News 7/1/16

Top News

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

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

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

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

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

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

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

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

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

I scoured the Web for how to secure RDP:

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

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

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

Government and Politics

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

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

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

Other

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 6/30/16

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 6/30/16

The Biggest Obstacle to the Health-Care Revolution

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

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

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

But seriously, why did Theranos have just one spokesperson?

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

Why there is no beta in health care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Change Your Change Management

Change Your Change Management
By Tyler Smith

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

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

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

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

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

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

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

Here are a few suggestions for moving forward:

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

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

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

Morning Headlines 6/29/16

About the Proposed Combination

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

Jeremy Hunt suggests second EU referendum

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

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

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

Patient Payment Responsibility up 13% in One Year

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

News 6/29/16

Top News

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

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

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

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

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

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

… but not the day after the transaction closes.

Your trivia questions for today:

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

People

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

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

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

Announcements and Implementations

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

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

Government and Politics

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

Privacy and Security

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

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

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

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

Technology

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

McKesson Spins Off Its Technology Solutions Business with Change Healthcare

McKesson announced this morning that it will move its Technology Solutions business into a new company that it will co-own with Change Healthcare (the former Emdeon), with plans to take the new company public sometime in 2017.

McKesson Chairman and CEO John Hammergren said in statement, “This is a bold, innovative transaction that creates a company with an enhanced ability to help customers address their increasingly complex financial and clinical challenges. The new company will establish a more efficient suite of end-to-end payment and claims solutions, as well as clinical capabilities, while unlocking the value of our MTS businesses in a tax-efficient manner. We look forward to partnering with Change Healthcare’s management team and employees to create this new enterprise and to help customers reduce complexity, lower costs, and ultimately provide better care.”

McKesson will receive cash proceeds of $1.25 billion and will own 70 percent of the separate company. Change Healthcare, which is contributing all of its assets except for some minor pharmacy components to the new company, will get $1.75 billion in cash and a 30 percent ownership stake.

McKesson will retain its RelayHealth Pharmacy business. It will also keep its Enterprise Information Solutions division, but will “explore strategic alternatives” for that product line. That means that McKesson’s go-forward hospital information system, Paragon, is up for grabs.

McKesson’s John Hammergren will serve as chairman of the new company, while Change Healthcare President and CEO Neil de Crescenzo will become CEO.

The new company will take on $6.1 billion in debt to fund the transaction, of which $2.7 billion will be used to pay down existing Change Healthcare debt.

Morning Headlines 6/28/16

Medtronic to Buy HeartWare for $1.1 Billion

Medtronic will pay $1.1 billion for ventricular assistant device manufacturer HeartWare. The deal, which is worth $58 per share, represents a 93 percent premium on closing prices Friday.

Our Comments on the Proposed MACRA Regulations: MIPS and AAPMs

Aledade, the startup of former national coordinator Farzad Mostashari, MD submits comments on the proposed MIPS and AAPM rule.

In healthcare, we’re flying blind

Jonathan Bush discusses the impact disconnected systems and missing patient data has on physician workflow, noting that analysis of Athena data has revealed the average provider has to “chase down 35 missing lab results, 18 missing imaging results, and 12 missing specialty referrals” per month.

Curbside Consult with Dr. Jayne 6/27/16

I’m having a little bit of professional déjà vu this week. I originally started working in healthcare informatics somewhat by coincidence. I was working for a group that wanted someone to test-drive an electronic health record for the practice, and since I was relatively new and didn’t have a large patient backlog, I volunteered. Little did I know that it would eventually grow into a full-time career in informatics.

After my time piloting the EHR (which turned out to be a total mess of a system), I was asked to participate in the search process for a replacement. When they selected a system and were looking for a medical director to oversee the EHR project from a clinical perspective, I threw my hat into the ring.

It started as a half-day a week, which was compatible with managing a full-time practice. As the project ramped up, it became a full day a week, which was still doable, but once they wanted me on the EHR project half time, I knew I would have to do something different about my office practice. I contracted with a nurse practitioner to help me co-manage my patient panel.

That worked for a while until the informatics work began to take even more of my time. Eventually I was only in the office one day a week, which created an unsatisfying situation for everyone. Patients weren’t happy that they couldn’t get in to see me. Since I had previously run an open access practice, they were used to same-day attention.

Some of the patients resented the involvement of the nurse practitioner since, in my part of the country, this was well before the concept of “team-based care” started taking root. Those patients felt that if they didn’t get to see the physician, they were somehow being shortchanged. It didn’t seem to matter whether it was an acute visit or whether it was a chronic condition that we were managing through a comprehensive plan of care. The bottom line was that they weren’t getting to see me, and eventually it reached a point where I felt like I was unable to give good care.

At that point, I went to informatics full time, cobbling together enough clinical work to keep the licensing folks convinced that I was in “continuous practice” as required in my state. It’s not entirely clear what happens when you have a lapse in practice, but I wasn’t willing to find out.

Sometimes I covered my former clinical partners in the office when someone was out, seeing acute visits or functioning in a locum tenens capacity. It was a little unpredictable, so I started doing more locum type work and working with some other groups, eventually working my way towards emergency and urgent care practice.

I’ve been in that space (with the occasional stint in a “traditional” primary care setting) for nearly a decade now. While staying on with the health system, I worked in their emergency departments both as an employee and as a contractor. After some changes in their clinical staffing, I bounced around a little until I wound up in my current clinical situation.

