Morning Headlines 6/26/17

Google begins removing private medical records from search results

In light of the increase in medical records inadvertently becoming exposed to the Internet, Google adds medical record information to its list of information users can request be removed from its search results.

Anthem Agrees to $115 Million Settlement of Data Breach Lawsuit

Anthem will pay $115 million to settle a class action lawsuit filed in the aftermath of the 78 million record data breach it experienced last year after hackers compromised one of its servers.

Northern Territory Selects InterSystems to Implement Single Digital Medical Record for All Territorians

In Australia, the Northern Territory Department of Health chooses InterSystems TrakCare on its HealthShare platform for its Core Clinical Systems Renewal Program.

Monday Morning Update 6/26/17

Top News

Google adds medical records to the handful of categories that users can ask the company to remove from searches. Someone whose medical records have been exposed inadvertently or otherwise can ask Google to hide their information from its search results.

Medical records thus join the Google categories of federal ID numbers, bank account numbers, credit card numbers, scans of signatures, copyrighted materials, and revenge porn that are already covered by Google’s removal policies.

The material is still visible on whatever site posted it, but is less likely to be discovered when it’s filtered from Google searches.

Reader Comments

From Vendor Locking, Data Blocking: “Re: Cerner and the DoD/VA. You covered this a year ago and it’s even more outrageous in light of the VA’s decision. Cerner forced the DoD to host MHS Genesis because, by Cerner’s rules, only Cerner can, even though the DoD finds that it’s technically doable by others. Cerner ‘is not willing to negotiate at this time for the procurement of the data rights that would enable the government to utilize the Cerner solution in a competitive environment.’ Why? Because it ‘could adversely impact Cerner’s … competitive market advantage.’  Is this is the good faith Shulkin should expect heading into negotiations without a competitive bid?” I don’t know much about government procurement (and don’t want to), but publicly naming Cerner and presumably Leidos as the VA’s no-bid vendor for a contract whose value could exceed $10 billion seems absurd regardless of the Congressional pressure the VA is facing. The DoD messed up in failing to force Cerner (pre-contract, of course) to open up the DoD’s hosting options even though Cerner came up with a hollow-ringing excuse about population health management requirements, forcing us taxpayers to ante up a few more dozen million dollars that unfortunately constitute little more than a rounding error in the massive project.

From Supine Position: “Re: losing an IT job when systems are replaced. It’s SOP for health systems implementing Epic.” Indeed it is. Epic forces its own employment model onto its customers, requiring experienced hospital IT employees to interview competitively for newly created Epic positions and to take Epic’s bizarre but apparently effective logical reasoning and IQ-type tests that are scored secretly by Epic, resulting in only a gladiator-like thumbs up or down passed along from Epic to the hospital’s project executives who defer to Epic’s wisdom for fear of rocking the boat of their employer’s gazillion-dollar project. It’s almost like Epic is invalidating the hospital’s own methods of choosing and keeping employees. The rank and file who get passed over for the Epic team are thanklessly turfed off keep the legacy system lights on, huddling depressed like death row inmates as they watch former teammates head off to new physical locations, Epic training, and a secure employment future. I’m surprised that hospitals are readily willing to part ways with employees who have decades of experience, but on the other hand, the Epic model of creating new jobs and then eliminating the old ones is a convenient way to clean house without feeling guilty. Make no mistake – when your health system employer chooses Epic but not you, your IT life, your social standing among peers, and perhaps your city of residence will change.

From Interested: “Re: Quantros. The CEO is leaving, according to this announcement that identifies her new position.” A May 26 trading update from Informa PLC says that Quantros CEO Annie Callanan will join the business intelligence and publishing company this summer. She joined Quantros in July 2014.

HIStalk Announcements and Requests

The majority of HIStalk readers don’t believe Apple will live up to the hype in making the iPhone a significant interoperability component. John Smith says Apple doesn’t understand interoperability but instead is mostly interested in selling hardware to customers of its walled garden. Nick predicts Apple will be Fitness Trackers Round Two in giving already healthy people yet another gadget to play with. JC says the company’s deep pockets and strong consumer focus could allow it to make a difference, while Mobile Man says people need ways to store and share the medical information of themselves and family members that could be accessed by providers and anything Apple can do to support that would be great.

New poll to your right or here: Have you ever lost a job due to a health IT implementation?

Jenn did a great job covering for me while I was on vacation for several days. I like that she makes me at least temporarily redundant so I can get away without worrying about HIStalk, although I’m always anxious to get back in the saddle.

My candidate to become the next MySpace – LinkedIn, which under Microsoft’s ownership has become maddeningly slow, is being bloated with questionably useful and unintuitive features, and is becoming a nagware showcase of trying to get users to buy premium services. I actually dread looking someone up on LinkedIn now, nearly as much as I hate getting unsolicited pitches from it (like never-ending recruiter spam and generic partner pitches from India-based companies).

Webinars

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

This Week in Health IT History

One year ago:

• Massachusetts General Hospital (MA) notifies 4,300 patients that their information was exposed in a February 2016 breach of dental practice systems vendor Patterson Dental Supply.
• McKesson announces that it will divest its Technology Solutions business into a new joint venture company that it will co-own with Change Healthcare (the former Emdeon).
• The VA signs up for IBM Watson to bring precision medicine to cancer treatment.
• Teladoc announces its planned acquisition of consumer engagement platform vendor HealthiestYou for $155 million.

Five years ago:

• ONC’s Director of Meaningful Use, Joshua Seidman, PhD resigns to take a job as managing director of quality and performance improvement with Evolent.
• The Supreme Court rules to uphold the ACA, including the individual mandate.
• A GAO report finds that the VA and DoD have made progress in their pilot project to integrate care at the James A. Lovell Federal Health Care Center (IL), but delays in implementing the IT component have created additional costs.
• Practice Fusion gets $34 million in Series C funding from by Artis Venture.
• Five senators introduce a bill that would create a national standard for notifying affected individuals about information security breaches.

Ten years ago:

• Michael W. Carelton joins HHS as CIO.
• The Healthcare Solutions business of JPMorgan Chase and RelayHealth offer an integrated set of claim and payment processing solutions.
• Mediware delists itself from the NYSE Arca stock exchange.
• Two DoD medical agencies attempt to stifle use of the Joint Patient Tracking Application so they can spend millions to build their own.
• Cerner gets 510(k) clearance for its new transfusion and specimen collection system that will be marketed under the Cerner Bridge Medical name.

Weekly Anonymous Reader Question

Last week’s survey: what is the best practice you’ve seen for a company to encourage gender equity?

• Pay equality.
• Promote the qualified women into management, upper management, and into the C-suite.
• I have not seen this implemented anywhere, but names should be removed from resumes. Resumes should stand alone on the quality of the content, not the name of the applicant. This would also level the playing field for people who get bypassed (and there are a LOT who do) for their “ethnic” sounding name.
• Can we please stop referring to our MAs, RNs, and receptionists as “girls,” as in “I’ll have one of my girls get that for you” or “My girls didn’t come in today, so we unable to see patients.”
• Actually promote women to senior line roles. Most senior teams are a horde of white guys and a few token women in legal, HR, and marketing.
• Data, data, data. Benchmark all positions against market rates and target hiring/paying everyone at the 50th percentile. Stop asking new hires what they make (now the law in Massachusetts); decide what the position is worth and pay that to all applicants.
• Having a respected female leader.
• Hire more men? Not always true at upper management, but at middle and down, my teams have been dominated by women for as far back as I can remember. Nurses (female-predominant career) switching to IT plays a huge role in this.
• None that I’ve seen, but the term gender equity is a good example of an oxymoron.
• Truly following an employee engagement strategy like those from Gallup, Press Ganey, etc.
• It’s not really a best practice per se, but I started my career at Epic, and as a female, I did not see any limits to my career based on gender. The CEO and many senior leaders are female. I think having that as a first example helped shape what I will accept and what I have sought out culturally at future employers.
• Several years ago while I was on active duty, the Air Force opened fields that were previously closed to women. Of all the careers positions that I have held since then, I have come to appreciate that no organization does a better job at “assimilation” than the military.
• Promoting a feminist to CEO.

This week’s survey: If you were offered a new job, what would be your limit on expected weekly work hours and travel requirements? I’ve never had a travel-intensive job so I don’t really know how that works, other than I’ve heard people gripe about spending their evening hotel hours catching up on work after a full day in front of clients and prospects. Maybe my next survey should address travel tips from road warriors who have learned to live out of a suitcase with little time back at the office.

Last Week’s Most Interesting News

• Senate Republicans publish the Better Care Reconciliation Act of 2017, the GOP’s renewed effort to repeal and replace ACA.
• Theranos reaches a tentative settlement with Walgreens that would result in the retail pharmacy getting only $30 million and losing more than $100 million of its original investment.
• Teladoc acquires Best Doctors, a telehealth vendor focused on offering remote second opinions to support complex medical cases.
• CMS publishes the 2018 Quality Payment Program proposed rule.
• FDA Commissioner Scott Gottlieb, MD outlines his digital health plans for the agency, which include the development and launch of a third-party certification program for low-risk digital health products.

Announcements and Implementations

The ACOs and IPA of Orange Care Group will implement Epic’s Healthy Planet population health management system and will also offer its EHR via Memorial Healthcare System (FL) and Epic Connect.

