Curbside Consult with Dr. Jayne 1/25/16

Although I’m still thinking pretty seriously about hanging up my consulting shoes, I decided to accept an EHR vendor’s offer to become a potential subcontractor. Apparently they’ve heard about my work with some of their clients and would like to able to book my services on their paper.

I thought about it for quite some time before accepting. Although financially it’s a wash for me, it has the potential to increase my pool of potential clients. It might also lead to a bit of accounting efficiency, as I will bill the vendor for my time and expenses rather than having to deal with the accounts payable departments of multiple practices, hospitals, and health systems. That can be a blessing and a curse, though, if their accounting department turns out to be chaotic or they’re a slow payer.

Any of their clients that I’m already working with will remain my direct customers. The agreement is year-to-year and I have a 90-day out clause if it doesn’t work out, so I thought I would give it a shot.

One of the benefits of being an official subcontractor is gaining expanded access to their client support site and their online training and education materials, so that’s a plus. I can also attend formal training at the corporate office if I choose. Prior to this, I’ve had to rely on the kindness of my clients in obtaining access to the vendor’s support system and documentation.

Although I had taken a bit of a break from travel at the end of 2015, I’m now back in the air and watching some of their client-facing training sessions from 38,000 feet. What did we ever do before in-flight Internet?

I’m pleased to see that the vendor has made some significant improvements to the application from a user workflow standpoint. They’ve added quite a few “nice to have” items that I’m guessing have been in their development backlog from some time. For many of the products I work with, vendors were forced to push pure usability enhancements to the side while they pressed forward with a seemingly endless list of Meaningful Use and regulatory enhancements. Although MU3 continues to lurk, it feels like there may be some breathing room and ability to go back and give users things they actually want and need.

I’m grateful that my travel this week takes me away from the Blizzard of 2016. I’m going to meet with a potential new client who heard about my work after I met one of their physicians at the AMIA meeting. Apparently they’ve been through multiple physician and operational leadership changes in the last few years and the organization has finally hit rock bottom, or at least that’s what it feels like to the physician I met who is stuck trying to get value out of the EHR with little support.

From the information I have so far, it looks like they may have been a victim of trying to follow the “flavor of the month” in healthcare without any semblance of strategic planning. The group dabbled in Patient-Centered Medical Home, followed by an Accountable Care initiative, then acquired several independent physician groups and tried to do some work with procedural subspecialties including an Ambulatory Surgery Center. They applied for numerous grants and agreed to participate in multiple incentive programs without a clear plan or strategy.

Based on those goals, they went on to build custom reminders into the EHR for all of them, which has largely driven the end users to their wits’ end. They also mysteriously spun up a practice that operates on the concierge model, yet has to document using the same templates and content used by everyone else even though some of them are not relevant. The physicians feel bombarded by an alphabet soup of initiatives that lack coordination or staff support.

They’re also suffering from staffing issues, including high turnover, lack of coverage in certain skill sets, and perceived budget constraints that have led to the departure of seasoned clinical managers. They allowed several payers to embed care management staff in the practices, but didn’t have a plan for how they would document in EHR or how they would truly coordinate care. In many instances, care has actually become more fragmented as some of the care managers are documenting in systems hosted by their employers rather than in the practice’s EHR.

It’s not just their clinical house that’s in chaos. Their revenue cycle management has also taken some hits. He’s had patients complain that they’re receiving bills for visits that were never sent out to insurance. After investigation, it appears that timely filing deadlines were missed, so the billing office just moved those balances to patient responsibility.

Needless to say, the patients are irate. Co-pays aren’t being collected at the time of service, so even for those visits that did get sent to insurance, they’re spending an inordinate amount of money sending statements to chase the co-pays. Physicians aren’t seeing regular performance metrics and have been told that there are problems with the EHR that prevent accurate reporting.

Sometimes when I meet with groups like this, they want to dwell on the aspects of what went wrong and how they got to this place rather than putting their resources into moving forward. Although some root cause analysis and probing of organizational psychology is a good thing, pointing fingers or trying to pin the blame on people who have left is not.

Even if the organization is ready to move in a new direction, change leadership is difficult. If they don’t have the collective will to devote long-term support to new processes, they might find themselves back where they started or potentially in a worse position. The outgoing CIO had tried to bring in some assistance previously, but was stymied by budget issues.

The physician who recruited me for this adventure isn’t sure whether they’re truly ready to accept outside help, but I am certainly willing to pitch to them. In reality, he didn’t have to do much arm-twisting since the client is located in one of my favorite cities.

As a bonus, I get to visit with one of my health IT mentors while I’m in town. He recently retired to the area and I’m hoping he has some sage wisdom to offer. I won’t just be pitching to a potential client on this trip, but also to him, in hopes that if I’m successful, he’ll agree to help with the onsite work. There’s just something about the lure of putting the band back together that I don’t think he’ll be able to resist.

Are you a sucker for hopeless causes? Email me.

Email Dr. Jayne.

Morning Headlines 1/25/16

Hurley Medical Center Confirms ‘Cyber-Attack’ as Anonymous Hacking Group Threatens Action Over Flint Water Crisis

Hacker group Anonymous is suspected of a cyberattack on a hospital in Flint, MI after the group posted a YouTube video promising realization for the city’s recent water crisis. Hospital administrators report that the attack was detected on January 21, but that patient care was not companied.

athenahealth Partners With University of Toledo Medical Center to Accelerate Development of Inpatient Electronic Health Record

Athenahealth will work with the University of Toledo Medical Center to develop its inpatient EHR, The University of Toledo Physician Group has been on Athena since 2014.

Data Sharing

A NEJM editorial raises concerns about medical research based on big data when combining data sets is often an imprecise endeavor, asking “Can it be assumed that the differences in study populations, data collection and analysis, and treatments, both protocol-specified and unspecified, can be ignored?”

Monday Morning Update 1/25/16

Top News

The hacker group Anonymous is presumed to be behind a cyberattack against Flint, MI-based Hurley Medical Center, with the group apparently following through on its threats from the previous day to take action against those involved in the city’s water crisis. The hospital says its IT team detected the attack and reports no impact on operations.

Meanwhile, Flint-based McLaren Regional Medical Center says the city’s contaminated water probably contributed to a January 2014 Legionnaires’ disease outbreak that occurred right after the city started drawing water from the Flint River. The hospital president says health agencies didn’t inform the public about the outbreak until just a few weeks ago, adding, “It’s a public health issue. There were people in the city of Flint seeing brown water. It would seem logical that there would have been public reporting or public awareness about the Legionella situation.”

Reader Comments

From Caveat Emptor: “Re: Epic hosting. We’re one of the first, scheduled to go live in a few months. The IT department tells us we may not be able to scan documents into Epic due to poor integration with our McKesson document management system. There is some very serious anger at Epic right now. They seem to have been caught flat-footed, which raises questions about what other third-party vendors Epic-hosted solutions can’t accommodate.” Unverified.

From Mark: “Re: CenTrak. Heard it was acquired this week.” I’ve seen no news about the RTLS vendor so far.

From InBetweener: “Re: CHIME. They will award $1 million to anyone that technically solves the national patient identifier problem (underwritten by a vendor contribution, of course). Here we have a classic political failure that needs to be solved by technology. Healthcare is full of these ‘insane’ situations and we wonder why systems overly complex, don’t work as planned, have errors, and cost a bundle? The simple albeit political solution is to allow a opt-in/out NPI, just like TSA does for trusted fliers. Works for TSA, no privacy uproar. Why not for CMS? Why isn’t HIMSS/CHIME spending a million to lobby for that solution?”

HIStalk Announcements and Requests

A slight majority of poll respondents expect CMS’s changes to the Meaningful Use program to be positive. New poll to your right or here: is an ONC-produced EHR "star rating" a good idea?

Four firms donated $1,000 each to DonorsChoose to attend my HIMSS lunch with 10 or so CIOs. I won’t recite the individual projects I funded as a result since it’s a long list, but I’ll run photos and updates from the teachers when I get them (most of them emailed me their thanks over the snowy weekend). Nearly everything I funded was STEM related – iPad Minis, programmable robots, Chromebooks, math manipulatives, headphones, and science activity kits. Thanks to these companies for helping teachers and students in need.

Consulting firm Optimum Healthcare IT made a second $1,000 donation following its first one last week.

Serra Health Consulting donated $1,000.

Electronic forms and workflow vendor FormFast provided $1,000, which funded six great projects.

Nordic, which always steps up to support HIStalk, donated $1,000 to fund projects that include two I chose specifically from teachers in their home state of Wisconsin.

Our budget-minded HIMSS Booth #5069 will by necessity be microscopic, remote, and amateurishly furnished. However, it always overflows with more enthusiastic, fun visitors than those block-spanning monolithic monuments to executive egos. Contact Lorre if you are an industry celebrity (loosely defined) and want to hang out for an hour with her saying hello to readers. I’m hoping she can get Martin Shkreli to sign up. 

We give out “secret crush” beauty queen sashes on stage each year at HIStalkapalooza for whoever submits the most convincing reason they deserve one. I’ve ordered ones indicating Mr. H, Jenn, Lorre, and Dr. Jayne if you want to send your entry to me. My main lesson learned from years of planning the event – other than that people vastly prefer an open bar to drink tickets — is that nearly everyone likes wearing a beauty queen sash.

Mrs. Twigg from Missouri says the document camera we provided in funding her DonorsChoose grant request has changed her classroom’s dynamic since students can now see everything up close and are able to demonstrate their own work to the class. She says, “There are a few students who are soft-spoken and a little uncomfortable speaking in front of their peers. The document camera has been especially beneficial for these students because the focus is more towards their work, and less on them individually … I have noticed that the document camera has greatly enhanced their oral communication skills …It’s nearly impossible to imagine our classroom without the document camera because it has created endless opportunities for each student and their learning experience as a fourth grader. On behalf of every fourth grader who walks through room 205, thank you.” That’s a really impressive result from our donation of just $100 (I applied matching funds from the Ewing Marion Kauffman Foundation).

Also checking in is Mrs. C, who says her Texas second graders love using the iPad Mini keyboards and styli we provided.

Here’s an old but funny video of a sketch from Britcom “That Mitchell and Web Look” called “Homeopathic A&E” that amused me when I ran across it this week.

I’m fascinated by the war that’s heating up between ad-serving websites and their readers. Internet users started it by using ad-blocking software that threatens the sole revenue stream of most online publishers in squelching their increasingly intrusive expanding banner ads, pop-up banners, and obnoxious auto-play video commercials. Some of those sites in turn starting blocking access unless the ad-blockers are turned off. Google gets most of its revenue from displaying ads and thus is obviously not a fan of ad blockers (and in fact prevents Android users from installing them), but just announced that it suppresses some of the more annoying or misleading ads, apparently hoping to convince people they don’t need ad-blocking software that it can’t control. One ad-blocker vendor just accused a big competitor of accepting company bribes to let their ads through its filter, while Firefox creator Mozilla just released a new browser (Brave) that blocks publisher ads but instead inserts its own. I’ve noticed that quite a few sites won’t even load on my tablet due to the mess of advertising junk that’s trying to load in the background or pop up intrusively in ways that don’t work on tablets.

Here’s when hospitals will see the impact of this weekend’s blizzard: early November, in their L&D departments.

