The White House publishes the Presidents transcript from the Precision Medicine panel discussion, in which he calls out interoperability issues directly, saying, “Part of the problem with have right now is that every patient’s data is siloed — it’s in a hospital here, a hospital there, a doctor here, a lab there.”
CMS extends the hardship exemption deadline for hospitals and providers to July 1. Hospitals originally had until April 1 to file for an exemption, while EPs only had until March 15.
Hello from Las Vegas. I always skip the usual HIStalk format during the HIMSS conference, focusing on what I see or hear directly for the most part. I’m holding off mentioning all but the most significant vendor announcements until next week because I don’t have the time or interest to wade through the glut of press releases that companies unwisely held until this week while everyone is too busy to care.
The weather continues to be great in Lost Wages, so folks coming to the conference from cooler climes are going to love it. The trees and grass are green, the sky is blue, and the restaurant patios are perfect for a leisurely lunch. Until Tuesday, that is, when the area is overrun with pasty-skinned, tote bag-slinging HIMSS attendees determined to glad-hand their way out of winter and get in your way at every opportunity.
Here’s a tip if you need to drive to the Sands Expo for exhibit setup or some other reason – use the Palazzo parking garage and self park (don’t valet unless you want to wait to retrieve your car), which has a very busy entrance on Las Vegas Blvd. and less-busy one off Sands. It’s the best parking garage in Las Vegas with 4,000 spots, it’s free, and the escalator will take you right to the casino, from which it’s a short walk to the hall. Also, Uber finally beat the Las Vegas taxi lobby, so there’s that.
Here’s another tip. Just a few hundred yards down the street from the convention center across from the Wynn is Fashion Show Mall, which doesn’t look big, but has 250 stores and restaurants. If you rip your pants or realize you forgot your socks, there’s a Macy’s as well as a lot of higher-end stores right there (even an Apple Store). Good chain restaurant choices there that I can vouch for are Maggiano’s, Kona Grill, and RA Sushi.
I snapped this photo in the conference center hall. It looks as though HIMSS has just over 60 corporate supporters, of which I note that at least 15 are also HIStalk sponsors (my iPhone picture isn’t quite clear enough to read every logo).
I’m impressed every year that HIMSS sells ads on nearly every square inch of available convention center real estate – walls, escalators, tabletops, and even on the floors. Here’s my business model for the only space they missed in the Sands (above): I propose to replace that ho-hum artwork above the urinals with vendor ads. In addition, I will hire someone just to stay in the restroom all day, and once a HIMSS attendee has settled in at his chosen spot, my lackey will sidle up behind him and announce in his ear, “Hi, I’d like to just say a couple of words about your restroom sponsor ABC Tech, which is in Booth #9999. Don’t stop what you’re doing – I’m just going to slip their business card into your pocket. Excuse me if we don’t shake hands.” When he’s not busy, my man will also slip printed collateral under the door of occupied stalls. Talk about your captive audience. It reminds me of the HIMSS conference a few years ago when a vendor brilliantly placed ad-imprinted drain screens in all the urinals, at least until they got busted by HIMSS.
I look forward to only two things about the HIMSS conference: the Hyland magician and MedData’s scones. I had heard previously that the latter might be threatened by Sands Expo rules prohibiting baking in booths (can you imagine?) I was horrified to see actual evidence of this – the MedData booth contains no scone-baking apparatus. If the magician is a no-show, I’m going home.
All of us exhibitors were doing setup today, with the exhibit hall acres covered with palletized equipment, plastic-covered carpet, yet-to-be installed signs and furniture, a few blue-jeaned vendor employees, and leisurely Freeman people with drills and ladders. We carted in our mighty HIStalk exhibit today, which involves two roll-up signs, a tablecloth, and a banner, weighing maybe 20 pounds total. It all fits into a single duffel bag. We have little to give away, nothing to sell, and no real reason to even be back in Booth #5069 by the freight door other than to give our fellow outcasts a place to call home among the multi-storied, fluorescent sterility.
I always ponder as I walk through the Las Vegas hotel equivalent of a mall food court littered with cookie-cutter restaurants bearing celebrity chef names: have those big-name cooks ever actually set foot in the place? My suspicion is that they just license their name out to some dull restaurant chain operator, take their cash, and move on to their next venture. I picture the Venetian having one giant commissary kitchen that makes all the food for every individually branded restaurant using corporate-approved formulas and quality control, with the “chefs” given about as much creative freedom as they would have packaging airline meals or prison food. That’s one more way Las Vegas seems like Orlando to me other than they’re the only two cities hosting HIMSS conferences in the future – unsophisticated visitors can’t wait to try all the chain restaurants they don’t have back home.
Bands coming to town this week that I wouldn’t mind seeing are Iron Maiden, Metric, and Gin Blossoms.
We’re giving away these first aid kits from Arcadia Healthcare Solutions in our booth. If the HIMSS conference gives you a headache, heartburn, foot blisters, or sticky hands (how could it not?), you’ll want one. Arcadia will have them in their booth, too. I snagged a couple of them last year and they’re very handy both during and after the conference.
From Former Bruin: “Re: City of Hope Medical Center (CA). Specializing in oncology treatment. Switching from Allscripts to Epic.” Unverified.
From The Oracle of Alpharetta: “Re: McKesson. All signs point to McKesson EIS to be in Stage 1 Shutdown Mode. Customers continue to leave for other vendors. Horizon conversions to Paragon are at a trickle. InSight users group attendance was abysmal. Customers are angry. EIS senior management have no healthcare experience, but they do have expertise in valuation and slimming down businesses prior to dissolving them. Large RIF likely coming in March. Development and QA rapidly shifting to third-party, offshore workers to reduce headcount and severance and bonus liabilities. Constant reorgs in Alpharetta, Charlotte, and Westminster. MCK will focus on its roots: pharma and med/surg distribution. HIT was fun while it lasted.” Unverified.
Ireland-based Oneview Health plans to go public on the Australian stock market, valuing the company at $200 million.
Next up: HIStalkapalooza. I’ll probably post a brief recap and some pictures Monday night. Safe travels.
From the transcript of President Obama’s remarks Thursday about the White House’s Precision Medicine Initiative:
Part of the problem with have right now is that every patient’s data is siloed — it’s in a hospital here, a hospital there, a doctor here, a lab there. The goal here is if we can pool and create a common database of ultimately a million people that’s diverse so that they have a lot of genetic variation, we can now take a disease that may be relatively rare, but because we have a pretty large sample size and start seeing patterns that we might not have seen before. But a couple things that requires — it requires, first of all, us understanding who owns the data. I would like to think that if somebody does a test on me or my genes, that that’s mine, but that’s not always how we define these issues …
In terms of the model that we use for health records that hopefully will be digitized more and more, companies help hospitals keep and collect that data. They should get paid for that. They’re building software. They’re building an infrastructure. On the other hand, we don’t want that data just trapped. So if I am sick and voluntarily I want to join with other people who have a similar disease to mine and donate our data to help accelerate cures, I’ve got to be able to work with the electronic health record companies to make sure that I can do that easily. There may be some commercial resistance to that that we have to talk about — although we’re seeing some terrific participation now, and that’s part of what we’re announcing, of those companies in terms of helping that happen.
There’s privacy issues. We’ve got to figure out how do we make sure that if I donate my data to this big pool that it’s not going to be misused, that it’s not going to be commercialized in some way that I don’t know about. We’ve got to set up a series of structures that make me confident that if I’m making that contribution to science that I’m not going to end up getting a bunch of spam targeting people who have a particular disease I may have.
Reader Comments
From Sitz Bath: “Re: your Epic report. How many people downloaded it?” About 1,200 that I know of, but the Politico people messed me up by publishing a direct link that avoided the sign-up page I had created to keep count. You can download it here.
From CMIOmaha: “Re: your Epic report. Much appreciate the amazing summary on Epic. The most objective and down to earth summary I’ve ever seen. I downloaded it this morning and shared with all our C-level with an immediate and incredible feedback! I wish you’d do the same with Cerner.” Maybe it would be interesting to ask the same questions to the executives of Cerner users. Peer60 did all the heavy lifting via their market feedback platform, so it wouldn’t take much of my time.
From HIMSS PR: “Re: Greenway Health. Second staff reduction in the past six weeks. Sales leadership and enterprise sales team taken out. Not the best PR heading into HIMSS.” Unverified.
HIStalk Announcements and Requests
I’m writing this Saturday from Las Vegas, where it’s sunny and warm. I rented a huge, luxurious house five minutes off the Strip for $200 per night and it’s filled with friends and family (all female, I just realized) who are helping with HIStalkapalooza. We have a heated pool and hot tub in our outdoor oasis, so last night it was pizza and this afternoon I’m grilling hamburgers and hot dogs poolside. I fell asleep last night to the gurgling of the hot tub’s waterfall outside after catching up on emails on the 25-megabit Wi-Fi (take that, crappy hotel Internet made worse by guests streaming Netflix and porn). It’s nice to be able to relax before the madness starts Monday, not to mention that I’m saving a fortune in hotel and restaurant bills. I should hang the HIStalk booth banner over the garage door.
I’m not sure when I’ll post over the next couple of days. Certainly Monday night after HIStalkapalooza (which means I won’t sleep much before a long Tuesday), but maybe Sunday if anything interesting happens.
Here’s your Las Vegas weather forecast. Trust me, it’s probably nicer here than wherever you’re coming from.
I was amused that the marketing manager of a vendor I highlighted as misspelling HIMSS on their site emailed me to accuse me of Photoshopping the screen shot, saying they had spelled it correctly. However, the sneaky alterations were on their end – they took down the page with the misspelling and posted a new one, perhaps not realizing that I could simply email them a link to Google’s cached image of the original page to prove my point. Doh!
The results of the reader-requested poll of health systems allowing the use of test patients in production systems are as follows:
15 percent say they never allow it
46 percent they allow it under strict conditions
30 percent they allow it as needed within reason
9 percent say they allow it without restriction
Concerns listed by respondents include the possibility of dropping real charges, the downstream effects on interfaced systems, and inadvertent printing of documents (I’ve seen all of these).
Two-thirds of poll respondents say IBM Watson Health is just hype. MEHIS Expert says it’s just an IBM ploy to increase consulting revenue, while HackerDoc questions whether IBM has the right medical informatics physicians with computer science backgrounds involved. Hype provided thoughtful analysis:
It’s beyond hype. They have now officially taken what was a brilliant branding strategy (personifying the intangible and making it both relatable and revolutionary sounding) and turned it into pure silliness. The Phytel acquisition last year was when my red flags were raised being that pop health is still just a buzzword, vapor and yet to be proven, but this addition just confirms that IBM is just trying to over-PR their revenue shell game. What is funny is that Truven began as the mixed bag business unit of Thomson Reuters after they went on a silly publishing buying binge while the publishing world was crashing (PDR, Micromedex, etc.). Thomson couldn’t find a way to blend those brands well into their financial and media strategies and spun them off, which resulted in Truven. How IBM is going to find a better fit for these brands that were too out-of-date for an old publishing co company is beyond my logical understanding. It makes me speculate that IBM may want to closely observe what is currently happening to Xerox. Bottom line, I no longer view Watson with the shock-and- awe wonderment that I once did.