Government and Politics

Some of the scariest words I’ve heard out of Washington, DC involve the idea that people shouldn’t be forced to buy health insurance they “don’t want or need.” Who might that be, other than psychics who can predict with certainty that they won’t have an auto accident, experience a stroke or heart attack, get hit by an exploding genetic time bomb, or find that they have cancer? Choosing not to buy insurance is a gamble in which those who bet wrong on the likelihood of circumstances beyond their control stick hospitals with their bills (and thus everybody else who was responsible enough to insure themselves), receive inadequate care, or lead their families into medical bankruptcy. There’s a reason that even good drivers are forced to buy auto insurance even though they might rather spend the money elsewhere. Healthcare is so expensive that even the relatively rich couldn’t afford the uninsured cost of a major, short-term illness or any long-term one. Personal responsibility in healthcare comes from both lifestyle decisions as well as backstopping the inevitable eventual costs with insurance.

Meanwhile, here’s the most insightful comment I’ve seen on the US healthcare system given that everybody focuses on the cost of insurance that inevitably reflects the cost of healthcare services.

Sales

Australia’s Northern Territory selects InterSystems for its $196 million clinical systems replacement project. Telstra Health, Epic, and Allscripts failed to make the cut from the shortlist, while Cerner, Meditech, and Orion Health didn’t advance to the final four.

Decisions

• Ocean Beach Hospital (WA) will replace Healthland (CPSI) with Epic in October 2017.
• University of California Irvine Medical Center (CA) will go live on Epic in November 2017.
• Winneshiek Medical Center (IA) will replace Meditech with Epic in September 2017.
• Mayo Clinic Hospital – Rochester (MN) will go live on Epic in 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

Privacy and Security

Anthem will pay $115 million to settle a class action lawsuit over the 2015 cyberattack that exposed the information of 78 million people.

Other

A hospital in India denies well-placed rumors that its patient oxygen supply went offline for 15 minutes and thus killed 11 patients, even though reporters seeking information found that the records of the victims had vanished along with the oxygen supply logbook. Administrators of the 1,400-bed hospital say there’s no need for alarm since 10-20 patients die there each day. The same hospital killed two children last year after giving them nitrogen instead of oxygen.

A professor in South Korea says hospitals interested in artificial intelligence should focus their efforts on EHRs instead of IBM Watson. He adds, “I have to question whether we can use Watsons with absolute trust. It seems that hospitals have introduced the technology mainly for publicity reasons. They are promoting Watson to win the competition, especially now that its cost is falling.”

A depressing New York Times article covers the opioid addiction problems of Delray Beach, FL, whose paramedics responded to 748 overdose calls in 2016, 65 of them involving fatalities. Most of the victims were from elsewhere since the town has several addiction treatment centers that draw in addicts from all over the country who stick around afterward, who are then pursued by minimally supervised, often fraudulent, and insurance-paid treatment centers, labs, and group homes that profit from their relapses. Delray’s mayor notes that you can’t cut hair in Florida without a license, but you can run a substance abuse center. Also noted is that the Affordable Care Act gave young addicts insurance that made them a target for unscrupulous operators found in abundance in South Florida, to the point that they try to steal business from each other by offering addicts manicures, gym memberships, and sometimes even drugs, also rooting for their relapses that restart the insurance benefits clock. Residents complain that the rapidly proliferating sober homes create endless noise, property crime, and homelessness once a resident’s insurance runs out.

Georgia Tech researchers are developing a touchscreen that will allow dogs to call 911 if their owners experience distress or ask them to summon help. Those in technology-powered homes who plan in advance might name their dogs Alexa or Siri to double their chances of obtaining assistance.

Weird News Andy notes the potential rollout of “self-driving doctors,” in which a Seattle design firm proposes a rather ridiculous system of in-home monitoring and a self-driving health pods that people step into to have their health-related measurements taken at their own location. The pods would also offer telemedicine sessions and dispense medications via artificial intelligence, whatever what means. The company says it’s just a concept, but adds that “there’s a very big need for much better care experiences.” I wish the many people who propose Jetsons-like ideas for improving health would take the time to understand it first, particularly from a public health perspective, but unfortunately all the techno-gimmickry focuses on that small population of self-paying people who can theoretically fuel a company’s bottom line.

Sponsor Updates

• QuadraMed, a Harris Healthcare company, Sagacious Consultants, The SSI Group, T-System, ZirMed will exhibit at the HFMA ANI Conference June 25-28 in Orlando.
• Surescripts will exhibit at the AHIMA Long-Term Post-Acute Care & HIT Summit June 25-28 in Baltimore.
• Verscend Technologies releases a new podcast, “why value-based care requires ‘strength from all sides.’”
• ZappRx names Julia Austin (Digital Ocean) to its board.

Blog Posts

• A New Plan to Help B2B Marketers Reach Their Goals (Salesforce)
• Improving Hospital Point-of-Service Collections (The SSI Group)
• 5 Ways to Text Your Practice’s Way to Success (Solutionreach)
• 2016 National Progress Report Points to New Tools to Combat Opioid Abuse (Surescripts)
• UltraLinq’s Summer Release is June 29th (UltraLinq)
• Can you? Visage can: Image Display (Visage Imaging)
• No-fuss user experience. (Voalte)
• Behind the Scenes at West’s Emergency Call Relay Center (West Corp.)
• Predictive Modeling Keeps What You Don’t Know from Hurting Your Revenue (ZirMed)
• Meeting the Challenges of the Revenue Cycle (Leidos Health)

Contacts

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

Morning Headlines 6/23/17

Better Care Reconciliation Act of 2017

Senate Republicans publish the Better Care Reconciliation Act of 2017, the GOP’s renewed effort to repeal and replace ACA. A vote is expected on the bill next week.

Google’s DeepMind will deploy Streams at Taunton and Somerset

In England, Taunton and Somerset NHS Foundation Trust will implement Google’s Streams app, which will alert care providers of potential kidney failure in patients.

Looking ahead to our 2018 map

Insurance startup Oscar Health announces that it will expand its footprint in 2018, offering individual market plans in five new states: Ohio, Texas, New Jersey, Tennessee, and California.

News 6/23/17

Top News

Senate Republicans release a draft of the Better Care Reconciliation Act of 2017. Main points of discussion thus far seem to be the bill’s curtailment of Medicaid expansion, elimination of most of the taxes created to pay for coverage expansion, elimination of subsidies for out-of-pocket costs beginning in 2020, restrictions on tax subsidies, and giving payers the right to charge older consumers more than younger ones. It does away with individual and employer mandates, and keeps policies related to pre-existing conditions and dependent coverage. A vote on the final bill is expected next week.

HIStalk Announcements and Requests

This week on HIStalk Practice: Industry insiders react to the 2018 Quality Payment Program Proposed Rule. The Dark Overlord strikes again. Persivia adds quality measurement reporting and submission capabilities to its PHM tech. Drchrono COO Daniel Kivatinos describes the ways in which blockchain just might survive healthcare. Eagle Physicians implements Carequality framework via ECW EHR. Tandigm Health selects Tabula Rasa’s medication risk mitigation technology. Formativ Health moves forward with $1.6 million expansion. Aledade announces Medicare Advantage ACO plans in Arizona.

Webinars

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

People

Navicure hires Robert Hendricks (McKesson) as chief product officer and Andrea Maizes (Tradestation Group) as chief human resources offer.

Stanford Medicine (CA) hires physician burnout expert Tait Shanafelt, MD (Mayo Clinic) as its first chief physician wellness officer. Shanafelt will direct the WellMD Center and serve as the School of Medicine’s associate dean.

Acquisitions, Funding, Business, and Stock

Theranos reaches a tentative settlement with Walgreens that would result in the retail pharmacy getting only $30 million and losing more than $100 million of its original investment. Theranos recently told investors that it only has $54 million left, while its monthly expenditures are said to be around $10 million.

Bucking the current market-exit trend, Oscar Health will expand its ACA health plan offerings in Ohio, Texas, New Jersey, Tennessee, California, and New York. “For all of the political noise, there are simply too many lives at stake for representatives in Washington, DC not to do what’s right for the people,” says CEO Mario Schlosser, who co-founded the company in 2013 with Josh Kushner, the brother of President Trump’s son-in-law Jared.

Chronic disease management startup Omada Health lays off 20 employees just over a week after announcing a $50 million investment round led by Cigna.

Forward Health Group is awarded a patent for its “system and method for the visualization of medical data,” which the population health analytics vendor will use to enhance its PopulationManager and PopulationCompass products.

Announcements and Implementations

Epic will offer end users the ability to license Mediware’s blood bank management system in combination with its Beaker LIS.

University of Pennsylvania Health System goes live on NLP technology from Linguamatics.

Technology

GetWellNetwork will add medical animations from Nucleus Medical Media to its Interactive Patient Care software starting next month.

Iatric Systems will help US and Canadian providers integrate Think Research’s cloud-based medication reconciliation tool with their respective EHRs.

The SSI Group releases Analytics 2.0 to give providers deeper RCM insight.

ICare will add evidence-based content from Zynx Health via FHIR to its EHR for acute and post-acute markets.

Sales

WellStar Health System (GA) will roll out PatientPing’s real-time care notification technology at 25 locations.

Ohio Valley Surgical Hospital (OH) will implement Meditech’s Web Acute EHR next year.

The City of Corpus Christi Fire Department in Texas selects RCM software and ambulance supplemental payment program consulting services from Intermedix.

In England, Taunton and Somerset NHS Foundation Trust will implement DeepMind Health’s Streams patient safety alerts app over the next five years. DeepMind Health is a London-based Google company that encountered media scrutiny in the UK last year after patients cried foul at having their data involved in a Streams pilot without their consent.

Carolinas HealthCare System (NC) will deploy Cerner’s HealtheIntent population health management technology across the organization, including its Carolinas Physician Alliance. The health system – a Cerner Millenium shop – will also extend its remote hosting agreement with the company.