I’ve been working with this group for over a year and it’s been an interesting journey. The group is growing by leaps and bounds. The managing partners know that clinical informatics is my full-time gig, so they’re flexible with my work assignments, which is good.

I only had one near-miss with my consulting travel when I had a serious flight delay and wasn’t sure I’d be home to work my shift, but my colleagues were very understanding and were ready to back me up if I didn’t make it. It was a nice feeling since being a part-timer sometimes doesn’t lead to those kinds of relationships. Maybe it’s because they’re just nice people, or maybe it’s because I work a fair number of “undesirable” shifts (weekends and holidays) and they’re grateful. The rest of the physicians and staff know that I have a full-time job elsewhere and are always interested to hear my tales from the consulting trenches.

It’s been a little odd, though, because I have no real leadership or management role and I’m used to working in that capacity. They’ve tried to get me to move into a more permanent role a couple of times, but I haven’t been ready to just yet. Part of the reason is that I’ve been trying to build my consulting practice, but part of it is that I simply am not a fan of 12-hour clinical shifts and that was part of the role.

Recently, though, as the practice has grown, they’ve shown more interest in having someone with a solid informatics background take over that part of the administrative tasks. When they came to me recently with an ask to devote “just a half-day a week” to the EHR and its related operational and clinical impacts, I found myself unable to say no.

Although the pay is less than I’d typically make consulting, it’s nice to have 10 percent of your work hours accounted for without having to try too hard. Not having to write project proposals, do accounting and hours tracking, and deal with the payroll and task aspects balances out the relative loss of income. There’s also the intangible feeling of knowing that my work is making a difference in the grand scheme of things rather than just being an informaticist for hire. They’re willing to be flexible on the hours I spend with them given my travel schedule. Knowing the personalities of my employers, though, I can’t help but think that four hours a week is going to turn into something more.

One of my favorite books to read to my nephew involves a mouse who wants a cookie. When he gets it, he asks for a glass of milk. When he gets the milk, he’ll probably want a straw, and then a napkin, and so on. If you give a clinical informaticist four hours a week…. You never know what might happen. I do hope it involves cookies, though.

Email Dr. Jayne.

HIStalk Interviews Steven Liu, MD, Chief Medical Officer, Ingenious Med

Steven Liu, MD is founder and chief medical officer of Ingenious Med of Atlanta, GA.

Tell me about yourself and the company.

I’m the chief medical officer and founder of Ingenious Med, going back to 1999. I’m also a practicing physician. I started the company as a solution to help me as a clinician manage the practice and to capture charges and data.

Since we last talked in our interview four years ago, we’ve gotten way bigger and moved toward what we call the Right Side of Healthcare. We’re focused on helping clinicians change their behavior. We’re focused on cost reduction.

Describe the day in the life of a physician interacting with your system.

The platform is cloud- and mobile-based. We’ve moved outside of just physicians, which used to be our bread and butter. Now it’s physicians and the care team members who surround them — nurses, case managers, pharmacy, whoever. We have a heavy emphasis on the acute care space, the hospital space, where there’s a large part of cost.

The world is different these days. Clinicians have wear two hats. They have to put on the hat for their practice. But then they put on a second hat after they take care of the practice and do pro fees and work capture if they’re at risk. Then they focus on those other incentives to line up with their healthcare system — hospital throughput, transition, reducing readmission, and reducing avoidable days. All of those cost and quality things that weren’t front and center in traditional reimbursement schemes.

At the point of care, they use us on every single patient. We whisper back information, things that will change their behavior and make the entire acute care process more efficient. The results we’re getting are driving a lot of our growth these days.

People who work in academic medical centers sometimes forget that most of the non-hospitalist doctors in community hospitals work in their own practices and spend minimal time in hospitals, sometimes in more than one hospital using more than one information system. How hard is it to integrate those doctors with hospital-based care teams?

That’s part of our secret sauce. Because of our roots from way back when the majority of clinicians were affiliated — the employed drive hadn’t really taken off in the early 2000s — we grew our bones on affiliated private practice physicians. That’s how we got a great footprint. About five years ago, we started to become involved with enterprise enterprise rollouts with employed as well as affiliated physicians. The system was designed and being used by affiliated physicians.

You can think of us as a bridge. Alignment is a big focus of our company. The alignment is focused on the employed physicians, obviously, but the nice thing about it is that we’ve got the affiliated doctors.

I probably shouldn’t say this in this interview, but when we released our coordinated platform two years ago, I was trying to come up with brief wording on what to call it. I was saying, “It’s a clinician risk alignment platform” until someone pointed out that the acronym for that is CRAP. [laughs] I swear I didn’t catch that.

Still, that’s what it is. We’re agnostic to the EMR, sites, locations, and the employment model. We can change behavior.

It’s hard to get doctors to use something that doesn’t benefit them directly. What’s the “what’s in it for me” story for users?

Times are changing. A lot of people looked at us strangely when we said we can’t wait for MACRA, MIPS, and the drivers that are coming next year and in 2019.

As incentives change and people start to feel the pain, they have to align. Private physicians can’t keep their heads down and think of themselves as separate entities. To survive, especially for standalone practices, they’ve got to deliver on cost reductions and quality. Part of our platform is maximizing the revenue portion, but the other part addresses those other things like cost and bed days.