New poll to your right or here: will EClinicalWorks and Athenahealth become major inpatient system vendors?
Here’s where Lorre will be spending the week – Booth #5069, with those other companies around us hopefully being OK with the significant traffic of interesting people we bring to an otherwise undistinguished location right next to an area labeled “Chain Link Fence – Storage.” I’m not sure I really get $5,000 worth of value from a 10×10 booth, but I’ll feel better about spending the money if everybody at least drops by to say hello.
Welcome to new HIStalk Gold sponsor Ellis & Adams. The Austin-based research and consulting firm offers IT strategic planning, project management, Lean workflow design, cost analysis, and data science services. Co-founder Don Ellis, MBA, MPH has a long industry history working for both providers and vendors; co-founder Jeff Adams, MBA spent a lot of time as a healthcare CTO; and partner Bill Blewitt has spent his whole career in healthcare IT. The company just published a description of its EHR optimization work with Dameron Hospital (CA). Thanks to Ellis & Adams for supporting HIStalk.
Healthcare IT Leaders donated $1,000 to DonorsChoose to attend my CIO lunch this week, which I used (along with third-party matching money) to fully fund these teacher grant requests while sitting by the pool:
Programmable robots for the media center of Ms. Becote’s elementary school in Florence, SC.
Physics learning kits for Ms. Stuckeman’s middle school science and math club in Fort Worth, TX.
Math games for Mrs. Wolfe’s fifth grade class in Little River, SC.
Programmable robots for Mrs. Marinin’s elementary school classes in Green Bay, WI (she is targeting females, hoping to expose them to careers in to computer science).
A maker space (programmable robots, invention kits, kinetic sand, and a duct tape creation kit) for the library of Ms. Harrison’s elementary school in San Juan, TX.
Six Amazon Fire tablets for the gifted elementary school classes of Mrs. Evans in Orlando, FL.
Mrs. Newman reports on the STEM activity kits we gave her Indiana second graders by funding her DonorsChoose grant request: “Thanks to you, my students are benefiting more from discovery learning as opposed to teacher led instruction. With team work, they are working collaboratively building roller coasters to learn more about gravity. They are also reading instructions on how to incorporate levers and pulleys into their creations. It is so exciting to watch them in action! Your help in providing these amazing STEM materials has been appreciated by my students, parents, and myself. Thank you very much!”
Also checking in is special education teacher Mrs. Allen from South Carolina, who reports, “My students were so excited when they came back from Christmas break to new headphones! They actually want to use the computers now … They have begun taking pride in our computer center and want the computers to look neat … I had no idea that something as simple as headphones could make such a difference in the attitudes of my students.”
Last Week’s Most Interesting News
The White House announces commitments from vendors and providers to support its Precision Medicine Initiative, most of them involving patient-contributed research data, patient access to their own data, and interoperability.
HIMSS announces the retirement of two EVPs, John Hoyt and Norris Orms.
ResMed announces that it will acquire Brightree for $800 million.
EClinical Works announces plans to develop an inpatient EHR.
England’s Royal Berkshire Hospital cancels surgeries when its Windows XP pathology systems are taken down by malware.
Webinars
None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
We’re running a HIMSS special on webinars. Contact Lorre or see her at our booth #5069 (don’t blink or you’ll miss it).
Here’s the recording of Thursday’s webinar, “Analytics For Population Health: Straddling Two Worlds.”
People
XG Health Solutions promotes Mike Bertrand to CTO.
Cerner reassigns John Glaser to SVP of population health. I’m not a fan of the title since “population health” is not at all the same as “population health management,” which in turn is not at all the same as “population health management software.” Despite his new title, John isn’t responsible for the health of any population other than his own.
Sponsor Updates
Whirl Magazine features TeleTracking’s volunteer activities in its March issue.
Validic publishes a new white paper, “The Unprecedented Convergence of Healthcare and Technology.”
The local news covers the opening of Versus Technology client University of Minnesota’s Health Clinic and Surgery Center.
Voalte publishes a case study featuring Frisbie Memorial Hospital (NH).
Leadership Excellence recognizes PerfectServe Vice President of Human Capital as a Top Corporate Leader in the over 35 category.
PeriGen releases a new eBook, “A Vision of the Future of Obstetrics.”
The White House releases an update on its Precision Medicine Initiative, detailing commitments from 40 private organizations that will work on the project, largely on efforts to improve cybersecurity and data sharing as researchers work to build a one million participant research cohort.
As part of the Precision Medicine Initiative, the NIH will issue a grant to Vanderbilt University and Google’s life science business Verily to fund a pilot project to learn how best to recruit cohort participants and collecting their data.
A video of Army veteran Dennis Magnasco trying to schedule an appointment at his local VA clinic, but being unable to get through to an actual human, goes viral after his employer, Rep. Seth Moulton (D- Mass) shares the story on social media. The attention garnered Moulton several additional co-sponsors to his Faster Care for Veterans bill, which would allow veterans to self-schedule appointments using an app.
The White House announces several commitments to its Precision Medicine Initiative call to action, including:
The Advisory Board Company will create APIs for up to five pilot sites interested in building FHIR-based applications.
Allscripts, Athenahealth, Drchrono, Epic, and McKesson will pilot open APIs that will allow patients to contribute their EHR data to research in “Sync for Science” pilot projects.
The CRISP HIE will enable consumer “data donation” to support research.
Get My Data will initiate a “virtual march” of consumers via pop culture events, social media, and media campaigns.
Hackensack University Medical Center will adopt FHIR and open APIs for patient access.
Intermountain Healthcare will create a patient portal for cancer genomic data.
Ochsner Health System will expand its wearables data pilots.
PicnicHealth will publish a guide explaining how consumers can get access to their data and will create a Web-based portal for requesting data from the country’s 500 largest health systems.
PCORnet will help patients get access to their EHR data and contribute it for research.
Sage Bionetworks will create a way for study patients to contribute data for research.
St. Joseph Health will make data from Allscripts and Meditech available through an API and allow patients to see, edit, and contribute their own data.
Surescripts will give patients participating in the first precision medicine cohort the ability to contribute their medication and health information.
University of California Health System will give patients tools to download their information from all five of its medical centers and to share the information with providers and researchers. It will also develop a Blue and Gold Button, working with Cisco on a standards-based interoperability platform.
Validic will give users an opt-in form that will allow them to donate their patient-generated data to researchers.
Yale New Haven health will give patients access to their full medical record and allow them to share or donate their information.
New York Genome Center will use IBM Watson to generate cancer insights.
Inova Health System will create a $100 million precision medicine venture fund.
UPMC will make its legacy EHR data available to applications and services via a FHIR API.
University of Arizona Health Sciences will spend $22 million to expand its open-source analytic methods for disease-associated gene expression changes.
Reader Comments
From Sage on the Stage: “Re: same old HIT problems. Usability, interoperability, and security require addressing socio-technical challenges that start-ups and politicians are reluctant to admit, much less address. For those going to the HIMSS conference, ask vendors the hard questions.” Here’s the list from SOTS:
Do your system designers observe real clinician users in their busy clinical setting, recording how many errors they make, the problems they have finding data, or workarounds used in providing care to someone’s mother? If you have conducted those observations, what are you doing to correct the problems? If not, do you have any free tee shirts?
How does your EHR identify patients from disparate organizations, reconcile clinical terminologies, and normalize the clinical and administrative data before importing it and integrating it into your EHR and displaying it to clinicians? If so, can you connect me with a customer using those features? If not, do you have any free golf balls?
Does your product use two-factor authentication for remote access? How do you ensure that clients have implemented all the appropriate security precautions and most recent application and OS updates? Do you perform announced penetration tests on your clients’ networks and databases?
From Boy Wonder: “Re: HIMSS conference. Today in our company-wide prep meeting we reviewed your ‘booth rules for vendors’ rant from a few years ago … such good content. Hopefully our team members will learn from it and not screw up!” It was a culmination of my life’s work a couple of years ago to capture the fleeting image of every single employee in one vendor’s booth simultaneously tuning out passers-by while obsessing over their phones. I can’t top that, but I will be on the prowl for inhospitable booth behavior that disrespects attendees and robs employers. I would offer to mystery shop for companies interested in my blunt, objective opinion, but I fear I would be overwhelmed with requests.
From Blown Cover: “Re: HIMSS spelling. It’s crazy after decades that people in the industry don’t know the difference between HIMSS and HIMMS. Come on, people – get it together!” Googling “HIMSS16” gives 5,410 results, while searching for just “HIMMS” returns 577,000 results. Even hashtag “#HIMMS16# “ turns up usage by tweeters like CHCF Innovations, Carestream, GetMyHealthData, CSC Health, and Cylance. You might find this startling lack of attention to detail is concerning given that, by definition, it involves companies offering patient-impacting technology products.
From Gone Guy: “Re: HIMSS and SIIM. Last time I checked they dealt in the digital world.” The stock photography doctor not only is peering intently at a now-antiquated film, she’s got a giant, turquoise syringe handy should she feel the need to inject something unsterile into someone. I can only imagine how often the HIMSS-SIIM Enterprise Imaging Workgroup’s name will be mangled into HIMMS-SIMM.
HIStalk Announcements and Requests
We provided an Osmo learning system in funding the DonorsChoose grant request from Ms. Murphy in Wisconsin, who emailed, “As you look around the room when students are using these materials, you can see the excitement on their faces, how highly engaged they are in the math, and the social skills that are being developed. You can hear mathematics vocabulary being used in their discussions and how they work together to solve problems, whether they are academic or social.”
We also provided math picture books for Ms. Schmidt’s Indiana kindergarten class, which she says are so popular that the kids are reading them outside of their math workshop sessions.
This week on HIStalk Practice: The US Oncology Network and McKesson Specialty Health help oncologists move to value-based payment models. Family Health Care of Siouxland sees success in depression screening with new check-in tablets. : Andy Slavitt addresses physician burden, MACRA next steps at AMA conference. MBS/Net merges with Medsphere. KP Northwest enters the standalone – and telemedicine-friendly – clinic market in Portland. Georgia rolls out HIV telemedicine program at its public health clinics.
This week on HIStalk Connect: Fitbit shares fall 20 percent on low Q1 earnings and revenue guidance. Insurance startup Oscar Health raises a $400 million private equity round to expand its geographical footprint. Crisis Text Line releases a dataset containing more than 13 million de-identified text messages between its crisis counselors and teens that use the service. Opternative raises $6 million to ramp up its online eye exam business.