Privacy and Security

From DataBreaches.net:

• The Halifax Supreme Court in Canada rules that Roseway Hospital must pay $1 million to members of a class-action lawsuit filed over a 2012 privacy breach. It seems to be the first successful suit of its kind in Canada.
• Michigan-based Purity Cylinder/Airway Oxygen notifies 500,000 customers of a ransomware attack that did not ultimately compromise PHI.
• Four-physician Cleveland Medical Associates experiences an unsuccessful ransomware attack that prompts it to switch medical records systems.

Innovation and Research

An Accenture report projects a annual growth rate of 40 percent through 2021 for AI focused startups working in healthcare, with robot-assisted surgery, virtual nursing assistants, and administrative workflow assistance topping the list of top AI applications in healthcare.

A CHIME survey on medication reconciliation practices conducted on behalf of DrFirst shows that 75 percent of hospital executives are most concerned about inaccurate or incomplete medication data, followed by inconsistencies across departments and shifts, and discharged patients being given incorrect medication lists.

Government and Politics

AHRQ reports that between 2005 and 2014 opioid-related ER visits doubled and opioid-related inpatient visits increased by 64 percent.

In India, the state of Andhra Pradesh’s Department of Health, Medical, and Family Welfare signs a three-year agreement with Cerner for HIE services, data analysis, and policy expertise. The organizations will set up a Knowledge Command Centre from which to direct operations. Chief Minister N. Naidu has expressed a desire to eventually give every citizen access to their health data electronically.

Other

A man who jumped from an ambulance in a drunken state sues the City of Staten Island, its fire department, and the EMS workers who attempted to care for him. He claims they should have prevented him from taking the leap, and ultimately caused the injuries he sustained as a result. The patient’s lawyer contends that, though the facts of the case are unusual, he was in such an inebriated state that he was in no condition to make decisions about his own safety.

Sponsor Updates

• LogicWorks announces managed services support for Microsoft Azure.
• Experian Health, MedData, and Navicure will exhibit at the HFMA ANI conference June 25-28 in Orlando.
• Netsmart will exhibit at the Long Term Post Acute Care and HIT Summit June 26 in Baltimore.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN 2017 National Convention June 25-27 in New Orleans.
• Reaction Data publishes “Hottest Trends in Revenue Cycle Management.”
• Walter Groszewski joins The Direct Companies (Direct Consulting Associates and Direct Recruiters) as director of client partnerships, HIT & Life Sciences.
• DrFirst exhibits at the Annual Physician-Computer Connection Symposium through June 23 in Ojai, CA.

Blog Posts

• Lab on Demand Geo-Location: Launching From the Closest Datacenter (Learn on Demand Systems)
• Patient Engagement in Healthcare: The Impact of the Patient Centric Model of Care (Liaison Technologies)
• The Senate’s health care bill just dropped. Here’s what you need to know. (The Advisory Board)
• Best practices in clinical communications: The Rocket, The Reuben, and the Rubberband (Meditech)
• Cause of Death: Alphabet Soup Overdose (Medicomp Systems)
• Lessons from summer vacation packing – What’s on your revenue cycle team’s list? (Navicure)
• International MUSE Conference Recap (Parallon Technology Solutions)
• Opinions-as-a-service and other service-oriented musings (CloudWave)
• Healthcare Pros Prescribe Mobile Technology Use for Enhanced Care (PatientPing)
• The 3 Keys to Unifying Clinical Communications and Workflow (PatientSafe Solutions)
• The Telehealth Revolution: 5 Obstacles Standing In The Way (PokitDok)
• How to Reduce Length of Stay through Communication Performance Metrics (Uniphy Health)
• Four Principles of Productivity (Access)
• When is the Best Time for an EHR Go-Live? (The HCI Group)
• Go phish: How to build a human firewall to protect against phishing (The Advisory Board)
• Better Together: Spok + Cisco Elevate Healthcare Communications (Spok)
• 4 Questions with Robert Tarola, CFO of Southcoast Health Systems (Optimum Healthcare IT)

Contacts

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

EPtalk by Dr. Jayne 6/22/17

The HUMAN Project calls for New Yorkers to “help power the scientific research and societal solutions of the future.” The initiative is looking for 10,000 participants who are willing to share virtual reams of personal information, including cellphone locations, credit card habits, and blood samples over the next 20 years. Researchers plan to use the data for insights into health, aging, education, and more. Baseline data for accepted participants includes everything from basic laboratory panels to IQ and genetic testing with repeat labs every three years. Participants are eligible for a payment of $500 per family.

The mention of the word “family” made me wonder if they’re going to include children for all of the projects. Although minors are included in research studies, it’s usually for a defined goal rather than for a large set of projects. What happens when minors reach majority and no longer want their data shared? Can they opt out? The website mentions the need for research beta testers and will accept participants age 13 and older.

The project has paid a lot of attention to data safeguards including encryption and firewalls, but as we all know, nothing is non-hackable. They claim outside researchers won’t have access to raw data, but we’ve seen past efforts to re-identify anonymized data sets that have worked. The effort is being coordinated by New York University, and I would love to be a fly on the wall for institutional review board discussions. It looks from the website like they handle the consent process for their beta testing through an online consent portal that allows potential participants to watch videos about consent, which it says are “quicker and easier” than reading the full text of the informed consent document. Personally, I’d want to read every word, but that’s out of the question since I don’t live in New York City and that’s one of the primary screening criteria.

On the other hand, the National Institutes of Health is looking for 10,000 beta testing participants for its “All of Us” precision medicine research program. The beta program is the precursor to a plan to power their research with a cohort of 1 million patients as they look at genomic, clinical, and lifestyle data. The beta program will be coordinated by the University of Pittsburgh Medical Center, which plans outreach at more than 100 locations during the next five months. Ultimately, NIH plans for the program to last for 10 years, and it doesn’t appear to have any geographic restrictions.

Compared to the HUMAN Project, All of Us looks a bit more like a traditional research platform, open to adults in the US who are able to consent on their own and who are not in prison. Participants have to be over 18, although they may allow minors in the future. Also in contrast to the HUMAN project, participants aren’t required to have smartphones to participate. That’s likely to give it a broader cross section, although they’re narrowing it down to English and Spanish speakers currently with a plan to expand to more languages in the future. I don’t have an invitation code so I couldn’t get very far with the website. It’s a little less sexy than the HUMAN project but feels more accessible.

Given the nationwide nature of their 100 beta sites, and the fact that I’m a patient at one of their partner hospitals, maybe I’ll get an invitation. Participating would certainly be an experience. They hope to launch the major part of the national project in late 2017 or early 2018 – once testing is complete. I appreciate a vendor that says their go-live dates are fluid based on the results of testing, because you don’t always get that candor from EHR vendors. Not to mention, the technology isn’t the only thing being tested – it’s the systems, processes, and engagement approaches as well as their ability to build rapport with diverse groups of people in many regions.

All of Us has similar language on its website about data security and safeguards. Given the fact that NIH is sponsoring the initiative, I think it’s safe to say that they understand the implications of a breach or hacking. Thinking back to the HUMAN project and its app, though, it seems that most people don’t give a lot of care to how or with whom they are sharing their data on their phones. Among people I’ve informally polled, most accept all requests for application permissions (and therefore data sharing) because they don’t have the time or interest in determining whether they can use the app they want without allowing permissions. Indeed, we live in interesting times.

I mentioned last week that my EHR platform was experiencing some API issues, and I was annoyed by the fact that they kept sending us emails about the outage that offered no information. A reader responded, mentioning similar struggles and asked what changes would make the communication more meaningful. First, I’d like more information on what stage of investigation the issue might be in. Are they still gathering data? Are they running traces? Are they to the point of troubleshooting? Have they even identified the problem yet? Once the problem has been identified, I’d like to hear about potential timeline to resolution, whether they’re testing a fix, etc.

I’m sure a lot of customers don’t want that level of detail, although it is nice to know whether they’ve even found the problem and are fixing it or whether they’re still digging. I’d also like a published timeline for communication, like we had when I was a CMIO. If it was a critical outage, we provided an update every hour. Major but non-critical outages led to updates every other hour. And minor issues were updated mid-day and at close of business. Finally, I would want notification that the issue was resolved. In the case of the API issues we were having, there was never a notification that they were fixed. We stayed in the application with some workarounds rather than going to downtime procedures, but had we been on paper I definitely would have preferred a notification rather than having to keep checking to see whether things had been sorted. Since the problems were mostly with pharmacy search and e-prescribing, they were difficult to replicate using test patients.

Email Dr. Jayne.

Morning Headlines 6/22/17

Artificial Intelligence: Healthcare’s New Nervous System

An Accenture report projects a annual growth rate of 40 percent through 2021 for AI focused startups working in healthcare, with robot-assisted surgery, virtual nursing assistants, and administrative workflow assistance topping the list of top AI applications in healthcare.

Theranos reportedly settles $140M Walgreens suit for less than $30M

Theranos reaches a tentative settlement with Walgreens that would result in the retail pharmacy getting only $30 million and losing more than $100 million of its original investment. Theranos recently told investors that it only has $54 million left, while its monthly expenditures are said to be around $10 million.

Behind the scenes at President Trump’s private talks with the tech industry

During President Trump’s meeting with technology executives last week, industry leaders pressed him to shut down some of the governments 6,000 data centers and move the data storage work to private industry, while simultaneously lobbying for more data transparency, calling for a “data liberation administration.”

Anthem Blue Cross Exits Obamacare In Two More Red States

Anthem announces that will exit the individual exchange markets in Wisconsin and Indiana, citing financial pressure and regulatory uncertainty.

Morning Headlines 6/21/17

Telemedicine provider Teladoc says to acquire Best Doctors

Teladoc acquires Best Doctors, a telehealth vendor focused on offering remote second opinions to support complex medical cases. Teladoc will pay$375 million in cash and $65 million in stock.