The conversations we’re having with clients or prospective clients are very much all about preparing for the new world of risk value-based reimbursement. All of our large enterprise deals are for what we do now, but also as they take on more risk contracts, all the stuff we’re doing with coordinate. They’re all preparing, although the industry is still moving slowly despite all this government push.

What is the low-hanging fruit of care team coordination?

One is alignment of incentives. If the hospital employs their physicians or if they have affiliations with practices, just based off their relationships with those physicians, the alignment incentives or reimbursement models that they have with those clinicians. If they’re not aligned and it’s straight, traditional fee-for-service, they’re not going to get the benefit. As long as the clinicians are aligned on reducing costs, being efficient, and having high quality, that’s a big, big one. It’s hard. It’s really hard.

Secondly, in the acute care space — even though that’s not where we primarily practice these days – it’s collaboration between disciplines. I’m not talking physician disciplines, but all the care team members. It’s still back in the Stone Age. When we go on site, sometimes there’s just no incentive for the physician to call up the case manager and spend an extra five minutes collaborating so they can get someone out safely that day as opposed to two days later.

There’s so much fat within the acute care space. A lot of people don’t realize it’s not a sunk cost. It really is a tremendous amount of inefficiency there that could be turned around.

You’ve had a long run with the company with changing technologies, getting funding, and bringing in new management. What are the top two or three lessons you’ve learned?

As the original founder, one learning point is that as the company grows, you need to grow with it. A lot of folks will be a little slow on the transition to bringing in senior talent, or in my case, bringing in a CEO to replace me, which I’ve done. We scaled and grew faster because we were able to split duties as we each focused on the important parts of the business that were critical to our success. That was one big one. If you can balance your ego for the bigger picture of the company, it’s so much more successful. You can grow faster and you have a broader talent base to execute.

Things change. The market changes. There’s a great saying: “If you’re coasting, you’re going downhill.” It’s so true. Innovation is a huge, huge part of being able to still kill it 15 or 16 years later.

It was probably right around when we had our last interview when we kicked off our next stage of innovation of, “How do we prepare for where the hockey puck is going?‘’ If it hadn’t been for that, we’d be in trouble. We would have a solution that was great that had great returns in the here and now, but wasn’t something that could also take the company to the next level as the world turned into value-based reform.

A constant focus on innovation and keeping an eye out for that. Innovation is hard. It’s not something that you can just pull out of the air and make happen. It is that right time, right place, and right mindset. Luck as well. We got lucky in a way and came up with a really wonderful solution.

You have health systems as investors. What value are health systems getting from creating their own venture funds or working with accelerators?

It makes sense. If you went to JP Morgan this year, every PowerPoint slide was about the incubators and investments the health systems are doing. It was more than I had ever seen. It’s a great idea. It helps them invest in technology they’re already interested in or are rolling out and to have an ability to influence it. 

We went through a majority recapitalization in October 2014 with North Bridge Growth Equity, but we ended up bringing in three other strategic investors — Ascension Health, Heritage Partners in Nashville, and Kaiser Ventures. What’s neat about it for companies is that you get to work with industry leaders. With the portfolio companies within those four investors, seven of the top 10 largest healthcare systems are investors within our company. We get to build for the nation’s largest healthcare systems. 

It’s great for us. Obviously you get contacts and many of them were already our clients, but it’s a great way for the healthcare systems that are investing to get exposed to transformative technologies that will help them pave their path to the new world, where it is a Wild West of technologies out there.

Do you have any final thoughts?

Our company has done well. We’ve really grown. We are used on one in five hospital admissions across the nation, so 20 percent of the nation’s hospitalized patients go through our system. It’s exciting to me because we’re whispering in the clinician’s ear at the point of care and influencing their behavior. It’s a responsibility, but also an opportunity to move the dial, change their behavior, and reduce cost.

I’m excited by the opportunity that I never imagined we would be given. We’re focused on all the things we could be doing to influence care. There’s nothing like being able to tell your employees that you might be able to change healthcare across the nation. It’s a fun and very stirring thing to be able to do. That’s what’s most exciting for me.

Morning Headlines 6/27/16

Ethical hacking at the DoD draws interest from HHS

HHS considers launching a hackathon that will pay hackers for discovering cyber vulnerabilities within the agency. The program would be modeled after the DoD’s recent pilot program “Hack the Pentagon.”

Medical Image Sharing | 2016

Peer60 publishes survey results on the medical image sharing industry, with respondents favoring cloud-based and site-to-site data sharing models.

Unexpected medical bills can cost American consumers thousands

PBS examines the problem of patients receiving bills from out-of-network specialists that delivered care during a hospitalization at an in network facility.

DaVincian Healthcare Nabs Overall Champion Award in Pymnts.com /Amazon Alexa Challenge

Austin, Tx-based digital health startup DaVincian Healthcare wins Amazon’s Alexa Challenge, a design contest launched to attract innovators to build new solutions for Amazon’s voice-command personal assistant. DavIncian entered a medication adherence solution that uses the platform to track prescription refills and connect patients, caregivers, and providers.

Monday Morning Update 6/27/16

Top News

HHS considers running an ethical hacking program to identify cybersecurity vulnerabilities, encouraged by results from the Pentagon’s recent pilot program. The concerns of such a program are that, (a) hackers would by definition be encouraged to seek exposed confidential patient information, and (b) they are likely to find a lot of it, thus requiring someone to take action.