Welcome to new HIStalk Platinum Sponsor Ability Network. The Minneapolis-based company has for 20 years been helping providers and payers simplify the administrative and clinical complexities of healthcare through innovative applications and data analytics. It has helped hundreds of health IT vendors connect to Medicare and commercial payers, giving easy EDI payer access and embedding eligibility and claims management directly into the vendor’s software. Hospitals can take advantage of platforms for Medicare billing management, FISS/DDE connectivity, all-payer eligibility and claims, and Medicare claims submission and remittance advice. The company has grown tremendously, fueled by over $500 million in capital investment and several notable acquisitions, the most recent being Thursday’s acquisition of RCM and analytics services vendor G4 Health Systems. Industry long-timer, pharmacist, and former McKesson President and CEO Mark Pulido is Ability’s CEO and board chair. Thanks to Ability Network for supporting HIStalk.
The folks at Peer60 helped me survey C-level executives from Epic-using organizations to create a free report, “Epic: the cold hard facts.” I came up with questions I always wanted to ask Epic sites. Are provider executives willing to speak up if they find Epic-related issues that could impact patient safety? Does Epic provide competitive advantage? Do Epic-using CIOs prefer Epic sites when looking for a new job? Did Epic go in on budget and do CFOs think it’s worth the cost? Are customers happy with Epic’s interoperability? It’s a free download – the form asks for basic information just for my use in understanding who is reading it, but you can enter dummy data if you aren’t comfortable sharing with me. It’s been crazy trying to get this finished during all the HIMSS hoopla and I’ve already noticed that I made a couple of aggravating minor typos, so forgive me for those. Free really is free: there’s no advertising, no charging vendors for copies, and no behind-the-scenes selling of data. Thanks to the provider executives who participated.
I’m heading to Las Vegas early this weekend, just to get settled in before the wave of HIT immigrants overwhelms the baggage carousels, taxi lines, and check-in desks. Nothing really happens until Monday, so I’m hoping to finally take a breath and get into HIMSS mode after a way too busy February.
Webinars
None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.
We’re running a HIMSS special on webinars – 25 percent off produced and two-for-one on promoted. Contact Lorre or see her at our booth next week.
Here’s this week’s webinar, sponsored by LifeImage, titled, “Completing Your EMR with a Medical Image Sharing Strategy.”
Acquisitions, Funding, Business, and Stock
Google’s DeepMind Technologies forms DeepMind Health, offering two apps it acquired. Streams, for acute kidney injury detection, was developed by Royal Free Hospital London, while clinical task management and communication app Hark was created by an Imperial College London team. Neither app uses DeepMind’s machine learning or artificial intelligence capabilities – these are apparently simple, hospital-built apps that don’t do a whole lot despite the Tweeters wetting their pants in anticipation of Google mounting an undeclared challenge to IBM Watson.
E-prescribing and electronic prior authorization network vendor CenterX raises $3.3 million in funding.
UPMC makes an unspecified investment in Vivify Health and will implement its care management and patient engagement technology. UPMC’s investment completes a round that was started in November 2014, increasing the company’s total to $23.4 million.
Meditech solutions provider Park Place International will rename itself CloudWave.
Minneapolis-based employee health benefits management technology startup Gravie lays off 21 employees – 25 percent of its workforce, with CEO Abir Sen explaining, “It’s a bad market out there and we need to invest in growth.” Crunchbase reports that the company has raised $25.6 million, with its last round of $12.5 million being completed in April 2015.
VitalWare receives an unspecified growth investment from F-Prime Capital Partners, which gets two board seats.
Medsphere merges with EHR implementation consulting firm MBS/Net.
Sales
The State of Oklahoma chooses Orion Health’s Healthier Populations Solutions Suite for Health-e Oklahoma.
Mission Health (NC) selects PeraHealth’s clinical surveillance solution.
Maine Medical Center (ME) chooses Lexmark’s accounts payable automation, which includes Perceptive Intelligent Capture and Perceptive Content.
University of Kansas Hospital (KS) selects Cerner’s HealthIntent population health management system. I was distracted by the press release’s use of two pompous substitutions (“leverage” and “utilize”) for the perfectly serviceable “use,” but I’ll give them a bye for whipping out “proactive” a couple of times, which is two too many.
Intermountain Healthcare will use Ayasdi’s clinical variation management software.
Orion Health prometes Wayne Oxenham to president of its North America operations.
Huron Consulting Group hires LaDonna Sweeten (Leidos Health) as managing director.
PatientSafe Solutions promotes co-founder Si Luo to president and CEO.
HIMSS announces pre-conference organizational changes: HIMSS Analytics EVP John Hoyt retires, Blain Newton is promoted to replace Hoyt, and HIMSS EVP/COO R. Norris Orms announces his retirement.
Announcements and Implementations
Catalyze announces Stratum, a compliance layer for healthcare infrastructure.
Aprima adds Chronic Care Management functionality to its EHR.
American Well releases a software development kit that allows providers to embed the company’s online doctor visit technology into their mobile apps.
LogicStream Health adds an executive overview area to its clinical process measurement platform, allowing leaders to monitor care activity at levels ranging from specific conditions (such as CAUTI or VTE) to overall quality.
CHIME announces a “unique partnership” with OpenNotes, with the press release babbling endlessly without actually saying what the partnership involves until Paragraph 7, which finally gets to the point in explaining that CHIME’s task is to “bring greater awareness.”
First Databank announces its OrderSpace CPOE medication ordering content system, with McKesson Paragon being the first inpatient system to make it available to users.
Geisinger spinoff xG Health Solutions will use Cerner’s HealtheIntent population health management platform, while Cerner will use xG’s clinical content in its HealtheCare and HealtheAnalytics solutions.
The Partnership for Health IT Patient Safety releases Toolkit for the Safe Use of Copy and Paste.
Elsevier lists its activities at the HIMSS conference, including serving as the red carpet sponsor of HIStalkapalooza. I’ve worn the sunglasses they provided last year in Chicago countless times while running, sunning, or doing yard work — I call them my Elsevier safety glasses.
Government and Politics
ONC announces its Interoperability Proving Ground, a community for sharing information about interoperability projects.
The National Institutes of Health says during Thursday’s White House summit on precision medicine that it hopes to be gathering data on 1 million people by 2019, also announcing that it will fund a Vanderbilt University study involving Verily (the former Google Life Sciences) to determine how to attract those volunteers.
Army veteran Dennis Magnasco spent two days trying to schedule an appointment with the VA clinic in Bedford, MA, but could never get through the phone tree to reach an actual human. He works for Rep. Seth Moulton (D-MA), who filmed Magnasco’s attempt and posted it to Facebook, where it received more than 2 million views. The outcry motivated the Bedford clinic to fix its PBX and earned Moulton several new sponsors for his Faster Care for Veterans bill that would require the VA to run an 18-month pilot project in which veterans can self-schedule using a smartphone app. Moulton criticized the VA’s plan: “They were planning to spend $623 million developing their own app. This is available today. God knows how long it would take them to spend that.” He says the VA just likes building its own proprietary systems, adding, “They gave a variety of silly excuses.”
Privacy and Security
A law professor’s USA Today op-ed piece that appears to be satirical proposes going back to paper to thwart hackers, explaining:
The truth is, paper records are inherently more secure. To steal 10 million electronic user records from a government agency, all you might need is a cracked password and a thumb drive. To steal that many records on paper, you’d need a fleet of trucks and an uninterrupted month. And ransomware wouldn’t work on paper records. What would you do – put a padlock on the file cabinets and demand ransom for the key? And often, putting things on computers is a crock anyway. Electronic medical records, touted as saving money and streamlining care, are a major cause of physician burnout. It’s gotten so bad that some hospitals actually advertise the lack of electronic medical record systems as a selling point in recruiting doctors. If I were running an intelligence agency, I’d have all my important stuff done in handwriting or on mechanical typewriters and distributed in sealed envelopes. If I were setting up a voting system, I’d use paper ballots. And if I were running a hospital, I’d seriously consider doing everything on paper. There’s a place for computer records, of course. But for things that really matter and that need to be genuinely secure, we should try a more advanced technology: Paper and ink. Take that, hackers.
A Venafi survey finds that CIOs are not properly managing security keys and certificates. You will no doubt be shocked to learn that Venafi sells tools to secure keys and certificates. The survey suggests that more hackers are attacking using untrusted keys and certificates that can be bought on the black market for around $1,000 to encrypt their evil-doing traffic.
Pro football player Jason Pierre-Paul sues ESPN and one of its reporters for violating his privacy in running a photo of a surgery schedule proving that he had blown off a finger playing with fireworks on July 4, 2015. Jackson Memorial Hospital (FL) fired a nurse and a secretary earlier this month for sending the information to ESPN. JPP is suing under a Florida health professions regulation, which seems to hold little chance for legal victory since, like HIPAA, it covers providers but not sports networks running celebrity news.
Technology
Apple sold 11.6 million Watches in 2015, placing it in wearables third place behind Fitbit and Xiaomi. I knew little about China-based Xiaomi, but learned that its $15 Band Plus Pulse (pictured above) added a heart monitor to its existing step counting, sleep analysis, incoming call alert, and integration with the iOS Health app.
NHS England Nursing Technology Fund provides Princess Alexandra Hospital with $1.4 million to purchase Nervecentre’s mobile clinical platform software for iPad-based documentation.
Other
An analysis of LinkedIn’s share free-fall says the company’s problems are fundamental to its business model as somewhere between business card holder and spam delivery service: its only content is generated by self-promoting but sporadic users (often only when they’re looking for work) who are then pestered endlessly by recruiters. The article says LinkedIn should stop rewarding bad user behavior, allow users to block unwanted communications, and integrate better with email.
A Pennsylvania VA nurse is charged with assisting in an emergency surgery while drunk. The nurse, who says he forgot he was on call, drove recklessly from a casino bar and was caught on hospital security video stumbling into the facility. He then had problems logging in to the OR computer and documenting the procedure.
Sponsor Updates
The Atlanta Business Chronicle interviews Liaison Technologies President and CEO Bob Renner.
Allscripts announces that its APIs have been used to exchange data one billion times in three years.
HCI Group partners with Securonix to enhance its security offerings.
Extension Healthcare will add AirStrip’s mobility platform to its Engage Mobile, providing event notifications and waveforms
This week has been completely off the rails, with all my best-laid HIMSS preparation plans left undone. There’s nothing like five inches of mucky wet snow, flight delays, and a case of pinkeye to throw a girl off her game. Luckily I made it home, saw one of my partners for some eye drops, and am now playing a frantic game of catch up.
The pre-HIMSS news cycle is pretty slow. There was a flurry of mailings earlier in the week, most of which were nondescript post cards that wouldn’t lure me to a booth. Today there was nothing, but there will always be those post-HIMSS straggler mailings to look forward to.
Several readers have been sending me their shoe pics, wondering if they’ll give them a proverbial leg-up on the competition. There’s even a HIMSS Style 2016 board on Pinterest, with suggestions for both ladies and gents. I do like the pink socks and fetching wing tips pinned from www.dapperclassics.com.
Another sent me a pic of this two-heeled number from Christopher Dixon, which are supposed to be extremely comfortable. They’re also tech savvy, using Silicon Valley partner Chronicled to ensure authenticity. Shoes are tagged using a microchip and registered from a mobile app, allowing a future secondary market for non-knockoffs. Accessing the shoe’s chip via the app also displays a story about the inspiration behind the shoe and the sourcing of its materials. I doubt we’ll see any on the show floor, but a girl can dream.