CMS Drops 2018 MACRA Proposed Rule – Proposes Continuing Flexibilities for Year 2

CMS publishes the 2018 Quality Payment Program proposed rule which allows for the continued use of 2014 Certified EHR technology, and increases the participation threshold  from $30,000 to $90,000 in Medicare Part B charges, which is expected to excuse another 130,000 practices from participation.

Patient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014

AHRQ finds that between 2005 and 2014 opioid-related ER visits doubled and opioid-related inpatient visits increased by 64 percent.

Prioritizing the Patient Experience Consumerization of Healthcare Brings Patient Satisfaction to Forefront for Providers

Two West surveys on healthcare and patient satisfaction finds that patients spend a lot of time researching providers before choosing one, but are quick to move on if they are not satisfied with the care they receive.

News 6/21/17

Top News

Teladoc will acquire Best Doctors, a global company that provides virtual medical consult services to employers and payers, for $375 million in cash and $65 million in common stock.

Reader Comments

From Ex-Epic: “Re: Epic billing services. Not sure if this has already been announced publicly. It looks like Epic is starting a Billing Services team: ‘Epic is seeking bright, motivated individuals to join our new Billing Services team as we enter the world of medical billing. Our goal is to simplify the payment process by helping Epic organizations with the complexities of submitting claims and posting payments. Attention to detail is vital as you’ll be posting payments and denials; reconciling payment files, claims, and statements; resolving posting errors; and calling payors to follow up on outstanding or unpaid claims.’”

From Ex-McK: “Re: McKesson’s ranking. The Fortune 500 issue was not too kind to the Pharma division of McK and it’s difficult to fathom how John Hammergren can bring in an average of $60M+ per year over the last 10 years. As one of those who was ‘released’ from my employment I find it galling, but that’s probably just me.” Fortune’s annual list puts McKesson at number five, just ahead of UnitedHealth and CVS Health. I didn’t care to dig any deeper into the list given its obnoxious interface and floating auto-play ads that took too long to recognize my many attempts to stop them.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock

LTC EHR vendor MatrixCare acquires competitor SigmaCare for an undisclosed amount.

The SSI Group expands its reseller agreement with Cerner, offering its RCM services to Cerner Millenium end users.

People

Robin Hackney (Greenway Health) joins Ingenious Med as CMO.

After just one year on the job, Memorial Hermann Health System (TX) CEO Benjamin Chu, MD resigns without providing a reason beyond his desire to pursue his “passion in health and public policy.” Charles Stokes, EVP and COO, has been named interim CEO.

Ability Network hires Jamison Rice (BCBSMN) as EVP and CFO.

Announcements and Implementations

Woman’s Hospital (LA) deploys electronic patient signature and eForms technology from Access.

HIE operator Vermont Information Technology Leaders implements Wolters Kluwer’s Health Language Enterprise Terminology Management solution.

University of Toledo Medical Center’s multispecialty physician group (OH) rolls out PatientKeeper’s Charge Capture technology to streamline billing at UTMC and affiliated SNFs.

Technology

Health Catalyst develops new technology to help providers better understand costs of care as they relate to patient outcomes.

Apple is reportedly working with digital health startup Health Gorilla in its efforts to turn the iPhone into a personal health data storage device. CNBC reports they are working to add integration points that will allow iOS to import results from hospitals and lab-testing companies like Quest Diagnostic and LabCorp.

Payment technology vendor Patientco announces enhanced integration with Epic.

Modernizing Medicine adds electronic prior authorization capabilities from CoverMyMeds to its EMA specialty-focused EHR.

SCI Solutions adds new scheduling and worklist management features for multi-location providers to its Schedule Maximizer software.

Recondo Technology adds payment collection capabilities from HealthPay24 to its RCM offering.

Sales

Auburn Community Hospital (NY) selects analytics and 340B drug discount program solutions from Sentry Data Systems.

Hartford HealthCare (CT) will implement Stanson Health’s analytics and clinical decision support software.

Privacy and Security

Citing last year’s ransomware attack on MedStar (MD), the Wall Street Journal reports that some hospital executives avoid reporting ransomware breaches because HHS rules say hospitals only need to report attacks that result in exposure of medical or financial information, while ransomware attacks encrypt the information, but don’t necessarily expose it.

From DataBreaches.net:

• Torrance Memorial Medical Center (CA) notifies patients of an April email breach that may have exposed personal information. Hospital officials have hired a third-party forensics firm to assess the scope and impact of the phishing attack.
• Daniel Devereux, a homeless computer hacker in the UK known as His Royal Gingerness, is jailed for his 2015 attacks on the Norfolk and Norwich University Hospital and Norwich International Airport.
• Thanks to a proactive encryption strategy, Waverly Health Center (IA) experiences little to no disturbance from a June ransomware attack.

Government and Politics

Michigan Lt. State Governor Brian Calley with Henry Ford Health System and Appriss Health representatives to announce $2.1 million in funding to connect the Michigan Automated Prescription System with provider EHRs across the state. Calley hopes the integration, which will be aided by Appriss technology, will increase physician use of the PDMP from 28 to 80 percent.

The Office of the Chief Actuary of CMS forecasts a 13 million reduction in insured patients by 2026 if AHCA is passed, 10 million less than the CBO’s prediction. Reuters reports Senate Republicans will unveil their version of the bill on Thursday.

CMS releases the 2018 Quality Payment Program Proposed Rule. Health IT-related highlights of the 26-page summary include continuing to allow providers to use 2014 certified EHRs, and offering bonus points for using 2015 technology exclusively.

Innovation and Research

A West survey on patient experience finds that shorter wait times, upfront pricing, more communication options, and not feeling rushed during appointments are key to their satisfaction with providers. Nearly 80 percent claim they won’t hesitate to fire doctors that don’t meet their expectations.

Other

Australia makes genome sequencing available to patients for $6,000 through Genome One and the Garvan Institute in Sydney. Should demand increase, the Australian Genomic Healthcare Alliance may look for a way to fund testing through the country’s Medicare program.

Babies in China, on the other hand, can have their genome sequenced for the bargain price of $1,500. Earlier this month, Boston-based DNA sequencing company Veritas Genetics – a spinoff of Harvard’s Personal Genome Project – launched full genome sequencing via MyBabyGenome. Its sequencing report addresses 950 inherited diseases, 200 genes connected to drug reactions, and 100 physical traits the child is likely to have.

Sponsor Updates

• Besler Consulting releases a new podcast, “Working with the first CJR reconciliation report.”
• CoverMyMeds will sponsor Startup Weekend Columbus – Maker Edition June 23-25 in Ohio.
• The Cleveland Plain Dealer and WorkplaceDynamics include Direct Consulting Associates in its list of Top Workplaces for 2017.
• Diameter Health supports the Juvenile Diabetes Research Foundation Promise Ball Gala.
• ECG Management Consultants will exhibit at the National Bundled Payment Summit June 26-28 in Arlington, VA.
• EClinicalWorks, Hayes Management Consultants, Imprivata, and Kyruus will exhibit at the HFMA ANI conference June 25-28 in Orlando.
• The Healthgrades award-winning internship program cultivates new talent to achieve excellence.
• InterSystems will exhibit at the International Healthcare Summit June 26-27 in Kelowna, BC.
• Solutionreach publishes a new white paper, “The Patient-Provider Relationship Study: The Ripple Effect Starts with Boomers.”
• Mez Pharma Group selects the Liaison Technologies Alloy Platform for Healthcare.

Blog Posts

• Are you Prepared for EMRAM Stage 7? (The HCI Group)
• Customer Care or Couldn’t Care Less? (Access)
• Let’s hack together! #AgfaHack17 (Agfa Healthcare)
• Integrity and Commitment (Aprima)
• Onramp to the Healthcare Cloud (Datica)
• Just in Time: A Heart of CareSync Story (CareSync)
• Creation of Institute of Medicine Care Plans with an Eye on Up-front Care – Oncology Care Model (Carevive Systems)
• Practicing Humankindness (Docent Health)
• Key Takeaways from DIUC17 (Dimensional Insight)
• 5 Inescapable Issues for Medical Groups (ECG Management Consultants)
• Chronic Care Management and Aging (EClinicalWorks)
• Arming the Marketer: Getting Started with Nurturing in Healthcare (Evariant)
• Know the Score: Understanding the MACRA Advancing Care Information Category (Hayes Management Consultants)
• Stop Duplicating Patient Data in Multiple Systems (Iatric Systems)
• 5 Steps to Getting Your Healthcare Technology Investment Approved (Influence Health)
• 5 Ways to Keep Healthcare Payments Secure All Summer Long (InstaMed)
• A Roundtable, An Epiphany, Six Takeaways (InterSystems)
• Three Ways Poor Provider Data Hurts Core Business Processes (Kyruus)

Contacts

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

Morning Headlines 6/20/17

Why Some of the Worst Cyberattacks in Health Care Go Unreported

Citing last year’s ransomware attack on MedStar (MD), the Wall Street Journal reports that some hospital executives avoid reporting ransomware breaches because HHS rules say hospitals only need to report attacks that result in exposure of medical or financial information, while ransomware attacks encrypt the information, but don’t necessarily expose it.

Memorial Hermann Health System Announces Leadership Change

Memorial Hermann Health System (TX) CEO Benjamin K. Chu resigns effective immediately without providing a reason. Charles Stokes, Executive Vice President and Chief Operating Officer, has been named as interim CEO.

Apple is working with this small start-up to change how we track our health

Apple is reportedly working with digital health startup Health Gorilla in its efforts to turn the iPhone into a personal health data storage device. Apple and Health Gorilla are working together to add integration points that will allow iOS to import results from hospitals and lab-testing companies like Quest Diagnostic and LabCorp.

