin, knew that the drug didn’t really offer 12-hour relief as its packing claims, but it  stuck to those claims because the 12-hour dose was the only advantage the patented drug had over older, cheaper alternatives. The company instructed sales reps to tell doctors to increase the dose rather giving it more often, causing many patients to be ordered dangerously high doses and to go into withdrawal even while failing to achieve pain relief, feeding a cycle of addiction in which seven million Americans have abused the drug. Meanwhile, the company’s owners (the Sackler family whose name adorns several art museums) have amassed a $14 billion fortune.

Sponsor Updates

• Ingenious Med launches a year-long bus tour to offer guidance to providers on how to lower costs through improved care.
• Influence Health announces the 2016 EHealth Excellence Award winners.
• Cumberland Consulting Group is rated by KLAS as the top-performing targeted Epic consulting firm.
• InstaMed sponsors the 21st annual Taste for a Cure at UCLA Health.
• PokitDok joins CommonWell Health Alliance.
• Visage Imaging will exhibit at ACR 2016 May 16-17 in Washington, DC.
• Netsmart will exhibit at the Decision Coordinated Health Care Summit May 9 in Baltimore.
• Obix Perinatal Data System will exhibit at the Philadelphia Pregnancy Center Prenatal Summit May 5-7 in Philadelphia.

Blog Posts

• Trading in Fear: the Anatomy of Ransomware (ID Experts)
• Moving Forward with Interoperability: the Behavioral Health Perspective (InterSystems)
• 7 Months in: Where do we stand with ICD-10? (HCTec)
• Limiting the Hidden Costs of Data Security and Compliance (Liaison Technologies)
• Direct Consulting Associates interviews former CIO and now consultant Sue Schade.
• Joint Commission allows texting of orders (DrFirst)
• Client Outlook and LifeImage: Unified Access to All Imaging Content (LifeImage)
• Partners in Time (MedData)
• What Today’s Patients are Borrowing From the World of Money Management (Navicure)
• The Joint Commission Recognizes the Value of Secure Text Messaging (Spok)
• Capturing Patient Stories (NVoq)
• What are your concerns about interoperability, in your healthcare organization? (Orion 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.

EPtalk by Dr. Jayne 5/5/16

Most of my colleagues are lamenting the proposed rule for MIPS and APM, citing the control that CMS is going to have over their day-to-day practice of medicine. I didn’t know until Wednesday, though, that the reach of CMS went even farther into the realm of fire safety. A newly-released final rule applies to hospitals, long-term care facilities, critical access hospitals, inpatient hospices, ambulatory surgery centers, religious non-medical healthcare institutions, programs for all-inclusive care for the elderly, and intermediate care facilities for individuals with intellectual disabilities.

The rule adopts provisions from 2012 fire codes. Unlike the MIPS rules, which require all kinds of work prior to January 2017, this rule gives facilities 12 years to come into compliance with sprinkler requirements. It also regulates the kinds of home décor items allowable in long term care facilities.

NCQA has weighed in on the proposed rules to implement MACRA, coming out in support, which is not surprising. They specifically cite independent third-party validation of Patient-Centered Medical Homes and Specialty Practices as a plus. If there is one thing that does make sense about the proposed rule, it is that patient-centered care is a winner. Practices that aren’t sure what they should be doing might want to consider a serious look at the models if they haven’t already.

I’m doing quite of bit of work lately with a customer who is switching EHRs. It always amazes me how easy people think this is, before they actually dig into it. The receiving vendors tend to over-promise on their ability to lift the data from the old system and place it into the new system in a usable fashion. Of course, they don’t mention that this often depends on the willingness of the legacy vendor to participate. Sometimes the legacy team will perform the data extract and sometimes a third party is used, but there is at least some baseline cooperation needed, especially if the legacy system is hosted.

Depending on the quality of the source data, there may be some degree of massaging of values to map to new data formats. Sometimes this requires clinical input, which can be extensive. When organizations look at the cost of physician time needed, it may impact decisions on how much data an organization decides to bring forward.

In this particular situation, the client is using a third party to perform the extract and manipulate the data so that the receiving vendor can perform the database insert. My client was concerned about some of the proposed mappings, so they asked me to take a look. I immediately identified some issues, and when I asked about them, the extract vendor became evasive. That’s never a good sign.

Working on behalf of the client, I asked to be put in touch with their clinical resources who were processing the data. It turns out they are using people who aren’t necessarily clinical. The extract vendor is actually operating from his home in a resort town in Thailand. On one call, I’m pretty sure I heard waves lapping in the background.

I asked the client to also reconsider their scope for the extract. They had been planning to move all the clinical data, but given that they have more than 15 years of data in their legacy system, it might not be the best clinical decision. If there are issues with data, it’s a lot easier to correct the most recent three to five years of data than trying to manipulate decade-old data that might involve drugs that no longer exist or diagnoses that are no longer valid.