I’m putting together my final social schedule for next week. Unfortunately, there are way too many events on Wednesday night and too few on Tuesday night. Most of the vendors who are hosting events are either gracious enough to allow public registration or are swayed by the MD accompanying my generic-sounding practice name.
I did have one of them question exactly how I received their invitation since it didn’t match their list. I had to just ignore it because I couldn’t exactly say, “Well, someone on your marketing team thought it was worth inviting Dr. Jayne.” One vendor offered to add me to its attendee list if I would send my real name – nope, not happening.
If you have an event on Tuesday that’s open to all readers, let us know. We’d be happy to have a member of the HIStalk team cruise by if time permits.
I tried to attend a Google Hangout this week, where NCQA was going to talk about the pilots for their redesigned Patient-Centered Medical Home program. The audio from the moderator’s PC was so bad that people couldn’t hear, which turned some attendees away. There were also a lot of people who weren’t muting their own microphones, adding to the problem.
Once the featured speakers started their talks, things got better, but it goes to show that Web conferences still can be tricky for a lot of people. At least the comments were fun to read.
I followed up after with one of my friends who does a lot of PCMH consulting work. She’s personally steering people away from NCQA, not only due to the complexity of their process, but also the growing fees. I haven’t had a chance to look at their new measures in depth, but she has seen them and thinks there are a few in there that are nonsensical. Looks like I have some reading to do.
CMS shut down the Medicare/Medicaid EHR Incentive Program attestation website over the weekend to correct an error preventing Eligible Professionals from claiming an exclusion for one of the measures in the Patient Electronic Access Objective. Those whose attestations were rejected previously must resubmit their information.
ONC has released a new Health IT Buzz post about “The Real HIPAA,” giving examples from care coordination and case management. This should be required reading for all the people who continually try to use HIPAA as an excuse not to share patient information when it is clearly permissible. The next installment is slated to cover Quality and Population-Based Activities and I’m looking forward to seeing what they have to say.
If you’ll be in Las Vegas next week and are interested in giving feedback to CMS, they will be hosting three Design Lean Planning Sessions during HIMSS. The goal is to receive feedback on the Merit-Based Incentive Payment System (MIPS). Sessions are one hour long and will be held March 1 at 2:30, March 2 at 2:30, and March 3 at 11:30 in the CMS Meeting Room, Venetian Level 4, Zeno 4603. Space is limited and you must email with your session choice, name, title, role, and organization to register.
Another reader recommended I not spend too much time at HIMSS job hunting, suggesting that I consider a position in New Zealand. They’ve been trying to recruit a primary care physician for more than two years with no takers. The position has good compensation, no nights or weekends, and 12 weeks of holidays. I’m not ready to live in the southern hemisphere, but a nice locum tenens gig might hit the spot. Unfortunately, he’s been inundated with applications of dubious merit, so he probably won’t see mine.
My week also went askew thanks to the usability efforts (or non-efforts) of Microsoft, who decided in their infinite wisdom to “update” Office 365 with a feature that completely broke my workflow. I have been enjoying my Surface tablet, especially the Surface Pen, which I use in lieu of a mouse or the touchpad on the keyboard. I have been working on a huge editing project (textbook chapter, anyone?) and two days ago the pen stopped working as a selection device and only worked for annotation. Using classic user psychology, I assumed I had done something wrong or activated something unknowingly. I immediately knew better when I did a Google search and typed “Microsoft Surface Pen” and it automatically suggested adding “stopped working” to the search.
Apparently Microsoft engineers decided we no longer want to use a pen or stylus for anything but annotation — the pen is now locked in Ink mode while using Office products. Although there appears to be a button to return it to selection mode, it doesn’t work. Multiple users have already weighed in on a Word suggestion forum that there needs to be an option to go back, with several comments from people who used the pen as an accessibility and adaptation tool to help with physical limitations. I use mine with the keyboard, so I can use the touchpad even though I don’t like it, but I truly feel for those actually using it as a tablet. Having to use the touchpad reduced my editing productivity by more than 50 percent.
Even worse, the on-board Microsoft Help seems to brag that the “select objects” button (which should turn inking off) no longer works. The Microsoft Answer Tech gave me an escalation link that wasn’t customer facing and the escalation site shows they don’t know the difference between a country and a language (featured above).
Help a girl out by sharing the link and helping us tell Microsoft they’re offending their users. If I scurry home from HIMSS, I’ll still have two days left in my return window to offload it.
I won’t post again until I get to HIMSS, If I have to ditch the Surface, what’s your advice on a tablet? Email me.
In an 89-4 vote, Robert Califf, MD, a cardiologist and clinical researcher from Duke University, has been confirmed by the Senate as the next FDA commissioner.
CommonWell will begin offering integration services in the post-acute care market in 2016, noting in its announcement that CommonWell members Brightree, Cerner, and McKesson have agreed to deploy the new services.
Google announces that it has teamed up with researchers from the NHS to co-develop a version of its DeepMind AI platform focused on developing healthcare applications.
WebMD CEO David Schlanger says on its most recent earnings call that the company would likely enter the telehealth space, through either an acquisition or a partnership.
HIMSS, Ice Cream, and the Law of Diminishing Returns (LoDR) By Mike Lucey
“Clearly the third scoop has fewer calories than the first and second. It is simply the law of diminishing returns.” This perverse application of the LoDR only returns a derisive, “You are pathetic” from my wife when used to justify the purchase of a large ice cream sundae. But I carry on and get the nuts on top — they are healthy.
It’s not that the LoDR doesn’t apply, just that I apply it to the wrong side of the counter. The medium at $2.75 (two scoops) and the large at $3.25 (three scoops) delivers less value to the ice cream lady. Extended (five or six scoops?), it would reach the breaking point where the ice cream would cost more to scoop then it would return in cash.
I wonder if some in our industry are confused as to which side of the counter they are on? More importantly, that the LoDR will flip the counter when we are not looking. Are we effectively and consistently asking the question, “Am I getting more than giving, or giving more than getting as I continue down this project path?”
Back in my days in financial services (maybe because our product was money), every project was systemically graded for current value. “Current” being the critical word. Not graded against the expected value we assigned at the start, but against the current costs, current value, and (here’s the kicker) current alternatives.
The Boston Globe recently published an article citing a Health Policy Commission study of the disparate cost of care in Boston-area hospitals. Using maternity services as an example, the study found large differences in what hospitals charge.
For us in the healthcare IT industry, it is notable that four of the five top hospitals are actively using or have recently installed Epic with a big price tag (three Partners hospitals, one UMass). This correlation raises the question: how much IT cost flows through the system, and are there effective checks against these rising costs? Did LoDR flip the counter in these cases?
To Epic’s credit, there is a concerted effort on their part to control costs that are often embedded in questionable customization. In other words, the folks at Epic are applying the concern of LoDR against the impulse of the client to work toward the elusive “best” at an ever-growing expense.
As we head toward HIMSS, our annual festival of IT goodies, we get to see a whole new set of “current” alternatives. Can we review the new stuff through the filter of LoDR? Stuff that is truly new for me, does it get me more then I need to give? And the stuff that is newer than what I have, does it keep me on (or get me back on) the right side of the counter?
And for me the ultimate question: who’s giving away free ice cream? Because free ice cream has no calories. Everyone knows that.
Removing Tunnel Vision from Enterprise Imaging By Karen Holzberger
I find the evolution of technology to be fascinating. Just think about music. Fifteen years ago, CDs were the most popular way to access music. Now you can listen to music anywhere, instantaneously, from tiny devices. The population has universally embraced the change. Why has accepting change in healthcare been so slow and difficult?
I’m not saying we all need to be on the bleeding edge of innovation, but it’s important to remove the tunnel vision and recognize advances not just in diagnostic medicine or medical research, but also in health IT innovations that make things faster, easier, and less costly.
I was surprised when I read a recent report on enterprise imaging that their research and results was limited only to organizations with a vendor-neutral archive (VNA) or universal viewer (UV) technologies.
The need to access and store medical images has been the most common demand of radiology departments for decades, but to think that in 2016 enterprise imaging is only done with these two approaches – it’s like taking a Polaroid camera to the beach and waiting a week for the film to be developed.
Don’t get me wrong. This report got it half right, but VNA and UV solutions don’t fit the needs of every organization, and that can lead people down the wrong path. If healthcare facilities are going to succeed in advancing the quality of patient care, then it is time to accept new and nimble health IT solutions for enterprise imaging today that bring patient images to people’s fingertips as swiftly and securely as the cloud delivers your favorite song.
Over the last few years, cloud-based image exchanges have gained popularity as an option for enterprise imaging. A HIMSS Analytics Cloud Survey showed that 83 percent of healthcare organizations used cloud-based apps in 2014. While this simpler approach is not the same as a VNA, it allows facilities to achieve the same overall goals, often more efficiently. Facilities can be up and running on an image exchange in as little as two weeks and have central access to all necessary images via the cloud – anywhere, anytime.
VNAs are one of the oldest imaging technologies. When introduced, they finally allowed healthcare sites to collect data from all departments in one location and exchange that information with a broader audience. But what about patient care happening elsewhere and other types of patient data?
Today, it’s critical that facilities share information with other facilities, not just other departments within the same building. In addition, the shift to value-based care means facilities require quick, efficient technology that follows patients across a continuum, which takes more than just sending an image from point A to point B. Imagine only being able to listen to your favorite song on your iPod and not on any of your other connected devices.
VNAs can take up to two years to implement and can be horribly expensive. Further, since they don’t encapsulate all of a patient’s data, sites need to use them in connection with other solutions, like a picture archiving and communication system (PACS), to have a complete enterprise imaging strategy.
Cloud-based imaging, on the other hand, provides more than the seamless sharing of images. It delivers real value and efficiencies like capturing and sharing all relevant patient data, just like how the cloud allows you to access your music, videos, and playlists effortlessly between your phone, tablet and laptop. Which is why I’m perplexed that society openly welcomes this technology in our lives, but accepting technology that can make life-saving differences has proved to be so challenging.
The time to embrace is now. If not, I fear that we will only continue set back an industry that so desperately needs to move forward.
Karen Holzberger is VP/GM for diagnostics at Nuance of Burlington, MA.
ResMed, a sleep apnea medical device manufacturer, will acquire Brightree, a software vendor focused on the clinical and business needs of home health and hospice markets, for $800 million.
ONC introduces the ONC Tech Lab, a group that will focus on standards coordination, development of testing tools, pilot project coordination, and health IT innovation.
Tech-savvy insurance startup Oscar Health raises a $400 million private equity investment from Fidelity on a $2.7 billion valuation. The company plans to expand to three or four new states per year as its works to grow its membership level to one million subscribers within the next five years.
Sleep apnea technology vendor ResMed will acquire home health and durable medical equipment billing software vendor Brightree for $800 million in cash. ResMed, which also gets a $300 million tax benefit, will pay seven times revenue and 19 times earnings for Brightree.
