Curbside Consult with Dr. Jayne 8/15/16

There are a lot of people in the clinical informatics field who have participated in vendor focus groups and other information-gathering activities. Those can be a lot of fun as well as a great way to meet other physicians in the field. They can also be a great opportunity to see the “next big thing” as it evolves and makes its way to market.

I’ve made some good friends in the marketing space. They’ve introduced me to other organizations that might be looking for some physician input on their product campaigns. Over the last year or two, I’ve had the opportunity to work in depth with a couple of organizations.

The first engaged me to assist with questions around their functionality. Although they had a strong development team, their clinical input was limited to a handful of informatics physicians and end users of their current product. This is fairly common with startups, who might not have the to put a physician on the payroll. Sometimes they do have the funding, but are spending it in areas other than clinical expertise, and it becomes my challenge to help them see the value that regular physician input might bring to their products and their development process. It’s much easier to have someone who can vet your designs immediately rather than having them get close to release and be shot down by a focus group because you missed the mark.

In addition to working with them on product development, they also engaged me to assist in marketing efforts and in ensuring that the script for their product demonstrations was both medically accurate and clinically relevant. I can’t understate the value of having solid clinical input in this area. There is nothing that causes a physician’s brain to shut off like being presented with a clinical scenario that makes no sense or is insultingly dumbed down. It’s one thing to use a straightforward scenario, like a visit for an acute illness, so that you can highlight the product’s abilities and not distract the user’s attention. But it’s another thing entirely to work through a scenario choosing nonsense data, explaining it away “because it doesn’t matter.” Especially where features such as clinical decision support are involved, the information needs to make sense for it to be believable.

They were also one of the more fun groups I worked with. They brought me back to do some product naming work, and although none of the names we came up with in our working session were ultimately chosen, it was exciting to be part of that process and to use the creative side of my brain. I was so proud when their product launched and every time I see it in the wild, it’s fun to know I had a hand in it.

My next adventure was with a startup EHR company. One of the founding partners fully realized that they needed physician input to ensure they were spending their clinical development resources wisely. Unfortunately, the other founding partner was not completely with the program. They were more interested in bells, whistles, and flash than they were in creating a product that could meet the needs for complex documentation, and what they ultimately produced could be described as Franken-EHR. Parts of it were beautiful and glossy, but lacked the clinical functionality that physicians want these days, such as the ability to link scanned images to open orders. Other parts of it were intended to allow robust documentation with plenty of discrete data, but ended up being a complete and total click-fest. Yet another piece of it looked as if it had been clearly lifted from another vendor where a third founder had once worked. I realized a bit later that it had – when I went to remove some of their code from my laptop, I found that one of the embedded components had a license linked to another vendor. Oops!

Another group engaged me to help recruit clinical participants for a focus group. I’m also working with them to gather materials to use when the group meets. The project is primarily around selecting images for a redesigned website and some marketing slicks. I’ve been visiting quite a few competitor websites to identify potential points that might resonate with physicians so that we can present them to the group. In the course of that project, I’ve stumbled on some great marketing efforts and also on some that are truly awful. One made me question whether the vendor (who happens to be large and very successful) even had marketing professionals involved in the creation of their materials, or whether they just threw some stuff together.

In putting together stats about the clinical representations – whether they showed the physician practicing, with a patient actor, or in home/leisure pursuits – I was struck by how much stereotyping I saw in some of the ads. The majority of the physicians represented were white males, with leisure pursuits of golf and skiing represented. One did have a physician testimonial showing him having more time for his grandchildren, which was a nice change. In the majority of campaigns I’ve viewed, women are largely featured in supporting roles as are non-white males. That certainly doesn’t look like the medical world I practice in. I was surprised at how often I saw those patterns.

My absolute favorite marketing piece (in the humor category) was all around being able to see your schedule from anywhere. This was primarily funny because pretty much every single product these days has that feature, so it’s hardly a market differentiator, yet the company had latched onto that idea and featured it prominently on their home page. It was even more funny because they included an embedded animation with a clinician at the gym, lifting weights. He stops in the middle of a set, grabs his phone, makes a couple of taps, then does some kind of smile/chuckle thing.

I don’t know about the rest of the clinicians out there, but it’s rare that I look at my patient care schedule and chuckle. It looked more like he was seeing an inbound text or a witty Facebook post, and the whole “multitasking at the gym” thing just felt a bit off-putting. We’ll see what the focus group says, because we’re going to include similar content to see what the participants think. If they’re anything like the physicians I talk to regularly, they’re more likely to be checking their schedule while they’re in the carpool line trying to drop off their kids at school, or while trying to hustle to the hospital to round on patients over lunch. Either way, once a feature becomes commonplace, I’m not sure why you’d market around it, but at least we’re going to find out if we do want to market a time-saving feature, what the best scenarios might be.

With the consolidation in the EHR market and the boom in add-on solutions, there is plenty of marketing out there. I’d be interested to hear from readers what kind of marketing they feel hits the mark, and what should be sent to the hall of shame.

Got marketing stories? Email me.

Email Dr. Jayne.

Morning Headlines 8/15/16

655,000 Bon Secours patients exposed to data breach

Bon Secours (VA) reports a 655,000 patient record breach after one of its business associates, R-C Healthcare Management, inadvertently left files containing patient information accessible on the internet.

Cerner’s Neal Patterson collects payday 21 years in the making

Cerner CEO Neal Patterson cashes in on a 25-year old stock option, netting him $26.9 million.

Athens Orthopedic won’t pay for extended credit monitoring in data breach

Athens Orthopedic Clinic (GA), which has refused to pay a ransom to hacker the Dark Overlord over 200,000 compromised records, is now also refusing to provide effected patients with credit monitoring services.

Strike preparations cost Brigham $24 million

Partners HealthCare reports a $33 million operating loss due to costs associated with an anticipated nursing strike, in addition to Epic-related implementation costs, and higher than usual real estate expenses.

Monday Morning Update 8/15/16

Top News

Bon Secours Health System (VA) notifies 665,000 patients that their information was freely discoverable on the Internet due to a mistake made by Phoenix-based revenue cycle optimization vendor R-C Healthcare Management.

Reader Comments

From Skip O’Frenia: “Re: KLAS. A colleague of mine got this email a while back when he spoke with KLAS. Is KLAS so desperate for input that they have to bribe participants with dinner?” It also offers to pair up respondents with vendor executives, which would seem to be a no-no if you’re claiming impartiality and transparency. I’m really uncomfortable with the way KLAS – as a vendor – friendlies up to the other vendors that provide its profit in ways that provider participants don’t see. I’m also recalling that I challenged the KLAS folks in an interview years ago to submit their survey and analysis process for independent verification of statistical validity and that hasn’t happened.

From Nice Threads: “Re: balance billing. I don’t remember seeing this on HIStalk.” A Virginia judge takes exception with a for-profit hospital that made a heart attack patient sign a financial responsibility agreement in the ED. The hospital billed $111,000 for a two-day stay and stent surgery. His insurance covered only $27,000 since the ambulance took him to a hospital that was not in his insurance network, so the hospital demanded that the patient pay the non-discounted difference based on its charge master prices. The judge said the contract was not binding, the hospital’s refusal to disclose its CDM pricing made them guilty of withholding a crucial contract element, and that a hospital willing to accept an insurance company’s payment in full should not then go after the patient for even more money. The judge ruled that the patient owed only another $500 to cover the value of the care he received. His attorney says it’s the first time balance billing has been challenged in court and his firm will go after other hospitals since secret CDM rates are just bargaining chips used to extract payment from individual patients.

HIStalk Announcements and Requests

Two-thirds of poll respondents expect hospital and medical practice consolidation to harm rather than help cost and quality. New poll to your right or here: what is your reaction when reading about the expensive campuses of Cerner and Epic? (or any other vendor with comparable offices, assuming of course there are others).

Last Week’s Most Interesting News

• Karen DeSalvo, MD, MPH steps down as National Coordinator to focus full time on her job as HHS Assistant Secretary for Health, with Principal Deputy National Coordinator Vindell Washington, MD taking over as National Coordinator.
• CPSI announces poor quarterly results, acknowledging during the earnings call that Cerner’s hosting services has made it a small-hospital competitor but discounting Athenahealth’s claims of growing small-hospital inpatient momentum.
• Apple publishes several healthcare-related patents as CEO Tim Cook makes unspecific but firm commitments to expand the company’s healthcare offerings.
• Press Ganey sells itself to a Swedish private equity firm for $2.35 billion.
• The FDA issues draft guidance on when medical device manufacturers must file for new 510(k) approval, specifically excluding security-related software updates.
• Newkirk Products, which prints customer ID cards for several insurance companies, announces that hackers breached its systems and thus exposed the information of 3.3 cardholders.

Webinars

August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

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

Our “summer doldrums” webinar services sale ends Labor Day, September 5. Thanks to the several companies who have signed up for the always-busy fall webinar season.

Acquisitions, Funding, Business, and Stock

Analytics vendor Innovaccer, which offers products for healthcare and other segments, raises $15.6 million in a Series A funding round.

Cerner Chairman and CEO Neal Patterson cashes in stock options going all the way back to 1995, collecting $50 million and netting $27 million after costs and taxes. Experts say holding options for longer than 10 years is almost unheard of and Cerner doesn’t offer options with that long of a term now, but that arrangement back in the 1990s was apparently intended to keep Patterson on board. President Zane Burke also sold shares worth $10 million last week.