We had already had a very difficult conversation about using the new system as their archive. They had originally planned to migrate all their patients, even if they were expired. It remains to be seen how this is going to work out, but the extract vendor is supposed to be working on another data pull for the client to review with me. I hope they’re successful, but in the immortal words of Han Solo, I’ve got a bad feeling about this.

AMIA has announced its InSpire 2016 event, which is specifically dedicated to informatics educators. Expanding beyond the Academic Forum, the conference is seeking submissions around education innovation. Additional topics include academic career advancement, informatics for curriculum developers, research, and data science.

DocuTap is hosting its annual user group June 15-17 in Sioux Falls, SD. It should be an interesting meeting since they were just acquired by private equity firm Warburg Pincus. The event is free for clients and includes sessions on telehealth, analytics, and target-marketing to payer specific patients. I got a kick out of their “20 reasons to attend” document which included the ability to take extra time off to visit Mount Rushmore and the Black Hills, noting that it is an additional five-hour drive across the state.

Next week is National Nurses Week, held May 6-12. Being in clinical informatics, I’m proud to work with quite a few informatics professionals who are nurses, as well as nurses who specialize in nursing informatics. I’m also eternally grateful to the nurses at St. Somewhere who saved my backside repeatedly during my first rotation in the coronary care unit as a resident physician. They taught me a tremendous amount of real-world medicine.

They also taught me the value of respect – they knew I respected their judgment and knowledge, so they batched their questions for me throughout the night so I could get a little sleep (unlike my counterparts who got paged every 15 minutes because they were jerks).

Has a nurse made a difference in your career? Email me.

Email Dr. Jayne.

Morning Headlines 5/5/16

Email from insider led to Epic Systems’ $940 million legal win

A disgruntled Tata Consultancy employee working at Kaiser Permanente alerted Epic that the company had been illegally downloading trade secrets through Epic’s UserWeb. The employee had reportedly been passed up for a promotion.

IBM Gives Free Storage to ResearchKit Users

IBM announces that it will host ResearchKit apps on its Watson Health hosting platform for free.

Acting Administrator Slavitt Speech at the American Hospital Association’s Annual Membership Meeting

During the AHA Annual Membership Meeting, CMS Acting Administrator Andy Slavitt called on doctors to engage in the rule writing process while MACRA was in its public comment period.

Medical Errors Are the Third Leading Cause of Death: Study

A BMJ study estimates that medical errors kill 250,000 Americans each year, making it the third leading cause of death in the US.

HIStalk Interviews Travis Good, MD, CEO, Catalyze

Travis Good, MD is co-founder, CEO, and privacy officer of Catalyze of Madison, WI.

Tell me about yourself and the company.

My background is technology — focused specifically on cyber-security — clinical medicine, and the business of medicine. All converging in the arena of healthcare technology, which is where I’ve been for the past eight or nine years.

Catalyze is a three-year-old company that we built. The name is intentional. We help catalyze the shift within the industry from volume to value. We did it, not by building a specific type of application, but by building infrastructure that enables a thousand flowers to bloom within digital health.

How much of a startup’s efforts to get to scale are impeded by compliance or integration issues?

Obviously our thesis is that it’s a significant amount. From a previous venture, we estimated somewhere around 40 percent of product effort is spent on those two areas.

What kinds of companies seek you out and what help do they need?

It’s probably helpful to split it into two buckets. On the smaller side, there are vendors that are just getting started, signing and onboarding their first one to three hospital customers. In those cases, they’re fresh. They’re looking for a solution. They haven’t really tried that much themselves. They’ve done enough research to know that it’s something that they don’t want to try to do themselves.

The larger vendor side has companies that are pretty well established and are getting pushed by their hospital customers to integrate with the EHR. A lot of those customers have looked around. Some have tried to do it themselves using different tools and ended up coming to us because they just don’t want to manage those tools and that process themselves.

For those customers that had something in place and decided to replace it, what was the value to them of turning that over to Catalyze to manage?

With larger vendors and anybody who’s scaled beyond probably five or 10 hospitals – and we have vendors that have hundreds of hospital customers — there’s significant value at that scale in having a consistent partner, where they don’t have to tweak their application for each one of their hospital customers. Essentially, we manage the different endpoint connections for them across, 10 to 50 or maybe a couple of hundred hospitals.

They have just one consistent endpoint from Catalyze. They don’t need to do a lot of custom development on their application for each subsequent hospital that they onboard. In a lot of respects with those larger vendors and in terms of integration at scale, there’s a lot more value than at just a handful of hospitals.

What would be the challenges for a company new to healthcare to build that infrastructure themselves?