Battery Ventures was an early Brightree investor and expanded the company with several acquisitions. It announced in December that it was exploring a sale of the company.
Reader Comments
From Pointed Commentary: “Re: Practice Fusion. Tough times, per the Wall Street Journal. While the article doesn’t focus specifically on health IT, I believe the current investment environment will be brutal on startups and companies working to scale. I predict we are going to see accelerated consolidation of the space and private equity players are going to have a field day picking up companies that are struggling.” The article, titled “For Silicon Valley, the hangover begins,” gives Practice Fusion as its opening example of venture capital drying up and forcing cash-challenged companies to frantically change their business before their financial runway ends. That isn’t really surprising — it’s the usual cycle where innovative startups strike amazing business gold, the VC money flows in indiscriminately chasing the Next Big Thing before it takes someone else’s cash, and flawed startups ruin the party by going up in flames fueled by the money investors poured into them. It’s a cruel but necessary Darwinian process.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor ECG Management Consultants. The Seattle-based, healthcare-only, full-service management consulting firm has offices in eight US cities. Its technology practice supports achievement of strategic, financial, and operational goals. The company has industry-leading expertise in system strategy, selection, implementation, and optimization, with a particularly notable history of helping ambulatory clinics improve their operations via technology, revenue cycle, and EHR systems. The company just announced formation of its bundled payments practice. Give their Value-Based Readiness Quiz a try or scroll through its impressive list of experts. Thanks to ECG Management Consultants for supporting HIStalk.
I found this ECG Management Consultants intro video on YouTube.
Ms. Stitt from North Carolina says her second graders were so excited when our DonorsChoose package came with a library of books that they insisted she immediately read one of their new volumes, voting to skip recess.
Also checking in was Ms. Tyler from California, whose Algebra 2 students are enjoying the eight scientific calculators we provided for students who can’t afford to buy their own.
CenterX donated $1,000 to DonorsChoose to attend my CIO lunch at the HIMSS conference next Wednesday, which funded these projects:
A programmable robotics kit for Mrs. Buchanan’s K-5 technology classes in Fort Mill, SC.
Electrical components for a student-led project at Ms. Read’s all-girls school in Austin, TX.
Eight motorized robot kits for the third-grade class of Mrs. Cespedes in Arcadia, FL.
Pizza gift cards to feed the after-school robotics team and their college engineering student advisors of Mr. Chen’s high school in Boston, MA. The student who is leading this project explains, “We are not trying to use the gift cards to start a feast, but we plan to use it slowly throughout the season. Also, Vivian sees that I, as the coach teacher, often provide my pocket money for getting the team food. As a result, she wants to take the lead to write this student-led project to get food for our team.” They emailed me to say, “Wow! Thank you so much for funding our project! We are writing to confirm with you that we have got the funding from you! We cannot be more excited to know about this! In the near future, we will share some pictures with you on how your donation helps our Robotics program! There are times that we hope that we can go easy on expenditures on food! Your help truly makes a huge difference! We cannot thank you enough for all this!”
An iPad Mini, case, and headphones for Ms. Alley’s elementary school class in Richmond, VA.
A 18-book STEM library for Mrs. Ochoa’s elementary school class in Phoenix, AZ.
A listening center and audio books for Ms. Bolinger’s elementary school class in Indianapolis, IN.
A couple of CIOs had to cancel their plans to attend the lunch. If you are a health system CIO who can spare a couple of hours next Wednesday to socialize and enjoy a delicious lunch (on me) with my donating vendors who are supporting DonorsChoose, contact Lorre.
Welcome to new HIStalk Gold Sponsor Audacious Inquiry. The Baltimore-based information policy and technology company helps government, private, and non-profit organizations share, manage, leverage, and protect information. Its implementation of master data management tools for health information exchange set the standard for HIEs throughout the US. Its Encounter Notification Service has securely delivered 10 million real-time event notifications and clinical summaries to patient hospitalization stakeholders in three years and powers FLHIE’s Event Notification Service, DHIN’s Encounter Notification System, UHIN’s cHIE alerts, CRISP’s Encounter Notification System, and HSX’s Encounter Notification Service. Here’s an overview of Audacious Inquiry’s Event Notification Services that I found on YouTube. Thanks to Audacious Inquiry for supporting HIStalk.
HIMSS Conference
The HIMSS ramp-up in HIStalk page views has started, with 8,700 of them in 6,700 unique visits Monday. The 52-week high is 13,500 page views on the Wednesday of HIMSS15. It would be cool to break the record this year.
I was looking over the HIMSS education schedule, which is indistinguishable from the exhibit hall stage talks given the number of sessions that have been turned over to vendor presenters, some of them using an entire slot just to talk about their products. It’s remarkable how the once-vital educational track has degraded into a lot of lame-sounding sessions presented by people I’ve never heard of. I’m clicking through the awkwardly designed session list on the HIMSS site trying to find something worth the time, but following my rule of never attending anything with a vendor presenter, there’s really not much left. Maybe providers are too busy cruising the exhibit hall for freebies to present.
I get this feeling that once I’m at the conference, I’ll just skip the education sessions and cruise the exhibit hall. The online guide shows 1,285 exhibitor booths, staffed by thousands of bored employees using them as the world’s most expensive telephone booths in screwing around with their phones instead of paying attention to attendees (although I admit that most of those attendees aren’t prospects or decision-makers anyway). I’m feeling sorry for the vendors banished to the downstairs Siberia that is Hall G (Booths # 9900 – 15209), which at HIMSS12 would have had few casualties if a bomb had leveled it. HIMSS must feel bad, too since they’re opening up only Hall G during Monday’s opening reception, giving it a few hours of undivided attention. We’ll be on the main floor in #5069 with our usual parade of interesting people sharing our area rug-sized space.
I doubt I’ll be the only attendee leaving Las Vegas long before Peyton Manning takes the mop-up snap after lunch on Friday to end the lamest set of keynotes I can recall. At least there’s no insurance company executives, Clintons, Bushes, Dana Carvey, or mountain climbers who hacked off their own arm this time around.
I was reading over my HIMSS12 Las Vegas coverage and decided I liked this line I wrote best: “Here’s a shot taken from the Venetian looking out to Las Vegas Boulevard. Inside, it’s a fake canal under a fake sky, women with fake breasts, and men with fake tans. Finally the exhibit hall isn’t the only place where things aren’t as they seem.” I opined that Las Vegas is like Orlando except with obnoxious adults instead of obnoxious kids.
DrFirst will be doing video interviews again at the HIMSS conference in the DrFirst-HIStalk “Roving Reporter” series. Healthcare IT leaders willing to share their experience, challenges, and perspective with their HIStalk-reading colleagues can schedule an interview time with Wendy Johnson.
HIStalkapalooza
HIStalkapalooza Sponsor Profile – NEC
Being the first enterprise communications technology provider in healthcare, NEC is proud to be part of HIStalk and the dedicated professionals who have grown with us and made this the most exciting, challenging and rewarding vertical industry. Leveraging 65,000 patents and over 100 years, NEC continues to develop healthcare industry-focused applications in communications infrastructure, IT/networking solutions, and award-winning biometrics. Want to learn more about NEC’s mission to orchestrate a brighter world through optimized solutions for healthcare? Follow us @NECHealthcare or #NECHIMSS16 and join our traveling “meet and greet!” We will post our positions to host you for coffee or a libation several times a day throughout HIMSS.
Webinars
February 24 (Wednesday) 1:00 ET. “Is Big Data a Big Deal … or Not?” Sponsored by Health Catalyst. Presenter: Dale Sanders, EVP of product development, Health Catalyst. Hadoop is the most powerful and popular technology platform for data analysis in the world, but healthcare adoption has been slow. This webinar will cover why healthcare leaders should care about Hadoop, why big data is a bigger deal outside of healthcare, whether we’re missing the IT boat yet again, and how the cloud reduces adoption barriers by commoditizing the skilled labor impact.
February 25 (Thursday) 1:00 ET. “Clinical Analytics for Population Health: Straddling Two Worlds.” Sponsored by HIStalk. Presenters: Brian Murphy, lead analyst, Chilmark Research; Jody Ranck, senior analyst, Chilmark Research. The Chilmark Research clinical analytics team will be sharing some of their key findings from the recently released “2016 Clinical Analytics for Population Health Market Trends” report. This will be followed by a Q&A session to make sure everyone goes to HIMSS16 well informed.
We’re running a HIMSS special on webinars – 25 percent off produced and two-for-one on promoted. Contact Lorre or see her at our booth next week.
Acquisitions, Funding, Business, and Stock
CTG announces Q4 results: revenue down 14 percent, EPS $0.16 vs. $0.08, beating earnings expectations but falling short on revenue and guiding down.
Insurance startup Oscar Health receives a $400 million investment that values the company at $2.7 billion, up $1 billion since its last round in September 2015.
Sales
Northwell Health (NY) chooses SigmaCare’s EHR for its skilled nursing facilities.
People
Raj Sundaramurthy (Equifax) joins Catalyze as chief product officer.
Huntzinger Management Group hires Ed Fisher (E.L. Fisher Consulting) as practice executive of technical services.
PM/EHR vendor MedEvolve names private equity investor Jim Crook and Jon Phillips (Healthcare Growth Partners, above) to its board.
Tim Zoph (Northwestern Memorial Hospital) joins Impact Advisors as strategic advisor and client executive.
Former Merge Healthcare CEO Justin Dearborn is named CEO of Tribune Publishing, which owns the Chicago Tribune, Los Angeles Times, and several other newspapers. Merge Healthcare was controlled by Michael Ferro, whose investment company bought a $44 million stake in Tribune Publishing in February. Ferro’s $20 million Merge investment in June 2008 netted $190 million when IBM acquired the company in October 2015 for $1 billion.
Announcements and Implementations
St. Clair Hospital (PA) launches a cost transparency portal, powered by Experian Health’s Patient Estimates, that allows patients to determine their estimated out-of-pocket cost for services using actual contracted cost.
EClinicalWorks announces that it will develop a cloud-based, single patient record EHR called EClinicalworks 10i that will span inpatient, ambulatory, and allied health. Tidelands Health (SC) will serve as development partner. The initial release in 2017 will focus on operations modules such as CPOE, bed management, inventory management, ED, surgery, and analytics. The CIO/SVP of Tidelands Health is Todd Rowland, MD, who completed a medical informatics fellowship at Harvard. I believe Tidelands is using Meditech.
Epic will integrate genetics-powered drug ordering clinical decision support from Genelex into its product. Genelex’s YouScript Precision Prescribing software provides alerts if the patient’s genetic profile places them at higher risk for drug-specific adverse events. I see that Genelex will be exhibiting at the HIMSS conference, suggesting that it may be seeking additional EHR partners.
Forward Health Group’s PopulationManager achieves Oracle Validated Integration with Oracle Enterprise Healthcare Analytics.
FormFast announces its Mobile Bedside Consent Solution.
