News 2/3/16

Top News

The White House will ask Congress to approve $1 billion for President Obama’s so-called “cancer moonshot.” Some of the areas to be funded within HHS are early detection via genomics, enhanced data sharing among institutions, and a virtual FDA Oncology Center of Excellence to review new combination products.

Reader Comments

From Judo Chop: “Re: Florida Hospital and Athenahealth. This is part of the December announcement by its parent company Adventist Health System selecting Athenahealth. Florida Hospital will replace a combination of Epic ambulatory EHR that’s used in a handful of clinics, Cerner ambulatory EHR, and Allscripts (the old Misys product) PM. Most of the rest of AHS is using NextGen’s EHR/PM.“ Adventist announced in December that it will be deploying Athenahealth’s PM/EHR to 1,600 employed physicians.

From Polecat: “Re: Meaningful Use hardship exception. The new form doesn’t even ask the EP or EH to submit documentation of their claimed reason.” Correct. I think we can assume that this wink-wink form means CMS will allow anyone to avoid EHR penalties. MU is an embarrassment to everyone involved at this point and even the government is trying to distance itself from it. Just check “EHR Certification/Vendor Issues” and you’re done.

HIStalk Announcements and Requests

Mrs. Haley from Georgia couldn’t wait to send photos of her special education and gifted students using the three tablets we provided in funding her DonorsChoose grant request. She took these photos the day they arrived, where she had already installed reading and testing apps.

Also checking in was Mrs. B from North Carolina, who just got word that we had funded her request for science activity tubs. She says, “I couldn’t believe the email I received with information about my project … I yelled out loud and other staff members came to my classroom to see what was going on … I try to purchase what I can, but it seems as if my money is not going very far these days. Thank you very much from the bottom of my heart. You have made one teacher very happy … You will never know if a future mineralogist, petrologist, or geologist will be inspired by these kits!”

I was thinking today: has anyone actually ever heeded the warning to, “If this is a medical emergency, hang up and dial 911” after hearing those boring, time-wasting phone tree warnings when calling everyone from a dermatologist to a drugstore?

HIStalkapalooza

HIStalkapalooza Sponsor Profile – Fujifilm

With 16 years of industry-leading experience, our TeraMedica division remains independently focused on advancing VNA technology and healthcare interoperability while now leveraging Fujifilm‘s clinical capabilities. As the centerpiece of Fujifilm’s comprehensive medical informatics portfolio, Synapse VNA provides the industry’s leading image management solution. Fujifilm is proud to sponsor HIStalkapalooza. Visit us during HIMSS16 for all your medical informatics requirements, Booth #1024.

HIStalkapalooza Sponsor Profile – PatientSafe Solutions

PatientSafe Solutions has mobilized clinicians and redefined clinical workflows for more than a decade. Meet our team in Booth #4257 to learn how our Clinical Communications platform improves patient care and satisfaction while decreasing costs. Meet us at HIMSS. Our team can’t wait for HIStalkapalooza this year. Look for us at the event to get your picture taken for the 2016 HIStalkapalooza video!

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Huron Consulting Group acquires 25-employee, Denver-based MyRounding, which offers a mobile rounding and survey tool for hospitals.

Aetna announces that its profit jumped 38 percent in the most recent quarter, mostly due to its Medicare and Medicaid business, but says it lost money on its exchange-issued policies and warns that it has “serious concerns about the sustainability of the public exchanges.”

Alphabet, the recently formed parent company of Google, surpasses Apple as the world’s most valuable company after reporting impressive numbers in its first detailed report. Alphabet made $4.9 billion in profit on $21.3 billion in revenue for the quarter. Share price jumped 8 percent on the news, raising the company’s market capitalization to $559 billion.

Sunquest parent Roper Technologies reports Q4 results: revenue flat, EPS $1.82 vs. $1.85, missing estimates for both and issuing 2016 guidance below expectations. The CEO said in the earnings call, “We think we will have mid-single digit organic growth in Medical throughout 2016 and we think that will get stronger as the year goes on. Sunquest has a number of version changes and software release updates that are rolling out in the second half that will be quite beneficial. And then Strata, Data Innovations, and SoftWriters which are growing rapidly, will become organic in the second half. Verathon and Northern Digital are going to continue to grow at a relatively high rate in 2016. And then we closed on January 7 the CliniSys acquisition in the UK, which is a European hospital laboratory software provider, and it will add to our acquisition sales growth in 2016.”

Machine learning vendor Digital Reasoning, which acquired Shareable on January 8 to create its healthcare business, raises $18.6 million, increasing its total to $53 million.

A New York Times article questions whether it was wise for the struggling Theranos to hire star litigator and company director David Boies as its legal representative, given that he would be representing Theranos management as a lawyer while his responsibility as a director is to the company’s shareholders. It concludes,

The potential for conflict is particularly great. What if Ms. Holmes resists changes that would be in the interest of shareholders? What if the board decides that it is time for her to go — and she stands her ground? The board could do little more than throw up its collective hands under the current governance structure. Mr. Boies and the other outside directors could resign in protest. But why would anyone, particularly Mr. Boies, be a director on a board that lacked the power to make fundamental changes? Indeed, what is Mr. Boies thinking? He may be paid lots of money for his roles, but for someone so successful and savvy to put himself in a position that is bound to be problematic is puzzling.

Meanwhile, Theranos finds another foot to shoot in indefinitely delaying its October promise to allow Cleveland Clinic to validate its technologies and insisting that it won’t publish anything about those technologies in peer-reviewed journals until it receives FDA approval for all 120 of its tests.

Sales

Joseph Brant Hospital (Ontario) chooses FDB MedsTracker MedRec for medication reconciliation.

Craneware signs a $7.5 million contract with an unnamed hospital operator.

People

Seattle Children’s Hospital (WA) names interim SVP/CIO Jeff Brown (Lawrence General Hospital) to the permanent role. He holds three master’s degrees in business administration, executive management, and health informatics.

Allscripts names Melinda Whittington (Kraft Foods Group) as CFO.

CareSync hires Russell Dumas (Napier HealthCare) as VP of clinical operations, David Antle (BobCAD-CAM) as VP of client services, and Teri Spencer (GTE Financial) as VP of human resources.

Cumberland Consulting Group hires Terrell Warnberg (QHR) as partner over its new performance improvement practice.

The Health Information Trust Alliance (HITRUST) appoints Epic President Carl Dvorak to its board and names David Muntz (GetWellNetwork) as senior advisor of public policy.

Athenahealh hires Prakash Khot (Kaseya) as CTO.

Laura Momplet, RN (Dignity Health) joins CTG as chief operations officer and chief clinical officer.

Employee health platform vendor Healthcare Interactive names John Capobianco (KickStart Partners) as president and chief marketing officer.

Announcements and Implementations

Craneware will offer patient payment plan technology from VestaCare with its medical necessity and price estimation products.

Premier announces that it will conduct Innovator Research using Medicare data from CMS’s Virtual Research Data Center. Premier’s research division will analyze episodes of care to identify best clinical practices for care improvement and cost reduction.

A Surescripts study of New York providers finds that 93 percent of pharmacies can receive electronic prescriptions for controlled substances while only 27 percent of prescribers have the technology to issue them. It also finds that 58 percent of prescribers are issuing electronic prescriptions in general. New York’s I-STOP law requires that all prescriptions be transmitted electronically by March 27, 2016, meaning a huge number of prescribers need to take action in the next seven weeks.

Government and Politics

New York Mayor Bill de Blasio hires a consulting firm to figure out what to do about the city’s 11-hospital Health + Hospitals Corporation, which despite extensive city support is expected to run a deficit of $2 billion within the next three years. The health system hopes to convince more patients with commercial insurance to use its facilities than those of its competitors, all of which have similar ambitions.

Privacy and Security

Australia’s Royal Melbourne Hospital says it hasn’t completely eradicated the Qbot malware that infected its Windows XP computers two weeks ago. The hospital says the virus mutated six times in a single day. The keystroke-capturing malware penetrated the hospital’s pathology computers via a Windows XP exploit, managing to evade detection by the hospital’s updated antivirus product.

Other

A study finds that mobile text messaging increases medication adherence rates in chronic disease patients from an assumed baseline of 50 percent to 68 percent, although the sites that are screaming this out as big news failed to note that:

• It’s a meta-analysis, meaning that instead of doing new research it just combines information from previously published studies.
• The studies it reviewed involved fewer than 3,000 patients combined.
• Texting results were measured only for a short duration.
• The studies relied on what patients said they did rather than measuring what they actually did.
• The text messaging in each study was not consistent as to frequency and style.

This is not newsworthy other than the fact that it was published in JAMA Internal Medicine, where it will reach a wide audience. It’s also surprising that the journal misspelled the name of the Johns Hopkins Bloomberg School of Public Health in its author affiliation section.

Duke University Health System (NC) reports making a record profit of $355 million for 2015, explaining that, “For the three or four years leading up to this past year, we had made a series of investments in facilities and information systems that helped to relieve capacity constraints limiting growth … With our new IT capabilities, we are able to better manage care across the spectrum and become more efficient in that way.” The system said it made a lot of money by buying up oncology practices to increase inpatient volume.

I received a survey link from HIMSS about its Learning Center, which sells thinly disguised advertising via its HIMSS Media business. Being a member of HIMSS means being inundated with its vendor-sponsored pitches, in this case disguised as “education,” where high-paying vendor members pay dearly to be hooked up with low-paying provider members in the “ladies drink free” business model. 

The Virginia Tech professor who led the study proving that the water in Flint, MI contains dangerous levels of lead says public science is broken as university faculty members are pressured to get funding and to become famous. He explains, “Where were we as academics for all this time before it became financially in our interest to help? … Science should be about pursuing the truth and helping people. If you’re doing it for any other reason, you really ought to question your motives … Everyone’s invested in just cranking out more crap papers … when you reach out to them, as I did with the Centers for Disease Control and Prevention, and they do not return your phone calls, they do not share data, they do not respond to FOIA … every single rock you turn over, something slimy comes out.”

A Congressional investigation finds that despite the patient-focused claims of since-fired Turing Pharmaceuticals CEO Martin Shkreli, the company was gloating with delight at the profits it would make by jacking up the price of ancient drug Daraprim by 50-fold.

Weird News Andy titles this sad story “Out of the frying pan and into the fryer.” A patient with mental illness jumps out of a moving ambulance while being transported from a hospital and is struck and killed by a driver who then fled the scene.

Sponsor Updates

• Catalyze co-founder and CEO Travis Good, MD will speak on “Excitement in Healthcare Regulation” at the 2016 Hosting Milestone Summit Series on February 4 in Las Vegas.
• Divurgent will attend the South Carolina HIMSS Networking Reception & Dinner February 4 in Columbia.
• FormFast gears up for HIMSS16.

Blog Posts

• Stop Leaking Revenue in your Private Practice; 3 Areas Where You’re Probably Losing Money (AdvancedMD)
• Your Medicare cost report as a source of additional revenue (Besler Consulting)
• New Year, New Security Posture: Top Defenses for 2016 (Burwood Group)
• Building a Culture of Physician Engagement in Population Health (Caradigm)
• CareSync Shares CCM Insights in Letter to Senate’s Chronic Care Working Group (CareSync)
• CodeMash 2016 (CoverMyMeds)
• Leaving No Stones Unturned – Post Live Revenue Challenges & Tools to Help (Culbert Healthcare Solutions)
• Top Ten Reasons Why Good People Quit (Direct Consulting Associates)
• Considering Optimization? Don’t forget about Chart Prep (Galen Healthcare Solutions)
• 11 Pitfalls of a System Conversion and How to Avoid Them (Hayes Management Consulting)
• The Three C’s of the Right Secure Text Messaging Solution (Spok)

Contacts

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

Morning Headlines 2/2/16

Athenahealth Names Prakash Khot as Chief Technology Officer

Athenahealth hires Prakash Khot as its new CTO. Khot was previously the CTO of Kaseya, and spent several years with Salesforce prior to that, where he rose to the position of SVP of Engineering, overseeing big data and analytics development.

American Heart Association, IBM Watson Health and Welltok Team Up to Transform Heart Health

American Heart Association announces a strategic partnership with IBM Watson and patient engagement vendor Welltok to develop employer-focused solutions to improve heart health.

Certification Frequency and Requirements for the Reporting of Quality Measures under CMS Programs; Extension of Comment Period

CMS issues a 15-day extension to the public comment period for its RFI seeking input on certification and testing of EHR products used for quality measure reporting.

Defining Value in Health Care: CMS Releases Updated Benchmarks for ACOs

Aledade publishes a blog analyzing the recent CMS update to ACO benchmarks.

Curbside Consult with Dr. Jayne 2/1/16

A wise man once told me to take as many business and finance classes as I could, even though I planned to go to medical school. That advice has served me well over the years, particularly as medicine has become more of a business and less of a calling.

Although my residency program provided solid education in practice management, it still didn’t fully prepare me to run my own solo practice. I was lucky to have some good advisors who could point me in the right direction and were willing to mentor me in learning more about healthcare economics.

As we move into the realm of value-based care, the ability to understand economics and finance will be critical for physicians and other care providers if they want to remain solvent. There has to be a return on investment — not only on technology and infrastructure expenditures, but also on staff.