People

Brian Moyer (Gaffey Healthcare) is named CEO of the Nashville Technology Council.

Jess Jacobs, patient advocate and director of innovation labs at Aetna, died Saturday.

Announcements and Implementations

The US Navy recognizes the IT departments of Naval Hospital Bremerton (WA) and Naval Hospital Oak Harbor (WA) for their preliminary work in preparing infrastructure for the implementation of MHS Genesis, the Department of Defense’s Cerner EHR project.

Health engagement solutions vendor StayWell chooses Validic for integration of digital health services and apps.

Privacy and Security

Athens Orthopedic Clinic (GA), which refused to pay the extortion demands of hacker The Dark Overlord after the records of 200,000 of its patients were stolen, says it can’t afford to provide free credit monitoring for those patients. The clinic’s CEO said in a statement, “We truly regret that we are unable to do so, as we are not able spend the many millions of dollars it would cost us to pay for credit monitoring for nearly 200,000 patients and keep Athens Orthopedic as a viable business. I recognize and am truly sorry for the position this puts our patients in.” The clinic also states that the breach occurred when the hacker used the log-in credentials of an unnamed HIM contractor.

From DataBreaches.net:

• Valley Anesthesia and Pain Consultants (AZ) notifies nearly 900,000 patients plus all present and former employees that its systems were breached by a hacker.
• Three breaches by The Dark Overlord are published by HHS, although with different counts of the individuals whose information was compromised. The practices and patient counts are Midwest Orthopedic Pain and Spine (29,000), Athens Orthopedic Clinic (201,000), and Prosthetic & Orthotic Care, Inc. (23,000).
• A medical practice in England is fined $52,000 for giving information about a female patient to her estranged partner.

Technology

Fitbit drops support for synching its fitness tracking data with MIcrosoft HealthVault. I had forgotten that HealthVault even exists and maybe Microsoft did too since its most recent app update was in January 2016. 

Other

Partners HealthCare (MA) loses $33 million in its most recent quarter, fueled by $24 million in costs to prepare for a nurses’ strike that was averted, expenses of its $1.2 billion Epic project, moving employees to a new headquarters building, and losses in its insurance arm.

Here’s Part 2 of the “Rating the Ratings” series from Vince and Elise. It contains a nice nod to the pioneering market analysis businesses created by Sheldon Dorenfest and Ron Johnson all the way through touching on KLAS and Black Book.

I had to read Weird News Andy’s headline carefully to get his pun: “The quality? Fair.” Scientists modify a $40 cotton candy machine they got from Target to create artificial capillaries, possibly paving the way to one day creating artificial organs on a 3-D printer.

Sponsor Updates

• Tierpoint will exhibit at the 2016 Tech Coast Conference August 17 in Jacksonville, FL.

Blog Posts

• Deloitte: Investing in the Patient Experience Pays Off (Versus Technology)
• Why selecting an MDM partner is no different than finding a life partner (VisionWare)
• Making the Business of Healthcare Easier (VitalWare)
• Mark your calendar for VUE16. (Voalte)
• Automating Resident Communications? 5 Pitfalls to Avoid (West Corp.)
• Four state and local approaches that address determinants of health (Xerox)
• Who can deny the challenge of denial management? (ZirMed)

Contacts

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

Headlines 8/12/16

Thrilled to make the hand off to @VindellW

National Coordinator Karen DeSalvo, MD, MPH announces her resignation, effective Friday. She will be replaced by Principal Deputy National Coordinator Vindell Washington, MD, who joined ONC in January. DeSalvo will continue in her full-time role as HHS Assistant Secretary for Health.

Apple Invents a New Health Wearable Device that Measures Electrocardiographic Signals

Apple publishes a patent for an ECG monitoring device that can correct for sensor placement.

The World’s Five Richest Women In Tech In 2016

Forbes names Epic’s Judy Faulkner as #4 on the list, estimating her net worth at $2.7 billion.

Hospitalists and the Decline of Comprehensive Care

A NEJM op-ed piece says the use of hospitalists diminishes the physician-patient relationship, makes coordination challenging, and limits the effectiveness of those doctors who see only hospitalized patients.

News 8/12/16

Top News

Karen DeSalvo, MD, MPH has resigned as National Coordinator, with her last day being Friday. She will be replaced by Principal Deputy National Coordinator Vindell Washington, MD, who joined ONC in January 2016.

DeSalvo will continue in her full-time role as Assistant Secretary for Health.

Reader Comments

From HIT enthusiast: “Re: Anthelio Healthcare. Acquired by France-based ATOS in a private sale this week.” Unverified. I reached out to the company but haven’t heard back.

From Anointee: “Re: HSM. Have you heard how much Huron Consulting paid to acquire it?” I have not heard. Reports are welcome.

From One Mississippi: “Re: rating the ratings. While working on my masters, I had a class in surveying and research. The class was mostly automotive folks since it was in metro Detroit. The professor brought up KLAS as an example of a horrible surveyor. Their margin of error is huge since participants engage for a variety of unscientific reasons. He said, ‘Research should be conducted for research purposes only,’ while KLAS does research to meet pre-determined criteria for their vendor customers.”

HIStalk Announcements and Requests

Grammar peeves: saying “less” instead of “fewer” when referring to something that has a discrete quantity. A hospital does not have less nurses, although it might well have fewer nurses. I’m also annoyed by “should of” instead of “should have” and “6 a.m. in the morning.” I’m also alarmed at the increasingly common practice of starting a sentence with “So” like the author is telling an overly descriptive tale (“So I walk into this bar …”) I immediately stop reading when I see that.

This week on HIStalk Practice: Justin Barnes brings readers up to speed on life after Greenway, plus offers his take on how the new administration will handle health IT. Pathway Health adds Virtual Health PHM technology to its consulting services for the post-acute care market. Kinsa hopes its smart thermometer tech will help identify Zika Virus hot spots in Rio. PrecisionBI develops ACO module for TouchWorks users. MyHealthDirect integrates online appointment scheduling with Microsoft Office 365. Community Care Collaborative selects Vital Data Technology’s case management, care coordination tools. Navicure CEO Jim Denny offers advice to practices looking to get an analytics program off the ground. Government initiatives to combat the opioid epidemic take center stage this week.

Webinars

August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

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

Acquisitions, Funding, Business, and Stock

Plymouth Meeting, PA-based Accolade, which engages health plan members to encourage them to make cost-effective healthcare decisions, raises $70 million, increasing its total to $160 million.

CPSI announces Q2 results: revenue up 45 percent, EPS $0.15 vs. $0.52. The company blames the poor results on hospitals taking longer to make decisions as well as lower add-on sales. Share price gapped down on the news and have dropped 37 percent in the past year. From the earnings call:

• The company will no longer provide earnings and revenue guidance due to variability in subscription vs. license sales and challenges in forecasting the contribution of Healthland, which it acquired in November 2015 for $250 million.
• Chairman David Dye said in the earnings call that traditional competitors have largely abandoned the community hospital EHR market and new entrants have fizzled.
• Dye adds that Athenahealth’s claims of displacing incumbent vendors, including CPSI, with the former RazorInsights system reflects their hard-selling of contracts with no money down and a 90-day out clause, meaning the hospital may never even go live, adding that only one Evident customer has gone live on Athenahealth while CPSI has replaced Athenahealth at two sites.
• Dye acknowledges that Athenahealth’s prices are lower and the company could become a formidable inpatient competitor, but adds that of the 23 RazorInsights hospitals that attested for Meaningful Use, three have moved to CPSI, another signed with CPSI this week, three have closed, and another three are converting to another non-CPSI system.
• Dye says that CPSI rarely faces off against Epic, but Cerner’s hosting services and price reductions have allowed it to sell to even the smallest hospitals in competing with CPSI.

Predictive analytics vendor CareSkore raises $4.3 million in its initial funding round. The company’s product analyzes EHR inpatient data to assess a patient’s clinical and financial risk.

NantHealth announces Q2 results: revenue up 167 percent, adjusted EPS –$0.15. Shares are up around  8 percent since the announcement, but are still down 42 percent from their first-day close following the company’s June 2016 IPO.

Sales

In Canada, Joseph Brant Hospital will implement Orion Health’s Rhapsody Integration Engine.

People

Medicomp Systems promotes Jason Valore to GM of Asia/EMEA.

Announcements and Implementations

The HIMSS-SIIM Enterprise Imaging Workgroup publishes a white paper covering enterprise viewers, the fifth in a series that will be published in the Journal of Digital Imaging.

Forward Health Group and Leavitt Partners will collaborate to support practices and payers participating in CMC’s CPC+ payment initiative.

Government and Politics

The VA issues an RFI for change management services related to its potential implementation of a commercial EHR product, with the VA indicating that it is especially interested in companies with prime contractor experience in large EHR conversions. Areas of interest include governance, change management, go-live planning, business continuity planning, testing, patient safety, cybersecurity, and interoperability.

Privacy and Security

From DataBreaches.net: a Virginia dermatology practice notifies 13,000 patients that their information was exposed when it fell victim to a ransomware attack. The practice’s statement did not say if it paid the ransom.

Technology

Apple publishes another health-related patent, this one for a wearable ECG monitor.

In other Apple news, the company rehires Evan Doll, who left his Apple iPhone software development job in 2009 to co-found the Flipboard magazine reading app, to develop healthcare-related software.