“Hack the Pentagon” was the first bug bounty program run by the US government. It drew 1,410 participants this past April and May and paid $71,200 in bounties, or an average of $588 for each verified vulnerability. Most of the reported vulnerabilities involved cross-site scripting, but one participant discovered a significant SQL injection bug.

The DoD used the HackerOne bug bounty program that provides hacker invitations, a leaderboard, hacker messaging, payments, and workflow.

Reader Comments

From Venus de Milo: “Re: Epic’s new product name. Userweb shows a whole treat titled, ‘We are excited to announce Caboodle as the new name for Epic’s enterprise data warehouse.’” It’s a quirky name, but I like it. At least they don’t use eye-rollingly unoriginal names like Insight.

From Brownian Movement: “Re: Epic. The company forces the individual employees of consulting firms sign a non-compete directly with Epic. If you work for a consulting firm and have access to an Epic client’s system, you can’t work in software or sales for an Epic competitor for one year after leaving the consulting firm.” The non-compete agreement that Epic requires its own employees (and those of its customers) to sign is almost certainly not legally defensible, so it’s even more likely that such agreements signed by the employees of other companies couldn’t withstand a legal challenge. However, Epic’s industry clout and legendary legal firepower cause everybody to sign the paper anyway. Most of the griping happens only when someone wants to change jobs, but the sit-out period would be over before any expensive legal challenge could be completed. Think about Epic’s heavy-handed control – Epic’s new customers are required to let the company administer tests to their employees who want to work on their Epic project. Epic scores the tests secretly, providing only a hire/no hire recommendation. If you score well, you get to work on the Epic project team and thus get to retain your job. Score less well (by whatever standards Epic uses) and you’ll be banished to the legacy maintenance team with all the other rejects, thus assured of losing your job once Epic is live and your legacy system babysitting skills are no longer needed. It is reasonable to expect companies to stack the deck in favor of their own interests unless someone musters a challenge.

From Follow the Money: “Re: DOJ’s bust for a measly $900 million in Medicare fraudulent billing. Reminds me of a poem by James Roche.”

The Net Of Law

The net of law is spread so wide,
No sinner from its sweep may hide.
Its meshes are so fine and strong,
They take in every child of wrong.
O wondrous web of mystery!
Big fish alone escape from thee!

From Stiffie: “Re: healthcare IT writers and reporters. I looked up their lightweight credentials and made you a table of who is out there dispensing analysis and advice.” I don’t necessarily agree since most publications simply rewrite press releases to resemble original reporting, so it would be a waste for them to hire someone with actual industry experience. If these folks can find and keep an executive-level audience, more power to them because it’s not easy.

HIStalk Announcements and Requests

Two-thirds of poll respondents disagree with the AMA’s opinion that technology reduces the efficiency of care delivery. Some of those respondents correctly noted that “efficiency” is in the eye of the beholder, whose personal data capture efforts might – like paying income taxes — detract from their own performance in deference to the greater good. New poll to your right or here: how would you characterize McKesson’s contribution to health IT?

Mrs. Riley’s Maryland second graders are using the 25 sets of headphones we provided in funding her DonorsChoose grant request to access Internet tools and educational games. They are less distracted by the noise of what other students are doing and she can differentiate the simultaneous activities being pursued by her special education subgroups.

My WiFi range extender was performing erratically, so I replaced it with the $30 Netgear N300. You just plug it into a wall jack near the end of the wireless coverage range of your router, connect your smartphone or tablet to the newly created network (whose name, unless you change it, is your existing network’s name plus _EXT at the end), then enter the network password on the setup page.  I’m getting five bars and high speeds far from the router and it’s never hiccupped even once in several weeks. It’s a great solution for coverage problems (distant bedrooms, garage, workshop, or patio) or if you want to stream Netflix from a spot where coverage is too weak to support a high-quality picture. The little gadget even has an Ethernet port if you need to hardwire something.

Listening: Eye Empire, an apparently defunct band that offered the compelling combination of alt metal chops with understandable vocals rather than screaming and grunting, not that there’s anything wrong with that. For an even harder edge with a biker bar vibe (since they love featuring strippers in their videos), there’s always Southern hard rockers Texas Hippie Coalition, which sounds and looks like Charlie Daniels fronting Pantera.

Last Week’s Most Interesting News

• The newly installed president of the American Medical Association says his practice doesn’t use an EHR, preferring to pay the penalty rather than participate in Meaningful Use.
• An HHS OIG analysis finds that one-third of Medicare recipients were prescribed potentially addictive opioids last year at a cost of $4.1 billion.
• HHS credits analytics for helping it identify the 301 people it arrested for Medicare fraud.
• The VA continued its hints about eventually de-emphasizing or replacing of VistA in favor of a commercial product.
• McKesson is reportedly trying to sell its health IT business to Change Healthcare (the former Emdeon).
• A federal report recommends national quality reporting, real-time data sharing, use of best practices, and civilian-military cooperation in reducing 30,000 unnecessary trauma patient deaths each year.

Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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

Acquisitions, Funding, Business, and Stock

How health IT stocks performed in Friday’s Brexit-triggered selloff, which I expect to be reversed Monday as investors realize that several mechanisms exist to reverse the UK’s decision and that the timeline is long in any case:

Dow: down 3.4 percent
Nasdaq: down 4.1 percent
S&P 500: down 3.6 percent
Allscripts: down 2.7 percent
Athenahealth: down 0.8 percent
Cerner: down 3.1 percent
McKesson: down 3.8 percent
Quality Systems: down 3.1 percent

People

Paula McCann, VP/CIO of East Texas Medical Center Regional Healthcare System, is appointed to the Texas Health Services Authority board.