Curbside Consult by Dr. Jayne 6/19/17

I received some sad news from a friend this week whose employer recently migrated to a single vendor platform. She’s worked for her health system’s IT team for years, primarily supporting the ambulatory practices on the practice management application. When the group initially decided to migrate to a new platform, all IT employees were given the opportunity to either transition to the team that would be supporting the migration, or to remain in their current positions with the understanding that following the migration, they would move to positions supporting the new application. She’s developed deep relationships with her customers over the years, and agonized over the decision. She finally decided to stay where she was, keeping the lights on for the legacy application users while everyone else focused on the shiny new thing.

Plans changed along the way, however, but the leadership didn’t give any hints to the support teams. Literally five days after cutover she was given notice that her employment would be ending in two weeks. She of course is welcome to apply for any of the new support positions, however, all of them were posted as requiring current certification on the new system. Having been a CMIO, I understand how these decisions are made, but it seems like a gutless way to get rid of people. I’m not aware of this particular vendor being willing to accept freelance people off the street to train and certify on their products, nor would it be reasonable to expect a full-time employee to try to train on a new system on the side and at their own expense.

It’s not about reducing headcount, because they actually have more posted open positions than the number of people they’re laying off. More likely, it was seen as a way for the health system to get out of paying for training. Not to mention, getting rid of people with 15 to 20 years experience and replacing them with people earlier in their careers is generally cheaper in its own right. The problem, however, is that they didn’t just jettison the employees, but they also got rid of the relationships and history they have built with their customers. They’ve given no weight to the fact that these support workers know their customers, know how the offices run, and understand the dynamics at play. One might think that could be part of the strategy, if they were worried about the “old guard” creating complications with new processes and policies, or being a barrier to effective change.

However, I know enough people at her employer to understand that they didn’t do hardly any work on people or process, but rather treated this migration simply as a technology swap-out. Based on their outreach to me to see if I’m available for some consulting work, I suspect they’re reaping what they sowed as far as failing to use the opportunity for further standardization and clinical transformation. I hate, though, to see good employees negatively impacted by lack of executive strategy and will. Fortunately, my schedule doesn’t allow me to get involved with them right now, because I’m not sure I could do it in good conscience. Although they may think this was strictly a financial decision, when you factor in the loss of “soft skill” expertise, such as knowing how best to handle Dr. Frazzled’s high-maintenance billing team, and the ramp-up time for new technical employees who don’t know the landscape, I bet there is a negative financial impact.

One could argue that there is also a larger domino impact, looking at a health system that provides a large volume of uncompensated care. They’re about to release quite a few workers in their 50s and early 60s, and based on IT hiring needs in the city, they’re going to struggle to find jobs. Eventually COBRA runs out, assuming former employees can afford it in the first place, and depending on what happens with healthcare legislation, they may not be able to afford individual plans. They may wind up needing uncompensated care, with ultimately greater cost to the system in the long run. Although the logic may be a leap, it’s something to think about especially when you’re talking about a non-profit organization that advertises the breadth of their community-mindedness.

Those of us who have seen the balance sheets for those kinds of organizations know the numbers are a little different from what they advertise. They can afford nearly half a billion dollars for an EHR migration, but they’re going to cheap out on training a couple dozen seasoned employees who have been loyal workers, some for decades. They can afford hundreds of millions in capital expenditures but don’t even provide cost of living wage increases to their low-paid clinical employees, let alone to the support teams like IT. Especially for nonprofits, shouldn’t charity begin at home? As a small business person, I understand that businesses need to make money. Even the not-for-profit ones need money to further their missions. Too often, however, that mission is keeping up with the proverbial Joneses rather than being good stewards. It reminds me of when I was in the hospital this winter, when I didn’t get scheduled medications on time due to a staffing shortage. Is it really cheaper to risk a poor outcome? When did people become less valuable of an asset than mammoth IT systems or another outpatient imaging facility or ambulatory surgery center? And do we really need another glass and marble temple to healing when the actual patient care suffers? Every time I think about going back to a health system or large hospital, these are the kinds of issues that keep me up at night.

Fortunately for my friend, there are plenty of opportunities in her area that use the system on which she is proficient. She has a great work history and strong references, so hopefully she will find something quickly. I’d be happy to bring her on to do some projects, but not enough for a full-time position. I’ll help her however I can though, until she finds something permanent. I’m sure her story is representative of those that happen every time a hospital or health system makes a big change. But just because it happens, it doesn’t make it right.

Email Dr. Jayne.

Morning Headlines 6/19/17

Fostering Medical Innovation: A Plan for Digital Health Devices

FDA Commissioner Scott Gottlieb, MD describes his plans for regulating digital health innovation, saying that the FDA “should carry out its mission to protect and promote the public health through policies that are clear enough for developers to apply them on their own, without having to seek out, on a case-by-case basis.”

On AHCA, CMS Actuary Finds Smaller Coverage Losses, Smaller Spending Reductions Than CBO

The Office of the Chief Actuary of CMS forecasts a 13 million reduction in insured patients by 2026 if AHCA is passed, 10 million less than the CBO’s prediction.

What Health Systems, Hospitals, and Physicians Need to Know About Implementing Electronic Health Records

Kaiser Permanente Medical Group CEO Robert Pearl, MD outlines the lessons he learned while working on the health system’s $4 billion Epic implementation.

Baby Genome Sequencing for Sale in China

Boston-based DNA sequencing company Veritas Genetics is offering full genome sequencing to parents in China. The sequencing report addresses 950 inherited diseases, as well as 200 genes connected to drug reactions, and 100 physical traits the child is likely to have.

White House task force echoes pharma proposals

STAT reports that behind-the-scenes discussions being held by the Trump administration on how to reign in drug prices are being influenced by lobbyists for the pharmaceutical industry.

Monday Morning Update 6/19/17

Top News

FDA Commissioner Scott Gottlieb, MD outlines his digital health plans for the agency, which include the development and launch of a third-party certification program for low-risk digital health products that it deems “software as a medical device.” He adds that using “a unique pre-certification program for SaMD could reduce the time and cost of market entry for digital health technologies.”

Reader Comments

From Peg Leg Pete: “Re: Problems at Baptist Health. As a group concerned with how EHR implementations are affecting hospitals and their financial situations, we are currently seeing some problems in Florida. Baptist Health in Pensacola is having delays and cost overruns on their Allscripts implementation. The hospital may face layoffs. As it’s a private hospital, this news isn’t reported publicly.” The 492-bed Baptist Health selected Allscripts in 2015, deciding to implement Sunrise plus a number of other financial and population health management technologies. The provider’s bond ratings agency noted in April of last year that it had taken on a $22 million loan from Allscripts to fund the roll out.

From Potato, Tomato: “Re: VA Cerner vs. DoD Cerner. There seems to be some debate at the VA and in Congress as to whether Cerner will use an ‘identical’ system to the DoD or a ‘similar’ but separate system. (I’ll bet 10 out of 10 HIStalk readers know the answer.) No doubt Cerner’s PowerPoint experts are frantically focus-grouping which line style looks the most ‘seamless’ when you draw it between a VA box and a DoD box.”

From Gordon Gecko: “Re: Cerner financials. I read somewhere (was it HIStalk?) that Cerner’s stock price didn’t pop on the VA announcement because it was already expected/baked in. More likely, the street is aware that … if you take out the DoD and one deal that bundled 30 micro-hospitals … Cerner has actually lost more hospitals as customers (96) than it has added new (92) in the last two years. Not confidence-inspiring, especially when coupled with a late and scope-reduced DoD pilot.”

From Eagle Eye: “Re: Middle Eastern HIT. Ministry of Health Saudi Arabia is about to sign a $1.5 billion dollar deal with GE. GE will be developing an HIS that consists of its specialty modules (maternity, cardiology, etc.), and combine it with two very basic health information systems – one locally-developed billing solution and a Turkish HIS. The MOH is in for a major mess as the solution has not been even built. It is not clear whether GE is planning to re-enter the HIS market after exiting it a long time ago, or if it’s a one-off thing taken on for the money.”

HIStalk Announcements and Requests

The “Noes” have it when it comes to considering research studies before purchasing health IT or signing up to participate in private or public clinical programs. Pragmatist puts the role of such studies during decision-making in perspective: “Research results are very important from many standpoints, but generally provide minimal insight into commercial systems that are not readily subjected to research comparisons due to intellectual property considerations.”

New poll to your right or here: Given the latest round of industry speculation around Apple’s healthcare efforts, do you think it is truly capable of moving the patient-centered interoperability needle? I know it’s a loaded question, and so I’m hoping you’ll expound on your “yes” or “no” by leaving a comment.

Welcome to new HIStalk Platinum Sponsor PatientPing. The Boston-based, Silicon Valley-backed company is building a network of providers who are notified via real time "pings" when their patients receive care elsewhere, allowing them to share care instructions for better care coordination. The network includes physicians, nurses, case managers, and care coordinators in hospitals, EDs, ACOs, physician practices, SNFs, home health agencies, and payers, all of whom rely on PatientPing’s network to support their delivery of high-quality, cost-effective care with improved patient outcomes and experience. I interviewed CEO Jay Desai earlier this year and he did a great job explaining the company’s lightweight technology, the resulting workflow, and its business model. Thanks to PatientPing for supporting HIStalk.