Clinical Architecture launches a natural language processing application for converting free text to discrete data, with the SIFT for Meds Web API service translating free text from clinical documents into RxNorm codes. It can also be used in real time to suggest coding as free text is being entered.
ZeOmega and Vivify Health will integrate their respective population health management and remote patient monitoring technologies.
Zynx Health announces a new release of its Knowledge Analyzer for management of clinical content and documents.
Government and Politics
ONC announces the ONC Tech Lab that will coordinated interoperability standards, work on testing tools, conduct standards implementation pilots, and run challenge contests.
The Healthcare Leadership Council calls for six immediate steps to improve US healthcare, including setting a firm date of December 31, 2018 for achieving nationwide health IT interoperability.
A Harvard Business Review op-ed piece by David Blumenthal, MD and Aneesh Chopra calls for penalties “for providers and vendors that slow-walk the digital revolution to protect their economic interests” and a payment system that rewards improved quality and cost. It says, “If healthcare markets functioned well in the US, HITECH would have been unnecessary. The industry would have wired itself like our financial, travel, and retail sectors.”
The Wall Street Journal says New York’s hospitals and physicians will struggle to meet the state’s mandatory e-prescribing law that eliminates paper prescriptions as of March 27, 2016. Some providers are demanding an extension to the date that had already been moved back a year.
In Western Australia, the Labor party calls for the resignation of the health minister following an auditor’s report released last week that concluded that a $32 million data center contract has run $58 million over budget. The agreement with Fujitsu was amended 79 times, often by employees who were not authorized to make changes. The case has been referred to the state’s Corruption and Crime Commission.
Privacy and Security
Dartmouth College researchers announce a commercial prototype of a digital “magic wand” that allows non-technical home users to easily and securely configure new Wi-Fi devices, such as medical monitoring tools.
St. Joseph’s Healthcare (NJ) notifies 5,000 employees that their information has been exposed in a phishing scam.
Child activity tracker uKnowKids announces that its database was breached by a white hat hacker who was trying to convince the company that its security systems were inadequate, exposing 6.8 million text messages, 1.8 million images, and the names and addresses of its young users.
Office of Personnel Management CIO Donna Seymour resigns two days before she is scheduled to face a House committee on the massive China-based theft of government personnel records last year. OPM’s OIG warned the office that the systems were insecure and therefore operating illegally, but Seymour overrode those concerns.
Innovation and Research
A small study funded by the Gates Foundation finds that fingerprick-drawn blood can give wildly different hematology results compared to venipuncture due to significant drop-by-drop variability. This could be important for point-of-care hospital testing and certainly adds another question mark to the nanotainer draws used by Theranos.
Technology
Google announces a Watson-like service called Cloud Vision API, which will generate insight from images. It can detect common objects, analyze the emotional attributes of people in the photos, and extract text using optical character recognition. Pricing is $2 per 1,000 images for label detection and $0.60 for 1,000 images for OCR.
Other
A man’s lawsuit against the nursing home in which his mother was killed by her roommate will test the legal validity of the arbitration clauses nursing homes insert into their contracts. Judges have consistently ruled that the clauses, which are also common in cell phone and credit card contracts, are binding if signed by the purchaser, even in cases where purchaser can’t read or write. The woman’s son argues that the contract he signed was not binding on his mother since he did not have power of attorney.
Alibaba Health shares drop 14 percent when the Chinese government’s version of the FDA decides to allow alternatives to its drug supply chain tracking system, support of which generates half of Alibaba Health’s revenue.
Healthgrades announces its top hospitals for 2016.
Sponsor Updates
Awarepoint customer Zion Medical Center (CA) – a Kaiser Permanente organization – wins the IHA 2016 Award for Innovative Healthcare.
Besler Consulting releases a podcast on the future of bundled payments.
Bottomline Technologies wins a Killer Content Award in the Agency/Publisher Partnership category from Demand Gen Report.
Divurgent publishes a new white paper, “Improving Your ICD-10 Program: Preparing for Oct. 1 2016 & Beyond.”
CTG Advisory Services delivery directors Vivian Chun and Patricia Newcomb achieve the Patient-Centered Medical Home Certified Content Experts certification from NCQA.
Extension Healthcare is nominated for a Mira Award honoring the “Best of Tech in Indiana.”
SK&A publishes a market profile of US orthopedic surgeons.
A coalition of payers, providers, patient advocates, and vendors has issued a report calling for legislative action to help the US health system improve six key issues, including interoperability, care coordination, and patient engagement.
Tenet reports Q4 results: revenue was up slightly to $5.03 billion, adjusted EPS $0.35 vs. $1.03, beating estimates on both. The company recorded an overall net loss of $97 million.
Former National Coordinator for Health IT David Blumenthal, MD and former US CTO Aneesh Chopra, MD co-author a HBR article calling for improvements to the usability of EHRs and “penalties for providers and vendors that slow-walk the digital revolution to protect their economic interests.”
During a panel discussion, DoD deputy CIO Richard Hale calls for improved network cybersecurity at DoD hospitals and an increased emphasis on identifying and prosecuting hackers.
I’ve mentioned a couple of times about having issues in the office recently, where our cloud-based EHR is down. A reader asks: “Please explain to me as an IT physician expert why your cloud EMR was ‘down again.’ Mission-critical systems should have backups. I also believed that bigger organizations should have more resources (like you) to prevent/remediate these events. Please tell your readers why this is happening and what procedures your organization has in place to prevent this?”
We actually went down again while I was seeing patients last week, although it only lasted for a few minutes. I’m happy to tell my story.
In my current clinical situation, I’m more representative of the “average Joe” (or Jayne) physician than an IT physician expert. Like many other physicians in practice, I am employed. Although I used to own my own practice, that was more than a decade ago and the demands of running the business took all the joy out of medicine, sending me into employed practice in the first place.
That was the position I was in when I became a CMIO – homegrown by my hospital/health system to take the reins as we moved into the EHR world, long before Meaningful Use was even thought of.
From a physician informatics consultant perspective, I live and breathe downtime strategy. Clients hire me to engineer their downtime strategies and ensure that being down is something they never have to encounter. Whether it’s the threat of utility providers with backhoes or a natural disaster, I’m all over it.
The downtime solutions I helped engineer when I was a CMIO were initially ridiculed by the IT department as overkill, but they proved themselves time and again as we encountered a variety of unstable situations. Car crash into the data center, knocking out power? Check. Flood in the backup data center? Check. IT guy pulls the Halon fire suppression system on accident, shutting down the building for half a day? Check. Network switch down? Check. Vendor fries your database with a bad upgrade? Check. We had it covered and I learned a great deal along the way.
However, when I go into the office now, I put on my physician hat. My employer knows full well what I do the rest of the time, and although we are a good-sized independent physician group, we don’t have the level of dedicated informatics or IT resources that a hospital-owned group or academic medical center might have. We sometimes run on paper-thin margins as we deal with shifting reimbursement schemes and a rising balance of patient pay accounts.
The bottom line is that that our management (like many other private practices) are not able (or perhaps willing) to pony up to have a full-time or even part-time expert deal with the situation.
That scenario is exactly why I went into consulting in the first place. I started my consulting practice on the side while I was still a CMIO, working with practices that might be on the smallish (or cheapish) side but that still wanted expert advice. Practices who may not feel like they can afford ongoing expert assistance, but might be willing to hire someone to come in, do an evaluation, and give them advice. But despite dire warnings and imperatives, clients don’t always take my advice and sometimes simply cannot afford to do so.
Eventually my consulting practice grew to where I also handle large hospitals and health systems, especially ones with more than their share of challenges. I left the hospital-based world some time ago and hung out my consulting shingle full time.
I had several locum tenens and urgent care-type assignments before settling in at my current practice. In my employment as “staff physician,” I am somewhat blinded to what our owners are doing with regard to the EHR vendor and the ongoing issues. I do receive direct emails from the vendor when the system goes down, and they’re “all customer” type bulletins, so I know that our outages aren’t due to local connectivity issues.
The level of redundancy our vendor may have is a black box to me as an end user. Although I have made suggestions about improving the downtime documentation tools and having regular drills, as an end user employee, dealing with the vendor is not my responsibility. (As a CMIO, I’d have had a vendor exec on a plane and hundreds of thousands of dollars of maintenance credits by now, had we had these issues.)
I’m not excusing the actions of my employer, but just sharing how it is in my world as an employed physician. They know what I do. They know I’m available if they want my opinion. Otherwise, my role is to care for patients and let management do the managing.
I will be visiting the vendor’s booth at HIMSS and asking a lot of pointed questions, but I won’t be doing anything to jeopardize my employment. A practice that lets me work a relatively limited schedule and is flexible with the demands of my consulting practice is rare. One that actually performs (from a clinical standpoint) at the level of my current employer is even more so. Despite the recent failures of our EHR, it does generate mounds of quality data that put us in the top decile for many benchmarks. Patients are voting with their feet as well, allowing the group to continue to grow.
You can bet that things would be different if I held a leadership or ownership position. But much like many other physicians across the country, I don’t. I am subject to the decisions of my employer. Maybe someday they’ll reach a place where they have dedicated informatics resources, but until then, I’m going to put my stethoscope around my neck and see patients.
How do you feel about being an employed physician? Email me.
This is company number three for me in my career. It’s been 27 years in healthcare IT. I started back in 1992. I think that’s before healthcare IT was even an industry. [laughs]
I’m an entrepreneur focused on disrupting inefficient processes, keyed in on healthcare. It’s never really been about a market size opportunity for me. It’s something that somehow clicked for me, something that I found my passion for.
Startups won’t succeed unless you are waking up in the morning ready to take on the world. It’s intense. It’s pressure packed. I’ve been fortunate to have found a love in virtually everything that I’ve been involved in.
I’m getting a big charge out of NDSC. We’re at the precipice of defining how guidelines and pathways can be used in an actionable way, beyond paper and flowcharts, to impact outcomes in a positive way. We wake up every morning thinking that we’re doing something great.
What is the status of Medicare’s imaging appropriate use criteria?
It’s for outpatient Medicare imaging, the use of appropriate use criteria for all high-tech diagnostic imaging services. The original target was January 1, 2017. That has since been delayed. They haven’t set a specific date, but if you look at the regulations, all the timelines line up to January 1, 2018.
Is it a given that properly presented appropriateness guidance will change usage patterns?
How wouldn’t it? It really comes down to how it’s implemented. If you’re going to put guidance in front of a doc who’s about to do something wrong, where normally that order would just go through, and you give him guidance, how would it not have a positive impact?
The mechanisms that commercial providers use are radiology benefits management services. That’s an old-world version of what CDS does. It’s phone call driven. I’m going to make a call. I’m going to tell somebody that I want to order a test for a given reason. They’re going to look in a book. They’re going to say that’s a good reason or it isn’t.
CDS is embedded in the ordering process. It’s at the point of service. The easiest way I can describe it is that it’s the difference between calling the travel agent back in the day or logging onto Expedia. Implemented properly, there’s absolutely no reason why it won’t work. There’s evidence that shows this in multiple studies.