The latter seems to be the hardest for some organizations to understand. I have worked with quite a few employers over the last several years that don’t have a working knowledge of productivity benchmarks. I’m not saying that everyone needs to go out to national sites and compare their staff right off the bat, but at a minimum, organizations should understand productivity within their own site, practice, or location. If they’re serious about operating in the value space, they’re going to have to get very cozy with benchmarking and determining the total cost of various episodes of care.

It’s hard to reconcile complaints about the EHR being too clicky or too cumbersome when you have physicians seeing dramatically different numbers of patients. I was recently at a site where providers were seeing 16 patients a day in the primary care setting. Personally, I haven’t seen that few patients since I was a first-year resident and still had to review every patient visit with a supervising physician. After getting them past their initial arguments about how their patients were sicker or more complex than anyone else’s, the physicians in question were eager to blame everything on the technology, when a careful review of their office process revealed otherwise.

I spent several days in the office observing workflows and what I saw was shocking. Staff were blatantly surfing the Internet on their phones and ignoring patient-related tasks that were waiting for their attention. The amount of gossip and chatter reminded me of a middle school lunch room.

The Hawthorne Effect poses that when people are observed, they change their behavior simply because they are being studied. I couldn’t help but think that if this is what they were doing in front of someone observing them, the amount of waste when they weren’t being observed might be staggering. And yet the physicians felt that they couldn’t give the staff any more work because they were “too busy” and therefore were taking on more non-value-added work for themselves, such as filling out forms and looking for missing lab results.

After documenting the current state thoroughly with not only summary statements but actual time studies, I presented my case to the physicians and practice managers. Generally, I expect a little push back, including concerns about being able to hire better staff or that staff will leave if they are confronted with a lack of productivity or with rising expectations.

This organization, however, had worked its way into a seriously co-dependent state, with the physicians mounting a strong defense of the status quo even though it was adding to their misery. They continued to blame the EHR and government mandates even when presented with data from high-functioning practices using the same EHR under the same government mandates. The practice’s leadership was unwilling to accept the possibility that the staff (and lack of management thereof) was a significant part of their problem even though it was directly impacting physician satisfaction and the bottom line.

After presentation of a proposed set of future state workflows, we had several hours of discussion. I used all my Jedi mind tricks, but was unable to get them to consensus around what needed to be done to take their practice to the next level. They have it in their minds that they want to achieve Level 3 Patient-Centered Medical Home recognition. How are they going to create a highly functional team care structure when they are unwilling to take the time to even discipline a staff that is obviously goofing off?

They also want to join an Accountable Care Organization because they’ve heard it’s the way of the future. Don’t get me started on changing your model of care just because you read somewhere that you should. Furthermore, if they’re not willing to address both staff and provider performance issues, how do they think they are going to use data to address patient compliance issues and drive outcomes?

Knowing that I was getting nowhere fast with the idea of practice accountability, I tried to appeal to their understanding of economics. We discussed the money they are losing by not making the most of their existing resources as well as the potential cost of hiring incremental resources to accomplish their goals. Again, they tried to throw the technology out as a cause, citing what they perceive as a high cost of ownership of their current client-server EHR.

One of the doctors mentioned that they were considering chucking the system in favor of the free online EHR that he saw an ad for in one of his journals. I asked how much they thought it would cost to migrate 10 years of data from their existing system to a new one and how much they might lose in the transition. It was clear that those thoughts had never crossed their mind.

I know they have at least a minimum desire to move to a better place. Otherwise, they would not have hired me to come in and do an assessment. I have to say, though, that I was grateful that my engagement with them only included the assessment and the creation of a report with basic findings, and not the actual optimization effort. Without committed leadership that “gets it,” they are doomed to stay right where they are.

Frankly, I don’t think I can handle another train wreck client right now. I know they’re going to push me to provide a proposal for the next phase, but I think I’m going to have to respectfully decline for my own sanity.

There is at least one health system in the area that is in acquisition mode. I wonder if this practice will become a potential target. Despite the mess they’re in, they have a fairly large patient base and a decent location. Stronger leadership with a better understanding of the big picture and a willingness to ruffle some feathers (if not getting rid of the chickens all together) could turn this into a much more successful situation.

Although some of the practice’s leadership thought I would be able to force change from the outside, I had told them that it rarely works that way and played out exactly as I had predicted. Unless they’re willing to give an outsider control of their staffing or are willing to take charge themselves, they’ll likely just keep running in circles. Worst case, they’ll run themselves into the ground if they attempt to do an EHR replacement no matter how “free” they think it is. I’ve never seen that turn out well despite the claims of the vendors.

What do you think about free EHRs? Email me.

Email Dr. Jayne.

HIStalk Interviews Marc Probst, VP/CIO, Intermountain Healthcare

Marc Probst is VP/CIO at Intermountain Healthcare of Salt Lake City, UT.

You have a history of speaking out about Meaningful Use. How has your opinion of it changed over the last several years?

Meaningful Use came out as a stimulus package. Did it stimulate the economy and health IT? It clearly did. If that was the plan, it was successful. Did it get more EHRs in physicians’ offices and in hospitals? It clearly did.

Did it move healthcare dramatically to lower costs, or even incrementally, to lower costs and higher quality? It has not. It has a long way to go, and because of the way we approached it, with check-the-box certification and achievement of Meaningful Use, it just didn’t deal with the underlying challenges of things like standards of interoperability.

The last point on that is simply how much money we’ve spent for the value that we’ve gotten. It’s minimal. All along, I felt we should have dealt with that and that’s why I’ve been so outspoken, a thorn, probably, in the side of my colleagues at ONC.

What was your reaction to Andy Slavitt’s remarks at the JP Morgan Health Care Conference, and then in the follow-up CMS blog?

On one hand, it’s disappointing because we’d like to see the end of Meaningful Use. I don’t speak for every CIO, but the ones I know were kind of excited to see it end. It wasn’t achieving necessarily all the objectives we want to achieve, so that was the negative.

The good side is that the national conversations picked up around what is the value of Meaningful Use and how the program should be changed to become more effective. I think that’s positive. The water under the bridge is how much money we’ve spent and the steps we’ve taken to this point.

The optimist in me things we’re going to have a good conversation about it. We’re going to talk a lot more about outcomes and how organizations can achieve outcomes that are better with technology. If properly done, properly incentivized by the government or not disincentivized by penalties, I think we can make some really important strides.

How would you like to see Meaningful Use transition into something truly beneficial?

I’d like to see it become outcomes-driven. If I can prove to you that I have lowered the incidence of diabetes or some of the clinical outcomes that are associated with diabetes because I’ve used information systems and data to do that, that’s a good thing. It lowers cost for the country and improves healthcare.

If we can do that with diabetes, let’s go to heart disease. Let’s go to incidence of jaundice in or around birth. There’s so many areas we could focus on, and if we turned it to that direction, you’re going to have clinicians and technologists working together to leverage these tools we’ve put in place to improve care and lower cost.

That ought to be our outcome, not whether or not we placed 60 or 90 percent of our orders through CPOE. If we can shift that conversation and then the incentives around that, I can just see massive innovation and much more benefit come out of these systems.

Intermountain is just over two years into its contract with Cerner. How is the partnership going?

It’s going very well. I think like every other organization, our very first go-live was a learning experience. Having to help physicians and other clinicians understand how to use the system was a tad painful. It wasn’t easy. We were Intermountain Healthcare. We thought we knew everything, but we had a few things we had to learn.

We did that last March. We went live with our first two facilities on clinical and rev cycle. That was two hospitals and about 20 clinics. Then we went live in late October with two more hospitals much larger in size, one of them our second-largest hospital.

Then probably 60 more clinics and rev cycle and everything surrounding it. That one went much better because we had learned so much from our first implementation and we’re now ready to go much more quickly. We’re going to probably bring up probably 12 to 15 more hospitals in 2016. We know how to do it better now, so I would say it’s going very well.

If you had to pinpoint one lesson learned that you’d like to share with other CIOs and IT teams, what would that be?

Adequate resources on the clinical side to help physicians adopt their work flows, without a doubt. It wasn’t technical issues. Technically, this thing went swimmingly. It’s all around adoption, use of the system, and changing work flows.

Did you bring in any consultants to help with those initial implementations?

The second one we did. The first one we did all on our own with Cerner’s help. The second one we brought in Leidos, primarily, to really help us get it done. They were very, very helpful. We’ll use them going forward.

What’s the biggest lesson you think your end users have learned or are in the process of learning?

Just how involved they have to be. You must have leadership on all levels. We’re divided into regions and then those regions have multiple facilities in them. That local leadership has to participate. This isn’t something that can be done to them. It has to be done with them. As they participate, our success rate goes way up.

What sort of ROI are you looking to get from your partnership with Cerner?

I don’t think any of us have fooled ourselves into thinking it’s going to be cheaper than our self-developed systems. What we’re getting with Cerner is a much more comprehensive solution. That’s been really positive.

Given that we’ve built systems very unique to the needs of Intermountain, our concern in transitioning to a system we didn’t build was, would we be able to retain that level of … I hate to use the word interoperability … tightness between what we’re doing from data analytics and what we’re trying to do from a process and workflow perspective to obtain those levels of best practice care and cost that Intermountain is known for. It’s actually what drove us to Cerner, because we thought we had a much better chance of doing it with them than we might with one of their competitors.

To date, that’s become much less of a concern. We’ve achieved a lot. We’ve done a lot of work in enhancing the core Cerner model system to have more of those capabilities, so I think our ROI is with this more comprehensive system and the greater amount of data that it provides.

We can go to the next level of best practice care. We don’t think we’ve gotten there. We think we can build in a lot more activity-based procedures and cost mechanisms so that we can even better understand where we’re spending money and where we can lower our costs and improve our quality. That’s really been our focus and that’s where we see the ROI.

The expense of doing something like this … did we lower IS costs or workforce costs? We haven’t really focused on that and we won’t. We know the benefit comes from providing better care and doing it at a cost that’s lower than what we’re doing today.

What is Intermountain looking to accomplish from a population health management standpoint this year?

We’re building a digital health strategy, and so this year we’ll be looking at how to engage patients with portals, mobile, that kind of thing. We’re really building out the strategy on how to do that. To suggest in 2016 we’ll accomplish a ton, I don’t think so. We’re just getting our ducks in a row this year as to how we’ll pull it off.

However, from the data side, we’re looking at understanding where our opportunities are around population health. How do we get to value-based payment and how do we contract with physicians that are going to be moving to population health and value-based care? We’re working with Cerner with HealtheIntent to support that exercise, but we’re also depending upon our legacy electronic data warehouse and traditional analytics.

What will you be looking at on the HIMSS show floor this year?

Security’s going to be a big issue. In fact, I just got out of a meeting to have this call, an all-day meeting that’s got some big players in town talking security.

Also, I think anything around population health and more visible things like portals, mobile, and wearables, that kind of thing. That’ll be pretty interesting to me.

Plus, I’m looking forward to connecting with old friends. I’ve been in the industry a long time and it’s a pretty small one, all things considered. It’s a great industry.

Morning Headlines 2/1/16

New Proposal to Give Providers and Employers Access to Information to Drive Quality and Patient Care Improvement

A proposed rule by CMS will allow qualified entities to sell de-identified Medicare and private payer claims data to providers, employers and other groups interested in using the data to support quality improvement projects.

Flint doctor used Epic Systems records to expose lead crisis

The pediatrician who brought the water crisis in Flint, MI credits EHRs for allowing her to quickly calculate the recent rise in lead poisoning among local children, noting “If we did not have Epic, if we did not have (EHRs), if we were still on paper, it would have taken forever to get these results.”

Meditech Form 10-K Annual Report

Meditech reports its 2015 year end results: total revenue was $475 million, down eight percent from 2014, driven down by decreased product revenue. Net income was $70 million.

Quality Systems Beats Q3 Earnings, Lags Revenue Estimates

Quality Systems, parent company of NextGen, reports Q3 results: revenue fell 1.6 percent to $117 million compared to the same quarter last year, adjusted EPS $0.16 vs. $0.16.

Monday Morning Update 2/1/16

Top News

CMS proposes a rule that would allow qualified entities – of which 13 have been approved so far — to provide or sell Medicare and private claims data to providers to support quality improvement. Only two of the qualified entities report provider performance nationally — Health Care Cost Institute and Amino. Physician practices (or employers paying for their services) would be able to review all-payer data for their patients.

Reader Comments

From Eddie T. Head: “Re: CHIME’s patient identifier challenge. A 100 percent match is unrealistic. Even in countries with a national medical identifier the accuracy is about 95 percent. The 100 percent goal will get in the way of creating a real solution nationwide.”

From AthenaAscending: “Re: Florida Hospital. Is replacing Epic’s PM/EHR with Athenahealth.” Unverified.

From Unintended Consequences: “Re: AGH in Pittsburgh. Its Epic acute go-live has created medical care havoc in peripheral LTAC and SNF facilities that had relied on Allscripts Sunrise for order entry and results retrieval. They are not on Epic and have resorted to a 1980s paper requisition and lab retrieval system. Doctors cannot see a list of their patients. AGH’s command team has informed doctors that stat orders must be called in and cases ordered as consultations won’t appear on the consultant’s patient list.” Unverified. 

HIStalk Announcements and Requests

A reader asked me to post a single summary of my unsuccessful quest to obtain an electronic copy of my hospital stay information, which I’ve done here.