Other

A Wall Street Journal report notes the 10-fold increase in Medicare payments for tests administered in physician offices over the past two years, although the total is still relatively paltry at $16.7 million. Four of the 10 fastest-growing Medicare service costs involve tests run on new in-office devices that the physician can bill for directly rather than referring them out. Examples include a sweat test device and the TearLab tear osmolarity test for dry eyes, which one “Accredited Dry Eye Center” ophthalmologist ran on 84 percent of his Medicare patients in 2014 for payment of $131,000.

Forbes names Epic’s Judy Faulkner as one of the world’s five richest women in technology, estimating the value of her company ownership at $2.7 billion.

A NEJM op-ed piece by a medical school professor says the hospitalist model is good for hospitals, but unproven when it comes to patients and physicians as it diminishes the physician-patient relationship, introduces coordination challenges, and puts patients in the awkward position of having to trust someone they’ve never meet in times of critical need. It also notes that hospitalists who never see outpatients don’t understand what happens outside the hospital and thus can’t serve as advocates for comprehensive care. The author wonders how physician knowledge sharing and collegiality will suffer as the doctors’ lounge is “depopulated” as inpatient and outpatient physicians stick to their respective turfs. It also notes that hospitals market themselves as being more important than relationships with individual physicians but community engagement is compromised by the reduced role of community-based doctors. The article concludes that “medicine can be practiced without hospitals, but hospitals cannot function without physicians … the hospital itself is ultimately a tool … without which patients can still be given care.”

Harvard-based Herald Health will pilot its customizable clinical alerting system at Brigham and Women’s Hospital, integrating with Epic to allow doctors to specify the conditions under which they want to be notified about new results.

An article in The Atlantic says people who go into cardiac arrest might fare better in a casino or on an airplane than in a hospital, where studies show that only two-thirds of providers would notice that a patient is not breathing and without a pulse. Laypeople are more likely to start resuscitation immediately, while clinicians spend time analyzing heart monitors or thinking about drugs to administer instead of starting compressions. The article mentions an algorithm developed by University of Chicago Medicine that analyzes vital signs in real time to predict which patients are likely to have cardiac arrest in the next 24 hours.

An MGMA survey finds that physician-owned multispecialty practices spent $32,500 per full-time doctor on IT in 2015.

Researchers looking at food and exercise studies whose results conflict (are coffee and flossing good or bad?) say most of them contain invalid conclusions or are not reproducible because patients don’t provide good information and the large number of data element possibilities for diet, exercise, and health outcomes can be used to prove almost any desired point.  Some experts say that it’s a waste of time to conduct lifestyle studies because they are full of problems and they almost never prove anything useful.

I guess this counts as tele-romance (or is it tele-cardiology?) A company launches a ring ($600 per pair for the basic model) that when tapped, connects to a love one’s counterpart ring via Bluetooth and smartphone to allow feeling each other’s heartbeat in real time. My initial reactions: (a) it’s huge; (b) it’s pointless given that the same smartphone it requires can already send text messages, voice calls, or video for free; (c) it’s yet another gadget that requires regular charging; (d) suspicions might be raised if the heart rate of the “working late” partner suddenly increases; and (e) someone’s going to panic when it can’t connect to the other person and they assume the worst.

Sponsor Updates

• HCI Group offers a Jaguars vs. Packers weekend event September 9-11 in Jacksonville, FL for Epic-certified consultants that includes an open house, happy hour, a beach day, and a pre-game tailgate.
• Twenty Meditech hospitals receive five-star ratings from CMS.
• Navicure will exhibit at the Azalea Health Leaders Summit August 18-20 in Atlanta.
• Netsmart will exhibit at the Mental Health Corp. of America Summer Conference August 16 in Portland.
• Experian Health will exhibit at Florida AAHAM August 17-19 in Clearwater Beach, FL.
• Patientco will sponsor the Decatur BBQ & Bluegrass Festival August 13 in Decatur, GA.
• PatientMatters will exhibit at the HFMA Arkansas Summer Institute August 17-19 in Hot Springs.
• SK&A publishes a complimentary report, “Top 25 Integrated Health Systems.”

Blog Posts

• The Patient Advocate: Meet Spok’s New CNO (Spok)
• CDI embraces patient-centric care with the Lexmark VNA (Lexmark)
• Perinatal Nursing & Technology – Time to Accept & Embrace the Challenge (Part 3) (PeriGen)
• Lessons From Sticking Around (PMD)

Contacts

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

EPtalk by Dr. Jayne 8/11/16

It seems like every year I run into some kind of trouble with my HIMSS registration. I learned quickly that you have to make your hotel reservations early. When I went to make them this week, I quickly ran into an issue. It seemed like every hotel I looked at was sold out for Wednesday on. Mind you, the conference runs Sunday through Thursday.

No matter how far away from the convention center I looked, the blocks looked the same (except for a few of the pricier hotels). I looked on the hotel’s direct registration site as well, but it didn’t even appear as available on my desired dates. I went ahead and booked to depart Wednesday, since I didn’t feel like switching hotels.

I’m not sure what prompted me to do it, but today I went on the hotel website and tried to book for just Wednesday. Guess what? Rooms available, and lots of them! Apparently the HIMSS block only extends through Tuesday night, which seems pretty ridiculous for a conference that runs through Thursday. Needless to say, I have two reservations at the same hotel for adjacent dates. From experience, this will likely turn out fine, but it’s just one more needless aggravation. Especially for those of us paying out of pocket for the less-than-cheap experience, it’s doubly annoying.

Hot on the heels of my recent Curbside Consult addressing the gap for professional development for healthcare workers thrust into IT roles, ONC will host an informational webinar covering the Workforce Training Program available to healthcare IT professionals. It specifically says it will address new training programs available “to help health care workers and others stay current in the changing healthcare environment.” Training includes both online and in-person sessions and have been organized to address IT skills needed by various members of the care team. The webinar is on August 24 and registration is open. I’d love to hear from anyone who has firsthand knowledge of the Workforce Training Program.

I had mentioned back in the spring that I was waiting for Ringly to release a silver version of its bracelet. They put one up for pre-order a couple of months ago, so I took the plunge. I knew they wouldn’t be available until fall, and with everything that has been going on for me recently, I somewhat forgot about it. I was happy today to see a sneak peek of their packaging, so at least they’re getting closer to shipment. I’ll definitely do a product review once I have it in hand (or on the hand, as the case may be).

Speaking of fashion, Jenn alerted me this week to a recent statement by the American College of Surgeons regarding appropriate professional attire. Highlights include:

• No dangling masks
• Operating room scrubs worn outside the operating room should be covered with a clean lab coat or other “appropriate cover up”
• No operating room scrubs outside the hospital proper
• Operating room scrubs should have a distinctive color so violations of above are obvious
• Soiled scrubs should be changed before speaking to family members
• Scrubs should not be worn for encounters outside the operating room

I’m always horrified when I see people in surgical shoe covers outside the hospital because you can’t wear them back into the operating room and who knows what has been tracked out of the OR. I’d have liked to see something specific to that, although I bet they thought they implied shoe covers when they addressed scrubs.

There was a nice section on the wearing of the surgical skullcap as symbolic of the profession. It didn’t go into a debate on the use of the skullcap vs. the bouffant cap, which was a detailed topic of conversation during my surgical rotations as a student. The last surgeon I interacted with (as a family member agonizing in the waiting room) was wearing a Saints cap, which was appropriate given his recent fellowship training at Ochsner. I wasn’t that impressed, however, by his white rubber rain boots, into which he had tucked his scrub pants. It was a unique look that got more than a few funny looks by waiting loved ones.

I also received some updates from the Aprima user conference, which was held last week in Dallas. Apparently they were sharing hotel space with a Mary Kay cosmetics conference, where some attendees sported beauty queen sashes and tiaras. My correspondent said it reminded her of HIStalkapalooza. Educational highlights included Chronic Care Management tools, Patient-Centered Medical Home pre-validation, and MACRA readiness. There was also a Casino Night social event as well as the opportunity to help make blankets for the Children’s Medical Center in Dallas. Sounds like a good time, even with the Texas heat.

The annual user group season is upon us. The Allscripts Client Experience is going on this week in Las Vegas including a party on the Mandalay Bay beach. Next, Epic will host their “An Adventure in Wonderland” event September 19-22. Anyone want to lay bets on Judy being costumed as Alice? NextGen is holding their annual event November 6-9 in Las Vegas, with attendees hopefully remembering to absentee vote since their client event is being held on election night. Cerner rounds out the fall with their meeting November 14-17.

What makes a user conference worthwhile for you to attend? What’s the best social event you’ve experienced? Email me.

Email Dr. Jayne.

Morning Headlines 8/11/16

RFI – VHA supporting COTS EHR

In another sign that the VA will move to a commercial EHR, the agency publishes an RFI soliciting “industry feedback, guidance and recommendations on all aspects of the change management associated with a VHA COTS EHR acquisition and transition.”

Aetna-Humana merger challenge to be decided in January

In December, the District of Columbia US District Court will hear the antitrust challenge brought by the federal government to stop Aetna and Humana’s proposed $37 billion merger, with a decision excepted by January.

Banner Health cyberattack draws class-action suit

An Arizona physician is leading a class-action lawsuit against Banner Health following a cyberattack on the health system’s retail outlets that compromised the personal information of  3.7 million customers.