HIStalkapalooza

HIStalkapalooza Sponsor Profile – Forward Health Group

Forward Health Group to unBooth at HIMSS16! A visual extravaganza is rolling into booth #2477. FHG, a leader in value-based population health management solutions, zigs when everyone else zags. The fast-growing company will feature prodigious, on-the-fly artistic talents, generating marvelously whimsical graphic population health management collaborations with HIMSS visitors. Producing giant eight-foot, hand-drawn murals each day, recording booth visitors’ visions of their value-based population health futures, FHG will also provide demonstrations of five new PopulationManager products, including innovative pre-packaged FastForward PopulationManager solutions for chronic care, acute episodes, behavioral health, bundled payments, and national standards reporting. Fresh oranges, too. A splendid time is guaranteed for all.

Last Week’s Most Interesting News

• Titus Regional Medical Center (TX) remains without its EHR several days after its servers are hit with ransomware.
• The Senate’s HELP committee releases draft legislation that it will consider on February 9 that includes streamlining government EHR requirements, charging ONC with publishing an EHR star rating system, increasing interoperability efforts, and creating an ONC-led committee to drive creation of a national health IT infrastructure that includes accurate patient identification.
• An investigative report finds that Practice Fusion originally expected to go public next year with a valuation of $1.5 billion, but plans and expectations have changed with the decline in the stock market.
• Leidos is rumored to be close to taking over Lockheed Martin’s IT and services businesses.
• UnitedHealth Group announces that it lost $720 million selling insurance plans on the exchanges in the fiscal year and expects losses to continue, but reports stellar performance from its Optum services business.
• OCR clarifies the provider requirements for giving patients copies of their medical information, suggesting that it will step up its enforcement efforts.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cloud and managed services vendor TierPoint acquires Midwest competitor Cosentry, expanding its operations to 38 data centers.

Pre-launch digital medicine vendor Akili raises $30.5 million to continue development of its video game-like cognitive disorder diagnosis and treatment apps.

People

Hearst Health promotes Kevin Daly to president of its Zynx Health business.

Announcements and Implementations

Athenahealth customer University of Toledo Medical Center (OH) will help the company develop inpatient capabilities based on its acquired RazorInsights and WebOMR systems, which will be retooled to create an AthenaNet cloud-based hospital system. I’m not certain which systems UTMC uses, but I think it’s McKesson for both ambulatory (HAC) and inpatient (the ancient McKesson Star).

Government and Politics

I finally heard back from the Office for Civil Rights about the complaint I filed in July 2015 against a large, Epic-using, EMRAM Stage 7 academic medical center that refused to give me an electronic copy of my medical records (they told me, “We only do that for doctors.”) The letter acknowledges the hospital’s responsibility to give me what I requested, but concludes with, “We have determined to resolve this matter informally through the provision of technical assistance to the hospital,” thus closing my complaint. I still don’t have an electronic copy of my information seven months after requesting it and the hospital will apparently see no repercussions for refusing to provide it. OCR’s insistence last week that it will zealously protect patient rights to receive their own medical information seems to be bureaucratic chest-thumping rather than a commitment to actually meting out punishment for intentional non-compliance, at least from this N of one.

Privacy and Security

A patient of an Indianapolis hospital complains about receiving calls demanding that she make payments on her pacemaker, apparently originating from a con artist spoofing the hospital’s caller ID.

A Utah women is arrested for entering narcotics prescriptions for herself by logging as a doctor into an old computer at the Intermountain clinic where she previously worked as an administrative assistant. She wrote 260 prescriptions for 62,000 doses for which insurance paid $26,000. At an average of nearly 250 pills per prescription, you would think the pharmacy might have become suspicious.

Other

A Scripps Translational Science Institute study finds that smartphone-powered biosensor monitoring did not improve outcomes for patients with hypertension, diabetes, or arrhythmias. The study’s methodology was decent although it used data from 2012.

Nabil El Sanadi, MD, president and CEO of Broward Health (FL), commits suicide. 

A 54-bed hospital in rural Georgia that hired a local car dealer as its turnaround CEO faces closure again after paying big money to the CEO and experts he brought in. The CEO was paid $480,000 per year on contract (quadruple the pay of his predecessor) with checks made out directly to his Ford dealership. He paid millions to bring in employees and contractors with connections to Duke University, where he had studied, including a reported $458,000 over five years for the CIO. Employees claim his hired gun experts were driven by data rather than patient needs. The hospital faces closure if the locals don’t approve a tax increase.

An editorial in NEJM warns of “research parasites” who “use another group’s data for their own ends” and who might not understand the differences in multiple datasets that they combine. It recommends that researchers start with an original idea rather than a me-too concept and then find collaborators with whom to share data, work together to create new hypotheses, and jointly publish their findings. I can’t decide if this is sound thinking or egotistical data-hoarding by academics more interested in furthering their careers than making patient-contributed datasets available for the public good.

Weird News Andy says this doctor was uber-rude. A fourth-year neurology resident at Jackson Health System (FL) is suspended pending an investigation after a video of her attacking an Uber driver goes viral with several million views. The apparently intoxicated doctor hopped into an Uber car that someone else had called, refused to get out, beat the driver, and threw all of his belongings into the street while cursing at him. Police responded but filed no charges after she told them (while crying) that she would lose her medical license if arrested.

Sponsor Updates

• T-System and VitalWare will exhibit at the HFMA Region 11 Healthcare Symposium January 24-29 in San Diego.
• Wolters Kluwer Health publishes an e-book titled Integrated Clinical Decision Support: Accelerating Adoption of Evidence-Based Care for Optimal Outcomes.
• Valence Health will exhibit at the HFMA Tri-State Institute January 27-29 in Memphis, TN.
• ZeOmega will exhibit at the Strategic Analytics for Population Health event January 25-26 in Orlando.

Blog Posts

• TeleTracking’s 25th Year (TeleTracking)
• Making Cloud More Local and Other Observations Four Months in at TierPoint (TierPoint)
• Provider Success in an ACO Setting (Verisk Health)
• Household gadgets are coming to healthcare. (Voalte)
• How Clinical Informaticists Can Improve Healthcare (XG Health Solutions)
• Meaningful Use: Evolution, not Elimination (Wellcentive)

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 1/22/16

Virus hits TRMC computers

Ransomware has been blocking EHR access at Titus Regional Medical Center (TX) since January 15, sending all hospital operations back to paper. “It’s just like in the 1970s, before electronic medical records. Everything is on paper and people are serving as runners. There’s no automation,” explains the hospital’s public information officer. There is currently no estimate for when the system will be back online.

VA chief to Congress: You can’t fire your way to excellence

VA Secretary Robert McDonald testifies before Congress that he has fired 2.600 VA employees since he took office 18 months ago, and that he is now working to turn the organization into the number one customer-service agency in government, primarily through new IT projects

Clarifying, Eliminating and Enforcing Special Enrollment Periods

CMS updates its rules on special enrollment periods for insurance exchanges to crack down on those that “remain uninsured and then decide they need health insurance when they get sick.”

Time for a Patient-Driven Health Information Economy?

An NEJM opinion piece calls for APIs that could help establish a patient-controlled health record infrastructure, citing reluctance of providers to share medical records with patients, despite HIPAA and HITECH mandates.

News 1/22/16

Top News

The Senate’s HELP Committee will not vote on the House-passed 21st Century Cures act in its entirety, but instead will review it as seven separate bills. The committee will vote on an EHR bill on February 9 that covers unnecessary physician documentation, patient records access, information blocking, and EHR certification standards. In the draft legislation that was just published:

• HHS will establish goals to reduce EHR regulatory and administrative burdens.
• ONC will create voluntary EHR certification criteria for specialties, including pediatrics.
• ONC will make materials submitted by software vendors to earn certification publicly available.
• Vendors of certified software will be required to attest that they do not practice information blocking.
• ONC will publish an EHR star rating system that includes security, usability, interoperability, and testing  results. One-star vendors will be required to follow a corrective action plan and can be fined or decertified if they don’t improve their rating. The government will reimburse users for the cost of decertified products.
• HHS OIG will be empowered to investigate claims of information blocking by vendors or providers, with vendors subject to fines and providers liable for an unspecified “sufficient deterrent.”
• ONC will convene groups to create a trusted exchange framework for interoperability.
• HHS will publish a provider digital contact information index.
• ONC will create a 25-member HIT Advisory Committee to develop standards and to set the agenda for a national health IT infrastructure, including privacy, accurate patient identification (an effort that will be overseen by the GAO), and de-identification.
• HHS will define a common data set for public health reporting.
• ONC will certify software using patient usability criteria, including giving patients access to their information in a single longitudinal format and giving them the ability to add to their information and share it as desired.

Reader Comments

From Company Contact: “Re: HIMSS Analytics. The revised version looks like a search engine, returning information in a tightly nested and unreadable spreadsheet. For the fees companies pay, it’s a shame that some engineer got into their heads to change the format. “

HIStalk Announcements and Requests

Ms. Aguiar made a passionate plea for tablets and electronic flash card software for her Florida third graders, saying, “I truly believe they can and will succeed despite what society, prejudice, or others might think about them … my students don’t have have access to technology, which automatically puts them behind their high-income peers.” We funded her DonorsChoose grant request, about which she reports, “You have made a tremendous impact on our classroom and our success. Because of you, we now have access to technology in our room and now have the ability to access websites, games, and books online. We can now say that we are competing against our peers in a fair way.”

My fundraising lunch will be Wednesday of HIMSS week from 11 to 1. Vendors who donate $1,000 to DonorsChoose get to make a short pitch to the assembled CIOs and enjoy a social lunch following. CIOs from John Muir Health, Contra Costa Health Services, University of Colorado Health, Centura, UC Irvine, and several other health systems are donating their time to raise money for a worthy cause. Contact Lorre for donation instructions (the money is paid directly to DonorsChoose) and a seat at the table. I’ll mention the donations here as well.

Thanks to consulting firm Optimum Healthcare IT for joining my CIO lunch. Their $1,000 donation funded these DonorsChoose teacher requests with matching funds from third-party foundations:

• A programmable robot kit for Ms. Stokes’ elementary school gifted class in Charlotte, NC
• Three iPad Minis and cases for Mr. DePhillips’ elementary school class in Herminie, PA
• A programmable robot, vehicle building kit, iPad Mini, and case for Mrs. Bierhals’ elementary school class in Ruffs Dale, PA
• STEM manipulatives for Mrs. Lee’s kindergarten class in Tucson, AZ
• A wireless whiteboard, two iPad Minis, cases, and four science books for Mrs. Petrisko’s elementary school class in Herminie, PA
• A 26-book library for Ms. Stitt’s elementary school class in Charlotte, NC
• A listening center and 48 math skills books for Mrs. Gadsden’s kindergarten class in Durham, NC

This week on HIStalk Practice: Physiotherapy Associates rolls out the Athletic Trainer System EHR. University of Pennsylvania physicians find that fitness trackers aren’t all they’re cracked up to be. AllMeds rebrands and expands RCM offerings. De-identified health data means big bucks for business and a lack of confidence for consumers. CareCloud CEO Ken Comée recaps Practice Profitability Index findings. The American Academy of Sleep Medicine officially launches its telemedicine service. CMS tightens up on Healthcare.gov’s special enrollment periods. Panorama Orthopedics & Spine Center COO Lance Goudzwaard shares the benefits of virtual scribe technology.

This week on HIStalk Connect: The FDA publishes guidelines outlining postmarket cybersecurity requirements for medical device manufacturers. Scripps Translational Science Institute publishes results from one of the largest clinical trials measuring the effectiveness of remote patient monitoring conducted to date, finding no improvement to outcomes, overall service utilization, or cost of care. Patrick Soon-Shiong announces his own "Cancer Moonshot 2020" in conjunction with the President’s SOTU cancer moonshot announcement. Researchers from the University of Illinois unveil a new implantable brain sensor that monitors pressure and temperature, but that is made entirely of materials that break down naturally in the body over time, eliminating the need to remove implants.