A surprising 80 percent of poll respondents aren’t fans of the idea of the ONC-published EHR star rating that Congress is considering. Jacob Reider commented that it’s a terrible idea and is outside of the government’s role. Ross Koppel says summarizing complex systems with a single star rating is simplistic. Barbara Hillock thinks such ratings would be misleading since they would be driven by the expectations of customers who don’t always follow the vendor’s implementation recommendations. Meltoots commented that ONC and CMS need to stop getting in the way of patient care with new programs.

New poll to your right or here: how have recent statements from CMS affected your perception of HHS/CMS/ONC?

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

Mrs. Johnson from Illinois sent photos of her kindergarten class using the math tools we providing in funding her DonorsChoose grant request. She says, “It was so generous of you to help us succeed in getting some of the tools we need to make learning math engaging and fun! The look in these kids’ eyes when I tell them we have something new that will help us learn is motivation for me. I couldn’t have provided these materials on my own and appreciate the support you have given.”

Epic consulting firm BlueTree Network donated $1,000 to secure a spot at my CIO lunch at the HIMSS conference, which allowed me to fully fund these DonorsChoose teacher grant requests with the help of matching funds:

• Science activity tubs for Mrs. B’s first grade class in Richfield, NC.
• Three iPad Minis, cases, and a document camera for the second grade class of Mrs. Mann of West Newton, PA.
• Electricity and magnetism activity tubs for Ms. Anderson’s fourth grade class in Phoenix, AZ.
• Two Osmo gaming systems for Mrs. Boyd’s elementary school class in Chocowinity, NC.
• Three programmable robots and engineering components for the new middle school robotics club started by Mr. Rector in Beebe, AR.
• STEM challenge kits and for Mrs. May’s special education classes in Edgewater, FL.

HIStalkapalooza

I have received over 1,200 requests to attend HIStalkapalooza, so I’m closing signups Monday. Sign up now or never. I’ll be able to invite most of the people who signed up. We’ll be handling invitations, RSVPs, reminders, and electronic check-in through Eventbrite this time and I expect the invitation emails will go out this week. This is where the annoying part of throwing a free party begins as it does every year when I vow that this year’s event will be the last because of the time and energy it requires:

• People will email me asking if they can bring a guest. If you didn’t sign up your guest like the form clearly states, then they can’t come – it’s like going to an Adele concert or traveling on American Airlines –everybody needs a ticket, with the only difference being that HIStalkapalooza tickets are free.
• I’ll hear from folks who claim to be the most loyal and careful readers who swear they mysteriously missed the dozens of times I’ve provided signup instructions and wanted to be added after the fact. Sorry, no, it’s only a party and your life won’t be ruined if you miss it because you couldn’t follow the rules everybody else figured out.
• Vendor administrative assistants who don’t read HIStalk and who signed up bunches of their executives (who rarely actually show up) will start bugging us about why they haven’t received invitations. That’s actually already happened as the admin of one company keeps asking why her 23 executives haven’t been invited yet. This isn’t a company outing and we have more important things to do than swap party-related emails, so I’m hitting “delete” on those.

Last Week’s Most Interesting News

• CMS warns Theranos that its California lab practices are dangerous to patients and that it has 10 days to fix the problems or face suspension from Medicare.
• Leidos announces that it will acquire the IT business of Lockheed Martin for $5 billion.
• Cerner Chairman and CEO Neal Patterson notifies shareholders that he is being treated for soft tissue cancer.
• A Texas hospital regains access to its EHR after being locked out for more than a week by ransomware.
• Flint, MI-based Hurley Medical Center says it was hit by a cyberattack by hacker group Anonymous, which is protesting the city’s water crisis.
• Big Bucks Equals Big Interest in CHIME’s National Patient ID Challenge.
• McKesson’s Paragon Dilemma.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Capital BlueCross orders Theranos to stop performing blood draws in Capital’s storefront in Hampden Township, PA following a CMS investigation that found deficiencies in the California lab of Theranos that “pose immediate jeopardy to patient health and safety.”

Xerox will split itself into two companies, responding to pressure from activist investor Carl Icahn to separate its $11 billion document imaging business from its $7 billion business process outsourcing. Xerox, which acquired Affiliated Computer Services for $5.6 billion in 2010 and will now basically spin it back off, has 104,000 employees who will be part of the new BPO company. Xerox announced Q4 results with the announcement: revenue down 8 percent (its 15th consecutive quarter of declining sales), adjusted EPS $0.32 vs. $0.31, beating earnings expectations.

WeiserMazars acquires Lion & Company CPAs, which includes healthcare consulting among its offerings.

Quality Systems (NextGen) announces Q3 results: revenue down 1.7 percent, EPS $0.16 vs. $0.16, missing on revenue but beating on earnings. Shares dropped nearly 20 percent Friday on the news. Above is the one-year share price of QSII (blue, down 20.7 percent) vs. the Nasdaq (red, down 1.34 percent). Five-year performance looks a lot worse, as Quality Systems shares dropped 67 percent as the Nasdaq gained 67 percent.

The HCI Group acquires Houston-based Expert Technical Advisors.

Philadelphia-based orthopedic practice The Rothman Institute and the University of Virginia Health System participate in a $4 million funding round for Locus Health, a remote care management company of which both organizations are customers.

Meditech publishes its FY2015 annual report. Revenue was down 8 percent for the year (“primarily due to lower product bookings”) and net income dropped from $124 million to $70 million. Neil Pappalardo owns about $450 million worth of shares.  

Announcements and Implementations

Recondo Technology launches MySurePayHealth, which allows patients to estimate their out-of-pocket cost for a given procedure.

An emerging technology site profiles Valdic co-founder and CTO Drew Schiller as part of its “Today’s Entrepreneur” series, in which he lists his top three lessons learned:  (a) if someone isn’t interested in paying for your product, ask them what they would pay for; (b) reputations follow you, so treat everyone well; and (c) we are so fortunate to be living in an era where it is this easy to start a new company and iterate on ideas.

Government and Politics

Ashkan Soltani, senior advisor to White House CTO Megan Smith on loan from the Federal Trade Commission, announces that he has effectively been fired after just six weeks on the job when the Office of Personnel Security denies his security clearance. Soltani, whose White House assignment involved privacy, data ethics, and recruiting technologists for government service, previously won a Pulitzer prize as part of the Washington Post investigative team that revealed the extent to which the National Security Agency spies on American citizens.

This might be the highest-profile bungling of the HIMSS acronym. Pedantic grammarians such as myself smugly note that HIMSS and HIPAA are “acronyms” as opposed to “initialisms” (acronyms are sounded out as words, while initialisms are pronounced as their individual letters, as in “CIA” or “IBM”).

Privacy and Security

Scientific American’s “How Data Brokers Make Money Off Your Medical Records” contains no new information, but gives the public a glimpse at how companies are buying and selling their de-identified medical information. It mentions IMS Health, which takes in $2.6 billion per year by combining and repackaging information on 500 million people worldwide and then selling insights to drug companies and other to help them target sales. It repeats the now-obvious concept that it’s not hard to re-identify people by linking multiple databases. Drug company Pfizer spends $12 million per year to buy health data, but even its own analytics director says patients own their data, should be told how it’s being used, and should be given the ability to opt out of data that’s being collected for purely commercial purposes.

Technology

A Fast Company article describes the use of robots in long-term care, giving as an example Luvozo’s SAM “robotic concierge” that uses remote care staff. 

Other

A good interview with WebMD’s dethroned founder Jeff Arnold, now CEO of Atlanta-based Sharecare, describes how the company uses individual results from its acquired RealAge health questionnaire to push content to users. Sharecare also offers personal health consultations via its AskMD app and publishes a voice-analyzing app to detect stress. On the downside, the company’s co-founder is the pseudo-medical huckster Dr. Oz.

Kaiser Health News describes the enthusiasm patients of Newport Orthopedic Institute are expressing for the empathetic, automated post-surgery daily emails they receive from the practice’s HealthLoop system. The article provides an example of a knee surgery patient who responded to a system-generated, emailed question about calf pain, which triggered his doctor to see him immediately and diagnosis his dangerous blood clot.

The Hurley Medical Center pediatrician who uncovered the human effects of the Flint, MI water crisis credits the hospital’s Epic system and EHRs in general for allowing her to quickly discover the increasing number of children with high levels of lead in their bloodstream. “If we did not have Epic, if we did not have (electronic medical records), if we were still on paper, it would have taken forever to get these results,” says Mona Hanna-Attisha, MD, MPH. She cross-referenced the abnormal blood levels to home addresses using geographic information system software to prove what was happening despite the denials of state officials. She is also adding an Epic flag to allow doctors to track those children for lead poisoning symptoms that can take years to emerge. Note once again the key involvement of a doctor trained in public health when discovering and responding to a regional crisis.

Chester County, PA commissioners proclaim January 29 as R. James Macaleer Day, honoring the recently deceased local charitable benefactor and founder of Shared Medical Systems on his birthday.

The US Army Reserve highlights the actions of three members of the 345th Combat Support Hospital of Jacksonville, FL who are deployed to Kosovo and who saved the life of a motorcycle accident victim while on leave in Greece. Those involved were Major David Whaley, who is a doctor of pharmacy; Colonel Edward Perez-Conde, brigade surgeon; and Major Kirk Shimamoto, a doctor of dental surgery. Perez-Conde says he considered using a pocketknife and ball point pen to relieve the victim’s pneumothorax, but, “we didn’t know how the police would react to a medical procedure using a pocketknife and we certainly didn’t want to go to jail.”

Flint-based McLaren Health Care (MI) will centralize its 13 billing and collections offices, saying it lags in standardizing its revenue cycle processes but hopes it can increase revenue by $30 million by reducing denials and increasing collections. The health system also says it is working on integrating Cerner’s EHR and patient billing systems.

An article describing how ad-supported publishers are “freaking out” over their readers using ad-blocking software provides an example in Modern Healthcare. The Interactive Advertising Bureau calls AdBlock Plus, which has been downloaded 500 million times, “unethical” and “immoral,” declining to note that publishers are producing content that few people are willing to pay for in any form, including by the viewing of ads.

A New Hampshire jury awards $32 million to a former Walmart pharmacist who claims she suffered gender discrimination in being wrongfully terminated for notifying the state’s board of pharmacy about the large number of errors the pharmacy was making, some of which the store manager inappropriately blamed on her. Mauren McPadden, who had worked for the company for 18 years, also says Walmart violated her HIPAA rights by accessing her PHI and telling co-workers that she had suffered a nervous breakdown. Walmart claims it fired her because she lost her pharmacy keys.

Sponsor Updates

• T-System offers free tool to providers for documentation and diagnosis of influenza patients.
• Valence Health will exhibit at the HFMA First Illinois Managed Care Meeting February 4 in Chicago.
• Huron Consulting Group releases a new clinical research management briefing.
• ZirMed will exhibit at the AAPAN Annual Forum February 1-2 in Laguna Niguel, CA.
• Aprima launches its redesigned website. 
• Caradigm completes the ConCert by HIMSS interoperability testing and certification program.
• Sandlot Solutions will exhibit at the Louisiana Hospital Association’s Winter Leadership Symposium February 2-3 in Baton Rouge.
• Surescripts will exhibit at the EHealth Initiative 2016 Annual Conference February 3-4 in Washington, DC.

Blog Posts

• Best-of-Breed Solutions (Voalte)
• 3 Places to Find Patientco at HIMSS16 (Patientco)
• A Luxury Beyond Belief (PatientKeeper)
• How Secure Texting Apps Improve Physician-Physician Communication (PracticeUnite)
• Education Minimizes the Impact of Healthcare Hackers (PerfectServe)
• Predictions of Apple Q1 Earnings from Medical Charge Capture and Secure Messaging Users (PMD)
• Why our expansion at Partners matters (QPID Health)
• Content Interoperability: Achieving Clinical Data Quality Success (Stella Technology)
• 2016 IHE Connectathon in Full Swing! (Summit Healthcare)

Contacts

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

Why I Still Don’t Have an Electronic Copy of My Medical Records Six Months After Asking

I decided in June 2015 to go through the exercise of requesting an electronic copy of my medical records. They’re from an Epic-using, Most Wired-winning, EMRAM Stage 7 academic medical center at which my only encounter was an unplanned, uneventful one-night stay while traveling. I wanted to see how the records request process might work for the average patient.

I also tried using the hospital’s MyChart portal to look up my own records as a second experiment. That’s a different process managed by the hospital’s MyChart support team. I was not successful since my visit was not listed and the polite but baffled technician couldn’t figure out why. The technician did not offer to research the problem further.

Day 1

The records request page on the hospital’s website offers two options: dropping by personally to the hospital’s health information management department (which they clearly prefer) or downloading, completing, and faxing a form. Scanning and emailing the signed form was not possible, they said – it has to be faxed. Requests for images must be made separately by calling a different telephone number.

The form is complicated since it was primarily designed for patients who want to give someone else access to their records, such as for a workers compensation claim. The hospital really should create separate forms to avoid awkward references to “the patient” when it’s the patient making the request. It also asked for “patient medical record number or other identifiers” which hospitals frustratingly and somewhat arrogantly expect patients to learn and remember.

I completed the paper form as best I could, but it was not easy to figure out what they were looking for. Then I had to scan the signed form and find an online fax service to send it to the HIM department’s release of information fax machine.

The paper form did not provide an option for how I wanted to receive the information, stating flatly that paper copies would be mailed and that an unstated per-page fee would be charged by its contracted release of information vendor (it’s scary to agree to pay the fee upfront without knowing how many pages are involved or what the per-page charge is). It didn’t ask how I preferred to be contacted (not that it mattered since they never contacted me), but it did ask for a telephone number and physical address, again oddly worded since the multi-purpose form isn’t intended for patients only, with fields such as, “Phone (if known)” as though the patient might not know their own telephone number.