This Week in Health IT History

One year ago:

• Reuters reports that McKesson is discussing a merger of its Technology Solutions IT business with Change Healthcare (the former Emdeon).
• An independent investigation recognizes Healthcare.gov as the second-most secure consumer website, while Twitter took top honors.
• Doctors at the University of Pennsylvania are seeking approval to use CRISPR gene editing technology on humans for the first time.
• Federal agents have arrested 300 suspects in the largest ever crackdown on Medicare fraud, with suspected losses totaling $900 million.
• VA Undersecretary of Health David Shulkin, MD says during testimony before the Senate Committee on Veterans Affairs that its EHR modernization plans are “not dependent on any particular EHR.”

Five years ago:

• CMS reports that more than 110,000 EPs and over 2,400 hospitals have been paid a combined $5.7 billion in EHR incentives from Medicare and Medicaid.
• The VA establishes a goal of conducting more than 200,000 clinic-based telemental health consultations in fiscal year 2012.
• An FDA report finds that software problems cause 24 percent of medical device recalls.
• The US Supreme Court refuses to consider an appeal by former McKesson Chairman Charles McCall to overturn his 10-year prison sentence for scheming to inflate company revenue.

Ten years ago:

• Richard Granger, head of NHS Connecting for Health in the United Kingdom, has announced that he will leave the program at the end of the year.
• Pro basketballer Dikembe Mutombo buys a smartcard-driven EHR for a hospital in the Congo.
• Athenahealth announces IPO plans.

Weekly Anonymous Reader Question

Last week’s survey: What characteristics made the worst doctor you’ve ever had so bad?

This week’s survey: What is the best practice you’ve seen for a company to encourage gender equity?

Last Week’s Most Interesting News

• Rumors circulate that Apple wants to store health information on the IPhone, and work with EHR developers to allow users to export information to providers as needed.
• The House Appropriations Committee approves a $65 million down payment toward the VA’s Cerner procurement, with the stipulation that it will integrate with both DoD and private EHR systems.
• Omada Health raises $50 million in a round led by Cigna, which will offer the company’s digital chronic disease management technology to its members.
• Kieran Murphy is named president and CEO of GE Healthcare, succeeding John Flannery who has been promoted to CEO and chairman elect of GE.
• An OIG report concludes that CMS inappropriately paid eligible providers $729.4 million in EHR incentive payments.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock

ChartSpan Medical Technologies raises $16 million in a venture round led by Cypress Growth Capital, bringing its total funding to $22.15 million since launching five years ago. The Greenville, SC-based chronic care management-focused technology vendor plans to create 300 jobs over the next 18 months and expand beyond its Appalachian borders.

Inspira Health Network (NJ) announces plans to open the Inspira Innovation Center to develop and commercialize patient-focused health IT.

Government and Politics

TIAG will customize its Warrior Performance Platform to meet the needs of US Navy sailors. Originally developed for training programs for Special Operations forces, the WP2 will evolve into the Human Performance Self-Service Kiosk, enabling sailors to log fitness, training, and nutritional goals, plus sync them with data from select wearables. No word on whether the data will eventually link with the DoD’s MHS Genesis EHR from Cerner.

Decisions

• Wadley Regional Medical Center At Hope (AR) will go live with Cerner in December.
• Sartori Memorial Hospital (IA) will switch from McKesson to a Cerner inpatient EHR in October. (Its clinic will remain with an Epic ambulatory EHR.)
• Hereford Regional Medical Center (TX) will switch from Healthland (a CPSI company) to Cerner next month.
• Select Specialty Hospital – Danville and Gainesville (PA) plans to switch to Epic.
• Regency Hospital Of Central Georgia will go live with Epic in 2019.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

Privacy and Security

In New York, prescription eligibility check vendor CoPilot Provider Support Services agrees to pay $130,000 to settle a case with the state attorney general after waiting more than a year before notifying affected patients that a hacker had accessed its system and stolen 220,000 patient records.

A Global Cyber Alliance survey finds that US hospitals have, for the most part, not yet invested in cybersecurity tools at an enterprise level – a statistic that bodes well for hackers looking to take advantage of organizations that have made themselves sitting ducks either through lackadaisical attitudes on the part of upper management or lack of funds. Just six of the 50 largest public hospitals have adopted an email authentication, policy, and reporting protocol known as DMARC. Presumably bigger budgets have enabled 22 of 48 for-profit hospitals to implement DMARC; only one of those has implemented it to the level that it prevents suspicious emails from hitting inboxes.

Innovation and Research

Researchers from the University of Miami Miller School of Medicine and the California Pacific Medical Center will use a $300,000 grant from the Muscular Dystrophy Association to develop and integrate an ALS Toolkit with Epic. The kit will consist of a set of smart forms within the EHR that will help MDA ALS Care Center providers collect and access standardized health data for clinical and research purposes.

Sponsor Updates

• Summit Healthcare helps raise money for The Gatehouse, this year’s MUSE conference’s selected charity.
• QuadraMed, a division of Harris Healthcare, will exhibit at the Wisconsin Rural Health Conference June 21-23 in Wisconsin Dells.
• Salesforce will accept applications for its incubator program through July 15.
• The SSI Group renews its HFMA Peer Review designation for the sixth consecutive year.
• SK&A publishes a “US Elder Care Market Summary.”
• Versus Technology offers its RTLS for wayfinding initiatives using Bluetooth Low Energy networks.
• Zirmed will exhibit at the CAPG Annual Conference June 22-28 in San Diego.
• LogicStream Health will exhibit at the 2017 AMDIS Physician Connection Computer Symposium June 20-22 in Ojai, CA.

Blog Posts

• Are Alternative Payment Models Working to Reduce US Healthcare Spending? (The SSI Group)
• VUE17 registration is now open. (Voalte)
• Simple Tricks to Leverage Social Media to the Fullest (Solutionreach)
• Tackling the Adherence Epidemic with Innovative Technology (Surescripts)
• When Waste Becomes Fraud: Where Do You Draw the Line? (Verscend Technologies)
• VUE17: Sun, Surf and Intracoastal Connections (Versus Technology)
• Full Year MIPS Reporting – It Can Be Done. Even Now (Forward Health Group)

Contacts

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

Reader Survey Results: What characteristics made the worst doctor you’ve ever had so bad?

I asked readers what characteristics made the worst doctor they’ve ever had so bad.

Poor personal hygiene.

Seems otherwise occupied; rushes visit.

One who makes me feel their time with me is inconvenient.

Arrogance is a huge problem. Refusal to learn about new programs is a huge roadblock.

That’s easy – his inability to ask questions and listen. The result? Several misdiagnoses.

Two of my PCPs stand out as the worst in my experience:
1. One asked for candor but didn’t seem to want it. In my early college days, I disclosed during a social history check that I did, in fact, have a few drinks per month. The doctor was distinctly colder to me throughout the rest of the checkup.
2. Another decided that it was easier to assume I was lying about my symptoms than do the due diligence. This doctor actually told me that what later turned out to be a legitimate respiratory problem was “all in my head” and probed me for what might be “going on in my life” that I was lying about this problem to avoid.

Arrogance, cockiness, thinking they know your own body better than you, unwilling to listen to or quickly dismissing questions of serious concern to the patient, rushing the visit because the last guy took too long and patients are waiting in the lobby.

She made snap judgments about my health state. Continually ignored data that didn’t match her snap diagnosis and then put a pregnancy at risk because she didn’t ask better probing questions to figure out I was having gallbladder attacks.

I was willing to forgive this and a long, fear-ridden pregnancy because to some degree my symptoms were asymptomatic, BUT she then instituted a rule after years of delayed, long waiting times that if you as a patient were late for an appointment, that she would not  give you your full time slot. At my very first appointment after giving birth and having post-partum gallbladder removal, the first time she’d seen me since missing a year’s long series of gallbladder attacks, she had a very embarrassed nurse tell me that because I was 10 minutes late I wouldn’t get my full annual appointment check up. I got dressed, left the room, and changed doctors.

Two separate doctors who told me that my (very real) pain was all in my head and that I needed to "relax." This kind of disregard and automatic dismissal of the patient is chronic in treatment (or I guess non-treatment) of "women’s issues." If something I’m experiencing is bad enough that not only am I going to take a day off to go to your office, but I’m going to get my feet up in stirrups … you better not call me a liar.

New patient visit with physician who had little interest in hearing what the patient had to say and didn’t perform any type of exam. She read the MA intake notes, told me what labs she would order, and that she’d see me back after the labs were received. She then advised that the problems that prompted the visit were, in her expert opinion, generally due to poor diet and she highly recommended I purchase the diet supplements sold in her practice. She billed the visit to my insurance as a comprehensive new patient examination (something that requires a complete physical exam!). I never returned and filed a complaint with my insurance company regarding her fraudulent billing (which unfortunately went nowhere because apparently patient complaints to the insurance company don’t matter).

Thinking they are always right.

He was infuriated that after spending a good half hour with me discussing my needs, I decided to have my surgery and care provided by another physician. He practically threw me out of his office and threatened to call security if I didn’t immediately leave.

Physical: unclipped fingernails on a dentist.

Cold. Conversation was awkward. On a follow-up visit, she entered the room and just stared at me, as if it was up to me to initiate the discussion. So … last time you saw me …

An unwillingness to listen and an attitude that he knew everything and was always right, which was not true!

Would not listen,acted liked I was bothering him, and then seriously misdiagnosed me on top of it all. It was the beginning of me looking to alternative medicine for at least some problems.

Lack of respect for me and my problems.

Disinterest in patient, deferential attitude, otherwise preoccupied, feeling like patient was wasting doctor’s time.

Not explaining the pros and cons of recommended medications to me during labor and generally being dismissive of my questions. This was not my regular OB but the hospitalist who happened to be on call when I was triaged with my first child.

Morning Headlines 6/16/17

Apple is quietly working on turning your iPhone into the one-stop shop for all your medical info

Christina Farr reports that Apple wants to store health information on iPhone and work with EHR developers to allow users to export information to care providers as needed.