HIStalkapalooza

Last call: if you want to come to HIStalkapalooza, fill out the request form. I will almost certainly be able to invite everyone who asks, which hasn’t been the case in most years. Remember that I’m sticking with Monday night even with the screwy Las Vegas HIMSS schedule that is driven by casino greed, so you can make Michael Dell’s 5:00 p.m. keynote (if you care enough to bother, which I can’t say I do) but not the opening reception that runs the odd hours of 7:00 to 8:30 p.m. I guarantee that my event will be much more fun and memorable.

HIStalkapalooza Sponsor Profile – Wellcentive

The business case for quality has never been stronger. Incentives, penalties, risk, and market competition is at an all-time high. Is your organization positioned for success relational to quality, revenue, and transformation? Since 2005, Wellcentive has partnered with organizations to ensure successful transitions to value-based care. Our solutions are consistently ranked as a top performers by KLAS, IDC Health Insights, Chilmark, and Black Book. Stop by booth #468 and network with professionals leading some of the most complex transformations being witnessed today. Lastly, in the spirit of care, for every minute you spend with us, Wellcentive will donate $1 to impact the 20 million (or one in five) Americans living with an autoimmune disease. As a Histalkapalooza sponsor, join us and last year’s HIStalk King Wellcentive’s Gabe O for the party of the conference

Webinars

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

Acquisitions, Funding, Business, and Stock

Free EHR vendor Practice Fusion hired investment bankers to explore a 2017 IPO last year, but its plans may have changed due to poor stock market conditions, according to the New York Times. JPMorgan originally estimated that the IPO would value the company at $1.5 billion based on revenue growth assumptions that the company later reduced. Practice Fusion, which has raised $149 million, expected to lose $26 million on revenue of $46 million in 2015. Found Ryan Howard was replaced as CEO in November 2015 by the promoted Tom Langan, who has no CEO experience.

Agfa Healthcare buys a 27 percent equity position in My Personal Health Record Express, which offers the Minerva data aggregation platform.

Reuters reports that Leidos is finalizing a $5 billion deal to acquire Lockheed Martin’s government IT business.

Sales

Tuba City Regional Health Care (AZ) chooses Allscripts Sunrise and Care Director for its 73-bed hospital and clinics.

Neighbors Emergency Center, which operates 12 freestanding emergency departments, chooses T-System’s EDIS.

Centegra Health System (IL) expands its use of FormFast electronic forms to Centegra Hospital-Huntley.

Easter Seals Southern California chooses Netsmart’s EHR for providing services to 6,000 children and adults with intellectual and developmental disabilities.

The Military Health System selects McKesson’s InterQual for utilization management.

People

Pamplona Capital Management names Joel Hackney, Jr. (Avintiv) as CEO of the new company created by the merger of its holdings, MedAssets and Precyse.

Identity resolution vendor CrossChx hires former HHS CTO Bryan Sivak and former ONC chief medical officer Jacob Reider, MD for part-time, unstated roles.

WEDI names Charles Stellar (AHIP) as interim president and CEO.

Announcements and Implementations

Ireland-based patient engagement and clinical workflow technology vendor Oneview appoints two new board members following its $13 million capital raise in December.

Wolters Kluwer announces that it gained 113 customers for its procedure documentation system ProVation MD in 2015 and signed agreements with 86 healthcare facilities to replace the retired EndoWorks by Olympus, which named ProVation MD as its preferred replacement.

Experian Health announces its largest-ever Q3 results with 66 newly signed contracts and additional product selection by 192 customers.

Athenahealth, eClinicalWorks, Epic, NextGen Healthcare, and Surescripts are named as the initial implementers of the Carequality Interoperability Framework that was released in December 2015.

Government and Politics

CMS tightens up Healthcare.gov’s special enrollment period policies to eliminate “unintended loopholes,” such as people switching or dropping plans mid-year for purely financial reasons. CMS will reduce the number of those periods, clarify that a consumer’s relocation must be permanent to be eligible for move-related plan changes, and warns that it will audit consumer-entered information for accuracy. CMS helpfully clarifies that “special enrollment periods are not allowed for people who choose to remain uninsured and then decide they need health insurance when they get sick.”

Veterans Affairs Secretary Robert McDonald testifies to the Senate Committee on Veterans Affairs, outlining plans to transform the VA as the #1 customer service agency in government. Among his goals is to transform the VA from “sick care” to “healthcare.” He also wants to “bring our information technology infrastructure into the 21st century” and listed the IT-related goals above.

ONC announces that Franciscan Missionaries of Our Lady Health System VP/CIO Vindell Washington, MD will join the organization as principal deputy national coordinator.

Privacy and Security

Titus Regional Medical Center (TX) loses access to its EHR for several days when its database servers are hit with ransomware, which demands payment to restore access to the information. The hospital doesn’t know when it will get its systems back following the January 15 incident, explaining, “It’s just like in the 1970s, before electronic medical records. Everything is on paper and people are serving as runners. There’s no automation.”

The malware that took down the pathology department of Australia’s Royal Melbourne Hospital has been identified as a new variant of the Qbot worm. The department is still running Windows XP PCs and its laboratory information system runs on Windows Server 2003. Both products have been retired and are no longer supported by Microsoft. Qbot had a moment of fame in 2014 when security experts found that it had compromised 500,000 computers after being distributed from infected web pages, with its apparently Russian authors having stolen login credentials for up to 800,000 bank accounts.

Other

Two-thirds of hospitals don’t expect precision medicine to have much of an impact on their organizations in the next five years, according to a fairly small survey by Health Catalyst that also finds that few providers are adding genomic capabilities to their EHRs.

A NEJM opinion piece by Ken Mandl and Zak Kohane of Harvard and the SMART program observes that providers have mostly ignored their requirement under HIPAA to give patients copies of their medical records, often because they are protecting their competitive position. It adds that document exchange via C-CDA failed because it wasn’t standardized and Blue Button hasn’t matured. It urges IT purchasers to demand a patient-controlled solution powered by open APIs.

A study in JAMA Internal Medicine finds that people who spend less on healthcare after switching to high-deductible medical insurance aren’t shopping for care more wisely – they just use less of it because it costs them more. That throws water on the theory that people who are paying out of their own pocket seek lower-cost providers.

The International Committee of Medical Journal Editors proposes that its member journals (Annals of Internal Medicine, NEJM, JAMA, and others) require authors to share the de-identified patient data from clinical trials they used.

A San Franciso startup whose app allows women to easily obtain birth control seems to be crossing a telemedicine line it may not realize exists. Women fill out an online form that includes the brand name of product they want, a doctor reviews their information and issues a prescription, and the birth control product arrives within two days and is refilled automatically going forward. The patient never actually interacts with the doctor.

Sponsor Updates

• InterSystems will exhibit at the IHE North America Connectathon 2016 January 25-29 in Cleveland.
• Leidos Health will exhibit at the CHIME Spring Forum January 28-29 in Las Vegas.
• KLAS recognizes LifeImage as the market leader in image exchange.
• MedData will exhibit at the Texas Hospital Association Annual Conference January 21-22 in Dallas.
• Direct Consulting Associates will exhibit at the IHE North American Connectathon 2016 January 25-29 in Cleveland.
• EClinicalWorks releases a new podcast on the benefits of RCM at HCA.
• Healthgrades announces the 2016 Distinguished Hospital Award for Clinical Excellence recipients.
• Patientco will exhibit at HFMA’s Annual Revenue Cycle on January 22 in Foxborough, MA.
• Porter Research helps to develop the Institute of Health Information Technology’s annual HIT workforce report, and Navicure’s latest ICD-10 survey.
• Red Hat is recognized as a leader in two Forrester research reports ranking private cloud software suites and hybrid cloud management solutions.
• Sagacious Consultants releases the latest edition of its Sagacious Pulse newsletter.
• The SSI Group and Streamline Health will exhibit at the HFMA Region 11 Healthcare Symposium January 24-27 in San Diego.
• Summit Healthcare will participate in the IHE North American Connectathon January 25-29 in Cleveland.

Blog Posts

• Medical Device Protection: 13 Tips (ID Experts)
• #1 New Year’s Resolution for Providers: Collect More Patient Payments (InstaMed)
• Invisibility Cloak: Good for Superheroes, Bad for Data (Liaison Technologies)
• Do It and I’ll Shut Up (MedAptus)
• High Five! Our Top Five Blog Posts from 2015 (Navicure)
• Apply supply and demand to grow strategically while increasing revenue and reputation (Nordic)
• Residents Love Texting – But Do They Fully Understand Their Options? (Spok)
• Health Systems Call for a Halt to Meaningful Use Stage 3 (E-MDs)
• Balancing Act: How to Effectively Maintain Your Legacy System During the Chaos of an Install (Hayes Management Consulting)
• 8 Essential Factors for a Successful Epic EHR Upgrade (The HCI Group)
• Prescription Medication Errors: Latest Reports (Healthcare Data Solutions)
• Competing Viewpoints Wanted! (Healthfinch)
• Using the “Pre-Mortem” Process for Success in Implementations (Impact Advisors)
• Meaningful Progress (PatientKeeper)
• Bootstrapping Your Startup (PMD)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Contact us.

EPtalk by Dr. Jayne 1/21/16

I’m not always able to practice what I preach. Last week was one of those weeks. Our practice is experiencing a wild growth spurt and my last patient care day was one for the record books. Not only did we see more patients than we’ve ever seen in a single day, but we had several ambulance transfers and other critical situations.

I admit that my charts got out of hand, even with a scribe joining me partway through the day. At least 90 percent of the notes were done before the end of the day and all of them were done within 24 hours, but I had to spend some evening time going through and doing a final review and locking them.

Normally our “default” settings are great, but as I was reviewing, I discovered that partway through the day that my “award-winning, cloud-based EHR” began documenting a negative male genitourinary Review of Systems on all patients, even if they were female. Of course they’re not having any problems in their male organs, because they don’t have any.

I’m not sure what went haywire, but I had to stop my review process and call in the experts. Our practice’s staff tinkered with it for a while and then contacted the vendor. We still don’t have an answer. Although I can manually correct them, I’d rather not have to go through scores of charts if there’s a quick fix. In my consulting practice, I see a lot of physicians that quickly click through their documents without reviewing them, so this is a great cautionary tale for me to use in the future.

In the meantime, I’ve had plenty of diversion with dozens of people emailing me the CMS blog backpedaling on comments about the end of Meaningful Use. At least they made it crystal clear that they’re not eliminating MU and that we’re still stuck with it for the near term.

Although it was about as nice of an “oops, we take that back” post as I’ve seen, I take issue with their comments on offices being “wired.” As we all know and as I’ve said time and again, just because technology is present doesn’t mean anyone is using it or that it is useful at all. Most of us in the clinical trenches have used EHRs that have been decent and those that have been soul-suckingly bad. The fact that they’re “wired” has nothing to do with our outcomes.

I have several close friends that ran Level 3 Patient-Centered Medical Home practices using only pen, paper, and Excel – and with a level of efficiency and improved outcomes that would put many EHR-based practices to shame. Of course, that level of performance requires not only skilled staff, but individuals who are dedicated, compassionate, and believe in the practices and their missions.

It becomes harder to retain that level of staff when they become demoralized by a poor product or a good product with a poor implementation. I’d like to see people who should know better stop using computers as a proxy indicator of whether a practice is moving in the right direction or not.