Rosanna Morris, RN, MBA, chief nursing officer and Epic EHR implementation co-leader of Nebraska Medicine, is named CEO of Beaumont Hospital (MI).

Announcements and Implementations

IDC Health releases yet another worthless health IT vendor revenue ranking with methodology unspecified. Assuming its information is correct – which I don’t when privately held companies are involved – I don’t know exactly what anyone would do with that information other than, (a) the PR people in companies named to the list who brag on the bestowment of questionable awards; and (b) the uncritical health IT rags that milked this anemic “news” for several paragraphs of slightly reworded press release text. As a customer, I wouldn’t necessarily be delighted that my vendor has more revenue than its competitors, especially if the portion I contributed wasn’t worth what I received in return. Bigger is definitely not associated with better. Perhaps it is appropriate that IDC in text messaging parlance stands for “I don’t care.”

Austin-based revenue cycle technology vendor DaVincian Healthcare, which has raised $50 million in funding, wins a contest for using Amazon’s Alexa to solve financial payments problems. The winning system allows patients to receive prescription refill reminders, ask questions about their prescriptions, and send messages to their providers. I think a lot of people are like me, though – I bought Alexa but never use it since the benefit is unclear if you’re already near a phone and I don’t really know what all it does since Amazon is cool like Apple in not providing a manual. It seems to be best suited for ordering even more stuff from Amazon. The video features a robotic phony doctor decked out in the obligatory scrubs, white coat, and the doctor ego elevation tool (a stethoscope) sitting in what looks like a spare bedroom in front of a desk full of books puzzlingly turned around backwards (they probably didn’t have any actual medical books handy). In fact, the windows in the doctor’s office look exactly like the ones in the patient’s living room and in his daughter’s house, so perhaps they all live together in Alexa-powered health IT communal bliss. Fun aside, it’s a nicely done video and the product is interesting if someone can validate the extent to which Alexa customers have integrated it into their daily lives.

Government and Politics

HHS names Aaron Miri, CIO and VP of government relations of Imprivata, as the privacy and security representative of the HIT Policy Committee. Appointed to the HIT Standards Committee are new members:

• Rajesh Dash, MD (Duke University School of Medicine)
• Kay Eron (Intel)
• Peter Johnson (retired)
• Kyle Meadors (Drummond Group)
• Terrence O’Malley, MD (Massachusetts General Hospital)
• Andrey Ostrovsky, MD (Care at Hand)
• Wanmei Ou (Oracle)
• Larry Wolf (Strategic Health Network)

In Australia, the CIO of Queensland Health and CEO of eHealth Queensland resigns after just seven months on the job to take a private sector position. He was placed under investigation three weeks after taking the job following a nepotism complaint. He was hired by his wife, a Queensland Health executive.

China uses the death of a student from treatments he found from Internet searches to tighten the government’s control over the Internet, requiring search providers to censor “rumors, obscenities, pornography, violence, murder, terrorism, and other illegal information” along with limiting the display of paid ads. That won’t affect Google, at least for the moment, since the Great Firewall has blocked it almost continuously in the years after the company declined to censor search results.

A Vermont citizen advocate wants to know, “What does Vermont have to show for its $50 million investment in VITL?” in referring to Vermont Information Technology Leaders. He questions why patients don’t own their data and claims that VITL’s contract with its technology vendor Medicity requires it to transfer all of its intellectual property and patient information to the company.

Privacy and Security

A newly signed Illinois law requires covered entities that report a data breach to OCR to also notify the state’s attorney general even if the incident doesn’t meet the state’s definition of a breach.

Technology

Here’s your “Jeopardy” question for the week. The answer is, “A study surprisingly finds that you really can go blind from playing with this in the dark.” The correct question: “What is a smartphone?”

Other

A Peer60 medical image sharing report finds that McKesson is leading in installations and recommendation scores, with LifeImage leading the pack by a wide margin among vendors being considered by first-time adopters. The least-desirable image sharing technology is, thankfully, CDs, while cloud networks toped the list and site-to-site sharing came in #2. The highest-risk vendors for replacement are Sectra and Philips, with their  biggest threat being customers who are pursuing a single-vendor strategy and superior technology.

PBS covers the ordeal of a heart bypass patient who verified that the hospital and surgeon accept his insurance, only to get stuck with a $2,200 bill from an ICU doctor who doesn’t. The patient asks reasonable questions of an unreasonable healthcare non-system: “Out of nowhere, somebody who you never heard of, I don’t remember meeting, sends a bill. Why is he not accepting the insurance?  Why is he out of network?” The answer isn’t so simple, of course – hospitals take hundreds of insurances whose coverage varies widely, with the real problem being that hospital bills aren’t all-inclusive even though you might logically wonder why not. The article profiles another patient who was left on the hook for a $5,000 out-of-network plastic surgeon’s bill after rushing to the ED with deep ankle cuts. The hospital answered the reporter’s inquiry with a dry, concise response: “The current system is not optimal.”