Did you look at existing clinical decision support models to decide how to present the guidance without being obtrusive or causing resentment?
There are two things that we hold near and dear to our hearts. First is the source of those criteria, meaning s credible source using a defined process for the answers that are given. It doesn’t mean that everybody’s going to agree with every piece of guidance. That’s impossible. But having a defined process and a recognizable and a reputable source is key.
The second big one is that workload has to be a seamless in what they’re working in. There were earlier CDS products in the market. They were standalone solutions. It was go to this portal, click 14 times, and it will give you an answer.
Everything that we do leverages the existing EMR infrastructure, whether it’s Epic, Cerner, etc.. The user never leaves their environment. In the best integration, they don’t even know that it’s there unless they do something outside of the guidance.
Even then, the advisories are those that are native to the EMR. It’s like any other advisory that they would see. There is no ACR Select physically on a user’s desktop when they’re working inside of an EMR.
That level of integration requires both technical work as well as convincing those EHR vendors to allow a separate system to present messages to their users. How did you make that happen?
The source of the content as a standard really got their attention. That was one thing. The fact that we were coming to the market, there was something that recognizable, that it’s something that they believe that if they did it right, all their customers would use it, gave us a platform to get in front of them and work with them.
I would argue that these guys get a little bit of a bum rap with respect to interoperability. I know the stories. We’ve had nothing but positive experiences with the major EMR vendors out there. There are always improvements that need to be made. There’s always timing issues with release cycles. But we use whatever industry standards are out there and are available, whether it’s XML or Web services. Even now they are working with us on the new FHIR and SMART standards.
It was hard. It took time and an unbelievable amount of patience. Every release, the integration gets better. We are reliant on their release cycles. We move faster. We’re a smaller company. These guys have thousands of users. Even if they wanted to turn on a dime, they couldn’t. It’s just taken time, an open mind, and some patience.
Who pays NDSC?
Primarily it’s whoever is at risk for payment. The majority of our clients now primarily use ACR Select for their at-risk population. In scenarios where there’s a third-party payer involved, there’s a relationship there, too. Bit it’s primarily the providers, because it’s an efficiency on their end and a savings on their end. If the risk starts to shift to the providers, we’re going to see even more of that.
Your website suggests that you’ll be moving into other types of order guidance.
Yes. ACR Select keeps me up at night. The new stuff, which is something called Care Select — which we’re announcing at HIMSS — is what gets me up in the morning. Care Select is going to be a revolutionary way of looking at how to put guidance at the point of care for a clinician around these high-impact areas in an actionable way and a credible way.
We’re leveraging everything that we learned, everything from how to structure content so it can be read by an EMR to integration into the physician workload. Everything that we learned through ACR Select, we are leveraging for Care Select. Whether it’s for high-cost drugs, antibiotic stewardship, admission criteria, or anything in that area where providers are identifying high variability of care that is resulting in quality issues, Care Select is going to be able to handle.
We’re focusing right now on our Choosing Wisely criteria as well as criteria from the Number Needed to Treat, which will be very familiar to the ED docs out there. That’s our baseline. Like I said, that’s what gets me out of bed in the morning.
What kind of employees do you have to get the clinical content into the technology?
We don’t create our own content. We are shepherding. We’ll work with NCCN. We’ll work with the Choosing Wisely guys. We work with the ACC and American College of Emergency Physicians.
The thing with their criteria is they’re all narratives. I’ll look at a 40-page document that talks about how to image for low back pain or how to treat a full thickness rotator cuff tear. Literally, it’s a 40-page narrative. How do you turn that narrative into structured data of inputs and outputs that are consumable and known by the EMR so you can put it into the workflow?
We have informaticists on our team that do nothing but that — take these known sets of guidelines, criteria, and narratives and turn them into something that is consumable by the EMR. We have tools to do that. We have tools to localize them for site-specific needs, too.
That’s a big piece of the organization. I would say 75 percent of the company is informaticists and engineers. The rest are admin, sales, and marketing.
Since the clinical content is managed by mostly non-profit associations that have already earned the respect of your users, do you have to license that intellectual property from them?
In some, cases we have to. In others, we don’t.
We actually prefer to license. We’ll run into a society that has built criteria just because it’s the right thing to do. We’ll approach them and show what we’re going to do. Get someone excited. Then we tell them that we want to give them money.
We want to give them money because we want them to have the resources to continue to build and support. It costs money to do that. These are not-for-profits. To the extent that we’re able to generate dollars for them to continue doing good work, we want to facilitate that. We want to foster that.
There have been scenarios where we have started with, "Here is licensing" where they’ve asked us, and there have been scenarios where we’ve offered and facilitated.
Where do you see the company in five years?
Healthcare is undergoing a significant change, driven by alternative payment models and everything else. Everything else fixed and situated on and what we hear every day about how we’re spending too much money on care without comparable outcomes to Finland or Sweden or whatever other homogeneous population that is out there. We see ourselves as at the precipice of helping the market to define and to drive standards of care and put those at the point of service such that they can be acted on.
There’s a lot of effort being spent on deep analytics to understand outcomes and understand where the problems are. Once they’re defined, how do you act on it? How do you impact on a doc’s decision when they’re in front of the patient, when they’re documenting in the EMR? That’s the next step.
We see ourselves as a company that is well positioned to do that. We want to work with our partners. We want to work with providers, content partners, payers, and others to understand where those high-impact areas are that we’re able to impact immediately.
I could never predict five years out. But where we’re going is around actionable guidance embedded seamlessly in a physician’s workflow that will prevent mistakes from being made, driving appropriate care in accordance with agreed-upon pathways and guidelines. Five years from now, we’ll go from 100 customers to 1,000. That’s as accurate a statement as I can give you.
February 22, 2016NewsComments Off on Empowering Patient-Centered Care – Will New OCR Guidance be Enough?
We dig into the ramifications of OCR’s new clarifications on patient access to PHI. By @JennHIStalk
Since its introduction 20 years ago, HIPAA has come to mean a number of things to a number of people. Patients typically associate it with yet another form to be filled out without reading when visiting the doctor’s office, a vague reassurance via a Notice of Privacy Practices that their PHI will be protected from prying eyes.
Providers, meanwhile, see it as a framework governing security of that same health data – one that seems to have evolved into a rigid set of processes aimed at denying patients their PHI access rights. Business associates and payers likely look upon it with trepidation, wondering if and when their trove of hopefully secure health data will be breached.
What nearly all healthcare stakeholders seem to have forgotten is that HIPAA is also intended to be a means by which patients have clear rights of access to their data, a playbook that providers and patients can rely on to ensure timely delivery of sensitive – and sometimes life-saving – information.
Patient access complaints continue to mount even as the federal government widely publicizes its push for patient-centered and empowered care, a contradiction to be sure. To remedy the situation and send a reminder of what HIPAA is truly about, OCR issued updated guidance last month on how providers can best comply with patient PHI requests in a timely manner that doesn’t burden the patient with delay or expense. But will it be enough to truly turn the tide on an issue that seems to have historically been swept under the rug by both providers and OCR?
The Precision Medicine Push
OCR Deputy Director for Health Information Privacy Deven McGraw is confident the new guidance will bring HIPAA’s patient-empowerment side to light. “We have long wanted to provide additional guidance on this issue,” she explains. “When we began to get more involved in the White House’s effort to create the Precision Medicine Initiative, we could clearly see how the right of the individual to access a copy of her health information and send that information directly to a third party, like a researcher, could be very important. It would be very driven by the individual and their donation of data. The Precision Medicine Initiative really provided a hook to move this access issue up the priority list and get the new guidance out in a timely way.”
McGraw says that it’s been a long time coming, an issue that she has wanted to address from Day One. “The inability to access health information has always been one of the top five categories of complaints that we’ve received,” she explains. “When I interviewed for this position, I said, ‘I really want to work on the access issue,’ and it just so happened that they were thinking along the same lines.”
Understanding the Numbers
The sheer volume of patient access complaints (including Mr. HIStalk’s still-unresolved, six-month-long records request drama) may help explain why OCR has at times been sluggish in enforcing compliance with offending healthcare organizations.
“We get so many complaints that come into our office every year — in the tens of thousands,” says McGraw. “If one-fifth of those are complaints about access, we can’t investigate all of them. We try to deal with many of them by contacting the covered entity and just telling them they have to comply with the rules. I do suspect that often times what the individual or patient ends up getting may not be exactly what they want, and may not follow the letter of the law. Sometimes those people will complain again to our office and we’ll try to follow up, but often times they’ll just give up and take what they received, which is obviously not an ideal situation.”
The Root of the Problem
The access issue seems to stem from a lack of knowledge on the part of patients and a lack of efficient processes on the part of providers. Patient requests for records have historically been treated by providers as unusual occurrences. “It has not been built in as an ordinary function of providing healthcare,” says McGraw. “It’s really been dependent on people asking, and a lot of people didn’t know they had the right to ask. Sometimes they get turned away under the misimpression that HIPAA doesn’t allow them to obtain a copy of their own records, when in fact the truth is the exact opposite.”
McGraw continues, “An entity is required to give an individual a copy of their medical records. There has been a lot of misconception out there about what our rules require in terms of the actions that have to be taken by providers and health plans to respond to individual requests. That’s why we put the guidance out there.”
Because patients have been in the dark about their access rights, providers have in turn not rushed to make the process of delivering PHI efficient. “These processes may be antiquated for a variety of reasons,” says Erin Whaley, a partner at Troutman and Sanders law firm in Arlington, VA. “For instance, some providers still require individuals to deliver a request for access in person so that the individual’s identity can be confirmed. The provider isn’t trying to create a barrier to access. They’re trying to employ a best practice to verify the authenticity of a request.”
“They’ll need to make sure that they provide multiple avenues for an individual to request access, know which electronic formats they are capable of producing above and beyond the standard PDF, and enable various methods for transmitting the responsive information,” she adds. “Developing a new request form with all of this is obviously the first step. To the extent OCR has reviewed forms that it thinks represent the gold standard, it would be helpful to share those with the provider community.”
Getting the Word Out
McGraw and her team at OCR plan to move beyond the new guidance’s initial release with awareness campaigns aimed at trade groups, healthcare organizations, and patients. The office will release more in-depth FAQs into fees and the right of the individual to send their records to a third party within the next several months. It will also reach out to professional associations like AMA to help spread the word.
More consumer-friendly materials are also in the works via a partnership with ONC. “We’ve done some strategic thinking about how we’ll get these patient-centric materials out to people,” McGraw notes. “We’ve been in preliminary contact with other government agencies about how we can piggyback on their community outreach efforts. It’s premature to release any details about that.”
Enforcement is Coming
Enforcement is also a big part of the issue. That seems challenging given OCR’s bottlenecks in even responding to complaints, much less following up with enforcement.