Cerner Interoperability

Cerner launches an interesting data visualization map showing real-time interoperability transactions being processed through its exchange suite.

Morning Headlines 8/10/16

Playing The Long Game Inside Tim Cook’s Apple

FastCompany interviews Apple CEO Tim Cook following a year in which the company saw 13 percent declines in revenue and 16 percent declines in iPhone sales. He remarks "We’ve gotten into the health arena and we started looking at wellness, that took us to pulling a string to thinking about research, pulling that string a little further took us to some patient-care stuff, and that pulled a string that’s taking us into some other stuff. When you look at most of the solutions, whether it’s devices, or things coming up out of Big Pharma, first and foremost, they are done to get the reimbursement, not thinking about what helps the patient. So if you don’t care about reimbursement, which we have the privilege of doing, that may even make the smartphone market look small."

FDA Outlines When New Clearances Are Needed for Existing Devices

The FDA moves to streamline cybersecurity related software updates for medical devices by explicitly stating that these types of software updates do not require new clearances.

Governor Wolf Announces Cerner Corporation Expansion to Create 250 New Jobs

Cerner will invest $75 million in facility improvements and add 250 new jobs at the former Siemens’ offices it has acquired.

Security flaw may be responsible for Laurel clinic data breach

A cybersecurity researcher who discovered that patient data belonging to Jefferson Medical Associates (MS) was openly available on the Internet is called a criminal by the hospital after he quietly informed them of the security flaw in their system.

News 8/10/16

Top News

Apple CEO Tim Cook speaks about the company’s healthcare aspirations, which he shared while literally leaving the room from a Fast Company interview focusing on whether Apple has stagnated:

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

In a possibly related rumor, a Taiwan newspaper says Apple is finalizing suppliers for a new 2017 healthcare product that will capture the heart rate, blood sugar, and other information of users. The newspaper says the product will use new iPhone health sensors as well as Apple’s pressure-sensing technology.

Reader Comments

From Limber Lob: “Re: cost of Epic’s campus. At a User Group Meeting a couple of years ago, Epic founder and CEO Judy Faulkner showed a pie chart of Epic’s costs: 80 percent people, 10 percent buildings, and 10 percent everything else. It would be interesting to see corresponding numbers for other EHR industry players.” Unverified.

From The Stygian Gigawatt: “Re: HIStalk. You run too many unverified rumors.” My position on running reader-provided rumors is thus:

• Rumors are like HIMSS hallway conversations except I’m filtering out some of the blatantly suspicious ones. Readers are free to read them or ignore them.
• Reader-reported rumors are often accurate, even if inexact (a company had layoffs, but in smaller numbers than the rumor suggested).
• Sometimes rumors I run force the hand of companies to publicly admit that they’ve done something they aren’t especially proud of.
• I allow anyone to confirm or deny unverified rumors and will give those responses the same prominence as the original item.
• Readers who don’t like reading rumors are massively outnumbered by those who do, according to responses to my annual reader survey.
• Everybody likes rumors until I run something about their company. That’s when I get indignant emails lecturing me about the sudden need for responsible journalism.
• HIStalk isn’t for everyone and I’m not offended when someone chooses not to read it. There are no teams, corporate overlords, or committees to pretty it up or dumb it down – it’s just me sitting in a spare bedroom. On the other hand, I am happy and frankly shocked that around 50,000 people do read it and I feel a lot of responsibility toward them. My goal from Day 1 (in June 2003) has been to make readers think and rumors help do that.

From The PACS Designer: “Re: ICD-10 decimal places. As we approach the launch of ICD-10 Procedure Codes (ICD-10-PCS) on October 1, thought it would be a good time to discuss some short cuts used previously in ICD-9-CM Clinical Modifications. Removing decimal places should be eliminated for ICD-10-CM as a practice when the Procedure Codes begin being used by institutions. ICD-10-CM uses decimal places and ICD-10-PCS does not use them. Granted, legacy data parameters still need to be mined for the missing decimal place data parameters, but future mining and error reductions should be top priority for everyone to be successful with the new combined coding scheme for both CM and PCS.”

HIStalk Announcements and Requests

I don’t like seeing companies whose entire executive roster is mostly made up of white men. Now I’m questioning another phenomenon I see a lot: American companies whose leadership team is nearly all men of Indian origin. Is that an positive example of diversity or a negative example of the lack of it?

I was having my teeth cleaned today and the hygienist recommend some sort of quick scaling procedure that my basic dental insurance doesn’t cover. She offered to charge me just the discounted price the insurance company would have paid, which I liked, but of course I was wondering as a patient whether I really needed the procedure at all (and all I got for my $144 was a few extra hygienist minutes of scraping around). My post-visit conclusion was that medical and dental practices make a lot of money turning routine maintenance work into an expected healthcare standard and then turning the actual work over to lower-licensed or even unlicensed employees who crank out the billables with no owner involvement. Dermatologists, for example, have figured out that they can make a lot of money selling super-expensive cosmetics, Botox injections, and aesthetic services, all of which require only the dermatologist’s presence, not involvement. American healthcare is bizarre.

We provided two iPads in funding the DonorsChoose grant request of Ms. D in Texas, who says her students have become more engaged and can’t wait to do practice work on the iPads. I’m sorry to report that this is the last set of classroom photos I have since my last round of DonorsChoose funding was back around HIMSS time when I ran out of money, but I have another really large corporate donation that I’m ready to put to work. That will give me more teacher reports and pictures to share.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

Acquisitions, Funding, Business, and Stock

Virtual visit provider Aligned TeleHealth raises $12 million in Series A funding.

Australia-based startup Brontech creates Cyph MD, a blockchain-powered patient information exchange platform that will work across countries.

HealthStream acquires credentialing and privileging solutions vendor Morrissey Associates for $48 million in cash.

Press Ganey Holdings has reached a deal to sell itself to a Sweden-based private equity firm for $2.35 billion. The company’s May 2015 IPO raised $233 million. Shares have risen 27 percent in the past 12 months. CEO Patrick Ryan, who joined the company in 2012, owns shares worth $37 million.

Cerner will add 250 jobs and spend $75 million on facility upgrades at the former Siemens Medical Solutions Health Services offices in Malvern, PA.

Sales

Memorial Hermann Health System (TX) chooses Valence Health to support the Medicaid health plan it is acquiring from Molina Healthcare.

People

Netsmart hires Dawn Iddings (Garmin) as SVP/GM of its home care systems business.

Announcements and Implementations

Stanford Medicine (CA) will develop its clinical genomics service using Google Could Platform for analytics.

EHR/PM solutions vendor WRS Health adds electronic prior authorization functionality from CoverMyMeds to its EHR workflow.

Biometric  authentication solutions vendor EyeLock announces an iris recognition technology that works from two feet away, through glasses, and in daylight.

National Institutes of Health will use the clinical genomics solution of Allscripts-owned 2bPrecise as an early adopter, integrating genomic information into its Sunrise EHR.

PatientPing will work on a data-sharing initiative with UMass Memorial Health Care (MA). 

Government and Politics

An HHS OIG report finds that Arizona overpaid $14.8 million in Medicaid EHR incentives to hospitals. The state sent $219 million to Medicaid EHR users, of which 70 hospitals were hospitals that received $151 million. OIG suggests that the state repay the federal government, educate hospitals on how to calculate incentive payments, and review the documentation those hospitals to make sure they calculated correctly. Arizona reviewed OIG’s report and disagreed, saying hospitals provided OIG with different cost reporting data than the state used.

The FDA seeks guidance on a new draft report that outlines when medical device vendors must obtain new 510(k) pre-market clearance following a software change. The proposed regulations would require device vendors to submit their product for safety and effectiveness review if the change involves either of those attributes, while those software updates that address cybersecurity only would not require new FDA approval.

Privacy and Security

A hobbyist cybersecurity researcher who has warned several companies about flaws he found in their online security notifies Jefferson Medical Associates (MS) that their patient information is openly visible on the Internet via an unsecured database. The medical group shoots the messenger in having its legal counsel announce that he “accessed the information without our permission,” which of course is the whole point of nicely letting them know. They call his findings “criminal activity” and that he “unlawfully accessed” one of its databases, which is absurd since he didn’t do anything with the unsecured data he found. The practice also haughtily announces that it was already using an outside security contractor who concludes that, “Other than this one place that this individual found to get in, everything is secure.” I guess companies show indignation rather than appreciation since their screw-up requires reporting the incident to OCR and they have to throw someone under the bus to avoid looking stupid to the locals.

Other

Telemedicine remains illegal in technology-obsessed South Korea after legalization efforts fail due to the opposition of medical professionals. Residents also fear that only the wealthy will be able to afford telemedicine, that their data could be exposed in breaches, and that insurance companies might use the information to discriminate against them. The country’s telephone company shut down its e-prescribing program last year after charges that it had sold prescription information to pharmacies. The Korean Medical Association refuses to participate in telemedicine trial projects and in 2014 went on a one-day strike to protest planned introduction of telemedicine and for-profit hospitals.

Bruce Friedman, MD of Lab Soft News questions how conferences handle potential conflicts of interest in their selection of speakers, that discussion triggered by the AACC’s inclusion of Theranos CEO Elizabeth Holmes at its recent conference:

For me, the favoritism that the AACC leadership and planners of the annual meeting have shown toward Holmes is inexplicable. Although the incentive for the Holmes invitation could be attributed solely toward stimulating registration for the annual meeting … it’s possible that some member(s) of the organization may have had some "special" relationship with Theranos or that Theranos provided some financial remuneration to the AACC to pave the way for the Holmes invitation. I have no idea whether this is a the case, but the comments cited above do raise the question of what constitutes conflict-of-interest (COI) for members of professional societies when they participate in the selection of speakers for a conference.