Compliance and integration raise the bar in healthcare. They’re unique to healthcare. They definitely raise the bar compared to building and selling technology into other industries.

I think that there’s two core value propositions that they get from using Catalyze. One, it is a significant amount of work from a technical perspective to set up and manage infrastructure that is secure and compliant and does things like monitoring and intrusion detection and vulnerability scanning and all of those different pieces.

Then the secondary value in healthcare is that increasingly — especially with all the recent high-profile security breaches — there’s the requirement not just of saying that you’re in compliance, but being able to prove it. Those components that we offer — intrusion detection, logging, and backup and disaster recovery — have all been fully audited and are HITRUST certified. Our customers inherit not just that technical work from us, but also the proof and the audits from us to help expedite their sales process.

Some of those breaches involved business associates. How can covered entities protect themselves better with regard to their business associates?

Those things definitely changed a few years ago with the HIPAA Omnibus rule that expanded who was covered under HIPAA and who had to participate in the form of business associate agreement. It remains challenging for covered entities because they work with a myriad of business partners, business associates, and vendor customers or partners. The major challenge is that business associate agreements aren’t really standardized. Comparing business associate agreements is an additional level of work. Covered entities have to deal with that across all of their partners and business associates. That is a challenge for them.

A lot of large payers have standardized on HITRUST as a framework and as a more true certification, which goes beyond the business associate agreement. It certifies a lot of the different technical pieces and organizational requirements of HIPAA. It standardizes it across NIST, PCI, and a bunch of other frameworks. To expedite that process — not just through these business associate agreements, but also to assess the security of a partner or business associate — HITRUST is becoming the accepted standard in the industry.

Will we see more componentization or segregation of technical capabilities as cloud-based systems extend the functionality of EHRs?

Two or three years ago, every answer was, “Our EHR vendor is going to get around to it." Increasingly, that has changed. It has opened the door to telemedicine solutions, bundled payment platforms, and clinical communication solutions. All these other tools. 

The same is true of interoperability. CommonWell was announced. FHIR has been in the works for some time now. Increasingly, EHRs have not made it any easier to integrate. If you don’t have this middle layer, this componentry,  every company ends up reinventing the wheel. That is incredibly inefficient, both from the company’s perspective as well as from the hospital or health system’s perspective.

Increasingly, there is a need for that middle layer. There is a need to secure that connectivity and standardize it from the EHRs to the digital health tools, solutions, and services that are increasingly serving healthcare customers.

Healthcare is not unique. A company called Clever in education frees data from educational systems and standardizes it so that health applications can be created and distributed for schools. Healthcare is in need of much of the same thing. EHRs have been too slow to cover those things themselves. They’re not meeting the timelines that now the government has mandated things like MACRA and MIPS. There is a need for that middle layer componentry.

Are EHR vendors still trying to protect their own interests or are they now open to the idea that customers need third-party solutions?

Healthcare customers are demanding it. EHR vendors like Athenahealth have been out ahead with their More Disruption Please program in terms of creating an ecosystem. Increasingly, healthcare or EHR customers are demanding it. You saw the trend where consolidation on a standard platform was the epic stage of growth in the industry.

Now as we shift, we see new technologies coming into healthcare to deliver value that is needed by the health system customers. I mentioned some examples like bundled payments or virtual care solutions that then direct people to the appropriate levels of care and reduce costs. All of those different pieces.

Those are things that health systems desperately need to start implementing across increasingly large portions of their population. They are now saying that the EHRs aren’t necessarily going to get there. It’s not that EHRs aren’t going to remain the hub of clinical data and the hub of clinical workflow within the health system, but we will increasingly see these EHR add-ons, digital health solutions, and ecosystems.

Kaiser has already tested, piloted, and is starting to scale a lot of different solutions. Kaiser is a little bit different,  but it does reflect the direction the industry is going. I think we’re going to see a lot more with a lot more health systems.

What challenges will vendors experience in trying to open their systems up with APIs?

They should look at standards like FHIR. It’s gaining a lot of interest and "adoption," quote-unquote. “Adoption” because it’s  hard to find FHIR in the industry that’s actually implemented in production. Looking at something like that is probably a good guidepost for how to think about enabling access to your EHR. Cerner and Epic are the two big beasts, but increasingly, practice-based, specialty-based, all these other EHRs need to also be thinking about it. Looking at something like FHIR is probably the right approach. At least from the organizations that are promoting FHIR, it seems to meet the requirements in terms of accessing EHR data.

What have you learned from creating a company?

One of the biggest things is saying no and not pursuing certain things. When you look at healthcare, there’s a lot of opportunities and a lot of things that seem broken, inefficient, not optimized for care, and all the things you assume healthcare should be built around. But you can very quickly go down a rabbit hole if you don’t have focus. 