I didn’t make the list for the HIMSS16 Social Media Ambassadors. I shouldn’t be surprised because my use of Twitter and Facebook has been at low tide for months. But I found coverage of the announcement rather funny, in that it says that they are “credentialed by HIMSS to cover the conference.” I didn’t know you could be credentialed for social media – perhaps a license to Tweet?

Regardless, I’ll be covering the conference in my usual style, with scheduled strolls through the exhibit hall accompanied by real, live providers and in-the-trenches users of healthcare IT. The reasons I’m not all over social media became clear in another piece, this one featuring tips from the Ambassadors. Medicity’s Brian Ahier @ahier talked about only following “five or six hundred folks” but that he tries to read “every tweet of the people I follow.” There aren’t enough hours in the day for me to be that active in the Twitterverse, even when I multitask while hitting the treadmill.

Lately on the treadmill I’ve been working on some required Continuing Medical Education content for my primary specialty certification. I’m six years into a 10-year Maintenance of Certification cycle. Although at least one Board has somewhat put MOC on hold, mine hasn’t. I like to try to get the arduous (and wholly irrelevant) required module out of the way early in the year so I don’t have to sweat it later. In response to my comments last week about there being Clinical Informatics “LLSA” CME hours offered at HIMSS16 (my that was a lot of acronyms in one sentence!) I heard from a couple of readers.

One lamented the fact that there are virtually no approved LLSA hours relevant to clinical informatics unless you can attend one of the AMIA conference or HIMSS. It costs thousands of dollars to attend these conferences (most of the registrations are pushing $1,000 on their own) and they’re not always ideal venues for learning. Although I learned a great deal at the AMIA symposium, many of the non-LLSA sessions were more valuable to me as an informaticist than the approved courses. I also learn better when I can focus at home rather than being in a hotel meeting room with hundreds of other people some of whom are having sidebar conversations or moving around and being distractions.

Another reader complained about the costs of HIMSS in general and shared his hope that perhaps in the future the conference will become the irrelevant part of the week since there are so many events outside of the actual proceedings (did someone say HIStalkapalooza?)

Another reader shared some of his correspondence with the American Board of Preventive Medicine, who certifies a good chunk of the Clinical Informatics diplomates. The Board staffer commented that they had planned for AMIA to provide more LLSA-approved CME by this point. My response to that is that it’s irresponsible for a certifying board to rely on a third party to provide credits unless there is a contractual obligation to do so. At least my primary certifying board has its act together and provides adequate content (volume wise – some of it may be irrelevant depending on your practice) on its own.

HIMSS also responded to my difficulty in being able to find information on the LLSA sessions. Unfortunately, three staffers sent me a link that didn’t take me anywhere helpful. One did send a PDF with the schedule and instructions which was very helpful. Although many of them overlap, they also mentioned that after the meeting they will be posting the sessions online so that we can access them as “enduring materials.” That will help for those of us who wanted to attend multiple sessions at the same time.

There are now over 1,000 of us who are certified in clinical informatics, so for those of you in the latest class of Diplomates, welcome to the CME/LLSA party.

A reader who knows my fondness for shoes shared a link to this church recently completed in Taiwan. It’s supposed to draw more women to attend, but I’d also be on the lookout for fetishists.

Do you have your shoes picked out for HIStalkapalooza? Email me.

Email Dr. Jayne.

Morning Headlines 1/21/16

Postmarket Management of Cybersecurity in Medical Devices

The FDA publishes cybersecurity guidelines for medical devices, outlining requirements for manufacturers to conduct postmarket risk analysis, and conduct timely corrective and preventative action.

Senate won’t take up House’s 21st Century Cures Act

The Senate will not move the 21st Century Cures Act forward, citing disagreements over how to pay for the bill.

Oscar Health Raising Giant Funding Round led by Fidelity

Fortune reports that insurance startup Oscar Health is in the process of raising another massive funding round led by Fidelity, with $150 million already committed. Oscar Health has already raised $325 million in the two years since its launch.

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Scripps Translational Health Institute publishes findings from a six-month control trial designed to measure cost savings and quality improvements associated with the use remote patient monitoring technologies. Researchers found no difference in cost of care, resource utilization, or clinical outcomes.

CIO Unplugged 1/20/16

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Teams Redux

One of the biggest secrets to success is no secret at all. Often discussed, rarely employed: a killer team is the key to work and life.

At 20 years old, I was nose-to-nose with hardened combat veterans, many of whom had served multiple tours in Vietnam. My platoon sergeant and squad leaders had been in the Army longer than I was alive. The medals on their chests weighed more than I did. But there I was — their platoon leader.

I could hardly spell engineer, yet I was the leader, inspecting my troops. I was so insecure it took all I had to maintain eye contact while I evaluated them to ensure their combat readiness.

I was ill prepared, but desperate to learn. I quickly realized that if it were left to me, our platoon would fail. I had to rely on my non-commissioned officers to be successful.

I respected them, gave them plenty of room, and listened before making decisions. They made me look decent and saved me on more than one occasion.

It paid off. Third Platoon (vertical construction), Bravo Company, 244th Combat Engineer Battalion became one of the best in our Army command. At an early age, I stumbled on the secret to success. It was all about the people around me. Organization success was predicated partially upon my success. My success was predicated on my soldier’s success. That was the ultimate foundation. It all began with the team.

I have had the privilege of leading numerous teams in my civilian career. We did all sorts of crazy good things. At first the teams were small, but the size was irrelevant. We accomplished tasks with speed and precision. While our contributions may have been minor in the big scheme, we were contributing to our organizations’ success. Little did we know we were also contributing to our personal and career success.

I recall the Whiz Kids in Cleveland. Named after a book I read on the young leaders that transformed our automobile industry, my focus became team building. None of us fit the mold. We were so young and adventurous but passionate with vision balanced by a “get your hands dirty” mentality.

I managed to land fighter pilot and rotary wing pilots. I recruited young gun consultants looking to leave the road to spend time with family. There was a nurse ready to leave the hospital floor. Finally, the techie who wanted to change the world. We read books together and spent significant time with one another’s families.

We inherited a very poor IT organization. Within four years, we quadrupled customer satisfaction to best of class levels. We helped the organization achieve significant clinical and business outcomes. Gartner even made our IT turnaround a case study.

In Dallas, our organization required a new team. We had strong individual performers, but not the team needed for sustainable success. So we retooled. We became more social; more appreciative. We spent time team building off site and simultaneously insisted on personal and professional improvement. We began to gel as a team.

We won numerous industry accolades acknowledging the role of IT in clinical and business outcomes and became a “Best Places to Work” organization. It was a rush.

We are building this same kind of leadership team today. We have a hefty goal. The only way to transform a city is to first have the foundation of an amazing team. Our roles as healthcare technology leaders are too critical and impossible for one person to handle.

We all need help. Leaders that fail are typically the lone wolves who refuse help. They view the strength of their team as something to fear. Their insecurities and pride suffocate them despite the amount of oxygen immediately available.

These attributes on successful teams transcend the workplace. I am grateful to be on sport teams and community teams that accomplished things that no individual could have done on their own.

I am accused of arrogance. I am accused of self-centeredness, seeking glory for myself. The ironic thing is that I’ve never claimed that my organizations’ or sport successes were about me. Trust me — I always give credit to the team.

I have tried to lead on my own and I failed. I have sought glory and found myself alone. I am the first to remind people that left on our own, we will fail. Through the years, I’ve recognized that as with most things, pride hampers adoption. The meek will inherit the earth.

The only way for us to be good stewards of our roles and responsibilities is to get help. Reach out to others. Make those hard decisions and build a team that is better together than anyone by themselves. A team that accomplishes more than ever would be possible on their own. A team that puts organizational goals before personal aspirations.

Want to accomplish amazing things? Build and pour yourself into your team.

Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.

Readers Write: What EHR Vendors Need to Know About Implementing Minnesota’s Electronic Prior Authorization Law

What EHR Vendors Need to Know About Implementing Minnesota’s Electronic Prior Authorization Law
By Tony Schueth

It’s January 2016 and electronic prior authorization (ePA) is now “required” by law in Minnesota. There has been surprisingly little fanfare about this deadline, and it’s my observation that most electronic health records (EHRs) and providers are not ready to comply. Here’s what EHR vendors need to know about implementing Minnesota’s law, also known as MS §62J.497.

It’s not necessarily a mandate. Minnesota really wants clinicians to do PAs electronically using standards from the National Council for Prescription Drug Programs (NCPDP), but there are no penalties for non-compliance. According to a state fact sheet:

• “Starting January 1, 2016, prescription drug authorizations – including prior authorizations (PA) and formulary exception requests – must be exchanged electronically, using the NCPDP SCRIPT Standard version 2013101.”
• “The law does not require prescription drug PA and/or formulary exceptions. However, for those entities subject to the law, if PA requests and responses and/or formulary exception requests and responses are exchanged, starting January 1, 2016, they must be exchanged electronically based on the NCPDP SCRIPT Standard version 2013101.”
• No later than January 1, 2016, drug prior authorization requests must be accessible and submitted by health care providers, and accepted by group purchasers, electronically through secure electronic transmissions. Facsimile shall not be considered electronic transmission.”

While the language is very strong, the statute doesn’t definitively say that every single PA must be done electronically.

State officials acknowledge they may be out in front of everyone else: “technological updates to enable this functionality can take time, and manual methods for prior authorization may need to be used until electronic functionality is available with all partners.” Kudos to Minnesota for showing leadership.

Should you wait?

Despite Minnesota’s lack of a true mandate, I wouldn’t recommend waiting for the regulatory axe to fall in Minnesota. The paper-, fax-, and phone-based prior authorization (PA) process is time-consuming and burdensome to physicians and expensive for payers. In contrast, ePA promises efficiencies.

It’s early in the adoption cycle, kinks need to be worked out, and implementation isn’t uniform. That said, pharmacies and prescribers ultimately will prefer ePA over current processes to help keep pace with the PA requirements associated with the increasing number of drugs used to treat the rising number of the chronically ill. Furthermore, large integrated delivery networks will select EHRs that are compliant with the statutes and regulations in their service area. These EHRs must be able to handle transactions, such as ePA, regardless of site of care.

What about e-prescribing of controlled substances?

Minnesota has had 62J.497 on the books to mandate e-prescribing for all prescriptions effective since 2011 and the state has some of the strongest e-prescribing adoption in the country. We have heard anecdotally that Minnesota has a goal of having all controlled substance prescriptions being electronically prescribed by the end of 2016. While that appears to be just a goal, there are two aspects of controlled substances prescribing that should be kept in mind.

The first is that e-prescribing of controlled substances (EPCS) is permitted both at the federal and state level. Even so, the facts about the legality of EPCS are often surrounded by confusion. Because of this misperception and the fact that there are no penalties for non-compliance, demand by prescribers is just beginning to appear. But that is changing.

The second is interfacing with the state’s prescription monitoring program (PMP), which is up and running under the auspices of the state’s board of pharmacy. All dispensers (pharmacies or providers that dispense from their offices) licensed by the State of Minnesota must report on a daily basis all controlled substance II-V and butalbital prescriptions that were dispensed. To satisfy the reporting requirements, all EHRs should be able to interface with the PMP to provide the necessary information.

New York takes a different approach

What is interesting is the contrast of Minnesota’s electronic prescribing and ePA “mandate” with New York’s I-STOP. The spirit (and language) of the rules are very similar for both states, except, of course, that I-STOP doesn’t mention ePA. The key difference is that I-STOP articulates the penalties for non-compliance. New York has the right to impose professional misconduct penalties (including fines and possible license revocation) for non-compliance with I-STOP.