Sponsor Updates

• Sunquest will host the Tucson Cancer Regional Moonshot Summit on July 29.
• Craneware will exhibit at the HFMA ANI conference in Las Vegas this week and will co-present a session about pharmacy revenue integrity.
• Optimum Healthcare IT joins CHIME as a foundation partner.
• T-System celebrates 20 years of advancing care delivery and financial outcomes for EDs, freestanding emergency centers, and urgent care.
• ZDoggMD will make an appearance at TeleTracking’s annual conference, October 9-12 in Naples, FL.
• TierPoint is recognized in Gartner’s June 2016 “Magic Quadrant for Disaster Recovery as a Service” report.
• TransUnion, VitalWare, Huron Consulting Group, and Zynx Health will exhibit at the HFMA ANI Conference June 26-29 in Las Vegas.
• Valence Health Chief Strategy Officer Phil Kamp will speak at the HFMA ANI Conference June 26-29 in Las Vegas.
• Visage Imaging and Vital Images will exhibit at SIIM 2016 June 29-July 1 in Portland.
• Wellsoft EDIS publishes a new case study on its work with Kingston General and Hotel Dieu Hospitals.
• ZirMed client Baptist Health will share how it leveraged the company’s revenue cycle solutions at the HFMA ANI Conference June 26-29 in Las Vegas.

Blog Posts

• Clinical Alerting: Moving Beyond Nurse Call (Spok)
• Tips to Help Drive Your Population Health Journey and Avoid the Potholes (Verisk Health)
• Hospitals turn to Voalte for a communication do-over. (Voalte)
• Don’t Compromise Your Enterprise – Understanding the Role of Notifications in Your E9-1-1 Solution (West Corp.)
• Advanced Health Risk Assessments that Work (Xerox)

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 6/24/16

Andy Gurman, MD, Takes Reins as AMA President

Incoming AMA president Andrew Gurman, MD says that he has no EHR in his practice and prefers to take a penalty than participate in the Meaningful Use program.

Nearly 1 in 3 On Medicare Got Commonly Abused Opioids

A federal report finds that 12 million Medicare beneficiaries were prescribed opioids last year, at a cost of $4.1 billion.

Implementation Of Prescription Drug Monitoring Programs Associated With Reductions In Opioid-Related Death Rates

A Health Affairs study finds that prescription drug monitoring programs reduced opioid-related overdose deaths by 1.12 per 100,000 people in the year after implementation.

Statement of Dr. David Shulkin Undersecretary of Health Veterans Health Administration

VA Undersecretary of Health David Shulkin, MD says during testimony before the Senate Committee on Veterans Affairs that its EHR modernization plans are “not dependent on any particular EHR.”

News 6/24/16

Top News

The Justice Department charges 301 people (including 61 doctors, nurses, and other licensed professionals) with $900 million worth of Medicare fraud, with many of the cases involving prescription fraud and compounding pharmacies. HHS OIG credits its use of real-time billing data and analytics to identify outliers to investigate.

Reader Comments

From Caboodler: “Re: Epic. Just announced that their data warehouse product will be renamed from Star to Caboodle. This has got to be a new low in their ‘cute and clever’ naming convention.” Unverified, but I’ll be on the lookout for an accompanying product named Kit.

HIStalk Announcements and Requests

Mrs. Hendrickson says her Ohio middle school students are using the voice recorders we provided in funding her DonorsChoose grant request during “read to self” improvement time. She’s also sending the recordings home for the parents to review. She adds, “My students who struggled most seem to have made the most growth with the recorders.”

This week on HIStalk Practice: HHS announces $100 million in funding to help small practices with MACRA. Doctors Care becomes the first urgent care chain in South Carolina to offer telemedicine. American Well expands, welcomes new executive. PediaQ raises $4.5 million. FQHCs in West Virginia partner with Aledade to form a first-of-its-kind ACO. Eye Care Leaders Group gets into consulting. The Maryland Health Care Commission awards telemedicine grants to independent practices. Yard work inspires Dr. Gregg to coin the phrase “EHR litter.”

This week on HIStalk Connect: Samsung unveils its vision for Human-Centered IoT. Digital health insurance startup League raises $25 million. MassChallenge announces the $25.8 million Massachusetts Innovation Catalyst Fund. Online therapy provider Talkspace raises $15 million. Burner unveils a witty break-up app.

Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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

Acquisitions, Funding, Business, and Stock

Reflexion Health, which offers Microsoft Kinect-powered tele-rehabilitation software, raises $18 million in a Series B funding round, increasing its total to $30 million. It seems pretty cool, although basing a company on a consumer electronics gadget is risky, as those startups that built their business around Google Glass can attest.

Shares in Quality Systems (NextGen) hit their five-year low this week. Above is the one-year share price chart for QSII (blue, down 73 percent) vs. the Nasdaq (red, up 73 percent), with the company’s market cap at $726 million.

Sales

Eos Healthcare chooses the iTraycer medical device inventory management system from Jacksonville, FL-based Medical Tracking Solutions.

People

American Well promotes Jon Freshman to CTO.

Announcements and Implementations

Vital Images launches Version 7 of its Vitrea advanced visualization software that includes scalable deployment options, personalization, and standardized user interface across all modalities. Vitrea can also turn patient scans into 3D printing-ready files.

Visage Imaging releases new versions of its mobile apps for its enterprise imaging platform with enhancements that include barcode scanning, Touch ID fingerprint authentication, and multitasking views.