Day 11

I called the hospital’s HIM department since I hadn’t heard back from my request. They said they hadn’t taken any action because I hadn’t provided dates of service for my one and only encounter with the health system (since I couldn’t remember the date – it was more than a year before). They looked it up and said they would mail the records. I told them I wanted them in electronic form.

The HIM person said they don’t provide electronic information to patients, only to physicians. I said they were obligated to give me an electronic copy if I wanted it. She said she would get back with me after she talked to her supervisor.

Day 13

I hadn’t heard back from HIM, so I called them again. The supervisor repeated that they are not obligated to give patients electronic copies of their records and would provide only mailed paper copies. I repeated that they are indeed obligated to provide electronic copies. I said I would file a Office for Civil Rights complaint if they refused. Which they did, again.

I filed the OCR complaint. It was an easy online form to complete and I received quick email confirmation that it had been received.

Day 39

A letter-sized envelope arrived in the mail from the hospital. My name and address were scrawled nearly illegibly on the front with no indication of what was inside. I opened it up and there was my visit summary, contained on two pages front and back as printed off from the hospital’s Epic system. The hospital didn’t include a greeting or explanation or anything to indicate why they had sent the copies – it was just two Epic-generated pages that I finally figured out. I can’t imagine the average patient receiving the same document and making sense of it. At least they didn’t charge me for the two pages.

Day 211

I received a letter from the Office for Civil Rights informing me that my complaint was being closed without formal investigation. Instead, OCR said it had decided to “resolve this matter informally through the provision of technical assistance to the hospital.”

I haven’t heard from the hospital. I still don’t have an electronic copy of my records. My visit still doesn’t display in MyChart.

I invite readers to try this same process with their hospital or physician practice and let me know how it goes.

Morning Headlines 1/29/16

2015/2016 Best in KLAS Winners: Software and Services

KLAS publishes its annual list of Best in KLAS winners. Epic takes the Acute Care EMR category. Cerner wins Acute Care EMR for community hospitals, while MEDITECH wins the community HIS category.

No patient records involved in possible NCH computer breach

NCH Healthcare System (FL) notifies its employees that two servers being hosted at Cerner’s Kansas City data center have been breached, exposing employee and medical staff credentialing information.

CPSI Announces Fourth Quarter and Year-End 2015 Results and 2016 Guidance

CPSI announces Q4 and year-end results:revenue of  $44 million for the quarter, down 4.5 percent from last year, EPS $0.30 vs. $0.60, missing estimates on both.

MidMichigan Health investing $55M for electronic medical record system

MidMichigan Health selects Epic to replace its existing Cerner and Allscripts EHRs, for a total project cost of $55 million that the health system expects will pay for itself within six years.

News 1/29/16

Top News

CMS warns lab company Theranos that its December inspection of the company’s California laboratory found deficient practices that “pose immediate jeopardy to patient health and safety.” CMS has given the company 10 days to prove that it has corrected the problems, threatening to revoke its Medicare certification otherwise. Theranos respondes that 90 percent of its lab work is done in its Arizona facility and says it has already fixed some of its California lab problems, including hiring a qualified lab director.

Walgreens, which seems anxious to wangle out of its deal with Theranos, has told Theranos it doesn’t want its samples processed in the California lab and has closed its Theranos Wellness Center in Palo Alto, CA. Walgreens admits only that it is “currently in discussions about the next phase of our relationship.”

Reader Comments

From The PACS Designer: “Re: better cancer detection. Researchers at the University of Tokyo Graduate School of Engineering have developed haptic gloves that can more easily detect potential types of breast cancer lumps through a new type of bendable sensor. The gloves cling more tightly to your fingers, thus improving the feel aspect of detection.”

From Pale Imitator: “Re: KLAS report on Soarian. You didn’t mention how Soarian is seen as an orphan product.” KLAS has stopped sending me anything about their reports, so I don’t mention them since I don’t even have a summary to review like other sites apparently get. For example, I noticed KLAS’s tweet that talked up Medicity’s “most improved vendor” performance in its year-end awards and clicked the link, but goes to a sign-up page that doesn’t even mention Medicity’s award, so I’m left with nothing. Back to your original comment, Soarian is an orphan product, of course, with only the timeline in question.

HIStalk Announcements and Requests

FlexPrint donated $1,000 to attend my CIO lunch at HIMSS, which funded these DonorsChoose teacher grant requests:

• A programmable robot for Mr. Fess’s elementary school class in Port St. Lucie, FL.
• A programmable robot for Mr. Jewell’s  sixth grade engineering class in Beebe, AR.
• Headphones for Ms. Garris’s elementary school class in Fayetteville, NC.
• Math tools for Ms. Reynolds’s elementary school class in Springfield, MO.
• Electronic circuitry kits for Mr. Shawver’s career pathways high school class in Taos, NM, in a project led by sophomore Zack, who wants to earn a Harvard doctorate in math and engineering.
• Math games for Mrs. Dlouhy’s elementary school class in Las Vegas, NV.
• STEM activities for Mrs. Newman’s second grade class in Indianapolis, IN.
• A document camera and wireless printer for Mrs. Garcia’s elementary school class in New Haven, CT.
• Dry erase boards and markers for Ms. Hughes’s elementary school class in Marietta, SC.

QPID Health also donated $1,000, which funded these requests:

• A Chromebook, mouse, and case for Mrs. Williamson’s English language learner class in Rentz, GA.
• Science reading books for Mr. Beeler’s high school class in Houston, TX.
• Two trumpets for the area’s first band program led by Ms. A in Dallas, TX.
• Science learning centers for the kindergarten class of Ms. Estes in Franklin, TN.

This week on HIStalk Practice: Mississippi taps Teladoc for virtual firefighter care. Emerge Urgent Care opens as the "first telemedicine-based urgent care center in the US." Amazing Charts President John Squire lays out his vision for the problem-oriented medical record. RetraceHealth raises $500,000. AMA convenes disgruntled physicians for a town hall vent session in Seattle. PCPSs in Arkansas, South Dakota, and Iowa have it made – unless they’re female. Riverside Medical Group opts for an "always-open" model.

This week on HIStalk Connect: In England, the NHS partners with IBM, GE, Phillips, Google, and others to roll out several digital health pilot projects designed to objectively evaluate the benefit of introducing new technologies to care delivery. CMS sends a public letter to Theranos after discovering deficiencies during a routine lab inspection that could put patient safety in "immediate jeopardy." Texas Medical Center welcomes 13 startups to its TMCx accelerator program. Neurotrack raises a $6.5 million Series B to roll out an Alzheimer’s disease diagnostic tool that can detect cognitive impairment six years before symptoms present.

HIStalkapalooza

HIStalkapalooza Sponsor Profile – Clinical Path Consulting

Clinical Path Consulting is dedicated to optimizing the benefits of digital healthcare. Our team of industry experts help healthcare providers take advantage of technology to make operations more efficient, meet regulatory requirements, and improve the overall quality of patient care. Our professionals have extensive experience with, and an in-depth understanding of, healthcare business processes and industry technologies. Our services range from EMR implementation, optimization, upgrades, and training to specialized services, including our Healthcare Reporting Lab and our Clinical Concierge Program.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

McKesson reports Q3 results: revenue up 3 percent, EPS $2.71 vs. $2.04, missing revenue expectations but beating on earnings. Revenue in its Technology Solutions business dropped 8 percent on the sale of its nurse triage service and “anticipated revenue softness” in Horizon Clinicals. From the earnings call, John Hammergren says he’s pleased with the operating margin trends in the Technology Solutions business, citing the company’s focus on peer solutions, transactional offerings, imaging, and revenue cycle management. The transcript makes it seem that stock analysts tremble in Hammergren’s telephonic presence since they can’t seem to string together coherent sentences without Tourette’s-like verbal crutches. The Morgan Stanley analyst said “kind of like” a record 16 times in just three questions, such as, “It’s kind of like up 7 percent in the last kind of like 18 months, we’ve seen this growth in kind of like low to mid and even high teens,” while the ISI Group’s analyst, not to be outdone, used “sort of like” five times in his two questions.

HCA announces Q4 results: revenue up 6.4 percent, EPS $1.40 vs. $1.19. The hospital operator made over $2 billion in profit in FY15.

Anthem announces Q4 results: revenue up 7 percent, EPS $0.68 vs. $1.80, missing earnings expectations. The company says its insurance exchange policy volume ran 30 percent lower than it planned.

CPSI announces Q4 results: revenue down 4.5 percent, EPS $0.30 vs. $0.60, falling short of expectations for both. 

Telemedicine technology vendor SnapMD raises $5.3 million in Series A funding.

Sales

The Ohio Department of Mental Health and Addiction Services expands its use of Netsmart’s clinical and financial systems across its six psychiatric hospitals.

Orion Health signs two pilot project contracts with the French Ministry of Health.

MidMichigan Health chooses Epic in a $55 million project that it says will pay for itself within six years. They went live on Cerner in early 2011 and choose Allscripts for ambulatory that same year. The change was most likely due to its 2013 affiliation with University of Michigan Health System, which invested in the Midland-based system with plans to undertake joint projects in telemedicine, clinical data analysis, and IT.

The Cal INDEX HIE selects Wolters Kluwer’s Health Language for terminology management.

Steward Health Care Network (MA) expands its use of behavioral health access technology from Quartet Health, which has former US Representative Patrick Kennedy on its board.

People

Joshua Lee, MD (Keck Medical Center) joins Loyola University Health System (IL) as VP/chief health information officer.

Announcements and Implementations

Oracle announces Oracle Healthcare Precision Medicine, which it says connects genetic testing information to EHRs “for seamless clinical workflow and adoption.”

Continuous wearable vital signs monitoring technology vendor Sotera Wireless’s database of de-identified monitoring data reaches 1 million hours, supporting evidence-based alarm management.

University of Michigan launches MS and PhD degrees in Health Infrastructures and Learning Systems, which will focus on IT-driven innovation and continuous improvement.

DrFirst releases a new version of its Rcopia system for e-prescribing, controlled substance e-prescribing, electronic prior authorization, medication history, and medication adherence.

Government and Politics

ONC has a proposed rule in front of the White House that is described only as, “ONC Health IT Certification Program: Enhanced Oversight and Accountability.”

Privacy and Security

NCH Healthcare System (FL) notifies employees that two of its servers hosted at Cerner’s data center have been breached, exposing employee and medical staff credentialing information. 

Fitbit will add security measures to its fitness trackers after hackers brag openly about stealing user account information that they use to scam the company. The hackers sell Fitbit login credentials online for between 50 cents and $5, explaining to buyers how to convince Fitbit support reps to send them a replacement for a claimed defective device they never actually bought using a Photoshopped Amazon receipt as proof of purchase. They then sell the devices.

A short report by cloud security vendor Bitglass reminds us that one in three Americans were affected by a healthcare breach in 2015, with hacking and IT incidents making up 98 percent of the total. The big problem last year was loss of employee devices, but that was before the huge Anthem and Premera insurance company breaches that represented 80 percent of the affected individuals.

Other

A doctor in Canada warns the public of physician rating site RateMD, claiming the company’s salespeople offered him extra-cost options to hide up to three suspicious reviews and display his banner on the pages of other doctors. To be fair, the company is straightforward about that (and its business in general) on its FAQ page. The real challenge for ratings sites is that the small number of self-selected people who post have had either a great or terrible experience that may not be representative. That plus the fact that anonymous posts can’t be verified, allowing anyone to post a review.

KLAS announces its Best in KLAS winners for 2015/16. Epic won best Overall Software Suite, Impact Advisors won Overall IT Services Firm, and Medicity earned most-improved recognition. Some notable category winners:

• Acute care EMR: Epic
• Ambulatory EMR small practice: CureMD
• Ambulatory EMR medium practice: Athenahealth
• Ambulatory EMR large practice: Epic
• Business intelligence/analytics: Dimensional Insight
• Community EHR: Cerner
• Community HIS: Meditech
• ED: Wellsoft
• HIE: Epic
• Laboratory: McKesson
• Patient accounting/patient management: Epic
• Patient portal: Epic
• Population health: IBM (Phytel)
• Surgery management: Epic

Dear Healthcare IT News: your ad-filled junk email pitches for HIMSS16 are using a “from” email of “Destination HIMSS15.” Thank you in advance for your prompt attention in this matter.

The crack investigative team of a Louisiana AM radio station smugly discloses photographic evidence that doctors are wasting time using computers with an “absurd number of diagnoses and codes that total more than 18,000,” adding expert editorial comment opining that, “Remember that our tax dollars are going to buildings filled with bureaucrats who spend their days making rules and regulations that run our lives!” My question is this: does AM radio still exist?

A survey of doctors in Canada finds that 73 percent use office-based EHRs vs. 23 percent in 2006.

The Orlando paper notes the swelling but untaxed annual profits of Florida Hospital ($330 million) and Orlando Health ($247 million) as “the hospital chains gobbled up what were once taxpaying businesses and property and brought them into the non-profit, tax-exempt fold.” The systems would have paid $50 million in property taxes alone if they weren’t non-profits. Both organizations not only avoid state income tax, federal income tax, and sales tax, but they also receive taxpayer money in the form of taxing districts in three counties. The article notes that Florida Hospital parent Adventist Health System “trades $4.5 billion in securities, mostly through bonds, hedge funds, and money market funds.”