As a result, it appears that most EHR vendors with clients in New York have enabled their products to handle e-prescribing – including EPCS – and have emphasized their readiness.

I applaud both states’ efforts to lead and urge EHR vendors not to wait until the last minute to roll out products in either state. Your customers will appreciate it. Furthermore, your competitors will have solutions available for those who aren’t either prescribing electronically or facilitating ePA yet.

Tony Schueth is CEO of Point-of-Care Partners of Coral Springs, FL.

Morning Headlines 1/20/16

EHR Incentive Programs: Where We Go Next

CMS Acting Administrator Andy Slavitt and National Coordinator Karen DeSalvo, MD publish a blog post outlining the planned future of the EHR Incentive Program, noting that the transition to MACRA will change the focus from rewarding the meaningful use of EHR systems to “rewarding providers for the outcomes technology helps them achieve.”

Despite exchanges, UnitedHealth Group beats Q4 earnings estimates

UnitedHealth Group reports Q4 results: revenue of $43.6 billion beat analysts estimates and topped the insurers $33.4 billion revenue from the same period last year. UnitedHealth’s insurance exchange plans accounted for $720 million in losses between 2015 and 2016.

Digital Reasoning Acquires Health Tech Provider Shareable, Launches Health Care Business

Digital Reasoning, a cognitive computing vendor, acquires Nashville-based Shareable for an undisclosed sum. Shareable’s mobile clinical documentation apps, clinical systems integration engine, and cloud-based middleware platform will be integrated into Digital Reasoning’s existing data analytics platform.

Health service to begin electronic patient referrals

In Ireland, a nationwide electronic referral program will go live in March resulting in 95 percent of practices and all hospitals being able to exchange referrals electronically. Additionally, nearly all hospitals will be able to exchange diagnostic and and scanned images.

News 1/20/16

Top News

A CMS blog post by Administrator Andy Slavitt and National Coordinator Karen DeSalvo, MD says the administration has been “working side by side with physician organizations” to change the EHR incentive program. They will propose MACRA-based regulations that will:

• Reward providers for patient outcomes
• Allow providers to use IT in the way that works best for them
• Promote open APIs
• Focus on real-world interoperability goals while not tolerating data blocking.

Slavitt and DeSalvo warn that, despite their seemingly inadequately planned and oddly timed exuberant comments:

• Existing standards are still in effect as required by law
• MACRA covers only Medicare Eligible Providers and not hospitals or the Medicaid program
• MU Stage 3 remains in effect

Reader Comments

From See Me CMIO: “Re: NEJM article on intrusive, standardized patient visit requirements and EHR checklists. Cerner with Dynamic Documentation returns us to the old-school way and away from the tyranny of physician documentation templates. Our go-live of Cerner Ambulatory created angst by physicians using template- and list-driven EHRs from NextGen and eClinicalWorks (especially younger ones who never knew pre-EHR documentation) who were uneasy with a system that instead presented them with basically a blank sheet of paper. Dyn Doc allows the open-ended interview style described in the article, with the need for reminders accomplished on the health maintenance section, the best of both worlds. However, template-driven systems may work better for specialists such as colorectal surgeons and orthopedists who would be slowed down by an open-ended interview.” 

From EMR Expert: “Re: Cerner. Bid $23 million for the EMR tender of 1,095-bed King Fahad Medical City in Saudi Arabia vs. Epic’s $126 million. Only Epic’s price was similar to what it would have bid in the US. Why is Cerner overcharging its US customers compared to oil-rich Saudi Arabia?” “Oil rich” is an oxymoron these days as the barrel is almost worth more than the oil it contains, but I don’t know why Cerner would so significantly undercut Epic’s apparently predictable bid in a two-horse race. Going back to the petroleum theme, it’s like my local gas station whose price is 20 cents per gallon less than everyone else’s – why not go only five cents lower in undercutting competitors while still pocketing the difference?

From Not from Monterey: “Re: Centra Health of Central Virginia. A good source tells me they’ve chosen Cerner, ditching McKesson if my memory serves me correctly.” Unverified. They are a Horizon and Pathways shop going back many years.

From NantWatch: “Re: NantHealth. Patrick Soon-Shiong says he intends to ‘merge’ NantOmics and NantMobile (the recently rebranded NantMobileHealth) into NantHeath the first half of this year as a part of the ‘Moonshot 2020’ initiative, though he has a tendency to change his mind on a whim, so who knows if this will happen. Predictable internal power struggles have begun.” Unverified.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mrs. Nelson, who asked for science kits for her Alabama elementary school class (her “highest poverty” school has only old, outdated books). She reports, “When they heard the news that we were getting funded, they all cheered in excitement! They were counting down the days until they could see our science kits come in by mail. When they finally arrived to our classroom, my students chimed in perfect sync, YESSSSSS! We opened them immediately to see all of the contents inside. As I read the descriptions of the science kits and showed them the parts, they smiled, cheered, and gleamed with anticipation!” The students are using the electrical activity tub to study and build circuits and next week they will use that knowledge to begin studying renewable and non-renewable energy sources.

An anonymous reader sent $50 for my DonorsChoose project. I couldn’t find any projects that amount would fully cover even with matching funds, so instead I completed the donations already received for Mrs. Azorr’s elementary school class request for dry erase markers, pockets, and earbuds for math practice and, in a second project, printing supplies for Mrs. P’s class in Roanoke, VA.

Listening: new from The Strumbellas, a six-piece band from Canada whose music is somewhere between spare, catchy alternative and pop bluegrass. It didn’t seem promising, but I ended up liking it. I’ll note the untimely passing of Glenn Frey (even though I’d take a root canal over listening to the Eagles any day) as well as the death of another 60-something musician, glam band Mott the Hoople drummer Dale Griffin. It was all Nektar for me at the gym today and those guys are in their late 60s as well. One might argue that 1970s-era musicians were our Greatest Musical Generation and we’re losing them way too fast.  

Webinars

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

Acquisitions, Funding, Business, and Stock

Digital Reasoning acquires mobile clinical documentation vendor Shareable (formerly known as Shareable Ink). Digital Reasoning vaguely describes its work as “cognitive computing,” of which I could learn no more since its horribly designed website takes several minutes to load, vastly exceeding the limits of my curiosity.

UnitedHealth Group beats Wall Street expectations for Q4 revenue and earnings despite losing $720 million in the fiscal year selling insurance on federal and state exchanges, a much bigger loss than it originally expected. The company warns again that it may stop selling policies on the exchanges next year. Meanwhile, UHG’s Optum business generated earnings that were up 50 percent.

Three-month-old Malaysia-based doctor appointment booking startup BookDoc takes an unspecified investment from the royal family of Brunei. The company says it has “the highest pre-seed and seed funding valuations ever in the technology start-up history of Asia.”

Public relations firm Weber Shandwick acquires Nashville-based healthcare marketing firm ReviveHealth.

Johnson & Johnson will eliminate 3,000 positions in its medical device business, an action it optimistically euphemizes as, “to strengthen its go-to-market model, accelerate the pace of innovation, further prioritize key platforms and geographies, and streamline operations while maintaining high quality standards.” In other words, the little people it will fire are the problem, not the still-employed executives who hired them in the first place and then apparently mismanaged them to the point that the company is better off with 3,000 empty chairs.

In Spain, NTT Data will work with Everis Health and local hospitals to develop a new medical analytics service technology that will apply knowledge to ICU patient data streams.

Sentry Data Systems will acquire Agilum Healthcare Intelligence. Both companies offer data analytics solutions.

Announcements and Implementations

Divurgent and General Dynamics partner to offer security solutions to healthcare providers.

Ireland’s Health Service Executive announces that within a few months all of the country’s hospitals will be able to receive electronic referrals, 95 percent of physician practices will be able to send them, most hospitals will be capable of sharing x-rays electronically, all 19 maternity units will run a single computer system, and all of Ireland’s 43 medical labs will share information via an electronic network.

AdvancedMD launches AdvancedEPCS for electronic prescribing of controlled substances.

CHIME launches the year-long, $1 million prize National Patient ID Challenge to develop some kind of technology workaround to the lack of a national patient identifier. I have a lot of questions: (a) where did CHIME get $1 million to spend on an R&D project? (b) can any algorithm truly hit 100 percent accuracy without requiring patients to sign up for something new? and (c) if the best submission still isn’t commercially feasible with 100 percent accuracy, does the submitter get the million dollars anyway? Not to mention (d) who has the deep pockets to fund a possible solution with only the hope of earning a winner-take-all prize? (actually there’s a $30,000 prize after the second round, but still …) Perhaps CHIME is actually hoping that someone will launch a third-party registration service since a national health ID isn’t illegal – it just can’t be funded using federal money. I admire the initiative, but I would be somewhere between surprised and shocked if the winner’s solution earns broad adoption.

Government and Politics

The VA pays the director of its Danville, IL system $86,000 to resign and keep quiet after he complains to the Merit Systems Protection Board about being charged with threatening to fire a co-worker who reported him for doing little work, having sex with a female VA employee, and then bragging about his conquest to the female employee’s daughter, who also works for the VA. The daughter complained that she didn’t want to hear details about her mother, after which the director sent her a letter that said, “Would you like to live the rest of your life without a mom to be there for you and (redacted word) or would you prefer to have (her) available and happy in my company?’

New Jersey Governor Chris Christie kills a bill that would have required the state’s non-profit hospitals to pay city fees to help cover the cost of municipal services. Oddly enough, the New Jersey Hospital Association collaborated on the bill, hoping to avoid individual lawsuits brought against its member hospitals from cities demanding they pay their fair share. Or as the association’s CEO phrased it while comically avoiding saying the word “tax” in the same sentence as “hospital,” “for hospitals to support their host municipalities with added community contributions.”

Technology

The Rite Aid drug chain rolls out proximity beacons to its 4,500 stores in the largest such implementation in a retail setting. The app sends advertisements and offers (“contextual experiences”)  to the smartphones of in-store shoppers. I bet HIMSS will have it running by next year’s conference.

Other

I’m not sure what the British reporter (its political editor, of all things) who wrote a newspaper story titled “Strike all you like, doctors – technology will soon take away your power” expected, but he seems to be whining that doctors disagreed with his highly questionable conclusions, including his belief that people running around wearing Fitbits (which he spelled wrong) will upend “a profession reluctant to give up its position as the keepers of knowledge.”

Former Allscripts CEO Glen Tullman provides an interesting career bio to the Chicago Tribune. I wasn’t as interested to read about his investments in vendors of shoes, tea, and solar roofs as I was his recap of  his Allscripts days:

Then I went to a company called Enterprise Systems, which was in the healthcare business. Privately held. They asked me to come in as CEO. I took it public a year after arriving, and then a year later we sold it to the medical information company HBOC at a wonderful valuation … after we sold, I went to a company called Allscripts. Allscripts got to Series J financing [that is, the 10th round], which very few living people ever do. You have a lot of enemies, and you’ve burned through a lot of cash, and that’s when I arrived. We bought just over 60 percent of the company for $6 million … Then we went to work creating the first electronic business that prescribed at scale. We became the leading electronic health record provider in the country on the ambulatory side. Two years later, I took the company public at a $2 billion valuation.

In Australia, the pathology department of Royal Melbourne Hospital goes to manual processing when malware infects its computers running Windows XP, whose support and security updates ended on April 8, 2014. Given the infected location, I would bet that those PCs were running software that is regulated as a medical device and therefore can’t be upgraded without the software vendor’s approval.