A second thing is being  very open about what you’re doing, even if it’s early stage. Getting feedback, finding mentors, finding people at organizations that may be customers down the road, getting their feedback. Not being too what people call "stealthy" or a "stealth" type of startup, but being open about what you’re doing. 

Success is ultimately going to come down to execution. Scaling a company is going to come down to execution. You have to be much more open about the idea and what you’re doing if you want to be successful.

Do you have any final thoughts?

Having spent time at HIStalk writing about digital health and companies that were building solutions for the next wave of healthcare and then jumping to the other side of building a company that then helps those vendors and those different technologies of scale has been incredibly exciting. I get to work with a lot of companies that I used to write about and I was excited to see their history.

The industry has moved much faster than I expected in  embracing these digital health solutions and EHR add-ons. It’s exciting to see some of these digital health solutions start to scale and then get research and data about how they actually work. It’s very, very cool.

Morning Headlines 5/4/16

IMS Health and Quintiles to Merge

Quintiles, the parent company of Encore Health Resources, will merge with IMS Health, resulting in a company with $7 billion in annual revenue.

Imprivata Announces First Quarter 2016 Financial Results, Revenue Growth of 23%

Imprivata reports Q1 results: revenue climbed 23 percent to $25.6 million, adjusted EPS –$0.21 vs. $-.24.

How a tiny hospital has imperiled Mass. Medicare funds

Hospitals in Massachusetts face a potential ten percent drop in Medicare funding after consultants hired by the state’s only rural hospital, 19-bed Nantucket Cottage Hospital, miscalculate annual wage costs which are used by Medicare as a baseline for all hospitals in the state.

News 5/4/16

Top News

Pharma services firm Quintiles – which acquired Encore Health Resources in 2014 – will merge with drug data and marketing firm IMS Health, creating a drug data behemoth with 50,000 employees and $7 billion in annual revenue.

Quintiles founder Dennis Gillings, PhD was a biostatistics professor at University of North Carolina at Chapel Hill when he founded Quintiles in 1982, eventually making him a billionaire.  IMS Health is mostly known for selling drug prescribing and dispensing information to drug manufacturers to allow their salespeople to aggressively market their products to physicians.

Reader Comments

From Spiffy Duds: “Re: [vendor name omitted]. Glassdoor reviews say the place is imploding, running scared about Epic threat, losing customers and employees, late on software, new platform released with huge issues. The new president runs a fear-based shop and can’t stick to a strategic decision. The owner knows nothing about healthcare and is an incurable narcissist who believes the company is saving lives and doing things that no one else can do.” Unverified. I’ve omitted the company name since anyone can say anything on Glassdoor, plus Glassdoor now allows full viewing of comments only to those who write a review or submit a salary, of which I’ve done neither.  

From Publius: “Re: Coast Guard and Epic. It’s quite the coincidence that Leidos deleted the Coast Guard’s Epic SAN while working with Cerner on the DoD project.”

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mr. S from New Mexico, who asked for electronic circuitry to help Zack, a student in his high school class who has set his sights on obtaining a Harvard math and engineering PhD. Zack reports, “I thank you for empowering me to use electronic circuitry components to create Arduino circuits that I code and assemble. This is most exciting because I can use circuitry components that I previously was unable to access. Thank you for allowing me to do this.”

Also checking in is Ms. W from Arizona, whose preschoolers are learning “sight words” in the 10 minutes per day she has set aside for using them. She reports, “These tools may be small to some, but to my students who do not have the opportunity to have these things, it is a great essential. I can’t wait to continue using these tools for the years to come in my classroom and see the great learning that happens.”

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

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

Acquisitions, Funding, Business, and Stock

Healthcare managed services vendor MedData acquires patient engagement software vendor Duet Health.

Behavioral health telemedicine software vendor WeCounsel closes its $3.5 million Series A funding round. The company offers practices unlimited use of its platform for $15 per month.

NIH awards ID Genomics a three-year, $3 million grant to continue development of its 30-minute test that identifies the bacteria causing an infection and matches it against a profile of antibiotic resistance to help doctors choose the right antibiotic.

Cotivity, which sells payment accuracy solutions to payers in healthcare and retail, announces plans to launch an IPO.

Investor Warren Buffett, asked a question about board member diversity at Berkshire Hathaway’s annual meeting, uses Theranos as an example of what not do do when choosing a board:

You know, one organization recently, the one that did the blood samples with small pricks, they’ve got some very big names on their board. Theranos. I mean, the names are great, but we’re not interested in people that want to be on the board because they want to make two or three hundred thousand dollars a year for 10 percent of their time. And we’re not interested in the ones for whom it’s a prestige item and who want to go and check boxes, or that sort of thing.