Hospitals in China require non-emergent patients take next-number type tickets, providing a lucrative market for ticket scalpers. A woman who complained on state TV about offers to sell places in the hospital line for $700 says she was harassed afterward by the scalpers and is afraid to take her mother back to the hospital. Her summary would work equally well here even in the absence of scalpers: “My God, for average people to see a doctor takes so much money, so much energy.” 

Sponsor Updates

• Ingenious Med’s Scott Pierce describes the company’s new consulting practice.
• NTT Data is sponsoring the Northern California Chapter of HIMSS reception at HIMSS16 on March 1.
• Iatric Systems takes the Best in KLAS top spot for patient privacy monitoring.
• MedData will exhibit at the American Society for Anesthesiologists Practice Management Meeting January 29-31 in San Diego.
• Premier recognizes Inova (VA) with its 2016 Premier Excellence Award.
• InterSystems TrakCare wins Best in KLAS for Global (Non-US) Acute Care EMR.

Best in KLAS 2015/2016 Winners

Segment Leaders: Software
Cardiology: Merge
Claims and Clearinghouse: ZirMed
Emergency Department: Wellsoft
Global (Non-US) Acute Care EMR: InterSystems
Patient Access: Experian Health
Radiology: Merge
VNA/Image Archive: Merge

Segment Leaders: Professional Services
HIT Implementation Support & Staffing: Galen Healthcare
IT Advisory Services: Impact Advisors
Technical Services: Galen Healthcare
Value-Based Care Advisory Services: Premier

Category Leaders: Software
Cardiology Hemodynamics: Merge
Charge Master Management: Craneware
Clinical Decision Support – Care Plans: Zynx Health
Clinical Decision Support – Order Sets: Zynx Health
Clinical Decision Support – Surveillance: Wolters Kluwer
Decision Support – Business: Strata Decision
Enterprise Scheduling: Streamline Health
Labor and Delivery: Clinical Computer Systems/Obix
Medical Device Integration Systems: Capsule
Patient Flow: TeleTracking
Patient Privacy Monitoring: Iatric Systems
Quality Management: Nuance
Secure Messaging: Imprivata
Single Sign-On: Imprivata
Staff/Nurse Scheduling: GE Healthcare

Category Leaders: Services
Business Solutions Implementation Services: Xerox

Blog Posts

• What’s Going On, CMS? (Iatric Systems)
• Extending Software and Services to Community Affiliates (Impact Advisors)
• Reaching the Right Audience with Your CRM (Influence Health)
• Integration Trends Roundup for 2016 (Liaison Technologies)
• Ode to David Bowie (MedAptus)
• Cars, Wonton Soup and Healthcare: What can they possibly have in common? (Navicure)
• Making Life Easier for Radiologists and Patients (Spok)
• Apply supply and demand to grow strategically while increasing revenue and reputation (Nordic)
• Traveling the Path to Population Health: Access (Orion Health)

Contacts

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

Big Bucks Equals Big Interest in CHIME’s National Patient ID Challenge

A $1 million CHIME prize attempts to position the industry for patient identification success.
By @JennHIStalk

A perfect storm of healthcare concerns around near-ubiquitous EHR adoption, a resultant need for interoperability, patient safety and privacy, and federal stonewalling have swirled into an industry-wide conversation around the need for a national patient identifier.

Such an ID would, in theory, offer all providers a safe, accurate, and private way to identify patients no matter where they receive care. Correctly matching the right patient record to the right patient across care locations has the potential to save the US healthcare system money and lives.

The Implications

Intermountain Healthcare CIO Marc Probst estimates that his Salt Lake City-based organization spends as much as $5 million each year on administrative and technology costs related to accurately matching patients with all of their medical records. Minnesota-based Mayo Clinic has faced similar financial fallout, paying out up to $1,200 per misidentification, according to a 2014 ONC report.

Probst puts Intermountain’s patient-matching accuracy at 95 percent, above the industry norm of 85 percent. Similar rates show up at Kaiser Permanente, though that number falls to the mid-50s when records are shared between its regions and outside of its Epic system. Some estimates put identity errors in medical records at 14 percent, accruing to an annual estimated spend of almost $9 billion.

But wait, there’s more. A 2012 CHIME survey found that nearly 20 percent of its members could attribute at least one adverse medical event to incorrect patient matching.

That’s where the rubber hits the road. Adverse medical events equate to administering the wrong medication to the wrong patient, performing unnecessary procedures on misidentified patients, and burdening incorrectly identified patients with the hospital bills of someone else. Access to another patient’s health data is also of concern, as the steady stream of healthcare hacks over the last few years shows no signs of slowing down.

The Backstory

While the 2012 CHIME data might be dated, the statistic strongly shouts that the healthcare industry has a moral obligation to roll out an accurate national patient ID. While such an ID has never been developed, it’s not for lack of trying. There was talk of a federal patient identifier initiative when Congress passed HIPAA in 1996, but that was ultimately shot down by the industry’s privacy contingent, resulting in a 1999 law prohibiting federal funding to create the identifier.

What’s an industry in dire need of a solution to do? While there’s talk of removing the federal prohibition within the next year or two, industry stakeholders have taken the matter into their own hands and turned to the private sector for a solution – one fueled by cold, hard cash.

The CHIME Challenge

The CHIME National Patient ID Challenge, originally announced last fall, made its formal debut earlier this month, exciting just about everyone who has ever taken part in the national patient ID debate. The association, which has partnered with crowdsourcing company HeroX, is looking for innovators from around the world to develop a patient ID solution that:

• Easily and quickly identifies patients.
• Achieves 100 percent accuracy in patient identification.
• Protects patient privacy.
• Protects patient identity.
• Achieves adoption by the vast majority of patients, providers, insurers, and other stakeholders.
• Scales to handle all patients in the US.

ONC, National Patient Safety Foundation, AHIMA, and the AMA have endorsed the contest, which will award the winning solution $1 million. Over 80 entrants in seven countries have already signed up. With submissions due April 8, the clock is ticking for entrepreneurs and established companies to finalize their ID innovations. The winner will be announced February 19, 2017 at the CHIME/HIMSS CIO Forum in Orlando.

“We recognized that this is a real challenge,” says Intermountain’s Probst, who is also chair of the CHIME Board of Trustees. “We can’t identify people as well as we’d like to and there’s security issues around that. We’ve become well aware of this over the years, and talked significantly about it for probably the last five.”

Probst attributes the timing of the competition to learning about HeroX. “We discovered there was this creative way of looking at a problem – a much broader strategy than the healthcare industry has traditionally employed. When we heard from HeroX and XPrize founder Peter Diamandis and got aligned with the HeroX team, we thought this is something we could create a challenge around, and CHIME could really get behind.”

“We’ve come to understand that it’s more difficult to model a challenge like this than any of us realized,” he adds, “and I don’t think that’s necessarily unique to patient identifiers. You’re going to throw a million dollars on the table, so you hope that the winning solution is going to be really effective.”

The $1 million prize has obviously set a fire under the healthcare community. Some wonder where the winnings will come from. “CHIME will be looking for people to partner with to help fund this – organizations that would like to have their name associated with it,” Probst explains. “That’s actively going on. The CHIME board will make sure it gets funded one way or another.”

Competition Heats Up

With so many entrants — from credit bureaus to startups to clinicians to big business — committing to the contest in just over a week, competition will surely be stiff once submissions are reviewed and the chosen few move on to the “Concept Blitz” round in May.

“We’ve been working on this since 1995,” says Barry Hieb, chief scientist at not-for-profit Global Patient Identifiers. “There’s been a long pause on this issue, but now there is renewed focus due to the race for interoperability. There’s a desperate need to identify patients correctly. Between 100,000 and 400,000 people die each year due to medical misidentification. That’s what keeps me awake at night. That’s not acceptable.”

Hieb, who anticipates signing GPI up for the challenge, envisions rolling out the winning solution at several pilot sites for a year or two, and then making it publicly available. “It could be a card, an app, a USB drive … the key is determining what information is accessible,” he says, adding that his other big concern is management of the solution once its 15 minutes of fame have worn off. “We’ll need to sit down with CHIME and other stakeholders to determine who is trustworthy enough to run this capability in perpetuity.”

Michael Trader, CEO of biometric patient ID platform vendor and contestant RightPatient, echoes many of Hieb’s concerns. “Meaningful Use has been a big impetus for this. Now we’re at a stage where the next goal is interoperability. Combine that with the new influx of covered consumers and you’ve got to help providers avoid sharing dirty data.”

“We feel strongly that our current technology is the ultimate solution for this problem,” he adds. “The winning solution will be strong on the technical side, but will be practical, too. Providers will ultimately drive the adoption, which will in turn drive patient adoption. When all’s said and done, it’s got to be scalable and focus on multiple touch points.”

May the Best – Most Accurate – Solution Win

Probst seems confident that this competition will bring a viable solution to market. “We need these participants to figure this out,” he says. “I don’t know that it will be an algorithm. It could be a biometric, or a combination. Whatever it ends up being, we’d like to get 100 percent accurate identification. It has to be something that makes economic sense and can be reasonably introduced into the industry and afforded. All those are aspects of the challenge.”

“To the patient, this solution will enable your provider to access your medical records when you walk up to the registration desk. You won’t have to clarify. They’ll know it’s you when they create a bill or record or test or referral. We’re going to get it right.”

EPtalk by Dr. Jayne 1/28/16

One of my clients reached out to me today to discuss a potential safety issue with one of the network-enabled devices they use for patient care. Although there hasn’t been an official recall by the manufacturer, there have been enough concerns for my client to want to remove the devices from use while they perform an evaluation.

The new devices had only been in service for a couple of months. Luckily they still have the previous devices in storage and can redeploy them for patient care. They were looking for guidance on how to communicate the issue without alarming physicians who had come to rely on the data points from the machines. They haven’t had to do anything like this before and didn’t have a policy or procedure in place.

I recommended that they use the procedure they follow for pharmaceutical recalls as a potential template. It hadn’t occurred to them to think about it that way – I think they were mostly still getting over the idea that they had to deal with a situation with a number of unknowns. I was able to talk them through a step-wise plan for addressing it, and by the end of the call, I could tell their stress level was substantially lower.

It reminded me of some of the disasters I encountered during my first couple of years in the CMIO trenches, when it felt like every day brought a giant pile of unknowns that I had to deal with. It was a good reminder of the ways in which being a consultant can be rewarding as well as the fact that the role of CMIO is a relatively new one and there are plenty of us still learning as we go.

Many of us are homegrown clinical informatics professionals who got into it either because we enjoyed technology or we were “voluntold” by our employers that we would be wearing a new hat. I like to think that makes us very skilled at thinking on our feet and being creative with problem solving. Still, I sometimes envy people who completed formal informatics studies and had easy access to mentors at critical points in their careers.

One of my former colleagues who accepted an informatics role much in the same way that I did (come on, it’s only four hours a week!) is planning to take the Clinical Informatics board exam this year before the “grandfather” period expires. When you’re already in the trenches, the idea of trying to find the time and money to enroll in a formal program can be daunting.

On January 26, the US Preventive Services Task Force issued a final recommendation that all adult patients be screened for depression. Changes in recommendations usually lead to a flurry of IT activity as preventive services tracking and reminder software requires updating to accommodate the changes. The most nimble vendors will have the new guidelines embedded within a few weeks, but others may take significantly longer.

The HIMSS16 invitation cycle is finally upon us. I always get a kick out of the different event invitations. Some of the best parties I’ve been to are at HIMSS and putting together the social schedule is always a bit of a challenge. I’m hoping the Monday start will shake things up a little and allow me to attend parties I’ve previously missed due to conflicts. If you have an event (whether after hours or on the show floor) and you’re interested in coverage from the HIStalk team, let me know. We try to make as many events as possible as long as schedules (and our tired feet) allow.

ONC shared a list of its activities at HIMSS. The Tuesday session with Karen DeSalvo and Andy Slavitt might be a “must see,” especially if Mr. Slavitt goes off script again and starts lauding the demise of federal programs. If nothing else, the session should be Tweet-worthy. I’ll also be keeping my out for my favorite former ONC staffers, including Jacob Reider and of course Farzad Mostashari.

I heard a rumor that Medicomp Systems has something new in store for its Quipstar game show booth. I always enjoy seeing the game and catching up with the team, as well as taking advantage of their seating when I’m running out of energy. I had the opportunity to hang out with CEO Dave Lareau at HIStalkapalooza last year – I wonder if he’s eager to pinch hit for pie-throwing duties again?

A reader shared this piece on physician burnout. My initial read of the data focused on the specialty distribution, but that approach masks a larger problem. Burnout rates increased across all specialties from 2011 to 2014. Even more significant, only one specialty reported a burnout rate of less than 40 percent. The comments section is worth a read for those looking to understand why physicians are angry, stressed, and looking to do something else.

What are your strategies for dealing with burned-out physicians? Email me.

Email Dr. Jayne.

Morning Headlines 1/28/16

Theranos’ Deficiencies Put Patient Safety In “Immediate Jeopardy”

CMS has issued a public letter to lab test vendor Theranos warning that deficiencies found during its CLIA recertification and compliance inspection put patients in “immediate jeopardy.” Theranos has 10 days to submit proof that the deficiencies have been corrected, or it could lose its CLIA certificate. 