A Health Affairs study identifies the 50 US hospitals with the highest markups, of which 49 are for-profit and 20 are in Florida. Their list prices averaged 10 times their reported costs, meaning out-of-network or cash-paying patients get stuck trying to cobble together enough money to pay bills inflated with a 90 percent profit margin. The authors suggest policy changes that could include: (a) requiring hospitals to publicly post their charge-to-cost ratio; (b) forcing hospitals to apply the same markup to all services rather than selectively jacking up areas like anesthesiology; (c) setting a maximum allowed markup for a given patient; (d) requiring hospitals to offer their lowest negotiated rate to everyone; or (e) requiring insurers to use the same payment method (such as DRGs) but allow the actual payment to vary by insurer based on negotiated rates. 

A BMJ blog post from a palliative care doctor and David Bowie fan thanks the late musician for leaving an allegory-laden final album, for dying with dignity at home instead of in a hospital, and for inspiring patients to strive for a good death as the end of a good life.

I was thinking about NASA’s use of telemedicine for space station astronauts, which I assume must not involve Houston-based Johnson Space Center since the Texas Medical Board would otherwise find a way to shut it down.

Sponsor Updates

• PeriGen publishes a white paper titled “The Future of Electronic Fetal Monitoring.”
• Health Facilities Management publishes a Field Report detailing how Trinitas Regional Medical Center reduced the severity of injuries due to assault with Versus Staff Assist.
• Bottomline Technologies will sponsor Leadership Seacoast, a nonprofit that educates and informs future community leaders. Vice President of Services and Operations Jill McFarland will participate in the organization’s 2016 class.
• ZeOmega’s Jiva PHR earns ONC HIT 2014 Edition Modular EHR certification.
• Capsule Tech will participate in the IHE Connectathon January 25-29 in Cleveland.
• The local business paper features CareSync in an article on venture capital funding.

Blog Posts

• 7 Ways to Build a High-Performance Private Practice (AdvancedMD)
• Cybersecurity: New Area for Mobile Medical App Compliance, Part 1 (AirStrip)
• Next Generation ACO participants can choose among multiple payment models (Besler Consulting)
• Health IT Shows Up at 2016’s Consumer Electronics Show (Billian’s HealthDATA)
• CoverMyMeds Creating “Geeks’ Paradise” in New Cleveland Space (CoverMyMeds)
• The End of Meaningful Use? Not So Fast My Friends… (NextGen)

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 1/19/16

Privacy experts say Coburn op-ed misses the mark

Privacy experts respond critically to an op-ed published in the Wall Street Journal last week by former Senator Tom Colburn, MD’s in which he argues that “HIPAA makes it difficult for researchers to tap into large caches of clinical and genomic data shared across multiple institutions or firms, and then share their findings more broadly.”

50 hospitals charge uninsured more than 10 times cost of care, study finds

A Health Affairs study analyzing Medicare-certified hospital data from 2012 and 2013 finds that 46 of the 50 hospitals with the highest overall markup on care delivered to out-of-network or uninsured patients are members of for-profit health systems, and that 20 of 50 operate in Florida.

Cerner again teams up with KC-area startup

Cerner partners with local Kansas City startup Infusion Express, an outpatient IV therapy company, to reduce IV treatment costs among its employees and reduce absenteeism by a forecasted 5,000 hours annually.

Curbside Consult with Dr. Jayne 1/18/16

My inbox lit up last week after Andy Slavitt’s comments about the end of Meaningful Use. My clients were asking for immediate analysis of “the new rules,” but among friends, the emails were more along the lines of, “Did I miss a memo somewhere?”

I think Slavitt is overly optimistic in stating that MU will be replaced by “something better,” because ONC and CMS haven’t done such a great job of making things better in the modifications and revisions we’ve seen already. Frankly, I’m not sure they even understand the definition of “better” as it might be applied by a practicing physician.

Some of the emails had links to articles which either took the comments out of context or overly simplified the situation. That’s not surprising given the fact that we live in a society driven by sound bites, tweets, and Snapchat. Even if CMS wants to make the program go away, it may not be able to do it without a little bit of legislative assistance. MU is tied into the MACRA law, with MU being one of the elements contributing to the physician performance score that will drive payment adjustments.

I also take issue with his comments that, “We effectively have technology in virtually every place where care is provided.” That’s not really true – I know of quite a few primary care practices that still haven’t made the leap, largely because they’re in rural areas and are too busy actually caring for patients to deal with what they consider government nonsense.

One of my best friends from residency is one of those physicians, who has been in solo practice for many years and just splurged on the “luxury” of hiring a physician assistant to help support the practice since she’s been on 24×7 call for nearly a decade. We’re still lacking EHR in many care settings (home health, and nursing homes, anyone?) Not to mention that even though we may have computers in offices, that doesn’t mean that they’re used effectively or that they’re doing anything actually improve patient outcomes.

In my consulting practice, I see dozens of clients who may be meeting the letter of the law through workarounds and administrative processes, but who aren’t using their expensive EHRs to do anything truly meaningful. The ways in which vendors exploit vagaries in the requirements are often shocking. The CMS Frequently Asked Questions are sometimes confusing and occasionally contradictory, so I imagine it’s tempting to use what loopholes you can find.

I spend a lot of time counseling clients that, although they may be able to check the box for attestation, they’re cheating themselves and their patients out of the improvements that systems were intended to drive.

Some of my correspondents had conflicting thoughts on what the end of MU as we know it might do to the EHR industry. One was adamant that it would cause market consolidation since there are too many products out there that are certified but not terribly useful. Another felt that it would cause the return of diversity to the market, as vendors could focus less on certification and more on functionality and the ability to deliver improved patient care outcomes.

I tend to think that we’re headed for more consolidation due to economic and other factors. It won’t be easy to tell whether the proposed demise of MU really played a part.

It’s unclear how this will impact vendors who aren’t at risk for consolidation. Will this allow them to shift some of their development dollars back to usability and needed enhancements that were placed on the back burner due to certification requirements? Or will they still be dealing with regulations and calculations, but just in different forms? My physician friends that work in the vendor space share horror stories about the number of people vendors have dedicated just to keep up with ever-changing regulations. It’s not only federal, but state and payer regulations, too. The burden is endless, just as it is for providers in the trenches.

Personally, I’d like to see the regulators go after other parts of the health delivery system and spend some time regulating them in a way that will help all of us. Want to mandate that physicians include lab data with LOINC codes in their EHR? Then maybe you should require the lab vendors to transmit LOINC codes with their results. I spend a lot of time helping clients manually code around this issue because the lab vendors refuse to send codes.

That to me seems unconscionable — to force providers to clean up after other vendors who are in a better position to do something to make things better for patients. Want interoperability and portability? Force nationwide or multi-state lab vendors to standardize their various business units onto a single lab compendium rather than forcing EHR vendors and customers to code around it.

Let’s mandate that home health agencies, therapy providers, and other ancillaries also adopt electronic records and start communicating with us in a way that fits our new workflow. I still receive handwritten, barely legible reports from home health and PT providers, yet I’m held to the standard of doing everything in discrete and codified data.

While we’re at it, let’s also look at extended care facilities, nursing home providers, and everyone else that touches patients. Let’s back off on the providers and invite everyone else to the party, whatever ONC and CMS decide it should be.

What do you think of expanding Meaningful Use to other entities? Email me.

Email Dr. Jayne.

Morning Headlines 1/18/16

New Guidelines Nudge Doctors to Give Patients Access to Medical Records

The New York Times covers the recent OCR clarification reminding providers of their obligation to provide electronic copies of medical records to patients.

NHS out-of-hours GP service 12-hour wait ‘clinically unsafe’

In England, NHS callback times have reached 12 hours for patients calling out of hours with non-emergency conditions, a situation some describe as a “significant risk to patient safety.” The delay is blamed on a shortage of doctors and inefficient call handling.

Privacy-breach discipline against 24 of 48 health-care workers withdrawn

In Canada, 24 healthcare workers accused of inappropriately accessing medical records have had disciplinary actions against them dropped after a nurses union successfully argued that the hospitals policy was unclear.

Monday Morning Update 1/18/16

Top News

The New York Times takes public the recent OCR clarification for providers whose patients request copies of their medical records. An American Hospital Association SVP says the guidelines are “a helpful reminder,” the need for which she didn’t mention – that most of AHA’s members do everything they can, including citing non-existing policies or legal requirements, to avoid giving patients copies of their own information.

The statement was welcome, but areas of concern might be:

• The law was already in effect and was being widely ignored by doctors and hospitals, with no announcements of any resulting fines or enforcement actions.
• Patients will need to understand their rights and how to complain to OCR, which 99.99 percent do not.
• The effort required to file a complaint – and the potential for disrupting the provider relationship for doing so — will discourage most people from notifying OCR even if they know how.
• Providers still have a ridiculous amount of time to provide records that are most likely stored electronically.
• Many hospitals use release-of-information companies to handle patient records requests, allowing those companies to bill high per-page charges. It’s not clear to me whether that practice will be abolished since OCR’s requirements affect providers, not third parties.
• It would be nice if insurance companies, which have a lot more clout with providers than patients, would accept and manage records requests of their insured patients.
• OCR will have to respond to an increasing volume of complaints, which given their lack of response to a complaint I filed in July 2015 for exactly this situation from either the hospital or OCR, seems unlikely.
• OCR hasn’t done much to stop HIPAA violations, rarely using its power to levy fines.
• The only positive outcome for a patient who files an OCR complaint is finally getting the records, probably after a long delay in which their clinical value has been greatly reduced.

Reader Comments

From MU Later: “Re: your comment that CMS might be disappointed by how ONC has run Meaningful Use. ONC does not manage the program – that is solely done by CMS. ONC provides certification parameters and feedback to CMS, which is free to do whatever it wants.” I admit that I incorrectly think of ONC as being in charge of Meaningful Use since I’m not all that knowledgeable about the inner workings of ONC, CMS, and HHS or how much of ONC’s effort involves MU. Reading about the initial implosion of Healthcare.gov and the political differences between federal “agencies” and “offices” with their sometimes dueling fiefdoms and competing CIOs made me glaze over.

From Pustular Exudate: “Re: CareCloud. Of the 10 leadership positions listed on their website, nine are held by men. The one female is the head of HR.” CareCloud’s executive team is therefore 90 percent male, compared to Cerner (80 percent), McKesson (78 percent), Allscripts (92 percent), Athenahealth (90 percent), Meditech (62 percent), and Nordic (54 percent), just to list a few companies that I chose randomly.

From Gettin’ Jiggy: “Re: Becker’s Hospital Review. I wondered who is doing those clicky, empty stories. New grads, that’s who. Checked their LinkedIn employee list.” Reviews on Glassdoor say things like, “This is not journalism … editors suggested that writers rerun quotes and portions of old features and cobble them together to create new content” and “recapping real reporters’ healthcare news to spit out on our sites … working on a feature story with some sort of catchy, click-friendly title like ‘7 Ways to Make More Money.’” They are the industry’s Buzzfeed, cranking out click-baiting headlines and mindless lists from content reported better elsewhere, read by folks who can’t resist the temptation of journalistic junk food. I can’t fault it – it apparently has quite a few readers and its employees say it makes a fortune for the owner.

HIStalk Announcements and Requests

Two-thirds of poll respondents aren’t interested in company funding announcements. New poll to your right or here: what impact will providers see from CMS’s planned changes to the EHR incentive program?

Mrs. Perez is a new teacher in the gifted program of her Florida school and reports that her students are using the portfolios we provided via her DonorsChoose grant request to organize and present their materials when they attend their gifted class. She isn’t allowed to send photos that include student faces, but was nonetheless creative in having them pose with their “thank you” signs attached to their brand new portfolios.