Imprivata announces Q1 results: revenue up 23 percent, adjusted EPS –$0.21 vs. $-.24, beating analyst expectations for both. 

Announcements and Implementations

England’s West Suffolk NHS Foundation Trust goes live on Cerner.

CommonWell and NATE (the National Association for Trusted Exchange) will join each other’s organization as members.

Government and Politics

A study finds that citizens of states that spend more on social and public health services vs. healthcare services have better outcomes for several chronic and debilitating conditions.

The federal government will require the DoD’s Defense Health Agency to issue IT contracts through the General Services Administration.

Innovation and Research

A study finds that the most profitable hospitals (based strictly on operating income) are for-profit, have higher markups, have regional prestige that allows them to dictate terms to insurers, and are located in states (interestingly enough) with price regulation. The most profitable hospitals in the 2013 data studied were 268-bed Gundersen Lutheran Medical Center (which made $300 million in profit from patient care), Sutter Medical Center, and Stanford Hospital. I checked Gundersen’s federal tax forms, which show 2014 profit of $95 million, down from $312 million in 2013. To its credit, the hospital paid its executives comparatively modestly, with the CEO earning $910K and the CIO $385K.

Half of surveyed teens say they are addicted to their smartphones, with 78 percent of them checking their devices at least hourly and 72 percent believing they must respond immediately to texts and social networking messages. More parents than teens (56 percent) check their devices while driving, while a big chunk of both groups think the other ignores them and plays with their phones when they’re together. 

Technology

Microsoft’s SQL Server 2016 will launch on June 1, with speed and security enhancements, support for the R analytics tool, the ability to query both structured and unstructured data, and the ability to query encrypted data without decrypting it first.

Google donates $250,000 toward Flint, MI’s water problems, of which $150,000 will fund a University of Michigan data project to identify homes with likely high levels of lead. UM will also develop a mobile app and website that will allow residents to visualize data and communicate with the city.

Other

As reported here earlier in quoting Shriners CMIO Richard Paula, MD, the Joint Commission confirms in an emailed newsletter Monday that it has reversed its 2011 policy that prohibited sending orders via text message, effective immediately. Joint Commission says it changed its mind because messaging platforms have improved.

The only rural hospital in Massachusetts — 19-bed, Partners-owned Nantucket Cottage Hospital – may cause all state hospitals to lose $160 million in Medicare funding in the next year after consultants make mistakes in calculating the hospital’s labor costs. The hospital’s high-cost location makes it the state’s most expensive and Medicare sets the labor payments to all other hospitals based on its costs. Some hospitals could lose 10 percent of their Medicare payments due to the mistake.

An interesting article describes Mid-Atlantic Permanente Medical Group’s hepatitis C screening protocol, which has these components:

• An EHR alert recommends to providers that patients born between 1945 and 1965 undergo hepatitis C screening if they haven’t already had it.
• Patients who test positive for the hepatitis C antibody are automatically ordered confirmatory testing.
• An assigned hepatitis C coordinator manages the follow-up activities and educates the patient.
• A liver damage assessment is automatically ordered.
• Patients are connected to physicians to make sure ongoing care occurs.

A Kaiser Health News article concludes that hospitals are not good at coordinating post-discharge care with home health agencies and nursing homes, particularly when it comes to medications. The article notes that none of the $30 billion in HITECH EHR bribes went to nursing homes, rehab facilities, or home care providers. The article failed to note equally sobering problems in coordinating the care of patients with behavioral problems, which have a similar genesis.

The Chinese government will investigate search engine company Baidu following the death of a student who searched online for a treatment for his rare form of cancer. The student claimed that his search turned up a hospital that lied about a high rate of success with an experimental treatment he was given. Before he died, the student accused Baidu of promoting false medical information and called out the hospital for false advertising.

Two large employers who offered a healthcare price transparency tool found that only small percentage of employees used it and healthcare costs actually increased slightly.

A study finds that the price of oncology drugs is steadily and illogically increasing, as drugs whose initial high price was justified by expected narrow usage get more expensive even when new indications are discovered.