Six Sutter Health and Alameda Health hospitals in Northern California implement PreManage ED from Collective Medical Technologies to flag ED frequent flyer patients across their facilities. The Salt Lake City-based company’s real-time EDIE (Emergency Department Information Exchange) system has also been used in Oregon and Washington to reduce unnecessary ED visits.

Cedars-Sinai will offer discharged patients a ride home via HomeHero, a startup in the Cedars technology accelerator that claims to be “the #1 rated healthcare startup in the country.” HomeHero offers non-medical transportation and home assessments for $22 per hour, offering a customer app that allows choosing a provider and booking services in Los Angeles, San Francisco, and San Diego. The CEO’s failed previous venture was Flowtab, an app that connected bar patrons with the bartender for ordering and paying for drinks.

Experian Health announces new products that include Denials Workflow Manager, Compliance Manager, and Patient Financial Clearance.

Government and Politics

Medicare spent $4.1 billion last year to provide 12 million of its beneficiaries (one-third of Medicare recipients) with opioids such as OxyContin and fentanyl, with those patients averaging five such prescriptions filled. The AMA’s righteous indignation toward “digital snake oil” should perhaps be refocused on the free-wheeling prescribing of its members that is addicting and killing a lot more people than lame consumer apps.

Department of Veterans Affairs Under Secretary for Health David Shulkin MD says Wednesday in testimony to the Senate Committee on Veterans Affairs that the VA’s proposed digital health platform “is not dependent on any particular EHR” and that its VistA Evolution funding will deliver value “regardless of whether our path forward is to continue with VistA, a shift to a commercial EHR platform as DoD is doing, or some combination of both.” He adds that the Joint Legacy Viewer is a read-only connection between the VA and DoD systems, but eHMP (Enterprise Health Management Platform) will replace the 20-year-old CPRS as a provider point-of-care tool in 2017.

Other

An study finds that state-run prescription drug monitoring programs reduce opioid-related overdose deaths by 1.12 per 100,000 population. The authors note that West Virginia is the nation’s major outlier – despite implementing such a program in 2002, its overdose death rate is nearly twice as high as the next-highest state.

An interesting article by Mike Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health, observes the correlation between the decline in health of US citizens with their stagnant incomes in which the top 1 percent of earners have increased their annual wages 138 percent since 1979 while the bottom 90 percent had only a 15 percent increase in those 37 years, which is associated with an alarming disparity in survival. As is the case with most health measures, the US lags pitifully behind other high-income countries, coming in #43 in deaths of children under 5.

The European Union considers a law that would require companies to pay “electronic persons” social security taxes for robots they use. Governments are worried that such automation will raise unemployment, increase wealth inequality, and undermine employment-based social security programs.

The new president of the AMA says his orthopedic hand surgery practice doesn’t use an EHR, explaining that “I just take the [Meaningful Use] penalties.” I don’t see a website for his practice, either. As an orthopod, he’s probably not amused by the hilarious video above, although I shouldn’t generalize since the orthopedic surgeons I’ve known are among the most prolific jokesters about their profession. 

Sponsor Updates

• Ingenious Med, Leidos Health, and Navicure will exhibit at the HFMA ANI Conference June 26-29 in Las Vegas.
• PDR’s Jeffrey Wiltrout is recognized as a PM360 Elite Disrupter.
• LifeImage and National Decision Support Company will exhibit at SIIM 2016 June 29-July 1 in Portland.
• MedData is named a 2016 Top Workplaces, Workplace Achiever by The Cleveland Plain Dealer.
• T-System celebrates its 20-year anniversary as a leading provider of health IT solutions for episodic and emergency care this week.
• Meditech will exhibit at the Michigan Health & Hospital Association Annual Meeting June 29-July 1 on Mackinac Island, MI.
• Netsmart shares takeaways from its first annual Public Health Summit.
• Recondo Technology, Experian Health, Patientco, PatientMatters, Relay Health, and The SSI Group will exhibit at the HFMA ANI Conference June 26-29 in Las Vegas.
• Point-of-Care Partners expands its e-prescribing state law review resource to include new state mandates.
• Summit Healthcare supports Boys & Girls Clubs of Central Florida, this year’s recipient of the Heart of MUSE charity.

Blog Posts

• Medical Identity Theft: a Deadly Side Effect of Healthcare Data Breaches (ID Experts)
• Influencer Perspective: Slack Adoption (Influence Health)
• Why Time and Place Still Matter in a Connected World (InterSystems)
• Lunch with the Accountable Care Learning Collaborative (Medecision)
• Relieving the data and analytics pressure: 3 Nordic solutions (Nordic)
• Transparency: Shouldn’t Healthcare Consumers Enjoy It the Way Amazon Customers Do? (Orion Health)
• Sum-Sum-Summertime (PatientKeeper)
• Can the NHS go Paperless by 2020? (Lexmark)
• Single Sign-on Increases Security in Healthcare IT (Phynd Technologies)
• Why Analytics Training Should be Higher on Your Priority List (Sagacious Consultants)
• Operating at Peak Efficiency (Streamline Healthcare)

Contacts

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

EPtalk by Dr. Jayne 6/23/16

Lots of readers have written with their favorite travel stories in response to my recent post. Long lines at security checkpoints continue to lead the tales, with at least two readers noting trips where the TSA PreCheck lines were longer than the regular ones. Lots of people are frustrated with the summer surge in travelers, many of whom aren’t used to packing their liquids appropriately or getting rid of their drinks before trying to go through the scanners.