McKesson Reports Fiscal 2016 Third-Quarter Results

McKesson reports Q3 results: total revenue up three percent to $47.9 billion, EPS $2.71 vs. $2.04. Technology Solutions revenue was down eight percent, to $694 million, compared to the prior year.

Some States Look to Avoid Federal Obamacare Payments

State officials discuss sharing state insurance exchanges after CMS published new rules last year requiring states to pay a three percent user-fee per policy issued over Healthcare.gov.

Adoption of Certified Electronic Health Record Systems and Electronic Information Sharing in Physician Offices: United States, 2013 and 2014

The CDC publishes data from its 2014 National Electronic Health Records Survey, finding that 74 percent of office-based physicians are now using certified EHRs, while 32 percent are sharing patient health information with external providers.

HIStalk Interviews Charles Tuchinda, MD, President, First Databank

Charles Tuchinda, MD, MBA is president of First Databank of South San Francisco, CA.

Tell me about yourself and the company.

I’m a physician technologist. I got a degree in biomedical engineering at Harvard, where I built prosthetics and a hovercraft. Then I went to med school at Hopkins. I ultimately got board certified and licensed in internal medicine. I got an MBA at Harvard Business School, working on venture and biotech.

I joined Eclipsys many years ago and worked there for quite a few years. Then I joined Hearst, first as their chief innovation officer for healthcare, and then ultimately had the great opportunity to lead FDB.

FDB is a company that I’m very proud of and feel very privileged to be a part of. It plays an important role in healthcare. Its roots started at UCSF around medication, but today we have immense impact. We’re touching multiple stakeholders across healthcare and have an opportunity to expand beyond that. That opportunity lives at the intersection of healthcare information and technology.

Because I feel like I’m a technologist at heart — in fact, I’m a closet programmer — I feel so fortunate to be at a company that’s passionate about making a difference, improving safety for patients but also trying to drive a bigger agenda around cost-effective care and value. The way that we do it is so interesting to me because we can leverage the electronification or digitization of healthcare, but leverage the workflows and the fact that it’s applied to technology to make it easy for patients and clinicians to do the right thing.

Physicians have often expressed their frustration at clinical decision or guidance alerts are intrusive and not necessarily relevant to the clinical situation that’s in front of them. Has that changed over the past few years?

It’s a very delicate balance to deploy very good clinical decision support. You’re aiming for providing people with information that they may not have routinely thought about on the possibility that you’d change their decision-making process for the better. 

When you look back at the history of decision support, folks may have started first in a world where there wasn’t any, so the first tendency would be to add as many alerts or as many informational prompts as you possibly can. People took a very comprehensive approach to that. If you review the medical literature today, people are measuring the performance of alerting systems by positive predictive value, trying to look at when alerts actually change behavior. You’ll see many research studies.

At FDB, we’ve taken a multi-pronged approach. One of the products that we launched in the last few years was AlertSpace. It has great success today. We took an approach that first allowed for customization of those alerts, tailoring the practice with the information that’s available. But we’ve also invested heavily in trying to increase the specificity of our learning engine, having to deal with many more patient inputs.

We in fact have a whole initiative that we call Advanced Clinicals, where we’re trying to replace the older infrastructure with a revolutionary approach to alerting. A lot of times, that actually means that the guidance is not given in the form of an alert at all — that it’s a framework. Maybe a series of questions. A process. You may get that guidance at different steps in the process. We’re on the road talking about it and we have clients that deploy it. We’re pretty excited about the potential there.

A lot of the clinical decision support setup is made by people who aren’t entering orders on the front lines. Would it be safe to allow individual practitioners to determine which alerts they want to see instead of mandating the same alerts for everyone?

That’s  a really great point that often comes up when we talk to clients. Institutions certainly have a view — often around the mindset of liability protection for the institution — where they want to roll out a certain set of alerts to prevent some of the most severe or tragic consequences. Clinicians, on the other hand, especially sub-specialists, deal with some very powerful medications and very tough and complicated diseases all the time, so that balance has been hard. 

That’s where  the customization play has worked really well. The difference is that I would say most of the vendors that we’ve spoken to generally don’t like to allow for individual personal customization, even though they technically can and have had that as an option. A lot of the institutions choose not to deploy it that way.

We’ve thought a bit about it. In the way that we’re rolling out our future solutions — especially those based on our cloud technology and our Web services technology — we’ve allowed for the possibility of us learning the behavior of that individual. Following them around the healthcare system and even seeing patterns in that data so that we can give them alerts that have been beneficial to other people like them.

Although that’s not quite deployed, we’ve laid a lot of that foundation to make that a possibility in the future. That’s like personalization around the information that individual clinicians would need to deliver even better care for patients.

Have we solved the problem of getting medications reconciled for a patient across their different providers and care settings?

No, I don’t think med rec is solved. If you look at the data of the penetration of med rec, obviously it’s now a requirement or a best practice for clinicians to med rec on every transition of care. When I talk to clinicians — including my wife — it takes an incredible amount of time and the workflow around it doesn’t make a lot of sense. 

That’s where we thought there was an opportunity. In our acquisition of a company that provided the MedsTracker platform, we saw a very innovative workflow with some really smart algorithms that made extremely great use of the information that we could provide. We’ve reduce the time it takes to do med rec dramatically. Cut it in half sometimes, down to 25 percent of what it used to be.

When I think about the future and the importance of med rec, it’s a really important decision-making process that’s going on when you’re choosing the drugs and how the patient should take those drugs. It’s an area where FDB will be able to bring more to bear in the future.

The traditional FDB work clinical process is around ordering and around dispensing the drug. Med rec is doing that in bulk, when you’re thinking about the disease and then going to go communicate that to the patient. For us to be able to leverage some really sophisticated CDS and then create the documents and artifacts that gives the patient the best education, the best understanding of what they should take — that’s the right thing to focus on.

Do you see the company’s role or product line changing as healthcare moves from management of episodes to management of care?

Yes,  I do. I hinted at a few things. Maybe I’ll make them explicit.

One is when I looked at FDB and first started thinking about the strategy, I thought FDB would need to able to touch patient data. Getting into the clinical workflow with this MedsTracker platform and being very comfortable — and frankly, HIPAA-compliant — I thought was going to be an asset for the company in the long run. I thought that the future of applying information would require personalization to the patient situation.

Then when I think forward about FDB’s agenda, we have a great heritage of providing solutions that improve the safety of medications, but I thought that the potential would be greater than that, to the extent that we would have access and the trust of patients and clinicians to look at their data and give them personalized guidance. I thought that there would be a big opportunity there.

We looked into clinical workflows, which is why obviously we had an interest in med rec. The future will allow FDB to demonstrate our ability to deliver more than just safety, that we would help people achieve the outcomes that they want and look at a wide range of inputs. Hopefully we continue to earn that right.

What challenges do you see for IBM’s Watson and genomics informatics companies that are trying to take theoretical knowledge from one system and insert it into the workflow of physicians using another system?

I love that people are investing in innovating in healthcare because I think it really pushes the envelope and gets people to think beyond what they normally might.

When I look at technologies like Watson, they inspire us to think about how we could leverage that type of approach to what we do. When I look at where it could be made helpful to patients and to our vendor clients, we focus around making it simple and embeddable. When you look at our MedsTracker platform, we’ve made it very simple to put in med rec. When we look at our Cloud Connector, why I’m so interested and excited about that is because we can deliver technologies like natural language processing, really complex risk algorithms, all through a Web service interface that would be very easy for a developer to pick up.

When you think about genomics, there’s a massive database behind that. Millions of mutations and millions of mutations of variants tied to drugs, drug-gene pairs, and those disease processes. That knowledge in the old scheme is really not feasible to deploy, because in the old scheme, you would ship the information out and hope that the EMR would build that algorithm and process it. You really need technologies like Cloud Connector, like a platform that makes it so easy for developers and consumers to use it.

When I look at these companies and these trends, I like it because I feel like it’s educating the market on what people should need to improve healthcare. Then I think FDB’s prospects are great because we’re very much dedicated to simplifying it and aggregating that information and making it easy to use and then focusing it right to a very specific workflow so people can benefit from it.

FDB doesn’t just produce clinical content, but also performs the subtle activity of integrating the information into standardized databases and working with EHR vendors to present it seamlessly to their users. Will IBM or other companies look to FDB as the company that can make their jobs easier by providing existing hooks into vendor software and databases?

Yes, absolutely. We have had conversations with IBM. We’ve had conversations with other large technology companies. In many cases, they’ve licensed our content to do precisely what you’re saying, meaning bridge the expertise gap that might be at their general purpose tech company with how it might be applied appropriately in healthcare, in the workflows. Genomics companies have also licensed and collaborated with us as well. In fact, we’re very excited about some of the things that we’re planning to show at HIMSS.

People would traditionally think of FDB as a medication information company. If you’re a technologist looking at FDB, you would realize that we’re a data aggregation and normalization company that brings complex information, simplifies it, and makes it very usable for technologists to consume and deploy. That’s why we have great channel relationships with all the major EMRs. It’s something that we continue to build on.

One thing that I tell my friends about my work that I really enjoy is the type of relationship that we have with many of our clients. We’ll walk into a meeting and we’ll have an opportunity to teach them about something. We’ll say, "Hey, guess what, here is the latest approach to drug interactions," or, "Here is the latest approach to genomics. You could offer it as a feature in your software product and you’re going to have great impact where everyone’s going to benefit from it."

We teach them technically how to pull it off. We give them the information that would drive that functionality. That’s the type of impact that we hope for and the fun that we have deploying the technology to make a difference.

Your cloud-based product could collect a lot of information about what’s going on in the customer’s setting, not just in the form of alerts that were presented, but also as a snapshot of patient information and situations. Could that information be useful to drug manufacturers or for safety purposes?

Absolutely. That’s partly why we started the investment and deployed our cloud product.

I’ll give you two examples. First, on AlertSpace. Over the years, we’ve built up a lot of feature functionality. From a features and solution suite, we have the industry’s best alert management platform. It’s extremely easy to use.

On top of that, we’ve added community and crowdsourcing capabilities. You can see what other healthcare institutions like you have set and their decision-making process around it. There’s a lot of additional content to bear that not only comes from us, but comes from the community.

When you look at our Cloud Connector platform, I’ve talked about giving folks access to massive online databases and sophisticated computational algorithms, but we have this hope that we need to validate, this belief that we would could probably offer a zero-install analytics and surveillance system. Something where because we’re running all the clinical screening CDS, folks can benefit from additional analytics and reporting about their high-cost drugs, about the disease processes that they’re managing, about which physician is seeing which patient. That’s something that we hope to introduce in the future.

When you look at our MedsTracker platform, it is a platform that has a lot of patient data in it. We’ve deployed a solution, such as clinical quality measures, which is quite innovative. It’s in the ordering process. The clinician is prompted to walk through whether they’ve fulfilled the clinical quality measure. The nice thing about that approach is that it’s proactive. If you forgot to give an aspirin, it will ask you, "Did you give the aspirin for this diagnosis, which qualifies for getting aspirin in the first 24 hours?" Then you can just order it alongside while checking off that you completed it.

That actually makes a difference. Most clinical quality and analytics systems are retroactive, so they’re just looking backward and seeing what people actually did. The approach that we’ve taken is on the front end. We think that has a bigger impact.

The other big area for us is around cost of therapy. When we look at cost of therapy and the analytics potential there, not only is it trying to understand the price, but understanding the outcome and the alternatives that you could potentially use to get the same outcome. That’s an area that we’re going to continue to investigate.

How do you see FDB’s role in looking at drug cost and how to evaluate which drugs are cost effective?

We continue to monitor pricing. We don’t publish AWP and we continue the decision not to publish AWP, but that doesn’t mean that we’re standing still. We’ve worked with various states and groups to develop a “better than AWP” benchmark. Although that hasn’t materialized, that’s something that we’re actively continuing to consider and push for on a variety of fronts.

That mostly then leaves us in the area of therapeutic alternatives. In the UK, we’ve deployed a wonderful product called OptimiseRX, which helps folks select the best drug. The best drug there is maybe more easily defined because of their NICE guidelines and their British National Formulary, but essentially it will offer appropriate drug alternatives that are less costly. There they’ve been able to show significant savings in the populations that they’ve impacted.

We think that here in the US, that’s possibly another option — offering therapeutic alternatives. When you look at the data about where the savings are coming from, it’s coming from a lot of interesting places, like dosage form changes. It may not just be an active ingredient change. We’re keeping track of where those savings opportunities might be and then trying to serve them up at the right time and make it simple.

How do you see First Databank and Hearst Corporation being involved in healthcare changes over the next five years?

Hearst is still very interested in healthcare. We continue to invest through the Hearst Health group in companies across healthcare. We’ve assembled a great family of companies that span the entire continuum of care. We continue to be focused on delivering care guidance. As an example, FDB obviously delivers medication guidance across the continuum, but you’ll also see our sister companies delivering appropriateness criteria, risk stratification, and other tools to help people manage and understand how care could be delivered better.

In the future, we’ll continue to expand and we’ll be hopefully an even bigger part of everyone’s life by focusing on integration, focusing on patients, and giving value to patients and the providers that take care of them.

Do you have any final thoughts?

FDB is in a unique position. We’re a company that’s extremely well trusted by the industry. It’s because we’re unbiased and we really try to do the right thing. We’ve done that for many years.