Sponsor Updates

• KLAS recognizes Sagacious Consultants (now part of Accenture) as a top-performing Epic consulting firm.
• AdvancedMD releases a new ebook, “Advanced Practice Training: Changing the Game in Financial Reporting.”
• Extension Healthcare releases a video showing how its Engage Mobile solution integrates with AirStrip One live waveforms.
• AirWatch launches the Echo One Podcast.
• Aprima will exhibit at the ACP Internal Medicine Meeting 2016 May 5-7 in Washington, DC.
• KLAS recognizes Nordic’s Epic implementation support and staffing services, also ranking the company for the first time in the IT Advisory segment with a 92.6 score.
• Besler Consulting releases a new podcast, “What Hospitals Should Do Regardless of Who is Elected President.”
• DrFirst’s Rcopia e-prescribing platform wins the Surescripts White Coat of Quality Award for the fourth time.
• CapsuleTech celebrates National Nurses Week May 6-12.
• The Advisory Board Company features Carevive Systems in a presentation during its Oncology Roundtable series May 5-6 in Washington, DC.
• CompuGroup Medical will exhibit at the Rural Health Care Conference May 10-13 in Minneapolis.
• CoverMyMeds will exhibit at the 2016 New England Regional MGMA Conference May 5-6 in Bretton Woods, NH.
• Wellcentive develops a free tool to calculate the cost of delaying the shift from payer volume to value-based care and reimbursement.
• Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
• ECG Management Consultants will present at the MGMA New England Regional Practice Management Conference May 5 in Bretton Woods, NH.
• EClinicalWorks will exhibit at the IMGMA Spring Conference May 5-6 in Indianapolis.
• Healthwise will exhibit at the EClinicalWorks 2016 Health Center Summit May 11-13 in Boston.

Blog Posts

• Provider How-To: Minimizing Gaps in HCC Data Capture (Arcadia Healthcare Solutions)
• Data-Enabled ≠ Data-Driven (Catalyze)
• Protecting Against Ransomware with Layered Security (Impact Advisors)
• Gen Z in HIT (Direct Consulting Associates)
• Revenue Management: Pay Attention to Your No-Show Rates (E-MDs)
• 4 quick tips for your next cybersecurity conversation (The Advisory Board Company)
• The New Architecture of Healthcare Delivery (Part 1) (Extension Healthcare)
• Top 6 Reasons Healthcare Organizations Should Automate the Informed Consent Process (FormFast)
• The Death of an Electronic Note (Galen Healthcare Solutions)
• Tale of Two Systems: Making the Right IT Choice Following a Merger or Acquisition (Hayes Management Consulting)
• Healthcare Cybersecurity: Prevention, Detection, and Training (The HCI Group)

Contacts

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

Curbside Consult with Dr. Jayne 5/2/16

Since the release of the proposed rule for MACRA, many of my colleagues have been heads down trying to digest the content and figure out how to operationalize the requirements. While some organizations are taking the proposed rule and running with it, others are adopting a “wait and see” approach given the anticipated volume of negative comments from the public. They’re hoping that things will change prior to it becoming final, which is always a possibility given this crazy environment in which we all now operate.

Although CMS talking heads have said MU is dead, it must be zombie-dead. It’s just been reinvented as “Advancing Care Information,” which although more flexible than MU, is still too daunting for many practices. Physicians will not be accountable for cost category measures from claims data as well as being pushed towards further tracking and reporting on PQRS.

There are two tracks for physicians, with CMS expecting that most providers will be in the MIPS track vs. Alternative Payment Models. The numbers I saw estimated were 700,000 vs. 60,000, respectively. Unfortunately, providers will have to decide wither to submit under MIPS before they know whether they qualify for the APM track. Many organizations will be doing a belt and suspenders approach.

Several of my friends that work at vendors are extremely stressed out, realizing that federal requirements will dominate development efforts over the rest of the year. Just when they had breathing room to work on usability and customer-requested enhancements, they’re going to be forced back to the grindstone to crank out code that may or may not be what their customers want or need. Vendors have to walk a fine line between speculating on what will be dropped from the final rule and running full speed to get it all done.

Some vendors will start working on the requirements whether or not they think they’ll be modified. Given the way the last few rulemaking cycles have gone, even if a particular element gets taken out of the final rule, it will likely rear its head in a subsequent rule or in another program, so this might be a wise approach. On the other hand, if the rule is substantially modified, there is a risk of significant wasted development efforts. Once the comment period closes, it will be several months before we have a final rule. My friends with crystal balls tell me we’ll have the final rule in October with it taking effect in January. If that timeline holds, there won’t be much time for vendors to shift gears if the modifications are significant.

In the provider space, there is a tremendous amount of chatter about this being the last straw for small or independent practices. The requirements are daunting, especially for practices who haven’t been at the forefront of payment reform efforts. Just trying to read and understand all the rules and keep track of all the FAQs we’ll undoubtedly see could be a full-time job. As CMS goes, so go the commercial payers, and I expect we’ll see them ratcheting down on physicians as well. I’m still trying to fully absorb how this will affect my own practice given that we opted out of MU and haven’t looked back.

One of my colleagues brought up a good point. Although providers may not be ready to go to a direct model practice or all the way to a concierge / retainer model, providers have been slowly transitioning out of Medicare. It’s tricky for these non-participating providers when they want to continue to care for Medicare beneficiaries. Another option is to opt out of Medicare entirely. The complexity of the choices make it difficult for providers to consider leaving, especially when they consider that commercial payers will have matching requirements of their own that the providers will still have to deal with. The seemingly-onerous nature of the proposed rules might be a catalyst for providers to consider moving to direct models.