Ms. B checked in from her Illinois kindergarten class, for which our grant provided STEM exploration kits. She provides some background: “Thank you for providing my little scholars with the opportunity to experience the STEM activities from this proposal. You may say, ‘why linking monkeys?’ Well, just look at the joy on my students faces when they’re using the linking monkeys to learn the standard of number representation… What about the classifying chart? My scholars love to size up the various pictures and debate on who has it correct. Is a bus larger or smaller than a ball?”

Recruitment and consulting firm Healthcare IT Leaders donated $1,000 to DonorsChoose to secure a presenter spot at my CIO lunch at HIMSS (contact Lorre if you would like to do the same or to volunteer as a CIO attendee). I’ve exhausted the matching funds from my anonymous vendor executive, but I was still able to use dollar-for-dollar matching funds from third-party foundations to fund these teacher grant requests from their donation:

• Five tablets and three headsets for Ms. Johnston’s elementary school class in Aurora, CO
• Math manipulatives for Ms. Krieg’s fourth grade class in Round Lake, IL
• Math center games for Ms. Yoder’s first grade class in Jacksonville, TX
• A library of 13  literacy and numeracy DVDs for Ms. White’s kindergarten class in Phoenix, AZ
• Two Osmo gaming systems for Mrs. Jochum’s elementary school class in Norfolk, NE
• Math games for Ms. Medel’s fifth and sixth grade classes in Indianapolis, IN

My new dentist offers a $400 per year plan for patients without dental insurance that includes two cleanings, a whitening treatment, annual exam with x-rays, and a 30 percent discount on other services. I was running the numbers to decide whether I’d be better off dropping dental insurance and paying him directly when I realized that the most valuable contribution of insurance companies is to negotiate pricing in their contracts. His list price for a filling is something like $240 vs. the insurance-negotiated price of just over $100, so his 30 percent member discount would leave me paying $168 ($240 x 0.7) vs. $40 with insurance ($100 x 0.4 since insurance covers 60 percent of the negotiated price). I’m back to my never-ending question – why do providers charge so much more for cash-paying patients as a “cash surcharge” rather than a “cash discount?” Maybe it’s naive to think that they should offer the same rate to everyone, but that’s how it seems to me. It’s easy to understand why ever-expanding big health systems are increasing prices through pricing power rather than decreasing them through efficiency – because they can.

HIStalkapalooza

About 900 folks have signed up to attend HIStalkapalooza, so the window will soon close on your opportunity if you aren’t one of them. Barry and Jennifer will host again, the red carpet is set, and at least three HISsies winners will appear on stage. The good news is that unless I get swamped with additional requests, I’ll be able to invite everyone who signs up, same as last year. 

If you haven’t attended previous HIStalkapaloozas and are wondering why so many people rave about the band, here’s a video of Party on the Moon, who fills the dance floor literally from their first note to their last. As a music snob, I’ve never seen anything like them, which is why I keep bringing them back. They love the HIStalkapalooza crowd and are rewarded with reciprocation.

Last Week’s Most Interesting News

• A House committee review finds that the VA’s self-developed claims processing system is being used only as a document repository despite a budget that is running double the original estimate of $580 million.
• CMS Administrator Andy Slavitt announces the end of the Meaningful Use program in its current form in favor of “something better” in remarks delivered at the JP Morgan Health Care Conference, where he also warns that “data blocking will not be tolerated.”
• The National Center for Policy Analysis criticizes the Texas Medical Board’s “protectionist” restrictions on telehealth, noting that the state is worst in the country in providing access to care.
• The American Medical Association gets into the for-profit incubator business by spending $15 million to launch Health2047.
• OCR clarifies provider responsibilities in giving patients copies of their medical records, noting that they can’t require patients to physically visit their premises, can’t refer them to an online portal, and must provide electronic copies if patients want their records in that form.

Webinars

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

Sales

Duke University Health System chooses Phynd’s Unified Provider Management platform.

Announcements and Implementations

TierPoint appoints four former executives of its acquired Windstream Hosted Solutions to key leadership roles. The company offers cloud, co-location, and managed services.

Privacy and Security

In Canada, Alberta Health Services drops disciplinary action against 24 of the 48 employees it had accused of inappropriately accessing patient records in a high-profile case, including rehiring the one employee it had fired and paying any missed wages that resulted for all of them. The nurse and public employee unions successfully argued that hospital’s policies weren’t clear.

Montana health plan New West Health services says a stolen, unencrypted laptop full of PHI covering 25,000 people has inspired it to install “additional security on all company laptops.”

Other

I just noticed that Epic has been running job ads for Epic Hosting as “we enter the realm of multi-tenant hosting and create a data center with a cloud-based approach.” The way it describes the employer as “Epic Hosting” suggests that it’s a separate company.

In England, a doctor shortage is blamed for delays in returning patient calls to the non-emergency 111 service that’s run by a private company, with patients waiting up to 12 hours to hear back. Employees say they were told to falsify records to make the service appear more efficient.

Sponsor Updates

• The Salt Lake City television station features Health Catalyst in a report on the cost of healthcare.
•  T-System, VitalWare, and ZirMed will exhibit at the HFMA Region 11 Healthcare Symposium January 24-26 in San Diego.
• Valence Health will exhibit at the South Dakota HFMA Winter Meeting January 21-22 in Chamberlain.
• Verisk Health’s Sam Stearns and Jon Edwards pen a guest column on on-site clinics for Employee Benefit News.
• Versus real-time location solutions receive Novation’s Innovative Technology designation.
• Huron Consulting Group President and CEO James Roth shares his 2016 predictions with Consulting Magazine.
• The local business paper profiles WeiserMazars Digital Marketing Manager Gabrielle Chwazik-Gee.
• YourCareUniverse releases the latest edition of The Navigator newsletter.

Blog Posts

• A Communication Upgrade Pays Off (Voalte)
• After reading 2016 trends, let’s take some actions (Nordic)
• Healthcare’s Mad Rush to Consumerism (Xerox)

Contacts

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

Morning Headlines 1/15/16

Walgreens, UnitedHealth Are In Talks To Buy WebMD

Rumors of a buyout send WebMD share prices up nearly 10 percent today, but prices tumbled after the company issued a press release stating that no acquisition was being planned. Share prices ultimately overcorrected, closing down 7.7 percent.

Medical Taylorism

An opinion piece published in NEJM argues that EHRs, while “introduced with the laudable goals,” have undermined patient care by monopolizing the provider’s limited time during patient encounters. The author explains, “Open-ended interviews, vital for obtaining accurate clinical information and understanding patients’ mindsets, have become almost impossible.”

Athenahealth CEO uses CPR to resuscitate a stranger

Athenahealth CEO Jon Bush, a former EMT and combat medic, provides CPR to a man who had collapsed, commenting about the encounter afterwards, “It was like the US health care system. Everybody was standing there, nobody was helping.”

Chief Information and Technology Officer

In England, the NHS publishes a job description for a national chief information and technology officer to lead “the strategic procurement and successful implementation of the information and technology priorities that will support a modern, sustainable health and care system.”

News 1/15/16

Top News

WebMD shares rise on the rumor that the company is up for sale, with Walgreens and UnitedHealth Group named as possible acquirers. The share price dropped back to previous levels when the company denied the rumors.

Reader Comments

From Lax It Is: “Re: CareCloud. Missed 2015 revenue numbers wildly and its strategic partnerships have fallen apart. Sales execs are being axed and a high-level executive is being let go although the company is trying to keep it under the radar.” Unverified. I reached out to the company but haven’t heard back.

From Darned Kids: “Re: Cerner. I’m CIO at a health system implementing Cerner. We’re having trouble with resources, mostly leadership. A Department of Defense halo effect that I am battling with.”

From Beautiful Loser: “Re: Quality Systems/NextGen. Following its purchase of Health Fusion, the company is ceasing development of its next-generation ambulatory product and is laying off the entire Austin office. Everyone is seeking jobs at Mirth and other QSI divisions. What a waste of time and money to scrap the new system after three years of work.” Unverified. The company has so far not responded to my offer to comment.

From Pushing Daisies: “Re: Leidos Health. They are definitely recruiting for Epic people.”

From CMIOHio: “Re: CMIO lunch at HIMSS. Are you having another one this year?” I’m not opposed to the idea, but it won’t be as easy since the Bistro HIMSS lunch service program right on the exhibit floor isn’t offered in Las Vegas. I’m open to suggestions.

From NantWatch: “Re: NantHealth. The head of sales and business development has abruptly quit.” Unverified. His LinkedIn profile remains unchanged and there’s no executive page to check on NantHealth’s site since the only person listed has always been founder Patrick Soon-Shiong, not that he has a outsized ego or anything.

From Justa CIO: “Re: Denver Health. How many CIOs will have their careers either tarnished or blown up due to Epic? The body count continues and adds credence to the not-so-funny joke of how many CIOs does it take to do Epic? Three: (a) the one who was there when it was picked; (b) the one who implements it; and (c) the one who comes in after the financially driven bloodshed after the install. What is the cause of this effect? I would love to see thoughts other than my own.” I’ll hopefully be able to provide a bit more insight shortly as I’ve been working on a report with the Peer60 folks about Epic sites, in which we surveyed a bunch of CIOs, CEOs, CFOs, chief medical officers, and chief nursing officers to get their candid assessment of their Epic projects. I asked some blunt questions and got some great answers that I’ll make available for free once we’ve written everything up.

Here’s what one health system CEO said in my Epic customer survey: “Epic has increased our operating cost at a time when we had no ability to absorb that cost. The Epic EHR, at least until now, has not added an strategic advantage or underlying improved operations.” In contrast, a CIO said, “Epic has been a great vendor and partner of ours for over 10 years. I continue to get more impressed with them in most things through time and have yet to find another vendor (for any application) that is even close to matching up with them in quality, support, and future viability.” By the way, thanks to the many folks – including around 100 Epic-using CIOs — who responded to the survey.

Reader Gripes

• New CIOs who come into a hospital IT department that has had relative success for many years and the first new package they want to install is employee productivity software. Or worse yet, manual logging of time spent on every activity. How much good ever comes from this morale-busting practice?
• The VA system. The latest news of the Phoenix employees surfacing elsewhere in the system is just BEYOND outrage but wait, it’s the government—screwing the people that laid down their lives to keep us free.

You can sound off about your gripe or you can even say something positive if you’d rather.

HIStalk Announcements and Requests

Thanks to Nordic, Xenergy Healthcare, BlueTree Network, XL Health Partners, and Dak Systems Consulting, all of which offered to run the check-in table at HIStalkapalooza. It’s gratifying to mention a need and have so many people volunteer. Santa Rosa Consulting offered quickly and is taking charge admirably, even reviewing the possibility of using electronic invitations and barcode-powered check-in to shorten the line, something I’ve always wanted to do.