A fascinating New York Times article describes what it’s like to be claustrophobic in the subway- and elevator-filled New York City.

People complain that Epic’s campus is unnecessarily lavish considering it was paid for by non-profit hospitals, so then there’s this: an investigation finds that the VA has 167 interior designers on its staff.

Sponsor Updates

• Aprima customers make over 150 blankets for the Children’s Medical Center in Dallas at its annual users conference.
• GE Healthcare looks at how its Centricity technology is impacting Olympic athletes in Rio.
• Healthgrades releases a new white paper, “How Better Information and Stronger Platforms Build Trust and Improve Healthcare for Consumers and Physicians.”
• The Radicati Group recognizes AirWatch as a leader in its market quadrant for EMM.
• Besler Consulting releases a new podcast, “The challenges of hospital and physician alignment.”
• Boston Software Systems releases a new podcast, “Automating Medicare Patient Account Verification.”
• The Nashville Business Journal names Cumberland Consulting Group to its 2016 Fast 50 honorees.
• The Dallas Business Journal runs “Three Questions with … Michael Nissenbaum, CEO of Aprima Medical Software.”

Blog Posts

• How to Score Points for ACI and MIPS Quality Reporting (AdvancedMD)
• Why do Healthcare Information Systems Account for $40+ Billion? (Catalyze)
• Ensuring Your Patients Have What They Need (CareSync)
• Navigating the Job Market: a Guide for Today’s New Grads (CTG)
• A CIO problem: 50% of doctors don’t know what MACRA is (Advisory Board)
• Nurse Triage Raises the Bar for Centralized Patient Access Centers (Culbert Healthcare Solutions)
• 5 Tips to Managing Your Time Wisely (Direct Consulting Associates)
• CCD vs HL7, which should you choose? (Galen Healthcare Solutions)
• 7 Ways to Plug High-Deductible Health Plan Revenue Leaks (Hayes Management Consulting)

Contacts

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

Morning Headlines 8/9/16

Inviting patients and care partners to read doctors’ notes: OpenNotes and shared access to electronic medical records

A JAMIA study on the OpenNotes program at Geisinger Health System correlates offering patients access to provider notes with improved patient-provider communication and improved patient confidence in managing their care.

Health files make for a juicy target for thieves

The Boston Globe report notes that as cyberattacks on healthcare industry targets rise, attacks on retail businesses are plummeting.

Things Are Looking Bad For Jawbone

Investment firm BlackRock has dropped the price of its equity in Jawbone to less than 1 cent per share, and raised the likelihood of Jawbone being sold from 50 percent to 75 percent.

Unpacking the innards of Theranos’s new Zika-detection box

TechCrunch reports that Theranos will try to push its newly unveiled “miniLab” through the FDA approval process under the emergency use authorization fast-track because it is capable of detecting the Zika virus.

Curbside Consult with Dr. Jayne 8/8/16

I started my consulting work assisting small practices and that’s still the sweet spot for a lot of my consulting business. My partner does much more revenue cycle work than I do, so he sees more large clients than I do.

Based on what I hear from my clients and their needs, there are numerous areas where our current incentive programs have missed the mark. While they’re encouraging providers and organizations to try to improve clinical quality and reduce costs, they’re not providing much support to organizations who are struggling to actually get the work done.

It feels like we need a second push for organizations like the Regional Extension Centers. The RECs were initially aimed to assist practices through the EHR adoption process, including vendor selection, implementation, and achievement of Meaningful Use. Although the larger healthcare organizations and larger provider groups are doing well, many smaller groups either stalled along the way or failed outright. In working with practices over the last several years, I see some themes. Although some are technology related, many are related to a lack of business and operational skills among quite a few physicians.

Of course, this doesn’t mean all physicians – many are quite savvy and run highly-functional practices. Some of my best physician friends are MD/MBA type individuals who can tell you the exact cost of the services they provide and can closely predict what their profit margins will be prior to adding a new service or expanding their practices. They are successful at managing their employees and developing staff to be able to adapt to the changing healthcare environment.

Others need a tremendous amount of help, and maybe something like a REC to assist with the non-technology needs could be of benefit. Although some of these services are already provided by state and local medical societies, risk management vendors, and of course consultants, practices often feel like they are having to cobble things together to meet their needs. Then again, there are the needs they don’t even know they have, which aren’t necessarily recognized by assisting organizations with a narrow discipline.

Physicians don’t inherently know how to take members of a clinical or operational office staff and turn them into technical support or technical assistance resources. Even though practices could hire consultants or use vendor resellers or other third parties to fill that gap, often the perception is that the cost is prohibitive. Groups then try to use their own in-house resources to manage complex projects such as Meaningful Use, PCMH, PQRS, and accountable care participation. Often these assignments are under the “other duties as assigned” category that staff members struggle to achieve on top of their regular job functions.

Adding to the problem is the increasing turnover that we’re seeing in many primary care practices – often these offices are running on a shoestring, and may choose their resources based on cost over quality. It’s hard for any business to balance this, but when you have a physician-owned practice where the business skills are lacking, this becomes increasingly difficult. Owners may have difficulty explaining expectations and may underestimate the complexity of what they’re asking their staff to do, or the skills required for success. This can lead to cycles of failure when staff members become frustrated and leave, so the process starts over and over again.

Although some vendors offer support and assistance in these areas, the quality of help provided varies dramatically. Even with the best vendors that offer free staff training and ongoing learning opportunities, I see practices struggling to help their employees find the time to even attend sessions, let alone master the skills needed to change how a practice operates. This process is challenging enough when the practice is committed to a certain course of action, but when you have practices that are fractured in their approach, it becomes even more difficult. Maybe the partners don’t agree on how quickly or fully the practice plans to transition to value-based care; maybe there are members of the staff that openly sabotage efforts; or maybe everyone is just not on the same page about how things should be accomplished.

I’m happy to be part of the solution to the problem and have held the hands of many providers as we have moved into this journey. As a small consultant, I’m a lot more reasonable from a cost standpoint than some of the larger firms, but I can also only assist so many groups at a time. I take the primary care approach to helping offices solve their problems – serving as quarterback to get it all done, while looking out for the overall health and well-being of the practice. Similar to the original intent of the RECs, maybe we could benefit from a public health approach to solving the problems practices face as they try to transform how we deliver healthcare in the US.

Most of the incentive programs place the burden on the providers – perhaps they assume that physicians are smart enough to figure out how to make it happen. The reality is that everyone has different skill sets and some of us are better than others at putting all the pieces together and driving change. Some know to reach out for help (and can afford good help) but others continue to struggle.

I would hope that as rulemaking processes continue and we continue to make the process more and more complicated, that someone would think it would be a good idea to put additional resources behind helping providers make it happen, not just telling them what needs to be done. There may have been an assumption that vendors would assist, but that hasn’t fully been borne out for smaller practices. As the old saying goes, Rome wasn’t built in a day. Massive undertakings like transforming the healthcare system require an enormous amount of resources as well as strong leaders who are willing to help people be successful rather than just telling them to get to a destination.

What’s the solution for helping providers achieve success? Is there more we can do? Email me.

Email Dr. Jayne.

Morning Headlines 8/8/16

Newkirk Products, Inc. Provides Notice Of Data Breach

Hackers penetrate the servers of Newkirk Products, a service provider that issues healthcare ID cards for insurance plans.

Vexing Question on Patient Surveys: Did We Ease Your Pain?

The New York Times questions the rationale behind surveying patients on pain management satisfaction amidst the nation’s growing opiate problems.

Code Is My Co-pilot

A Missouri lawyer claims Tesla’s autopilot feature saved his life after suffering from a pulmonary embolism while driving and asking the car to take him to the nearest emergency department.

Monday Morning Update 8/8/16

Top News

Hackers breach the servers of Newkirk Products, which issues BlueCross and BlueShield insurance cards in several states, exposing the information contained on the cards of 3.3 million people. This will be one of the largest breaches ever, although the information stolen is not extensive.

Newkirk was acquired in 2011 by IT outsourcer and consulting firm DST, which sold its customer communications business to Broadridge Financial Solutions for $410 million just a few weeks ago.

Reader Comments

From Jett Cloud: “Re: Epic. I just returned from training and was shocked by the amount of activity that has nothing to do with healthcare, software, or any professional endeavor. There were constantly people playing games outside, sports, Pokemon Go, or similar things. As part of an organization that’s struggled financially and is really stretching to afford Epic, I’m a bit disgusted by the physical lavishness of the campus.” Epic people put in a lot of hours, so I wouldn’t worry that the tiny percentage of its 10,000 employees you saw playing around means they don’t work plenty hard. Most of them don’t even go out for lunch. They’re also mostly in their mid-20s, so just be amazed that despite being the offspring of hovering, overly indulgent parents they show up and get stuff done in what is the first real job many of them have had. I agree that Epic’s campus is unnecessarily extravagant, it’s part of the company’s culture but nobody put a gun to the head of customers to sign those gazillion-dollar Epic contracts that pay for it. At least both customers and Epic employees can enjoy the orchestrated whimsy instead of just the company’s executives – it’s Mahogany Row and reserved parking spots that annoy me. At one of my previous health system employers, we had to keep reminding our executives not to go off script at employee meetings and talk about their reserved parking lots, plush offices, company-paid cars, travel budgets, and big bonuses – they would genuinely forget that those in the room were working for no perks or bonuses, just a paycheck.