Coming to ONC – One Informaticist’s Journey

In his first blog post as National Coordinator for Health IT, Don Rucker, MD discusses the challenges facing the health IT industry, and his background as an informaticist.

Congress offers $65M as down payment on Vista replacement

The House Appropriations Committee approves a $65 million down payment toward the VA’s Cerner procurement, with the stipulation that it will integrate with both DoD and private EHR systems. The DoD’s Cerner implementation will cost $4.3 billion in total, and estimates suggest that the VA’s final cost could climb as high as $16 billion.

A.G. Schneiderman Announces Settlement With Healthcare Services Company That Illegally Deferred Notice Of Breach Of More Than 220,000 Patient Records

In New York, prescription eligibility check vendor CoPilot Provider Support Services agrees to pay $130,000 to settle a case with the state attorney general after waiting more than a year before notifying affected patients that a hacker had accessed its system and stolen 220,000 patient records.

News 6/16/17

Top News

Rumors related to Apple’s healthcare takeover abound, with CNBC reporting that the company is working behind the scenes to develop an Iphone-based repository of health data that users can share from at will. Lab results and allergy lists seem to be first on Apple’s pick list of data points to tackle. Tied in with that is the recommendation of a Citigroup analyst that Apple buy up Athenahealth in a move that would give it access to the EHR vendor’s 83 million patient records and its Epocrates physician end users and technology. Apple is certainly a force to be reckoned with when it comes the ubiquity of its mobile devices (though some have lately challenged that notion), but it seems the issue of interoperability with other competing platforms – as seen so often with healthcare – would raise its ugly head sooner rather than later. It would be fun to see how Apple fanboys would take to Jonathan Bush’s cult of personality.

Reader Comments

From First Fruits: “Re: App Orchard. Prices have gone up by $5,000 for the top two tiers effective May 25th from what I can tell. And they have taken away benefits, i.e. the number of included support hours, free app listings, and registrations to events. You don’t get any indication of available APIs until after you pay your annual fee. Does anyone consider this a pay-to-play interoperability?”

From Chip Hart: “Re: Larry Weed, MD. Larry passed away at the age of 93 earlier this month. Arguably the great-grandfather of EHRs, and certainly of the organized medical record. (He invented the SOAPM and POMR concepts.) His lectures are famous. I believe you’ve linked to them in the past. The stuff from the 70s is still relevant today. Here’s one.”

HIStalk Announcements and Requests

This week on HIStalk Practice: The FBI looks into Zoom’s falsified risk-adjustment payments. Community Health and Wellness Center of Greater Torrington leans on Stone Health Innovations for CCM expertise. Several cancer care practices select Flatiron Health software and support. Digital Noema Telehealth adds EazyScripts e-prescribing to virtual consult software. The Medical Society of the State of New York expands partnership with DrFirst. Spry Health raises $5.5 million. Dermatologist Stacia Poole, MD discusses the role health IT plays at a practice with older patients. Thanks for reading.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock

Omada Health raises $50 million in a round led by Cigna, which will offer the company’s digital chronic disease management technology to its members.

Cleveland Clinic and Oscar Health will offer co-branded insurance plans to people in northeastern Ohio. The move is a first for both organizations, marking Oscar’s entry into the state and the health system’s first time offering an insurance product bearing its name.

Weirton Medical Center (WV) sues Cerner and its Siemens subsidiary for their failure to provide adequate support and service related to a $30 million contract extension for Soarian in 2013. A trial by jury has been requested. WMC’s end goal appears to be termination of its contract with Cerner, and Cerner’s free-of-charge assistance in switching the hospital to a new vendor.

PokitDok acquires the software and pharmacy assets of Oration, a prescription management and savings app developer. PokitDok plans to make Oration’s commercial pharmacy benefit data available through its DokChain network.

Announcements and Implementations

JD McCarty Center for Children with Developmental Disabilities (OK) implements Evident’s Thrive EHR. The center enlisted the consulting services of TruBridge to assist with the roll out. Evident and TruBridge are both subsidiaries of CPSI.

Technology

Physician’s Computer Company adds FDB’s MedsTracker e-prescribing tool to its EHR for pediatricians.

MModal’s CAPD tools now support Epic’s NoteReader CDI module.

Salesforce adds new communications features to its Health Cloud CRM, enabling caregivers outside of the doctor’s office to communicate via mobile device, and to share care plans across different organizations.

Sales

Community Medical Centers (CA) will implement LogicStream Health’s Clinical Process Improvement solutions.

Neighbors Emergency Center selects Presidiohealth’s FSEC Foundation software, which combines T-System’s EDIS with Presidio’s PM technology.

People

Clinical Computer Systems, developer of the Obix Perinatal Data System, promotes Cindy Bell to VP of customer services.

Cambia Grove founder and executive director Nicole Bell will join Amazon Web Services as principal business development manager, serving as a healthcare industry liaison.

Erin Jospe, MD (PatientKeeper) joins Kyruus as CMO.

Citing closer proximity to family, Vancouver Island Health Authority President Brendan Carr, MD plans to step down to take over as president and CEO of the William Osler Health System in Ontario. His five-year tenure at Island Health has included oversight of the rocky rollout of the IHealth EHR, which still has physicians up in arms over its risk to patient safety. “I’ve learned immensely from that experience,” he explains, “sometimes painfully so. It’s been a challenging thing, and I think it’s something that will absolutely allow this organization to do great things in the future.”

Privacy and Security

Microsoft releases a bevy of security updates to protect users from WannaCry-like attacks. In addition to automatic updates, the company is making the updates available for manual download and installation for unsupported software versions including Windows XP and Windows Server 2003.

Sensato Cybersecurity Solutions will focus on the attacker’s perspective during its Hacking Healthcare Workshop, set to take place September 13-14 in Asbury Park, NJ.

Government and Politics

A GAO report finds that pharmacists at the VA have trouble accessing patient data via its pharmacy system, and often run into trouble when transferring or refilling prescriptions from non-VA facilities. Recommendations include updating the system and taking a deeper look at barriers to interoperability.

Innovation and Research

Colorado’s UCHealth launches the virtual Applied Decision Science Lab through its CARE Innovation Center to collaborate with entrepreneurs on healthcare technology. Researchers are particularly interested in using AI and machine learning to enhance EHR workflows and clinical decision support.

Other

Bloomberg reports that nearly half of the $2 billion raised on popular crowdfunding platforms like GoFundMe are being used to pay medical expenses. Facebook has gotten in on the action, adding a health category to a new feature that lets users set up fundraisers for personal causes.

A US District judge sentences Wilbert Veasey, Jr. to pay over $23 million to CMS and serve 17 years in prison for his part in what authorities call the biggest home health fraud in the history of Medicare and Medicaid. Veasey, along with four conspirators, convinced already vulnerable Medicare patients to sign up for unnecessary home health services, after which they then filed for reimbursements for via a number of shell companies. The racket ultimately ran up $374 million in fraudulent claims.

The Michigan Attorney General charges HHS Director Nick Lyon and Chief Medical Executive Eden Wells in the latest round of criminal charges related to the Flint water crisis in 2014 and 2015 that resulted in 12 deaths and dozens more sickened by contaminated drinking water. Lyon’s actions were particularly reprehensible. According to court documents, he “willfully disregarded the deadly nature of the Legionnaires’ disease outbreak, later saying he ‘can’t save everyone,’ and ‘everyone has to die of something.’”

Sponsor Updates

• Meditech releases a new podcast, “Home Care & Population Health.”
• Liaison Technologies will host an IT Leaders Forum on data strategy June 21 in London.
• Meditech will host the 2017 Revenue Cycle Summit June 20-21 in Foxborough, MA.
• Navicure will exhibit at the Florida MGMA 2017 Annual Conference June 21-22 in Orlando.
• Experian Health publishes a new case study featuring Yale New Haven Health.
• Health Catalyst adds Duncan Gallagher (Allina Health) to its Board of Directors.
• The Medical Society of the State of New York will offer its members complimentary access to DrFirst’s e-prescribing and medication management app.
• InterSystems customers Northwell Health and Mount Sinai Health System connect their private HIEs to the New York-based Healthix public HIE.
• ROI Healthcare Solutions will present at Inforum 2017 July 10-12 in New York City.

Blog Posts

• Is “Cloud Slice” the Next “VM” for Hands-on Learning? (Learn on Demand Systems)
• Planning for Collaboration: CMS Emergency Preparedness (LiveProcess)
• Easy as Pie: Most Effective Training Techniques for Learning New Technology (Navicure)
• Interoperability: It’s Time to Get in the Game (Netsmart)
• You Can Book Flights Online – Why Not Medical Appointments (Experian Health)
• Patient Payments and Patient Experience: A Chicken & Egg Scenario (Patientco)
• Brexit Follow-up (Reaction Data)
• Managing the surprisingly troublesome impact of real-time healthcare on decision-making (PerfectServe)
• Testing, it’s not just for IT anymore (Optimum Healthcare IT)
• Healthcare IT’s Relatively Brief and Exciting History (Spok)
• 6 essential tips for adding on Epic’s home care applications (Nordic)
• Interoperability Bubble (ClinicalArchitecture)

Contacts

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

Readers Write: Top 10 Takeaways From the EClinicalWorks Settlement

Top 10 Takeaways From the EClinicalWorks Settlement
By Colette Matzzie

1. The federal False Claims Act provides an effective way to hold EHR vendors accountable for failing to meet Meaningful Use standards.