When you think about it, direct payment models would go nicely with some of the goals of all these efforts. If the goal is to put the patient at the center of their own care and to engage them, what better way to engage them than with their pocket books? Patients who start to see the true cost of care (rather than being shielded by their co-pays) might start choosing their therapies more wisely. Perhaps the generic drug that’s been around forever but doesn’t have sexy marketing will start looking more attractive.

We’ve experimented with that to some degree with tiered co-pays and that has driven patients to ask about cheaper alternatives. I’ve seen some patients question their hospital-employed physicians when the patients start getting bills from both the provider and the facility through provider-based billing arrangements. A couple of organizations in my region have done away with the practice based on negative community feedback.

Understanding the cost of care may encourage patients and families to make end-of-life choices that are ultimately more compassionate – choosing palliative care or hospice rather than expensive interventions that may not prolong life and may even damage the quality of life. Patients may begin to analyze whether the expensive (and life-altering) cancer treatments that may only extend life a few months are really worth it for them or for their families. Maybe we’ll stop ordering CT scans for things that really could be diagnosed with a good history and physical exam.

Of course, this wouldn’t solve all our problems. The cost of care is still prohibitively high for many treatments. Patients would still need insurance against catastrophic medical bills and we would still need safety net facilities and arrangements for patients who have limited ability to pay.

It also doesn’t address the real origins of healthcare costs. Lifestyle and behavior-related factors are 40 percent of the pie compared to medical care, which is a mere 10 percent. Human biology is 30 percent, with social determinants of health at 15 percent and environmental factors at 5 percent. Although patient engagement may help the lifestyle and behavior-related category, there’s still much more work to be done.

I still have several hundred more pages to get through, but I’m not sure I’ll make it. It’s too depressing.

Have you finished the proposed rule? What do you think? Email me.

Email Dr. Jayne.

Morning Headlines 5/3/16

CHIME Letter to FDA on Interoperable Medical Devices

The College of Healthcare Information Management Executives submits comments to the FDA calling for assurances that medical devices will be interoperable with EHR software.

Not-for-profits dominate top-10 list of hospitals with biggest surpluses

Seven of the 10 hospitals with the largest surplus from patient care services in 2013 were not-for-profits, according to Health Affairs.

Hospital discharge: It’s one of the most dangerous periods for patients

The Wall Street Journal profiles problems that can arise during transitions of care, with a focus on the hospital to home transition.

ResearchKit Unlocks the Power of Real-Time Clinical Research

New studies at Boston Children’s and RWJF highlight the evolving role of Apple’s mobile research technology.
By @JennHIStalk

It’s been just over a year since Apple introduced ResearchKit, an open source framework that enables researchers and developers to design apps for healthcare research. In that time, participation has soared. The platform now boasts 100,000 users who are submitting data to studies sponsored by hospitals and non-profits, including ones focused on asthma, breast cancer, diabetes, heart disease, hepatitis C, melanoma, Parkinson’s, post-partum depression, prostate cancer, and sleep apnea.

Even the NFL Players Association has gotten in on the act, partnering with Harvard University researchers to use ResearchKit in a joint investigation into the long-term effects of football injuries on 3,000 former NFL players.

The platform has also made accommodations for personal genomics via integration with 23andMe’s module. Researchers can enable 23andMe customers to contribute their genetic data to a study or offer genotyping services from the company to study participants. It’s a timely move given the industry’s White House-driven focus on precision medicine and cancer moonshots.

Apple, having realized the escalating potential of its own creation, decided earlier this year to start collecting ResearchKit data for its own internal purposes. Study participants who submit data to the Mole Mapper Study app and Parkinson’s mPower study app now have the option of also submitting that data directly to Apple. The company no doubt plans to use the data to further refine the platform and to impact future iterations of HealthKit and the new CareKit, corresponding apps that help power and further ResearchKit’s capabilities.

Real-World, Real-Time Research

Studies leveraging ResearchKit continue to be introduced, evidence that the platform is well on its way to changing the face of medical research. “It’s the most evolved mobile platform to run studies,” says Paul Tarini, senior program officer at the Robert Wood Johnson Foundation, which has taken an interest in ResearchKit from the beginning. “We’ve been interested in what we call real-world, real-time data for a number of years now, especially what that data can tell us about our health, how it can be used for research, and how it can be used to improve care. ResearchKit was the first formal platform developed to conduct research by taking advantage of the IPhone’s native capabilities to collect real-world, real-time data.”