HIStalk Announcements and Requests

Poll respondents were fairly evenly split on whether CMS’s new hospital star rating system has value. Furydelabongo says it’s at least a good starting point even though lower-rated hospitals are predictably shooting the messenger. Mobile Man agrees that if you want healthcare to run like a business, this is how business works. Cosmos disagrees, saying hospitals are too complex to be rated by a single rating, and Michael Murphy explains further that the rating doesn’t reflect procedure volume.

New poll to your right or here: will the cost and quality impact of hospital and medical practice consolidation be good or bad? Vote and then click the poll’s Comments link to explain why.

We funded the DonorsChoose grant request of Mr. G in Wisconsin, who asked for two tablets and a programmable robot. He reports, “As many of our students are new to the field of computer science, these materials have helped to inspire them to build a strong foundation of programming knowledge as they enthusiastically dive into the content that is being taught, and seek out opportunities to help Dash and Dot complete new challenges. The pair of robots have also been a way to illustrate programming concepts that would otherwise be confined to a computer screen. For many students, this opportunity to observe and interact with the robots is key to mastering these programming skills. Finally, the robots and tablets have served as an excellent incentive to encourage positive behaviors in the classroom.”

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

Last Week’s Most Interesting News

• Advocate Health Care Network pays $5.55 million to settle HIPAA charges following an OCR investigation of three 2013 breaches in just a few weeks.
• Cerner dismisses Athenahealth’s efforts to penetrate the inpatient market in its earnings call.
• Banner Health (AZ) notifies 3.7 million people that their information was exposed in a breach of its food and beverage systems in one of the largest healthcare breaches ever.
• Theranos CEO Elizabeth Holmes didn’t address any of the company’s business-threatening issues in her presentation to the American Association for Clinical Chemistry and instead uses her podium time to pitch new blood analyzer hardware that has not yet been released or approved by the FDA.
• The FTC reverses an earlier decision to drop data security charges against LabMD.
• Apple publishes a patent that would allow iPhone users to connect with a physician, transmit their HealthKit-collected information, and then initiate a telemedicine session.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

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

Acquisitions, Funding, Business, and Stock

Outsourcer Cognizant Technology guides revenue and profit lower due to Brexit, banking, and US healthcare consolidation and spending cutbacks.

Honor, which matches seniors to home caregivers, raises $42 million, increasing its total to $62 million. One of its VC investors said his firm learned their lesson with Oscar Health, and unlike Oscar, Honor doesn’t just offer online matching – the company remains the intermediary with the user as its customer. It keeps in touch with families with its own app that also populates notes that each assigned caregiver can review. The company also offers a wellness check visit in which observational data is sent back to the user’s doctor. Services are offered only in the Bay Area and Los Angeles, but an expansion to Dallas is planned.

From the Allscripts conference call:

• Sales increased 39 percent for the quarter, or 22 percent without the contribution of the acquired Netsmart.
• The company added one new Sunrise customer.
• Allscripts expects to sell more consulting services after implementation of the “staggeringly large” number of MACRA and QPP reporting requirements.
• The company responded to an analyst’s question about how much revenue Northwell Health contributes to the total, with the answer being a single-digit percentage.

Caradigm provided this response to FlyOnTheWall’s rumor report that I ran Friday in which he said the company let 30 percent of its workforce go this past Wednesday:

Since Neal Singh was named CEO in April 2016, he has worked with Caradigm’s senior leadership team to drive our mission of accelerating the healthcare revolution with innovative solutions to promote better care, smarter spending and healthier people. In keeping with its mission, Caradigm is proactively reorganizing to provide clear accountabilities and streamline efforts to improve teamwork, drive simplicity and deliver quicker results – in order to better serve its customers. Caradigm has reorganized Product teams by key solution focus, with the aim of reducing its customers’ total cost of ownership and reducing time to go-live. Its Services organization has been reorganized to focus exclusively on customer implementations, product support, and driving the relationship and partnership experience that customers have with Caradigm. And in recognition of the fact that customers require deep clinical and technical support and expertise through their lifecycle, Caradigm has expanded the charter of the Care Transformation team. These changes required Caradigm to make difficult layoff decisions. The new organization will put Caradigm on a path for innovation to better support healthcare initiatives and enhance its customers’ experiences. Employees who had their positions eliminated have received both severance and resources to help them with their transition. Caradigm is not disclosing further details about the layoffs.

Marin Medical Practices Concepts, a California physician billing and EHR services company, pays a hacker’s unspecified ransomware demands regain access to its data. The company’s medical practice customers, which include the county’s public health clinics, had been unable to access their EHRs for a week.

More breach news from DataBreaches.net:

• Carle Hospital announces that an unnamed vendor placed files containing the information of 1,185 patients on its procurement document sharing site, unaware that other vendors could also view the information.
• Nordic Consulting notifies New Hampshire’s attorney general that one of its HR employees emailed current and former employees who were affected by a previous data breach to remind them to sign up for identity theft protection, but inadvertently attached a worksheet containing the demographic and patient information of employees covered by Nordic’s health insurance.
• Athens Orthopedic Clinic (GA) confirms that hacker The Dark Overlord has placed patient information from its breached system for sale on the Dark Web after the clinic declined to pay $335,000 to keep their records private. The Dark Overlord claims to have already sold the information of at least 5,000 of the 400,000 patients contained in the database he downloaded. He made a good business case to the clinic in pricing his services competitively with the alternative since just offering credit monitoring protection will cost more than his price.

Technology

Mayo Clinic researchers will climb Africa’s 20,000-foot high Mount Kilimanjaro this week, monitored by sensors from Philips that will help them understand the oxygen deprivation that occurs during both mountain climbing and heart attacks. A drug company is footing the bill.

Apple joins the “bug bounty” movement in which it will pay outside hackers who find and report security flaws in its products. The company will pay $50,000 for bug reports that involve gaining access to iCloud data.

Other

A New York Times article ponders whether it makes sense for hospitals to include a “did we control your pain” question on their patient satisfaction survey that might encourage doctors to over-prescribe the narcotic drugs that already have led a big chunk of America into addiction. Doctors say patients demand specific drugs and use their satisfaction surveys to retaliate if they don’t get them, cutting into the paychecks of the medical staff whose compensation is partly driven by those satisfaction scores.

A study finds that heavy, detailed media coverage of mass shootings causes more gun violence almost immediately afterward, as would-be mass killers see the fame earned by the shooter. The researchers suggests following the “Don’t Name Them” campaign in which mass murderers are deprived of their moment in the limelight by not publishing their names, photos, writings, and details about their past. That would be a fantastic idea except for the sorry state of “eyeballs at all costs” American journalism, where indeed if it bleeds it leads and no amount of public goodwill can offset those Internet page views.

A lawyer credits the autopilot feature of his Tesla Model X for saving his life when he has pulmonary embolism while driving and instructs the Tesla to take him 20 miles to the hospital ED. He’s still not sure that he shouldn’t have called an ambulance instead, but says he figured he could get to the ED faster on his own. Pricing for the Model X starts at $80,000, probably about the cost of his ED visit.

NPR profiles iNaturalist, a social network for wildlife in which users post photos of animals they’ve seen and share them with other to identify them in a form of gamification. At least one previously unknown species has been identified as a result.

Alameda County, CA replaces its long-time jail healthcare contractor after inmate deaths and allegations of poor care. One of its nurses cited inexperienced management and the implementation of new software that wastes clinician time.

I don’t think I was aware of this: the Ragon Institute of MGH, MIT, and Harvard, which has been working in HIV/AIDS vaccine research since 2009, is also supporting Zika virus research. I hadn’t heard of the institute, which is funded via a $100 million commitment from InterSystems founder and billionaire Phillip “Terry” Ragon. 

Drugmaker AbbVie tries to block introduction of a biosimilar drug that is a lower-priced competitor to Humira, which generates 60 percent of the company’s revenue. AbbVie has also filed new patents hoping to delay the entry of the new drug to the market. It’s a good reminder that the sole mission of drug companies is make profits for shareholders, not to perform societal good or to help patients. Companies by definition are not capable of having a collective conscience no matter how much their slick marketing suggests otherwise.

Somerset, PA police arrest a man caught wandering the local hospital’s halls by a nursing supervisor. He was wearing a white coat and claiming to be a doctor in the IT department, which might have been more convincing if he hadn’t then asked her for directions to that department or responded, “Yeah, are you?” when she asked if he was a doctor. Todd Knisely then claimed to be testing the facility’s security for an online journal write-up. He might be telling the truth: Googling him turns up his alter ego (the not very creative “Shadow”) and Shadows [sic] Government, where he wrote up his planned social experiment. He also offers IT security services and website management. He says he wondered about the hospital’s security when he was a patient a year ago and found that he had free run of the place – including computers and paper patient records – since the hospital had no security officers on duty. Knisely (or is that Shadow?) says his legal research indicates that he broke no laws, an interpretation not shared by officers who locked him up for impersonation, theft by deception, and receiving stolen property.