Many customers had complained to EClinicalWorks about major problems with its software, but little changed. It took a knowledgeable healthcare IT implementation specialist and the might of the US government to get the software problems fixed. They used a powerful whistleblower law known as the False Claims Act, which encourages whistleblowers to fight fraud by filing “qui tam” lawsuits, to force ECW to take action. Anyone who “causes” false claims to be submitted to the government is liable under the False Claims Act. Customers of ECW relied on representations that ECW’s EHR technology was properly certified and therefore, unknowingly submitted tens of thousands of claims for government incentive payments that falsely attested MU requirements had been met.

2. The federal Anti-Kickback Statute forbids EHR vendors from paying or rewarding users to promote or refer others as customers.

Many healthcare providers, pharmaceutical companies, and medical device manufacturers have been penalized for violating the Anti-Kickback Statute, but the ECW case is the first time it has been applied in the EHR industry. The government cited payments totaling almost $300,000 through ECW’s “referral program,” “site visit program,” and “reference program,” in addition to unknown amounts for consulting and speaker fees paid to influential users, as evidence of alleged violations of the Anti-Kickback Statute. The law prohibits providing money, gifts, or other remuneration intended to get referrals for services or items paid for by federal healthcare dollars except under very limited circumstances.

3. The accuracy of representations made to certifying bodies will be a factor when the DoJ reviews the liability of an EHR vendor under the False Claims Act.

Certification by a government Authorized Testing and Certification Body has been a prerequisite to successful sales because buyers can obtain federal incentive payments only for certified EHR technology. The government cited EClinicalWork’s decision to modify its software to “hard code” the drug codes needed for testing without meeting the certification criteria as evidence that ECW had “falsely obtained” its certification. This gave rise to its liability under the False Claims Act. Accurate and truthful information will remain a requirement for certification, despite the debate over whether the certifications adequately ensure software reliability and patient safety.

4. The Office of Inspector General crafted an innovative Corporate Integrity Agreement requiring ECW to fix deficiencies, notify its customers, provide customers with free upgrades, and permit customers to transfer clinical data without penalty.

As part of the settlement, ECW signed an expansive, state-of-the-art Corporate Integrity Agreement that the OIG put together to ensure that providers and patients are protected going forward. ECW is required to take significant remedial steps, which included sending out a series of notifications and advisories to customers that advise them of patient safety risks with its software, giving customers an opportunity to obtain updated (and presumably remediated) software free of charge; and offering the opportunity to transfer clinical data to another vendor free of onerous penalties or other restrictions. Software vendors should consider the agreement a guide to understand the risks they will face if their software does not meet federal requirements or if other misconduct occurs.

5. The government deems data portability and audit log requirements to be essential to proper EHR functioning.

EHR systems are required by the government to be able to export clinical information on patients electronically, including by batch exports, and reliably and accurately record user actions in an audit log. In its complaint-in-intervention, the government faulted ECW for allegedly misrepresenting these capabilities, and made clear that these omissions from the software were not acceptable.

6. EHR vendors need to respond in a timely and effective manner to customer reports of software defects, usability problems, or other issues that may present a risk to patient safety or that may violate federal law.

The Corporate Integrity Agreement requires ECW to notify OIG of certain reportable events that involve patient safety, certification, or a matter that a reasonable person would consider to be a violation of law. The government wants all EHR vendors to report significant problems or violations of law, especially when patient health or safety may be at issue.

7. EHR vendors should have persons and procedures in place to ensure compliance with federal law, just as healthcare companies do.

ECW’s Corporate Integrity Agreement requires the company to establish a compliance program with a compliance officer and a written code of conduct, similar to what many healthcare companies have. That’s something all EHR vendors should consider doing, as it’s wise to offer employees clear avenues to report concerns internally. Most employees prefer to address concerns internally before blowing the whistle by filing a qui tam lawsuit – unless the company has shown it is not responsive to legitimate concerns or will retaliate against employees who speak up.

8. The government will hold managers personally responsible for activities of the EHR vendor company.

The ECW settlement holds both the company and its three founders (the CEO, CMO, and COO) liable for payment. The settlements reinforce the DoJ’s commitment to individual accountability for corporate decisions in a very tangible way.

9. EHR vendors must ensure that all contracts and agreements with its customers do not restrict disclosures of information about the performance of the software or reporting of patient safety concerns (the “anti-gag” rule).

ECW’s Corporate Integrity Agreement requires that contracts between the company and its customers do not restrict customers from disclosing concerns about the performance of its software. This includes concerns related to patient safety, public health, and product quality. Other vendors should consider adopting similar “anti-gag” practices.

10. Whistleblower rewards may be paid for information that leads to successful resolution of a federal qui tam action against an EHR vendor.

The ECW case shows the government welcomes whistleblowers who have information about significant problems with EHR software. Under the False Claims Act, the government will pay whistleblowers a reward of 15 to 25 percent of the proceeds recovered by the government as damages and civil penalties, if the government joins the “qui tam” case filed by the whistleblower. The government awarded the ECW whistleblower $30 million.

Colette Matzzie is a whistleblower attorney and partner at Phillips & Cohen LLP, which represented the whistleblower in the EClinicalWorks case.

EPtalk by Dr. Jayne 6/15/17

Congratulations to the University of Arizona College of Medicine – Phoenix for receiving full accreditation from the Liaison Committee on Medical Education. The school was created more than 10 years ago to help address Arizona’s physician shortage and was originally a branch campus of the UA College of Medicine – Tucson. Now, UA joins the ranks of only a few universities with multiple accredited medical schools. Starting up a new medical school is a daunting process, whether it’s a branch of an existing school or not. I had the pleasure of speaking recently with one of the faculty members at the Dell Medical School at The University of Texas at Austin who shared some of their trials and tribulations. Becoming fully accredited is quite an accomplishment.

While EHR vendors are working on their certification testing, many are expanding the incorporation of user testing. NCQA is also getting into the act with a website usability and navigation study. I appreciate the fact that they’re trying to make the website easier to use, but I wish they’d make their recognition programs less cumbersome and more affordable for primary care practices. I’ve been contacted by multiple clients who are struggling with the transition from their 2014 program to the updated 2017 program. One of my staffers is attending the course in Washington, DC this week, and at nearly $900 for one day it’s certainly not cheap. Tack on some hotel and travel, and it’s a lot for a small practice to spend for training.

Fortune recently released its list of the 500 companies that generated the most revenue in the last year. Multiple healthcare systems made the list, including HCA Holdings, Community Health Systems, Tenet Healthcare, DaVita, Universal Health Services, LifePoint Health, Kindred Healthcare, and Genesis Healthcare. Health insurers made it on the list as well, with UnitedHealth Group ranking at number six. Other payers making the cut include Anthem, Aetna, Humana, Centene, Cigna, Molina Healthcare, and WellCare Health Plans.

A friend sent me this piece about “Perfect Non-Clinical Income Ideas for Doctors.” I had to laugh at some of the suggestions, especially considering the time pressure that many physicians face. I don’t imagine that many physicians would be up for multilevel marketing, peddling insurance, or renting out their cars. Not to mention, the author fails to appreciate the concept of “passive” income. The only side businesses I see my colleagues involved in are in the property ownership realm, and none of them are personally managing their properties.

My practice opened two new locations in the last 30 days, so I’m working more clinical shifts than I usually do. Unfortunately, that increased schedule came right when my vendor is experiencing an ongoing problem with API errors. The impact is worst when we’re trying to use the e-prescribing functionality or when staff is trying to search for the patient’s preferred pharmacy, which means it impacts pretty much every patient when it happens. Although I appreciate the communication, receiving an email every two hours that essentially says “yes it’s still going on, and no we don’t know how to fix it yet” becomes annoying. Even while I scowled at my inbox, however, I did get a kick out of a marketing email that popped in from our friends at EClinicalWorks. Apparently they’re offering an ill-timed promotion called “Make the Switch” that includes free data migration to the system. I wonder how many takers they’re getting.

A reader sent me this piece about workplace wellness programs. It references some interesting statistics that I wasn’t aware of, such as the fact that 50 percent of companies that have more than 200 workers either offer or require employees to complete biometric screenings. Of those companies, more than half offer financial incentives to employees to participate. Others mandate the screenings for employees who elect company-provided health insurance plans. I’m sure wellness programs will continue to expand, as employers try anything they can to try to control rising healthcare costs.

I’ve written about my concerns around wellness programs before, namely that programs often aren’t compliant with screening recommendations. They may require employees to participate in screenings, such as blood glucose and cholesterol, that are not recommended for their age group and that may lead to distress and interventions that ultimately do more harm than good. Another tidbit I wasn’t aware of is the fact that modifications to regulations around employee wellness programs were nestled into the Affordable Care Act, allowing employers to shift 30-50 percent of employee-only healthcare premiums onto employees who fail wellness tests. I haven’t had to participate in biometric screening since I left Big Hospital, although when you compare the hassle, invasion of privacy, and dubious science against the premiums paid by small businesses, it doesn’t seem so bad.

I’m always on the lookout for stories of adventures in healthcare, and today I had one of my own. I was calling to make an appointment for a procedure with a provider who has multiple offices. Even though I haven’t been seen there in a couple of years, they were willing to schedule the procedure without a consultation first, which seemed unusual given the opportunity to not only collect an updated history and physical but to also generate some extra charges in a procedure-based specialty. The scheduler then paused and said, “Let me write all this down” and I assumed that she was going to take my request to a surgery scheduler, who would get back to me for the actual scheduling. She “wrote” for over a minute, and apparently used the information as a reference while she looked at the computerized scheduling system. As a process improvement person, I can’t imagine how that works given an average office’s phone volume. I can’t wait to see it in person in a couple of weeks. Needless to say, I won’t be surprised if they call me back and ask to schedule a consultation first, but you never know.

Email Dr. Jayne.