What’s so great about FDB is that we have the scale and the passion to invest, and I think that we in fact do out-invest in innovation compared to many of our competitors. Over the next few years, you’ll see FDB getting into new areas. Not only will be continue to upgrade and revolutionize our technology approach, we’ll be in areas beyond medications.

We recently launched initiative around medical devices. We’re exploring a few other areas that we think start adjacent to medication, so we’ll have the permission and the power to deliver value. 

My hope is that FDB will be the go-to company for folks to use and deploy whenever they think about making a difference in healthcare.

Morning Headlines 1/27/16

Leidos To Combine With Lockheed Martin Information Systems & Global Solutions Business

Leidos will acquire the Information Systems and Global Holdings business units of Lockheed Martin, including its health IT business, for $5 billion.

Centene Announces Internal Search of Information Technology Assets

Insurance provider Centene Corporation announces that it has lost six hard drives containing the personal health information of 950,000 patients. The loss was discovered during a recent IT assets inventory.

Design Considerations and Pre- market Submission Recommendations for Interoperable Medical Devices

The FDA publishes draft guidance outlining interoperability standards for medical device manufacturers.

Scripps Trial Fails Where Geisinger Succeeded

Forbes covers the recent Scripps Translational Health Institute study on remote patient monitoring, highlighting the reasons it failed to demonstrate reductions in cost and utilization or improvements in outcomes.

News 1/27/16

Top News

Leidos Holdings will acquire Lockheed Martin’s Information Systems & Global Solutions business — which includes its health IT offerings — for $5 billion, confirming earlier rumors.

Lockheed Martin is known in health IT circles as having created the first CPOE system in the early 1970s when the company was operating as Lockheed (it merged with Martin Marietta in 1995 and changed its name to Lockheed Martin) but the company sold the product to Technicon in 1971, when it was named TDS. Lockheed Martin recently won the VA’s appointment scheduling system contract, bidding Epic through its recently acquired Systems Made Simple subsidiary.

With the acquisition, Leidos will become the #1 government IT contractor by revenue, with annual sales of more than $10 billion.

Reader Comments

From Smartfood99: “Re: Frisbie Memorial Hospital (NH). Cerner couldn’t flip a MedSeries4 hospital – they are going with Meditech 6.1.” Frisbie’s CEO says they wanted a system that would work for their 112-bed hospital sold by “a vendor we could trust.”

From Eddie T. Head: “Re: integration with Epic’s hosted systems. I would be surprised if Epic ever agrees to host third-party products. As far as I know they have always maintained that they will host the Epic infrastructure of servers, but they will not take on the role of a customer’s IT department for anything else. If the server-to-server integration comment is correct, then it sounds like sabotage (either by malice, or by incompetence) on the part of McKesson.”

RxNorm Follow-Up

A reader asked us to find out what’s going on with RxNorm updates and code changes, which they say is causing quality measures to fail because CMS has not updated its eCQM value sets with the new codes. Jenn asked the NIH/National Library of Medicine what happens with VSAC and quality measures when RxNorm is updated:

The short answer is, nothing. But it really has nothing to do with RxNorm or any other code system. ONC/CMS (back in 2012) statically bound all of the CQM value sets to their respective code systems, so the content of those value sets is legally locked to whatever versions of code systems specified by an update. So for example, the last CQM update back in 2015 used Feb 2015 RxNorm I believe. Thus, the problem for implementers who want to use the newer, better content (Lovenox as injectable heparin) to meet the treatment criteria for a measure, but are bound to use an earlier version of RxNorm. This has been a known problem for years. The real issue is providers vs. implementers. Providers, of course, want the new content as it benefits them meeting the care goals. Implementers see too much risk in updating/floating value sets dynamically, especially those that are authored as list (extensional) to begin with rather than as rules (intentional).

Julia Skapik, MD at the eCQI Resource Center adds:

This topic is known to CMS and ONC—the use of a static value set associated with each measure means that dynamic code system changes post-publication will not be reflected in the value set. To this date, we have provided the guidance that it is permissible to map where appropriate to a similar code. Where there are no similar codes, however, there will be a gap in the measure. Rob McClure, cc’d above, has been working on a proposal with CMS to provide an interim update to the value sets in the middle of the measurement period with additions only that will fill out dynamic code changes (and potentially correct errors) that affect real-world value set and measure performance.

In response to the reader’s example of CMS not updating the code sets for Lovenox as an injectable heparin that causes the VTE measure for anticoagulant therapy to fail, ONC/NLM consultant Robert McClure, MD responded:

Her defining example is confusing. Enoxaparin (Lovenox) has been included in the VTE measure anticoagulant value sets, such as "Anticoagulant Therapy" OID: 2.16.840.1.113883.3.117.1.7.1.200 and "Low Molecular Weight Heparin" OID: 2.16.840.1.113883.3.117.1.7.1.219 (and there others), from the very first release in October 2012. So if this is a good example of what ever her concern is, I’m afraid I don’t get the problem. 

If I was to wildly guess (a dangerous thing to do with you playing man-in-the-middle) perhaps she is not familiar with the expectation that data submitted in support of meeting an eCQM may at times require mapping, say from a code representing a branded drug (like Lovenox) to the “general form” (Enoxaparin) using RxNorm as the submitted code system. Or some entity that she’s relying upon is not getting this job done well.

There is the possibility that Sanofi (they make Lovenox) has come out with a brand new formulation of enoxaparin that did not get into the value set. If that is the problem, then this is exactly the sort of thing we are working to determine a better solution for implementers then simply “mapping to something close that is in the value set." If she is aware of such things then I encourage her to provide very specific evidence of this so we can design solutions that really work. She should do this by participating, like thousands of her colleagues have done, in the CMS/ONC eCQM JIRA site (http://jira.oncprojectracking.org) and report the specific issues so we can get to specifics.

HIStalk Announcements and Requests

The HCI Group donated $1,000 to participate in my CIO lunch at the HIMSS conference, with which I funded these DonorsChoose grant requests:

• A document camera, speakers, and dry erase lapboards for Ms. Hardy’s elementary school class in Upper Darby, PA
• A document camera for Mr. Martinez’s high school math class in Delano, CA
• Three tablets for Mrs. Haley’s elementary school class in Waycross, GA
• Model rockets for Mrs. Elliott’s sixth grade class in Indianapolis, IN
• Electronic circuit kits for Ms. Mills fifth grade science classes in Spring, TX
• An iPad and gaming system for Mrs. Swords’ fourth grade class in Douglas, GA
• Machining tools for the robotics team of Mr. R’s high school class in West Covina, CA

Ms. Osborne says her South Carolina elementary school class is using the math games and materials we provided in their math centers.

I was excited about Black Sabbath’s final tour, but video from their “The End” tour stop in Chicago shows Ozzie singing so wildly off key that he ruins all the songs they otherwise played excellently. I think they’re making the right decision to hang up their inverted crosses after nearly 50 years.

HIStalkapalooza

HIStalkapalooza Sponsor Profile – Healthwise

Amplify the impact of your patient touch points with Healthwise health education, technology, and services. Easily integrated into episodic care, care coordination, automated programs, and patient portals, Healthwise solutions give you the ability to deliver tailored, meaningful experiences. Since 1975, Healthwise has been driven by our non-profit mission to help people make better health decisions. Visit us on the HIMSS show floor in booth #3617 and at our kiosk in the Population Health Knowledge Center. To find out more about Healthwise or to schedule a one-on-one meeting, visit www.healthwise.org/himss16.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

CMS inspectors have found problems at the Northern California laboratory of Theranos, according to unnamed insiders. Meanwhile, a Wall Street Journal investigation finds that not only is Theranos using its fingerstick technology for just one test, it’s also sending some of its samples out to reference labs instead of running the tests itself, apparently losing money on each (Theranos sells patients a test for $7 while paying UCSF $300 to run it). The article also reports that Walgreens has met with the company several times since October to discuss concerns about the Theranos stations in its California and Arizona drugstores and isn’t satisfied by the company’s responses. The since-fired CFO of Walgreens approved a loan of $50 million to Theranos without involving the drug company’s senior clinical executives and signed an agreement that Walgreens can’t easily escape from, although a negative CMS report might give them reason.

Specialty EHR vendor Nextech acquires SupraMed, which offers a PM/EHR for plastic surgeons.

Medical image exchange platform vendor LifeImage acquires its mammography-specific competitor Mammosphere.

Enterprise integration vendor Jitterbit, which offers a platform for developers to build and expose APIs, raises $20 million in a Series B funding round. It lists among its customers Dignity Health, Eisenhower Medical Center, and ZirMed. Prices range from $2,000 to $6,000 per month.

Kaiser Permanente will open an 800-employee customer service center and a 900-employee IT center in metro Atlanta.

The Milwaukee paper profiles Epic with a potpourri of recycled facts:

• The company has 9,500 employees, up from fewer than 400 in 2000.
• The Verona campus has cost $1 billion and construction continues.
• The article claims that Epic departments don’t have budgets, there’s little hierarchy and few middle managers, and use of job titles is minimized.
• The company won 127 contracts in 2014 vs. 19 for Cerner.
• The article says the company is poorly equipped to deal with the criticism that goes hand in hand with its success, noting that its in-house communications team consists of one person and the company is run by limelight-shunning CEO Judy Faulkner, who has asked reporters not to run photos of her for fear that people will bug her at her favorite Madison ice cream shop.

Sales

Pikeville Medical Center (KY) chooses Medsphere’s OpenVista EHR.

Trinity Mother Frances Hospitals and Clinics (TX) chooses Stanson Health’s point-of-care recommendation system for appropriate use of medications, imaging, and lab tests.

Phynd Technologies announces sales of its provider management system to Premier Health (OH), Duke University Health System (NC), and Children’s Health (TX).

University of Iowa Health Care selects Oneview Healthcare’s interactive patient care system.

People

Cerner Chairman and CEO Neal Patterson notifies shareholders via an SEC filing that he was just diagnosed with a “treatable and curable” soft tissue cancer and will therefore be traveling less and attending fewer meetings as he undergoes treatment.

For-profit hospital operator Capella Healthcare promotes Vishal Bhatia, MD, MBA to SVP/CMIO.

Nashville healthcare entrepreneur R. Clayton McWhorter, who served as CEO of HCA in the 1980s, died Saturday at 82.

Announcements and Implementations

The California HealthCare Foundation will cease publishing its iHealthBeat daily technology news digest as of February 1 because “its exclusive focus on health IT no longer aligns with the programmatic focus of our work.” The newsletter was managed by The Advisory Board Company under contract to CHCF. I’m surprised that HIMSS didn’t buy it and fold it into its vendor-friendly publishing arm.

EHealth Ireland announces that available funding will allow it to increase its 288 FTE headcount by 47.

Vermont’s Depart of Labor notifies former and present employees of the South Burlington, VT office of Allscripts that they are eligible to apply for re-employment services if laid off.

Liaison Technologies launches its bone marrow transplant registry that includes one-click CIBMTR reporting.

CareSync joins Athenahealth’s More Disruption Please program, offering CMS Chronic Care Management program support services to providers.

Research software vendor Pulse Infoframe will use InterSystems HealthShare for interoperability.

Government and Politics

CMS encourages development in state Medicaid claims processing systems by permanently extending a 90 percent federal funding match for those systems. CMS is spending $5 billion per year on state Medicaid IT and estimates that 30 states are redesigning their Medicaid eligibility or claims processing systems. Cedars-Sinai CIO Darren Dworkin tweets that it’s a much bigger vendor opportunity than any population health app although it’s likely open only to large government contractors.

Blue Cross Blue Shield of Vermont calls for an independent review of the state’s Vermont Health Connect insurance exchange as errors force it to once again turn off the ability to enter “change of circumstance” situations. The state blames original contractor CGI and a consulting firm it hired that has since gone out of business. BCBS says exchange problems have prevented some of its customers from renewing their policies and doesn’t allow the company to reconcile its customer accounts. The exchange cost over $200 million to develop, nearly all of that paid by federal taxpayers.

A New York Times article describes the security-required modifications that are required before government officials (including the President) can bring mobile devices into the White House. A general who bought one of the first iPads in 2010 says DARPA technicians removed the device’s cameras, wireless chips, location sensors, microphones, and on-board storage capabilities, leaving him with “a pretty dumb iPad.” The article recounts a 2013 interview in which former VP Dick Cheney revealed that when his replacement defibrillator was implanted in 2007, his cardiologist insisted on disabling its wireless capability for fear someone might use it to assassinate him.

A Congressional Budget Office report finds that the federal government spend $936 billion last year on Medicare, Medicaid, and ACA subsidies vs. $882 billion on Social Security. The report warns about increased spending on mandatory programs and predicts that the federal deficit will increase.

CMS posts its 2017 Medicare EHR Incentive hardship exception application, due March 15 if EPs are involved or April 1 for just eligible hospitals, with these allowable reasons:

• Lack of Internet access.
• An EHR destroyed by natural disaster.
• Practice or hospital closure or bankruptcy.
• Problems with EHR vendor certification delays, decertification, or other vendor-caused delays.
• Lack of control over locations that fall short of 50 percent of patient encounters.
• For EPs, a practice that does not offer face-to-face interaction.

Privacy and Security

Insurance company Centene announces that it can’t find six hard drives containing the information of 950,000 members.

NIST invites companies to provide products and technical expertise to help develop use cases for IV pump security.