Vince and Elise introduce their “Rating the Ratings” series and offer one last chance to providers who have read or contributed to a report from KLAS, Black Book, etc. to complete my survey for future installments.

Sponsor Updates

• Experian Health will exhibit at the Illinois Rural Health Association Annual Education Conference August 10-11 in Effingham.
• PatientMatters will exhibit at HFMA Arkansas: Summer Institute August 17-19 in Hot Springs.
• The SSI Group will exhibit at the OASCA Annual Conference and Trade Show August 11-12 in Portland.
• Stanson Health enables provider compliance with the PAMA imaging clinical decision support mandate.
• VisionWare achieves Microsoft Gold Partner status.
• Huron Consulting Group closes its acquisition of HSM Consulting.
• ZirMed will host its 2016 User Group August 22-23 in Chicago.

Blog Posts

• Understanding an Overlay (PatientKeeper)
• Perinatal Nursing & Technology: Time to Accept & Embrace the Challenge (PeriGen)
• How all the King’s Horses and all the King’s Men Were Given One Single, Bundled Payment to Put Humpty Together Again (PMD)
• User Group Season Kicks Off: Upcoming Events and Conferences (Surescripts)
• Healthcare — today’s biggest ransomware target (Iatric Systems)
• 5 Tips from the Trenches: Best Practices for HEDIS 2017 (Verisk Health)
• Work and play, the Voalte way. (Voalte)

Contacts

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

Morning Headlines 8/5/16

Advocate Health Care Settles Potential HIPAA Penalties for $5.55 Million

Advocate Health Care (IL) will pay a $5.5 million HIPAA settlement, the largest in history, stemming from three separate breaches in 2013 that collectively compromised four million patient records.

Cerner Q2 2016 Results – Earnings Call Transcript

In its earnings call, Cerner President Zane Burke reports that 34 percent of sales came from outside the Millennium client base.

SA govt settles unlicensed software lawsuit

In Australian, the government settles a lawsuit brought by patient administration software vendor Global Health, which filed the suit because the government has refused to stop using its legacy software in a dozen public hospitals due to unexpected delays in its Allscripts Sunrise implementation.

Strengthening Research through Data Sharing

Senator Elizabeth Warren (D-MA) publishes an article in NEJM calling for more data sharing in the medical research community, backing a proposal that would require data sharing as a condition of publication in major medical journals.

News 8/5/16

Top News

Advocate Health Care Network (IL) will pay $5.55 million to settle HIPAA charges involving three 2013 breaches in its medical group. OCR found that Advocate failed to perform risk assessments, didn’t limit access to its data center, and failed to encrypt a laptop that was stolen from an unlocked vehicle.

Advocate reported three breaches over just a few weeks in late 2013:

• The theft of four desktops containing the PHI of 4 million people from an office building.
• The breach of the network of business associate Blackhawk Consulting Group involving 2,000 patients.
• The theft of an unencrypted containing the information of 2,000 patients.

Reader Comments

From Davadora: “Re: ER holiday shift coverage scam. My daughter was rushed to an in-network ED on Christmas morning. The doctor was not in in network and will not honor any discounts negotiated by my payer. A quick check finds that the provider accepts only one insurance and it’s not even a national one. Could it be a thing that doctors troll for holiday ER shifts to bill out of network?” It’s a patient-unfriendly healthcare system when doctors bill separately from the hospitals from which they provide services and where insurance companies penalize patients who don’t have a choice, leaving patients who by definition are unwell to sort it out instead of focusing on their own medical situation.

From FlyOnTheWall: “Re: Caradigm. Let 30 percent of their workforce go Wednesday.” Unverified. I’ve asked the company to comment but haven’t heard back.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mrs. B from North Carolina, who asked for science activity tubs for her first graders. She reports, “The great thing about these kits is the simple fact that I can use them over and over for classes in the future. We are moving into landforms and characteristics of our Earth. It was great to get a solid foundation about what the Earth is made of. Thank you so much for supplying the funds needed to purchase the materials. I wish I could list everything we were able to do with them. Just know that your donation did not go to waste! You may have sparked a new generation of Earth Scientists.”

This week on HIStalk Practice: Anonymous administrator shares practice’s cybersecurity journey. Healthstar Physicians selects population health management services from Transcend. X-Ray Associates of New Mexico goes live on MedInformatix RIS. The nation’s second-largest school district pilots telemedicine technology. Astellas Pharma, Matter Chicago team up for cancer care innovation competition. Ohio launches $60 million+ CPC program. Stealth startup 98point6 raises $11 million. Nicole Hartung, MD of Minnesota Oncology shares best practices for engaging physicians in OCM-required care redesign.

This week on HIStalk Connect: PerfectServe CEO Terry Edwards weighs in on the Joint Commission’s waffling on texting of orders. Behavioral health company Big Health raises $12 million. Fitbit entices Adam Pelligrini away from Walgreens. IBeat secures $1.5 million.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

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

Acquisitions, Funding, Business, and Stock

Video visit provider Teladoc reports Q2 results: revenue up 45 percent, EPS $0.38 vs. –$7.20, exceeding earnings expectations but falling short on revenue. TDOC shares dropped sharply on the announcement and have shed 47 percent since the company’s first-day IPO close in July 2015.

Analytics vendor Inovalon reports Q2 results: revenue up 5 percent, adjusted EPS $0.14 vs. $0.18, meeting earnings expectations but falling short on revenue.  Shares dropped sharply Thursday and are down 25 percent in the past year, valuing the company at $2.25 billion.

Allscripts reports Q2 results: revenue up 10 percent, EPS –$0.05 vs. $0.01, meeting earnings expectations but falling short on revenue.

From the Cerner earnings call:

• President Zane Burke reports that 34 percent of sales came from outside the Millennium client base, which he attributes to an active replacement market and success against Epic.
• The HealtheIntent population health management solution has been purchased by more than 100 clients.
• Burke says of Cerner’s small-hospital CommunityWorks service in apparently calling out Athenahealth, “A recent noteworthy win for CommunityWorks was the displacement of a failed attempted go-live by a cloud-based vendor that has been making a push in recent years to expand from the ambulatory market to hospitals. We have several active opportunities to displace this same competitor in both ambulatory and small-hospital settings, suggesting their approach of spending about three times as much on much sales and marketing as they do on research and development may not be the most effective approach for their clients.”
• The company sold two PHM deals of over $5 million.
• A new children’s hospital in Dubai was scheduled to implement Epic, but moved to Cerner because of the ITWorks IT management service.
• CFO Mark Naughton says of clients who had already notified Siemens that they were dropping their systems before Cerner acquired the company, “Every one of those is still writing me their monthly check or owes me their monthly check for their contract duration, which can extend anywhere from three to five more years.”
• Only 25 percent of customers have bought Revenue Cycle, which the company sees as an ongoing opportunity.

In Australia, software vendor Global Health settles its lawsuits with SA Health over the health department’s continued use of its 1980-era Chiron patient management software as its last remaining user. SA Health will pay $3.8 million for a five-year license, about the same annual fee it was paying before Global Health refused to extend its support agreement in insisting that the product was dead. SA Health wants to keep using the system due to delays in the EPAS Allscripts Sunrise Clinical Manager rollout at Royal Adelaide Hospital.

Elation Health, which offers a $299 per provider per month EHR, raises $15 million.

Sales

Wake Radiology (NC) chooses the Vitality IQ imaging practice management tools from Vital Images.

OptumCare signs a 10-year deal to deploy Allscripts Touchworks to its physician practices.

People

Ray Wolf (Redirect Health) joins Lumeris as SVP of architecture and innovation.

Announcements and Implementations

Peer60’s new report, “Health System Brand Reputation,” looks at which health systems C-level healthcare executives recognize most for quality, innovation, and overall brand reputation. Mayo Clinic and Kaiser Permanente scored highest on public presence, but Johns Hopkins and Cleveland Clinic have the best overall reputations.

Athenahealth alerts its Miami-area customers that 1,800 of their patients are at risk for Zika virus infection based on CDC guidelines, most of them at a single health care center. 

In Australia, SA Health wins a government innovation award for its use of healthcare integration technology from InterSystems.

IDS will incorporate SyTrue’s NLP OS natural language processing system into its Voice2Dox speech-powered clinical reporting platform.

The Sequoia Project validates ZeOmega’s Jive HIE Connect for use on the eHealth Exchange.

Privacy and Security

Banner Health (AZ) notifies 3.7 million people that its food and beverage systems were breached by a hacker in June, exposing patient and credit card information.

A former clerk of Tampa General Hospital (FL) is sentenced to three years in prison for using the computer information of 644 patients to file false tax returns that earned her refunds totaling $77,000. She also sold some of the information to others.

Innovation and Research

Drone delivery vendor Zipline announces plans to begin delivery of medical supplies to remote areas of Maryland, Nevada, and Washington within a year. The company’s 22-pound, GPS-directed drones can carry three pounds of blood products and supplies that hospitals order via text message, with delivery within 30 minutes by parachute drop.

A study finds that hospitals that send the most heart attack and heart failure patients to the ICU have lower quality and worse outcomes, suggesting that the purpose of ICUs is ill-defined and may be driven by non-clinical factors.