McGraw emphasizes that enforcement isn’t an efficient process, with cases often taking years to resolve. She points to the civil monetary penalty levied against Cignet Health (MD) in 2011 – the only time a provider has been taken to such public task for violating the HIPAA Privacy Rule. Cignet willfully ignored the medical records requests of 41 patients between 2008 and 2009, and then disregarded OCR’s attempts to resolve the situation and subsequent subpoena in the years following. All to the tune of an eventual $4.3 million fine.
“The Cignet case was obviously an egregious one where there was a pattern of non-compliance,” McGraw explains. “It wasn’t just that they were making patients jump through hoops, but that they were refusing to give people copies of their records. Then on top of that, they didn’t cooperate with us. That was a pretty egregious set of circumstances.”
McGraw says OCR will step up enforcement. “Given the new guidance, we’re working with our regional office heads to come up with a strategy for how to step up our enforcement of these access cases. Clearly we’re going to have to pursue more of these. We will start enforcing this more aggressively. When we’re able to put out more details about this, we’ll do so. People shouldn’t put their heads in the sand about this. We’re quite serious.”
But Are Providers Ready?
Whatever the level of enforcement, Whaley believes providers are not ready for the increased scrutiny. “Providers know that OCR is looking to launch Phase 2 of its HIPAA audit program in early 2016 and are making sure that their house is in order in case they’re selected,” she explains. “While individual access is certainly part of HIPAA compliance, providers, for the most part, have been focusing their compliance efforts in other areas. There are still far too many who are not conducting a comprehensive annual risk analysis, or who have never updated their BAAs following the passage of the HIPAA Omnibus Rule. These providers are focusing on closing these gaps and not on their individual access processes. Hopefully, OCR will understand that while the individual access right is not new, there is a lot of new information in the guidance that will take providers time to implement. If providers are making good-faith efforts to respond to requests from individuals for access to their records, hopefully OCR will recognize this.”
Patients are the Decision-Makers
McGraw is enthusiastic about OCR’s efforts to shed more light on the patient access issue, and believes that fewer barriers will ultimately help speed up the road to interoperability and truly patient-centered care. “The role of the HIPAA rules is to create a baseline,” she says. “Nobody can fall below what we require in terms of access, but people can certainly go above and beyond. To be really patient-centered as a healthcare provider, even as a health plan, I think you have to give people the same access to the data that you have in terms of patient care and payment for care. Patients are the ultimate decision-makers for the type of treatment that they want. We have to give them information in order to enable them to make those choices.”
Comments Off on Empowering Patient-Centered Care – Will New OCR Guidance be Enough?
During Allscripts earnings call, CEO Paul Black notes that Q4 bookings of $1.1 billion topped its 2011 record and beat bookings from Q4 2014 by 20 percent.
Peer60 releases a report on HIT purchasing trends, finding that population health management and patient engagement solutions are the top purchasing priorities for healthcare executives. 23 percent of respondents reported that their organization plans to switch EHR vendors, with Epic leading in mindshare.
In England, Royal Berkshire Hospital cancels surgeries after its Windows XP pathology systems are taken down by malware delivered as an email attachment. Australia’s Royal Melbourne Hospital had a similar problem a few weeks ago as malware affected its Windows XP pathology servers.
Reader Comments
From Red Zone: “Re: Allscripts India. President Nitin Deshpande is leaving Allscripts to join Valence Health. He set up the India office of Eclipsys from scratch in 2007.” Unverified.
HIStalk Announcements and Requests
Job seekers would choose Epic’s offer first, followed by Athenahealth. Allscripts and McKesson are the least-favored hiring companies. New poll to your right or here: is IBM Watson Health real or just hype?
This weekend’s Las Vegas weather will be nice: high 70s and sunny, around 50 at night. It should be good HIMSS conference weather.
I feel like I’m running my own “Just Say No” campaign in fending off people determined to selfishly waste my crazy, pre-HIMSS time:
Can I bring a colleague HIStalkapalooza who didn’t sign up? No.
Can you interview my CEO right now so it will run right before HIMSS? No.
Can I pay you to run our article on your site? No.
Will you run a list of our HIMSS booth and speaking activities in your news post? No.
Can I schedule time to meet with you in our HIMSS booth? No.
I’m thinking this week will be slow as everybody saves their energy for next week’s conference.
Check out what HIStalk sponsors are doing at HIMSS with our online (and printable) guide. It lists everything from giveaways to educational presentations. For those sponsors who aren’t exhibiting, it includes their contact information for scheduling a meeting. Thanks for supporting the companies that support HIStalk.
Hollywood Presbyterian Medical Center’s decision to pay a hacker’s ransom to regain access to its malware-locked systems was probably a great business call by them – they had been without access for 10 days and were diverting patients as a result, so their $17,000 was well spent. Unfortunately for everybody else, their widely reported decision at will encourage ransomware hackers to step up their hospital attacks. The right thing for the hospital to do is to share what happened, how they detected it, how it affected their operation, and whether the FBI or other involved agencies advised them to pay up.
Mr. Ventura’s Nebraska school requires blurring student faces in photos, but he sent the one above showing a student using the green screen we provided in funding his DonorsChoose grant request. She is performing a Winter Concert reading as Apple’s iMovie projects behind her on the green screen, making it appear that she’s outdoors. They’re also using the green screen to allow students of the month to record their accomplishment. Next up is increasing the confidence of students by having them do Readers Theater projects on screen.
I will allow Mrs. Swope from Alabama to describe the listening center project we funded in her own words: “The air in my class was charged with excitement when my students and I received a ‘mystery box’ one day after lunch. As I opened the box, my students couldn’t help themselves. They gathered around and proceeded to help me open our special gift (this has never happened to me before). It was almost as exciting as Christmas morning! As I unpacked each component to our new listening center, the children marveled at the equipment. They were so overwhelmed. The looks on their faces were priceless. My students couldn’t wait to get their hands on our new listening center. EVERY child has felt empowered when they have used the listening station to read books.”
HIStalkapalooza
Reminders for those invited:
You must RSVP the emailed Eventbrite order confirmation (click the “Attend Event” button). Once you’ve done that, you get a second email containing your actual PDF ticket. Once you get your ticket, you are set.
Print your ticket out in advance or installed the Eventbrite app on your phone – you’ll be checked in by scanning the unique barcode on your ticket.
We will close the check-in desk no later than 8:30, so arrive before then.
Security will turn away anyone without a ticket, just like at a Taylor Swift concert.
Last Week’s Most Interesting News
IBM announced plans to acquire Truven Health Analytics for $2.6 billion, rolling it into IBM Watson Health, the fourth such acquisition.
Hollywood Presbyterian Medical Center (CA) pays hackers $17,000 to return access to its systems that were crippled for 10 days by ransomware.
An investigative article warns consumers who might want to buy life, long-term, or disability insurance that any genetic testing results can legally be used to deny them coverage.
Cerner announced results that beat expectations, but shares dropped on the company’s first bookings miss since 2008.
Partners HealthCare’s $1.2 billion Epic project takes a hit on its operating profit.
Webinars
February 23 (Tuesday) 1:00 ET. “Completing your EMR with a Medical Image Sharing Strategy.” Sponsored by LifeImage. Presenters: Don K. Dennison, consultant; Jim Forrester, director of imaging informatics, UR Medicine. Care coordination can suffer without an effective, cost-efficient way to share images across provider networks. Consolidating image management systems into a single platform such as VNA or PACS doesn’t address the need to exchange images with external organizations. This webinar will address incorporating the right image sharing methods into your health IT strategy.
February 24 (Wednesday) 1:00 ET. “Is Big Data a Big Deal … or Not?” Sponsored by Health Catalyst. Presenter: Dale Sanders, EVP of product development, Health Catalyst. Hadoop is the most powerful and popular technology platform for data analysis in the world, but healthcare adoption has been slow. This webinar will cover why healthcare leaders should care about Hadoop, why big data is a bigger deal outside of healthcare, whether we’re missing the IT boat yet again, and how the cloud reduces adoption barriers by commoditizing the skilled labor impact.
February 25 (Thursday) 1:00 ET. “Clinical Analytics for Population Health: Straddling Two Worlds.” Sponsored by HIStalk. Presenters: Brian Murphy, lead analyst, Chilmark Research; Jody Ranck, senior analyst, Chilmark Research. The Chilmark Research clinical analytics team will be sharing some of their key findings from the recently released “2016 Clinical Analytics for Population Health Market Trends” report. This will be followed by a Q&A session to make sure everyone goes to HIMSS16 well informed.
Acquisitions, Funding, Business, and Stock
Opternative raises $6 million in Series A funding to further develop its app that allows consumers aged 18-40 to conduct their own vision exam, then send the result electronically to an eye doctor to have a prescription written. I’m sure it’s fine for generating a convenient eyeglass or contact lens prescription, but an exam should cover checking retinal health and screening for glaucoma. It seems like one of those bad ideas in which consumers get what they want instead of what they need. As the company’s disclaimer describes, “Opternative’s service does not include any type of eye health exam … our doctors recommend that all patients between 18 and 40 years old receive an eye health exam at least once every two years from a local eye care professional … Opternative’s technology is only intended and suitable for use by licensed ophthalmologists to perform online refractive eye exams on patients between the ages of 18 and 40 and in good health.”
Francisco Partners increases its ownership of CPSI to nearly 2 million shares, 14.6 percent of the company. Above is the one-year share price chart of CPSI (blue, up 4.5 percent) vs. the Nasdaq (red, down 9.2 percent).
Recurring revenue made up 76 percent of 2015’s total.
Q4 bookings exceeded the company’s 2011 record quarter.
The company sells all products are being sold as subscriptions rather than upfront licenses.
Service volumes are down as clients choose hosted options.
The company expects growth in UK, Canada, Australia, and Southeast Asia.
Sales
Connecticut Children’s Medical Center (CT) chooses Fujifilm’s Synapse VNA version 6.0.
Sarah Bush Lincoln Health System (IL) chooses Cerner, which will replace Meditech.
Announcements and Implementations
Peer60 releases a new report called “The Big Mega HIT Purchasing Report.” The top purchasing plans for 2016 involve population health management and patient engagement. Epic continues to hold the top inpatient and outpatient EHR mindshare, although the outpatient figure really is hospital-based since only hospital employees were surveyed. Epic also holds the top mindshare for population health management and patient engagement, although that finding might call into question the interpretation of respondents. Cerner leads in enterprise analytics.
Other
Here’s another pretty funny Athenahealth commercial.
Weird News Andy says his proposed title of “Pharmacists > Crooks” is not a menu, but a mathematical representation. An Alabama pharmacist resolves situation in which a gunman took hostages and demanded drugs. She chose drugs that put the gunman to sleep, after which she took his gun and waved in police to arrest him. Or as WNA says, “Say ni-night, Mr. Robber. Hope you were not to surprised when you woke up in the Greybar Motel.”
Sponsor Updates
The St. Louis Business Journal profiles TierPoint’s new $30 million data center in Oklahoma City.
WeiserMazars donates books to the Ronald McDonald House New York as part of its #HookedOnBooks campaign.
I hear, and personally experience instances where the insurance company does not understand (or at least can explain to us…