I have one friend with a pilot’s license who flies himself to jobs. I went with him once and have to say there’s something to be said about boarding at the local general aviation terminal and heading on your way. His company pays for the trips as long as they’re equivalent to the cost of a commercial ticket, but they did have to get a special waiver for insurance reasons.

I’m still waiting for my red-light ticket, which I imagine will come in four to six weeks once it makes its way through the rental car company data trail. I have a little bit of a bet with my partner, who thinks it will come much faster. Considering the wager, I’m optimistic that he’ll be reconciling the travel expenses this quarter instead of me. There’s always a chance I’ll get stuck with it again as well as having to pay the ticket, but where’s the fun in not taking advantage of a friendly wager?

It’s been a fairly low-key week and I’ve been glad to be working from my home office. It’s nice to have a 20-foot commute and be able to work in shorts and flip flops for a change. It’s also probably been good from a career preservation perspective since I’ve been on a lot of calls where had I been there in person, my facial leakage would probably have gotten me fired. Sometimes it’s the little things that just make you smirk uncontrollably. One of my consulting offerings is around conducting effective meetings and I’ve not only identified some candidates for additional services, but added some examples to my teaching arsenal.

I’ve mentioned before that I typically schedule 25- or 55-minute meetings rather than 30- or 60-minute meetings. This allows people to reset and recharge before the next meeting as well as clear the room and get organized. Of course, not everyone subscribes to that strategy which often leads to overlapping conference calls. It’s always awkward to come on the line in the middle of a call in progress, especially when all you were trying to do was arrive early so you would be prepared.

On one call this week, I arrived to find the moderator saying that, “It sounds like a couple of people here have a hard stop, so we’ll have to go ahead and end the meeting.” Yes, when your meeting time is up, it’s a good idea to end it regardless of whether everyone has a hard stop or not. Just because some people are willing to stay over doesn’t make it acceptable.

I also had so many calls that didn’t start on time that I started keeping a tally. The worst was a call that actually started 22 minutes into its allotted time. Although I hate wasting people’s time and money, as a consultant sometimes it’s my job to stay on the call until the client dismisses me. This one was particularly painful because it was scheduled to allow a prospective vendor to present its solution to my client. I had been engaged to help the client evaluate the solution since they’re a small practice and don’t have a lot of experience in this particular area. I’m certainly not impressed by a vendor that shows up late and isn’t prepared. I understand that sometimes inevitable things happen, but those are situations where one wants to call or text or do something to let people know you’re not just standing them up.

My other favorite is when people feel the need to make sure they say that the group is pausing for a “bio break” or a “coffee dump” or some other description of bodily functions. When did it stop being OK to simply say, “Let’s take a 10-minute break?” Do we have to discuss exactly what people are going to do during the intermission?

One of my calls this week was an all-day strategy meeting, which had several examples of restroom-related euphemisms. I was grateful, though, that it had a formal lunch break rather than a working lunch. Although my headset has enough range to get to the kitchen and make a sandwich or reheat some leftovers, I always worry that I will forget to put myself on mute. I was jealous though of the outstanding Texas barbecue that I knew was being eaten on the other end of the conference call. I had to be content with my chicken salad sandwich, but that’s how it goes.

I spent all day Tuesday creating recorded training materials for a client. They’re getting ready to migrate to a different EHR and ran out of steam in getting ready to train their end users. I long ago made my peace with Adobe Captivate and don’t mind doing the recordings, especially when it means not having to travel. They can be tedious at times, but fortunately the client realized that it’s still more efficient to hire someone to do it who has done hundreds of them rather than struggling trying to create them on their own. Fortunately, they had created most of the scripts and I just had to do some minimal polishing before digging in.

I also had the chance to attend a couple of educational webinars, which is a rare treat. They’re nice because I don’t have to present and can actually absorb information. Sometimes if I’m lucky and can plan enough in advance, I’ll hit the treadmill while I tune in, but that’s a rarity. This week I was able to catch up on some laundry folding and pack my suitcase while reinforcing my knowledge of MACRA and MIPS.

I’m back on the road in the morning for a quick proposal presentation to a prospective client, and as long as the travel gods are smiling, I’ll be home by dinner time. I hope they end up accepting it because they seem to be a really cool medical group that is already moving in the right direction but just needs a little boost. Those are my favorite kinds of clients, and the fact that they’re in a cool city doesn’t hurt.

What are your thoughts about the summer travel season? Where is your next great trip? Email me.

Email Dr. Jayne.

Morning Headlines 6/23/16

Justice Department Announces Biggest Medicare Fraud Crackdown

Federal agents have arrested 300 suspects in the largest ever crackdown on Medicare fraud, with suspected losses totaling $900 million.

Veterans Health Administration Review of Alleged Manipulation of Appointment Cancellations at VA Medical Center Houston, Texas

A VA OIG report finds that leadership at the Houston VA has been falsely reporting appointments cancelled by the clinic as patient requested cancellations. Investigators identified 223 appointments incorrectly reported as patient cancellations between July 2014 and June 2015.

Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care

A study published in Applied Clinical Informatics finds that 43 percent of primary care physicians use workarounds, rather than standard EHR functionality, to manage test results. Authors conclude that analyzing common workarounds in the clinical setting could lead to improved EHR design.

State Department eyes electronic health records

The US State Department has issued an RFI for a commercial EHR to support roughly 1,000 medical professionals along with diplomats and embassy personnel stationed at posts worldwide.