Other

A NEJM opinion piece by Senator Elizabeth Warren (D-MA) on the contentious issue of requiring researchers to share their study data calls for more openness. She recommends:

• Medical journals should require researchers to share the de-identified patient they used along with their article submission.
• The government should enforce FDA’s requirement that researchers register their clinical trials via ClinicalTrials.gov.
• Researchers should include their plans for sharing data when registering their study.
• Clinical trial sponsors should mandate data-sharing in their contracts, with the grant recipient being responsible for covering the costs from their award.
• The medical community should find ways to share results from failed trials, which can have significant scientific impact yet are rarely published. 

Eastern Maine Healthcare Systems lays off 35 of the IT department’s 300 employees as the department tries to cut its budget by $3 million.  The department eliminated 43 jobs in 2014.

In England, Burton’s Queen’s Hospital takes six years to finally go live on an unnamed, $2 million patient records system.

GE CEO Jeff Immelt makes some refreshingly frank comments in an interview with Vanity Fair:

• He says the company’s diversification strategy made sense in the 1980s and 1990s when GDP growth was 4 percent, but now, “If I would go out today and say, ‘Guess what? I have a great idea. We’re going to buy a media company,’ I’d get shot. Or if I were to say to you, ‘Hey, look, I was really great at picking jet engines and picking TV shows’—that’s complete bull, really.”
• He says GE will apply Internet of Things information to improve industrial operations in ways software companies can’t.
• Immelt says every new GE employee will “learn to code …  whether they join in finance or IT or marketing, they’re going to code.” He’s hoping to create programming and data scientist jobs for employees who have an associate’s degree only.
• Asked about GE’s succession planning, he says, “In some ways, we are working on succession all the time. You don’t become CEO for what you know. You become CEO for how fast we think you can learn. There’s a whole bunch of things that go into it. How fast can they learn? How resilient are they? How competitive are they? Those are things that really put you in good stead.”

A study of users of the free digital advance planning tool MyDirectives finds that people can do a better job specifying their own wishes via an electronic interview rather than checking off items on a paper form. The stored advance directives can be looked up by doctors and hospitals and users can even add a video statement via the company’s mobile app. The company makes money by charging health plans for storing the emergency care plans of their members, charging providers and health IT vendors to access the database, and selling de-identified data to third parties.

The CNN journalism cesspool doesn’t appreciate the irony of placing a story about Facebook’s crackdown on clickbait headlines among its own non-newsworthy clickbait headlines.

Sponsor Updates

• Intelligent Medical Objects and Obix Perinatal Data Systems will exhibit at the Allscripts Client Experience August 9-11 in Las Vegas.
• PDR and Navicure will exhibit at the Greenway Engage user conference August 10-13 in Atlanta.
• MedData VP of Human Resources Barb Astler is named a finalist for the Crain’s Archer HR Executive of the Year award.
• Netsmart will exhibit at the MHCAR Annual BH Institute August 9 in Hot Springs, AR.
• Nordic will sponsor the Collaboration of Revenue Cycle Epic Users Conference August 10-12 in Portland.
• Elsevier Clinical Solutions, Galen Healthcare Solutions, and Healthwise will exhibit at the Allscripts Client Experience August 9-11 in Las Vegas.
• Ninety-nine FormFast customers are named to the 2016 Most Wired list.
• GE Healthcare President and CEO John Flannery continues his LinkedIn series on “The Top 10 Reasons Transformation is the New Normal for Healthcare.”
• Healthfinch CEO and co-founder Jonathan Baran joins the Young Entrepreneur Council.

Blog Posts

• Preparing for Epic implementation: Your go-live playbook [podcast] (Nordic)
• CMS’ Mandatory AMI Bundle is Cause for Chest Pain (ECG Management Consultants)
• 4 Ways to Lower Cost-per-Acquisition (Evariant)
• Top 5 Tips to Prepare for EMR Data Archival (Galen Healthcare Solutions)
• Things to Consider When Selecting a Healthcare IT Vendor (Hayes Management Consultants)
• When Hospital Leaders Say, “Just fill those open CDI positions!” (HCTec)
• Don’t want to lose patients? Here’s how IT can improve price transparency. (Advisory Board)
• 8 Ways to Make Breach Notification Letters Effective (ID Experts)
• Building New Healthcare Facilities: Connected, Smart, Efficient, Flexible and Secure (Impact Advisors)
• 5 Keys to a Successful Healthcare IT RFP (Influence Health)
• Pharma Lifecycle Plagued with Integration and Data Management Challenges (Part V – Sales and Marketing) (Liaison Healthcare)
• The next generation of Healthcare IT solutions must create value for the clinician (NVoq)
• Healthcare’s Partner for Clinical Communications (Spok)

Contacts

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

EPtalk by Dr. Jayne 8/4/16

Even though we’re 10 months past the compliance date, CMS keeps sending me ICD-10 updates. They’re promoting “official coding resources that can help you maintain your ICD-10 progress.” I’m not sure exactly how one wouldn’t maintain their ICD-10 progress unless (a) they started seeing workers’ compensation patients that are still billed under ICD-9; (b) they started a cash practice; (c) they just came back to work after an extended sabbatical; or (d) some other extenuating circumstance.

The links direct back to the ICD-10 home page, which is topped by a February blog post by Andy Slavitt. Current events, indeed. The email did feature these funny icons and the first thing that popped into my head looking at the bottom one was “Sergeant Swaddle.” Between that and the baby bump one, I think they need a better graphic designer.

In other news, CMS announced the regions for its Comprehensive Primary Care Plus (CPC+) initiative and opened the application cycle for practices that would like to participate. CPC+ starts in January 2017 and is a five-year primary care medical home model. Up to 5,000 practices will be selected (2,500 in each of two tracks) to participate. Fourteen regions were announced including some full states. They were selected based on “payer alignment and market density to ensure that CPC+ practices have sufficient payer supports to make fundamental changes in their primary care delivery.” A list of payers that have been provisionally selected to partner is found within the FAQ document.

Practices can apply until September 15, and those applying to Track 2 must have a letter of support from their health IT vendors that outlines vendor commitment to supporting via “advanced health IT capabilities.” CPC+ counts as an Advanced Alternative Payment Model for MACRA purposes, so I suspect there will be a lot of interest. Selected regions are:

• Arkansas
• Colorado
• Hawaii
• Greater Kansas City area (KS and MO)
• Michigan
• Montana
• New Jersey
• North Hudson-Capital Region (NY)
• Ohio (and Northern KY)
• Oklahoma
• Oregon
• Greater Philadelphia area
• Rhode Island
• Tennessee

CMS has definitely been busy this week, also releasing a proposed rule that expands bundled payments into the realm of cardiac care. It also extends the current bundled payment model for hip replacements to include other hip surgeries. The cardiac elements aim to increase the utilization of cardiac rehabilitation services, which have been shown to lead to better patient outcomes.

CMS isn’t the only government agency that’s been busy, though. The US Department of Agriculture will fund distance learning and telemedicine projects in 32 states, helping rural communities to connect with medical and substance abuse experts. USDA will award more than $23 million in grants to support 45 distance learning projects and 36 telemedicine projects. Eligible applicants include: most state and local governmental entities; federally-recognized Tribes; non-profits; for-profit businesses; and “consortia of eligible entities.” Sounds like pretty much everyone is fair game.

A colleague forwarded me an article describing an observational study that appears to show “no overall negative association” of EHR implementation on short-term inpatient mortality, adverse safety events, or readmissions. It looked at the Medicare population across 17 hospitals that had go-live dates during the observation period compared to 399 control hospitals. It just came out this week so it only has one comment on it, which interestingly comes from a physician practicing in the United Arab Emirates.

Federal statistical agencies use the Standard Occupational Classification SOC) code system to classify workers into occupational categories. I learned from an AMIA blast this week that there’s finally a code for many of us: Health Information Technology, Health Information Management, and Health Informatics Specialists and Analysts. Right now it’s just a proposal which will hopefully be released for use beginning in 2018.

I had to make a last-minute trip this week to replace a subcontractor who flaked out on me. It was bad enough that my entire week was going to be disrupted, but even more, I wasn’t thrilled about the $1,000 airfare, nor was I thrilled about having a Monday morning flight. The TSA recommendation for my airport right now is to arrive at least two hours early. The travel gods must have been smiling on me at least a little bit because I arrived at the airport to find exactly no one in the TSA pre-check line. It was a beautiful thing, even though I ended up with a flight delay.

My client was cool about the last-minute substitution. It turns out that she only sees patients until 2 p.m. each day. After that, the office becomes a ghost town, so I’ve been able to keep up with other client engagements and even made it to the beach briefly. There’s something about having sand between your toes to rejuvenate you.

What gives you a little boost? Email me.

Email Dr. Jayne.

Morning Headlines 8/4/16

Massive Cyber Attack at Banner Health Affects 3.7M Individuals

Banner Health (AZ) confirms that hackers gained access to a payment processing system used to process credit card transactions at food and beverage outlets across its facilities, compromising the information of 3.7 million individuals.

Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014

A national survey of seniors over 65 years old finds little growth in digital health adoption, including minimal gains in the percent of seniors using technology to fill prescriptions, communicate with a clinician,  search for health condition information, or manage health insurance issues.

CHS now selling 12 hospitals, two more than originally planned

Community Health Systems (TN) is negotiating the sale of 12 hospitals, two more than originally planned, which will bring it an expected $850 million in proceeds.

Drones will begin delivering blood and medicine in the US

Zipline, a startup using drones to deliver medicine and blood in remote areas of Rwanda, is launching a similar program in the US that will bring drone delivery to rural areas in Maryland, Nevada, and Washington.