Tarini and his team began talking about what kinds of apps might be useful within the ResearchKit library not long after its debut. “In discussions with Apple staff and industry experts, we ended up settling on mood and what helps influence mood,” Tarini explains. The result of that decision – RWJF’s Mood Challenge – launched earlier this month.

“We’re hoping the winning app could be used in part or in whole by another study that’s interested in including some aspect of mood or variable in its focus – something that other researchers can pick up, use, and plug in as they build their own apps,” Tarini adds. “We’re also interested in apps that use a mash-up of data, such as data from the phone and other sources, to shed light on mood. In this case, we’re particularly interested in data on social context. What are the graduation rates in your neighborhood? The income rates, family structures, crime rates, weather patterns? How do these influence health, if at all? We’re really focusing on building a culture of health in this country, and social context is certainly a reflection of culture.”

Uncovering the New Normal

Researchers at Boston Children’s Hospital have also been ResearchKit fans from the beginning. “We are proud to be the first academic institution to launch our second ResearchKit app,” says Jared Hawkins, director of informatics and innovation and of the hospital’s digital health accelerator. The hospital launched its C-Tracker app last year to collect data on the effects of hepatitis C and debuted the Feverprints app last month.

“One of the major lessons we learned from C-Tracker was how best to link anonymized data from ResearchKit to our servers at the hospital, securely and at scale,” Hawkins explains. “There are a number of commercial solutions for this, but none of them offered the flexibility that we needed. Fortunately, the C-Tracker team developed open-source software, C3-PRO, to accomplish this, which we have leveraged for Feverprints.”

The Feverprints study and ResearchKit-powered app will help Boston Children’s researchers better understand what a “normal” temperature looks like, how fever patterns can be used effectively to diagnose disease, and how fever-reducing medications affect the course of an illness.

“The standard notion that a normal temperature is 98.6 and a fever is anything above 100.4 is based on questionable research from a few hundred years ago,” says Hawkins. “This study seeks to leverage modern technology, including smartphones and continuous temperature monitoring, to revisit this historical research and collect temperature from tens of thousands of participants to reassess what is normal.”

Form Factor Makes the Difference

The enthusiasm Hawkins has for Feverprints can be largely attributed to ResearchKit’s form factor. “It transforms how we can do clinical research by addressing some of the biggest hurdles we face as researchers – recruitment and long-term engagement,” he explains. “ResearchKit allows us to consent exponentially more users than would be possible traditionally, at minimal cost. These users have the power to enroll themselves, giving them a more direct role in the study and increasing engagement.

“Overall user experience is improved because ResearchKit makes it easier to share health data,” Hawkins adds. “If the user allows it, data from any connected smart thermometer can automatically be loaded from HealthKit. Even if data is entered manually, the whole process takes less than a minute. We hope that the data collected will allow us to identify distinct ‘feverprints’ that may aid clinicians in patient diagnosis in the future. For this, continuous data from a wearable device may prove to be the richest, although temperature data captured at any granularity will be helpful.”

Hawkins add that Feverprints app developers plan to add additional engagement features in the near future that will, for example, allow users to see how their data has specifically helped researchers better understand normal and elevated temperatures, and how they compare to the population as a whole. “We don’t have to wait until the study is over to begin to feed our results back to the user,” he says, “which really drives home the power of participatory real-time research.”

Tarini and his colleagues at RWJF also see immense value in ResearchKit’s data delivery methods. “We like the creativity, the flexibility, and the democratization,” he notes. “More people can enroll in the studies. We also like the fact that the platform is able to turn more results around more frequently to participants.”

Changing the Research Game

While there’s general consensus on ResearchKit’s ability to transform the way clinical studies are conducted, the verdict is still out on it being a bona fide “game changer.” It is, after all, available only to Apple users, which leaves the much larger Android user base without the means to participate. (an Android alternative called ResearchStack became available earlier this month.)

“I wouldn’t call ResearchKit a game-changer,” Tarini says, “because that means we’ve done it. I would say changing. ResearchKit is changing perspective on the importance of returning results to people. It’s producing greater engagement from the people who are participating.”

“We’re also excited about CareKit and the opportunity for more seamless integration of research data with regular care,” he adds. “You can repurpose the data that was collected by the research study and inject it into the processes of care so that a provider can see the data that’s coming in from the study. Previously, that was really hard to do, if not impossible. ResearchKit is changing the relationship between research studies and their participants, and the relationship between the research enterprise and the care delivery enterprise.”

Hawkins is more optimistic about the role ResearchKit has thus far played in the evolution of clinical research. “It’s absolutely a game-changer for health research because it addresses some of the biggest hurdles we face as researchers – recruitment and long-term engagement. We are looking for other projects at the hospital that would benefit from ResearchKit as well as the newly announced CareKit. Apple has built some truly exceptional platforms to enable health research.”