Titus Regional Medical Center (TX) finally regains access to its EHR more than a week after its servers were locked by ransomware. The hospital says it did not pay the money demanded and that the FBI is investigating. The Dallas Area Rapid Transit Authority was also recently infected with ransomware that demanded payment of $63,000 to restore access to encrypted files. DART declined to pay and was able to recover most files from backup copies, but some information was lost and some online services remain unavailable. The FBI stated a few weeks ago that it might make sense for some businesses to pay the ransom demanded, which was the case with at least one police department and a sheriff’s office that have paid to get their files back. The hackers behind the CryptoWall ransomware creation tool recently upgraded their product with a redesign of the ransom note.

Two organizations — New Jersey Cybersecurity and Communications Integration and Cell and National Health Information sharing and Analysis Center — create a third-party reporting and notification system in which the state’s hospitals can share cyberattack information anonymously.

Other

Apparently the unnamed health IT vendor who ran this ad in the Las Vegas Craigslist values its customers about as much as it does women in seeking a “booth girl” whose primary attribute is appearance.

The inquiring mind of Weird News Andy wonders whether a drug that can cure fear will work in cases of pharmacophobia, iatrophobia, and phagophobia.

Sponsor Updates

• Burwood Group packs 100 winter coats, hats, and gloves for the Boys & Girls Club of America during its annual company retreat.
• The local paper features CareSync in its roundup of local entrepreneurial ventures.
• The local paper features Healthfinch in its feature on “Madison startups to watch in 2016.”
• Qpid Health’s quality reporting solution achieves ONC HIT 2014 Edition Modular Ambulatory EHR Certification.
• Huntzinger Management Group hires Jay Boylan and Bill Ehrman as regional sales directors.
• EClinicalWorks is recognized as having the highest market share among cloud-based EHR vendors.
• Versus creates a dedicated clinical solutions department of RNs. 
• Stella Technology is supporting ConCert by HIMSS and conducting demos of the Interoperability Test Tool (ITT) at the IHE NA Connectathon this week in Cleveland, OH.
• Elsevier Clinical Solutions will host the New England HIMSS Social March 1 at HIMSS16.
• Frost & Sullivan recognizes the EClinicalWorks cloud-based EHR for highest market share.
• FormFast will sponsor the HIMSS Midwest Gateway Chapter networking event January 28 in St. Louis.

Blog Posts

• Reflections on 2015: Paving the Way to Value-Based Care (Medicity)
• Take Full Advantage of EPCS (AdvancedMD)
• Cybersecurity: New Area for Mobile Medical App Compliance, Part 2 (AirStrip)
• Intermountain Healthcare Puts Mobile Security at the Top of 2016 Priorities (AirWatch)
• Legacy Data Management Services: Archiving (Impact Advisors)
• Content Interoperability: Achieving Clinical Data Quality Success (Stella Technology)
• It is possible to identify 30% more Transfer DRG underpayments (Besler Consulting)
• 7 HIT Trends to Watch in 2016 (Culbert Healthcare Solutions)
• Touchworks 15.1: Note Enhancements (Galen Healthcare Solutions)
• HIT Challenges in Transition: Moving Toward a Clinically Integrated Network (Hayes Management Consulting)
• Using a Care Team Model to Drive Patient Engagement (Healthwise)

Contacts

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

Morning Headlines 1/26/16

Deficiencies Found at Theranos Lab

The Wall Street Journal reports that a damaging inspection report on Theranos’ California lab testing facility will be made public soon. The article says that investigators found “serious deficiencies” that could compromise its standing with Medicare and existing corporate clients.

Cerner CEO Neal Patterson being treated for cancer

Cerner CEO Neal Patterson files an SEC update announcing that he has been diagnosed with a “treatable and curable” soft tissue cancer. He reports that he will reduce his travel and work schedule while he receives treatment, but notes that “it will not be a big change compared to how we run Cerner day to day already.”

Kaiser Permanente says website woes, now on third day, weren’t caused by cyber attack

Kaiser Permanente’s website, including its patient portal, went down last week due to server issues. Kaiser has confirmed that the outage was not the result of a cyberattack, and has confirmed that all systems are back up.

McKesson’s Paragon Dilemma

The bumpy road McKesson and its users have found themselves on in the transition from Horizon to Paragon.
By @JennHIStalk

It’s been four years since Atlanta-based McKesson announced its decision to shift resources away from its Horizon Clinicals product line — known for serving several hundred large facilities of 300 beds and up — and to make Paragon its centerpiece hospital IT system.

The move — part of the company’s broader Better Health 2020 initiative of increased investment, research, and development of Paragon — was seen by the industry as an attempt to streamline McKesson’s technology solutions to better serve a customer base that was becoming increasingly vocal in its need for an integrated offering.

McKesson has faced an uphill battle in its attempts to convert Horizon customers to Paragon. Changes in leadership, rumored employee discontent, and user push-back have all played their part in McKesson’s attempt to remain competitive with scalable technology that can keep up with federal regulations, evolving payment models, and a customer base that seems to be jumping ship to Cerner and Epic in numbers the company didn’t anticipate.

The Evolution of Industry Reaction

Initial reactions to McKesson’s decision were tempered, with analysts and industry insiders coupling their wait-and-see attitudes with a healthy dose of skepticism regarding the company’s financial stakes. “On one hand, I laud MPT for coming clean on the challenges it has had with the development and support of the Horizon product,” Aspen Advisors (now part of The Chartis Group) Founder and Managing Principal Dan Herman said in a 2011 year-end assessment. “However, it appears that [McKesson’]s go-forward strategy is ‘déjà vu’ – a poorly thought-out approach to integrate disparate platforms, enhance a product that has experienced success in a focused marketplace (Paragon), and promise to customers that [McKesson] is committed to delivering a ‘fully integrated core clinical and revenue cycle IT system.’”

The situation wasn’t as positive after a few years and a few Horizon to Paragon migrations, both from an end user and company perspective. “As a customer, we have noticed that support and services have steadily declined since the Better Health 2020 announcement …. The average tenure of support employees supporting us has dropped severely with resignations,” noted one HIStalk reader and McKesson Horizon customer in 2013. “We have to run a gauntlet of triage and bottom-tier support before most of our issues are escalated to a rare senior resource. They are exerting pressure for us to migrate to Paragon while failing in their commitment to support us on Horizon. Actions speak louder than words and customers have been left to deal with the fallout.”

Fewer than one-fourth of respondents to an HIStalk reader poll in December 2011 said they had a positive reaction to McKesson’s Better Health 2020 plan. Three-quarters of respondents to a September 2012 reader poll said McKesson’s healthcare IT position had worsened in the past year, with one respondent commenting that the plan to move Horizon users to Paragon was, “Nothing more than puff-piece marketing. There was no tangible follow-up with their closest clients to show them concrete plans. The traditional, ‘Trust us because we’ve worked so hard together all these years’ and the implications of ‘we are too big to fail’ just do not hold water.”

The corporate side of the story correlated with user frustration, as McKesson leadership shuffled and Horizon employees were urged to take jobs at RelayHealth, which expanded to over 1,000 employees in 2013. McKesson’s February 2015 earnings call offered a slightly rosier picture of the company’s migration attempts. Chairman, President, and CEO John Hammergren mentioned that the Technology Solutions division’s seven percent drop in revenue was in line with expectations of lower Horizon Clinicals revenue, and that the company was “in [the] middle of the game” in trying to migrate customers.

He added that, “As you think out two or three years, the EMR space and the transition away from Horizon will be more complete or complete, and we’ll see more results, we think, in terms of this pay-for-performance priority.”

Fast forward almost a year. Hammergren’s prediction of a transition away from Horizon seems to be coming true, though not necessarily with the outcome he had hoped.

“The move from Horizon to Paragon has actually been pretty painful for McKesson and for their customers,” says Coray Tate, vice president of clinical research at KLAS Enterprises. “That’s not a secret. It’s a little bit of a perfect storm that Paragon got caught up in.”

Paragon, Tate explains, has suffered not only from a Horizon customer base that was unenthusiastic about switching systems and wary of Paragon’s ability to scale to larger facilities, but also from bad timing. The leader in KLAS customer satisfaction rankings for small community hospitals was caught up in the rollout of Meaningful Use and the prospect of a switch to ICD-10. Toss in high-level leadership changes and the “perennial leader” found itself falling behind.

“They took a product that had really struggled,” says Tate. “They reset expectations and have actually done a really good job of developing on that. But now you’ve got all these external pressures that they haven’t been able to meet. Meaningful Use made EHRs become a physician tool, and so that part has been the biggest gap and they are having a hard time getting to the point where physicians are happy with it. That’s not unique to Paragon, but that is definitely one of Paragon’s struggles and one of the reasons why you’ve seen their scores drop in the small market.”

End-User Fallout

Tate’s insight into market forces have been playing out in Horizon facilities. Mike Jefferies, a former McKesson technical advisor who is now vice president of IS at McKesson customer Longmont United Hospital (CO), agrees with the Better Health 2020 strategy. However, he questions whether big Horizon customers are comfortable with the idea of migrating to Paragon.

“You’ve seen a huge consolidation in healthcare,” Jefferies explained in a February 2015 HIStalk interview. “That consolidation has favored EHRs that handle a larger scale, which in our market means Cerner or Epic. What a larger organization consolidates smaller hospitals and organizations, they certainly aren’t going to uptake that smaller community EHR.”

Vanderbilt University Medical Center (TN) is one such customer. It announced its move from Horizon – much of which it had self-developed as WizOrder and then licensed to McKesson in 2001 to create Horizon Expert Orders — to Epic in December 2015, with an anticipated go-live in 2017.

VUMC Chief Informatics Officer Kevin Johnson, MD, MS, who is spearheading the effort, says that its decision was certainly strategic, though the IT team was understandably disappointed to hear the Horizon/Paragon news. “We realized that McKesson was focusing on a different segment of the healthcare market with the Paragon system,” he explains. “Therefore, we had begun surveying the landscape to be proactive about the move at the same time that McKesson sent us the announcement.”

“We have enjoyed a long history with Epic as one of their first revenue cycle clients, dating back to 1995,“ Johnson adds. “We had made a decision to upgrade our revenue cycle and billing system to a more recent Epic version for inpatient and outpatient billing. We also have Cerner’s lab system. Our decision, therefore, was to migrate our revenue cycle/clinical/lab environment to Epic/Epic/Cerner or Epic/Cerner/Cerner. Paragon is a system constructed with a different size and complexity health system in mind. Both Cerner and Epic were good choices for us, and after a thorough evaluation, we chose Epic for our clinical system.”

The Consultant’s Perspective

Mike Lucey, founder and president of Paragon consulting firm Community Hospital Advisors, paints a more intimate picture of Horizon end user reaction. ”I work with the IT folks and the doctors, nurses, therapists, and revenue cycle folks that actually use the product. They take it personally. This is their product,” he explains. “It’s very hard for the users to get around the idea that McKesson is taking something away that they like and works for them and giving them something that for years and years has been pitched as not good enough for their needs. They feel like they had the rug pulled out from under them.”

In Lucey’s best estimation, between 50 and 60 Horizon customers are still evaluating their options and  “a couple hundred” are on Paragon, with half of those being migrations.

“It’s important to remember that frustration has a half-life,” he says. “People get frustrated, they get angry, they stomp their feet. They run around and they put out RFPs and they get their responses back. Then the reality of money sets in. I think that’s where we are now. How many phases are there to grief? You know, you have denial. They kind of get stuck on anger for a while. Then somewhere along the way there’s acceptance. I think that’s the phase this market has gotten to. Folks are recognizing that they need to make a rational decision with good information.”

The Positives of Paragon

It’s not all doom and gloom, as Lucey’s current Paragon customer estimates attest. He is quick to emphasize that Paragon works, though the definition of “works” is, as with all IT systems, at the discretion of the implementing organization.

“The underlying technology and the functionality of Paragon is effective. It can get the job done for hospitals and multi-facility organizations, but it has to be put in well. It’s an issue of accountability. You can find many instances of Paragon implementations where the product is working very, very effectively. The difference between where it’s effective and ineffective is ownership. If the hospital owns it, it works well. If they don’t, it usually stinks.”

Paragon’s Success Hinges on McKesson’s Commitment

Both Lucey and Tate believe that product development and overall quality will make or break Paragon. “They’re going to have to be able to get code out to increase the physician experience,” Tate explains. “The code quality of the releases has got to get better. There have been reports of things being buggy as releases have come out. Overall, it’s going to have to mature to more of a clinical solution, meaning that it’s easier and faster for physicians to use.”

Lucey agrees that McKesson needs to show its commitment to Paragon by improving code quality within a few months. He adds that the company will have to deal with employee challenges. “A lot of them are the same people that were previously doing that for Horizon. A lot of them are still upset. Can they change uniforms from Horizon to Paragon, pick up the mantle, and advocate for it? Make it better, support it well, and sell it effectively? I don’t think a lot of them can, quite frankly.”

Lucey’s insight into McKesson’s internal struggles is shored up by several HIStalk reader reports that McKesson has turned to offshore resources to tackle Paragon’s development and that the company has begun pitching its technology division to venture capitalist firms, reported privately to HIStalk by someone who claimed to have been present in one of the meetings. McKesson President Nimesh Shah was unavailable for comment due to the company’s pre-earnings quiet period through April 1.

McKesson’s commitment to Paragon will determine whether it will continue to meet user needs, remain competitive, and capture a significant share of the Horizon customer base that is being forced to seek an alternative from McKesson or its competitors.