I’m declining to comment on the President’s so-called “cancer moon shot” because I think that concept is well-intentioned but naive, this perception that cancer is a single, curable disease that can be defeated by throwing money at research, having technology geeks lovingly stroke their Watson or NantHealth computers, or encouraging people to run around while wearing pink in October. Americans in general and non-scientist politicians in particular love the idea that bold innovation and taxpayer money can fix specific problems, but what we really need in US healthcare isn’t diagnostic supercomputers, gene editing, and yet another data-spewing wearable that benefit a small percentage of the population at best. We need to embrace the public health approach to improve the health of the most people, which involves far less sexy work such as:

• Focusing on the 80 percent of health that has nothing to do with impressive buildings containing people wearing scrubs. “Healthcare services delivery” is a small subset and a not necessarily major determinant of “health” despite its budget-busting cost.
• Making healthcare services affordable and accessible to everyone since we’re going to pay collectively for the consequences.
• Reducing the prescription and non-prescription drug epidemic that has a big chunk of the population stumbling around in a mind-altered haze, pocketing cash for fueling it, or being expensively supported by taxpayers while incarcerated because of their role in it.
• Turning healthcare into something other than profit center for drug and device companies, supposedly non-profit hospitals, insurance companies, and procedure-cranking specialists.
• Addressing obesity and physical inactivity as the only exercise more and more Americans get is lifting their forks and their phones to their faces.
• Dealing with mental health problems that cause expensive overreliance on EDs and community organizations.
• Increasing patient engagement responsibly, allowing patients an equal say in how their health is managed  while committing to education to stop their irresponsible requests for narcotics, antibiotics, and over-advertised prescription drugs.

We funded the DonorsChoose grant request of Ms. Carbo in Georgia in purchasing an iPad Mini and programmable robot to teach programming to her first graders and to allow them to participate in the Hour of Code. She sent some photos, including the one above.

This week on HIStalk Practice: Dr. Gregg thinks HIT might benefit from a little rock-n-rollness. GE Healthcare relocates to the US. Teladoc reports record revenue and visits, while American Well touts its top-app ranking. CMS releases its latest round of MU EP payment figures. Fitbits become one university’s link to student fitness and academic performance. Lyft gets into healthcare.

This week on HIStalk Connect: Flatiron Health raises a massive $175 million Series C to further develop its oncology EHR and clinical decision support platform. Researchers from multiple labs are working to change the way cancer screenings are conducted. Higi raises $40 million to expand its health and wellness platform. AiCure, backed by $7 million in NIH grants and a fresh $12 million Series A, works to solve medication non-adherence with an artificial intelligence platform.

It’s odd that Andy Slavitt from CMS moved so quickly from MU Stage 3 cheerleading to distancing himself from it in proudly announcing that it will be going away via Twitter this week. Maybe HHS is unhappy about how ONC has managed the program, or it could be that the endless whining of provider organizations about it was wearing thin, or perhaps it relates to the upcoming elections. Surely John Halamka’s call for its demise must have rattled the federal folks given his long and constructive involvement with the federal programs. I asked John what he thinks and he expanded on his Thursday blog post:

This is a general consensus among healthcare systems in the US that prescriptive regulations will not work. My feeling from speaking with many stakeholders in industry and government is that MACRA will offer incentives (not penalties) for achieving an outcome without mandating a workflow or requiring certified technology. Instead of “reconcile medication lists 80 percent of the time for transactions sent 50 percent of the time and incorporated 40 percent of the time,” the outcome might be, “Improve patient compliance with medications.” If you do that with Apple Watches and a patient-facing medication administration app, great. If you send high school students with a clipboard to inventory a patient medicine cabinets (with their consent), that’s OK too.

HIStalkapalooza

Signups are still open for HIStalkapalooza, which promises to spice up the otherwise mundane Monday (the equivalent of Sunday in non-Las Vegas HIMSS days). The HIMSS conference opening reception won’t have the fabulous Party on the Moon band, stage show, and the HISsies.

Sponsors of HIStalkapalooza 2016 are:

HIStalkapalooza Sponsor Spotlight

Validic provides the industry’s leading digital health platform connecting providers, pharmaceutical companies, payers, wellness companies, and healthcare IT vendors to health data gathered from hundreds of in-home clinical devices, wearables, and consumer healthcare applications. Validic was named to Gartner’s “Cool Vendors” list, received Frost & Sullivan’s “Best Practices and Best Value in Healthcare Information Interoperability” and was recently featured as a “Top 10 Healthcare Innovating Disruptor” in Forbes. Its scalable, cloud-based solution offers one connection to a continuously-expanding ecosystem of consumer and clinical health data, and reaches more than 223 million lives in 47 countries. Check them out at validic.com, on Twitter @Validic, or at their HIStalkapalooza Cabana on the House of Blues dance floor.

The CIO lunch to raise money for DonorsChoose will be Wednesday, March 2 from 11:00 a.m. until 1:00 p.m. at Maggiano’s Little Italy, just down the street from the convention center. A $1,000, tax-deductible vendor donation will provide admission to one person who will provide a company overview and then socialize with volunteer CIOs such as Dana Moore (Centura), Ed Marx (NYC Health + Hospitals), Drex DeFord (freelance consultant), Ari Entin (Natividad Medical Center), Chuck Podesta (UC Irvine Health), Steve Hess (UCHealth), and others helping out for a good cause. I’m paying for lunch, so all the money goes to DonorsChoose. Contact Lorre to sign up, either as a CIO or donating company. I’ll announce everyone who is involved.

Webinars

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

Acquisitions, Funding, Business, and Stock

GE will move its global headquarters from Connecticut to Boston to avoid high Connecticut taxes and to gain access to technology organizations and talent. Boston and Massachusetts are providing up to $150 million in incentives.

Practice Fusion says its 2015 revenue grew 70 percent.

CVS Health announces affiliations with John Muir Health, University of Chicago Medical Center, Novant Health, and University of Michigan Health System in which it will exchange EHR information and offer services from its MinuteClinic locations. All of the organizations, including CVS, use Epic.

Sales

Parkland Health & Hospital System (TX) expands its use of Kaufman Hall’s products to include cost accounting and capital planning software.

In Australia, St. George Hospital chooses Spok for radiology result notification to smartphones.

People

WEDI President and CEO Devin Jopp, EdD resigns to start a consulting firm.

Tim Kuebelbeck (NantHealth) joins LogicStream Health as EVP of sales.

Stuard Hammond (SCI Solutions) joins Forward Health Group as VP of sales.

Announcements and Implementations

HIMSS Analytics launches Logic, a more personalized, dashboard-driven version of its HIMSS Analytics Database. It will offer demos, not surprisingly, at the HIMSS conference.

Health plan MDwise will extend its use of ZeOmega’s Jiva population health management solution to monitor medication adherence and safety.

Government and Politics

The House Committee on Veterans Affairs reviews the VA’s “over budget and underachieving” self-developed claims processing system system, the cost of which is running double the original $580 million estimate at $1.3 billion and counting. Committee Chairman Congressman Jeff Miller (R-FL) says the Veterans Benefits Management System (VBMS) was supposed to fully support disability claims and pension applications but is only being used as a document repository for appeals. Testimony from the GAO says the system was designed only to serve as that document repository and delayed timelines are due to scope creep in extending its capabilities. GAO also concludes that the VA’s agile development methodology has prevented it from setting firm completion estimates, timelines, and deliverables.

In England, the NHS posts a job opening for the newly created position of CIO/CTO.

Florida eliminates decades-old quality standards for pediatric heart surgery following big political donations from for-profit hospital operator Tenet, which owns a hospital that had earned widespread media coverage for its poor outcomes. Death rates for pediatric heart surgery at Tenet’s St. Mary’s Medical Center were triple the national average while performing only 27 cases per year, information CNN had to obtain through Freedom of Information Act requests since the hospital refused to publish the data publicly and tried to block CNN’s investigation. CNN’s report aired in June 2015 and the state dropped the standards in July, claiming that the Department of Health didn’t the Legislature’s approval to implement them in  1977. The hospital closed the program and the CEO resigned in August.

Technology

Oral Roberts University will track the physical activity of all of its incoming students, who will be required to purchase Fitbits. The university had previously required all students to log their exercise in a fitness journal as part of its Whole Person Education program.

TechCrunch profiles Medal, which claims its software can be installed on a doctor’s computer in 60 seconds and can then move EHR information around to other providers. “We’re hoping to create true interoperability for the first time in this country,” says the founder. 

Other

Athenahealth CEO and former emergency medical technician Jonathan Bush elbows observers aside outside the JP Morgan Healthcare Conference to perform CPR on a man who had collapsed on the sidewalk. Bush did mouth-to-mouth as another good Samaritan handled compressions. Bush describes, “It was like the US healthcare system. Everybody was standing there, nobody was helping.” It’s a public relations bonanza for Athenahealth, which just happened to have a camera on hand to snap an action photo.

An opinion piece in NEJM decries the forced, efficiency-driven “one best way” standardization of the physician-patient encounter that is causing dissatisfaction and burnout as patients find themselves answering EHR-driven checklist questions instead of being allowed to speak freely. It adds,

Encounters have been restructured around the demands of the EHR: specific questions must be asked, and answer boxes filled in, to demonstrate to payers the “value” of care. Open-ended interviews, vital for obtaining accurate clinical information and understanding patients’ mindsets, have become almost impossible, given the limited time allotted for visits — often only 15 to 20 minutes. Instead, patients are frequently given checklists in an effort to streamline the interaction and save precious minutes. The EHR was supposed to save time, but surveys of nurses and doctors show that it has increased the clinical workload and, more important, taken time and attention away from patients.

In South Australia, technology vendor Global Health wins the EHR business of Adelaide Primary Health Network despite the company’s ongoing legal battle with the South Australia government, which refuses to stop using a 1980s Global Health application that the company insists has been sunsetted.

An Oregon health news site reports that PeaceHealth’s former president was fired in 2014 because of declining profit margins and problems with its implementation of Epic.

Bizarre: drug companies are chasing underage hemophilia patients like colleges pursue star high school athletes — hiring their relatives, taking them to dinner, infiltrating disease support groups, and paying recruiters (often patients themselves) a percentage of drug sales in hoping to convince the patients and their families to use drugs that cost up to $1 million per year (paid by insurance companies and taxpayers, of course, not the patient or families being courted).

Weird News Andy says that a good cleaning was apparently “out of scope” as a Senate investigation determines Olympus knew that the design of its duodenoscopes made them hard to clean, which caused at least 141 patients to become infected while undergoing procedures. WNA concludes that, “Clarence Darrow would not monkey around, he’d just win this trial.”

Sponsor Updates

• Leidos Health will exhibit at the Meditech Executive Institute January 17-19 in San Diego.
• Medecision CMO Ellen Donahue-Dalton discusses the consumer healthcare experience at the Atlanta CMO Breakfast series.
• Nordic representatives will attend the HIMSS Dallas/Fort Worth Chapter event January 22 in Arlington, TX.
• Recondo recaps 2015 and offers 2016 RCM predictions.
• PeriGen CNO Becky Cypher, RN contributes to a study on the effect of elective induction on C-section delivery rates published in Obstetrics & Gynecology.
• Summit Healthcare will exhibit at Meditech’s MUSE Executive Institute January 17-19 in San Diego.

Blog Posts

• When a Patient is Transferred with Incomplete Records (Medicity)
• Where’s the Beef (Benefits)? (Impact Advisors)
• Metrics That Matter for Digital Marketing (Influence Health)
• Want Better Insight Into Your Transplant Data? Visualize It! (Liaison Technologies)
• Transparency: Not great for your car, but ideal for healthcare (Navicure)
• Looking Ahead to the New Year: Trends to Expect in 2016 (Orion Health)
• Healthcare IT: Industry Review & A Look Ahead (Park Place International)
• Learn, Connect, Share: HIMSS16 (PatientSafe Solutions)
• Secure Texting Trends: Patient Demand for Secure Mobile Communications is Increasing (Practice Unite)
• 016 Trends: What’s Ahead in Healthcare IT? (PerfectServe)
• Shining a light on physician data across the enterprise (Phynd Technologies)
• Getting Insight from “Pretty Big Data” (PMD)
• What’s New in Meaningful Use 3: Public Health Reporting (Sagacious Consultants)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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