EPtalk by Dr. Jayne 6/23/16

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 6/23/16

Justice Department Announces Biggest Medicare Fraud Crackdown

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

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

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

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

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

State Department eyes electronic health records

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

CIO Unplugged 6/22/16

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

Pay Equality

As the election slugfest begins, we are going to hear more about gender issues, some related to compensation. Gender-based pay inequity is a fact in our culture. It is no different in the health IT world.

Findings from the HIMSS 2015 Compensation Survey and the 27th Annual Leadership Survey suggest that pay inequity exists. In analyzing the data several ways, we can see that women earn less than their male counterparts. Findings also conclude that women are harmed by many retention and recruitment practices and in fact are under-represented in healthcare IT executive and senior management roles.

I am not advocating that everyone be paid the same. Nor am I advocating that we take this on as a social justice issue. I am a believer in pay-for-performance and fair retention and recruitment practices. I don’t care about sexual orientation, race, or religion. What I do care about are values-based, data-driven results. That is what we must reward.

While I do not believe in reparations to cover for the sins of our fathers, it is the responsibility of leaders to ensure pay equality. Here are three things we must do to close the gap and eliminate the problem.

1. Human resource collaboration. Start with your HR leadership and conduct research on your own staff. Ascertain the data to determine if inequity exists. If so, measure the gap and execute strategies to close it and ensure it stays shut. HR will also ensure compliance with all legal aspects.
2. Evidence-based hiring and promotion. Ensure all hires and promotions are compensated commensurate with the position, not the gender. HR can help you monitor and look for any trends that can identify problem areas. Leveraging data provides an unbiased monitoring tool and makes it hard to hide the facts.
3. Evidence-based adjustments. HR can run reports that can indicate if gender inequity exists with your current team. Again, I am not advocating paying everyone the same. There will be legitimate deviations based on tenure and performance and you can allow for this. An evidence-based data rich approach will remove a significant amount of bias and pushback. If you find a gap, you need to adjust salary to close the gap. Simple.

None of these steps will completely eliminate inequality in a hostile environment. If such an environment exists, you need to use the data to make leadership changes in your own ranks. I understand the gap is not always perfectly clear even with data, but you have to start somewhere. Data is a very good place to begin.

I will never understand why anyone would purposefully pay one gender more than the other when all things are equal. Real leaders will want to surround themselves with the strongest people possible and reward them according to performance, not genetics.

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

The Hypocrisy of a Simpler Patient Bill

HIStalk gauges industry reaction to the HHS patient bill design challenge, which aims to highlight the need for easier-to-understand statements and more patient-centered engagement.
By @JennHIStalk

Medical bills, especially traditional paper statements, are not known for being easy reads. More often than not, they are a mixture of codes, abbreviations, dates, and — if a patient is lucky — breakdowns of services and supplies rendered.

The eyes of most patients stray immediately to the balance due, the derivation of which is typically shrouded in mystery. What makes perfect sense to a provider’s or payer’s accounting department causes sticker shock in patients, who feel helpless because they don’t understand what they’re being charged for. The bill inevitably sits unpaid for several weeks while patients wait for some sort of “deux ex machina” that never comes.

It is this frustrating fiscal conundrum that HHS is looking to address with its “A Bill You Can Understand” design and innovation challenge. Announced in early May, the challenge –which “seeks to draw attention to the complexity of medical billing and how patients are impacted” — has two components. One prize will be given to a participant that designs the easiest-to-understand bill. Another will be given for creating the best transformational, patient-centered approach to improving the medical billing system. Earning either prize will be no small feat.

Stop the Insanity

HIStalk readers have wasted no time in sharing their withering opinions of the challenge. Frank Poggio, founder and CEO of The Kelzon Group, got straight to the heart of the matter:

This is the height of hypocrisy. Does CMS think providers on their own created the insane billing requirements and processes? It started with Medicare Part A, then B, then D. Co-payments, deductibles, out of network, referral approvals, contractual allowances, UC charges, and on and on. Next, billing systems will have to deal with VBP, P4P, bundled payments, MACRs, and more. Providers never asked or suggested any of these — they just have to figure out how to carve up charges/costs and services and put it all on a one-page bill. A 1995 analysis found that the Federal Register contains 11,000 pages dealing with an IRS 1040 submission, but hospital billing required 55,000 pages to describe. If CMS really wants to simplify the patient bill, they need to go to a single-payer system. Until they do that (not likely), the patient bill will continue to be the mess it has been for the last 50 years. Who do I call to collect my $5k?

Poggio has a point, of course, but that doesn’t mean attempts shouldn’t be made to streamline the patient billing process, especially when recent studies have found that the most significant patient payment challenges include a patient’s inability to pay or pay on time and the need to educate them about their financial responsibility.

While the challenge hopes to address the education piece, it also opens a Pandora’s Box of questions related to price transparency and consumer empowerment. How can patients become savvy healthcare shoppers if the cost of services they ultimately select aren’t properly explained to them, not to mention agreed upon by all parties involved ahead of time?

A Step in the Right Direction

Ten healthcare organizations, including Cambia Health Solutions, have signed on to test and implement solutions submitted to the challenge. It’s an apt fit for Cambia given its history of focusing on improving transparency within its regional health plans and direct health companies, plus its emphasis on incubating transparency innovation within its collaborative Cambia Grove space.

“At Cambia, we are relentlessly focused on creating a healthcare system that removes confusion, mystery, and pain that it creates for consumers – a system built to engage with and flawlessly serve individuals and their families with respect at every turn and in every encounter,” says CHS President and CEO Mark Ganz. “Producing a medical bill that is simple, straightforward, transparent – and therefore truly accountable to patients – is a huge step in the right direction.”

HFMA Director Sandy Wolfskill echoes Ganz’s comments, adding that, “This new HHS challenge is focused on the medical bill for the patient, so receiving a standardized, understandable bill from all healthcare providers should help patients immediately understand what they owe and why they owe it. There is a very realistic chance that bills will be resolved more quickly.”

Wolfskill also believes that a truly understandable bill will ultimately help patients feel more in control of their care. “As patients, especially those with high-deductible health plans, begin to exercise their options to shop for more affordable, quality care,” she explains, “they will begin to expect that providers are transparent around price and quality, and can explain prices in a way that allows patients to compare providers.”

Ignorance Isn’t Bliss

When it comes to challenge detractors, Wolfskill advises HIStalk readers to remember that “HHS is challenging providers to produce an understandable bill for what the patient owes for the service – and assembling that information is totally in the hands of the providers. Yes, there are multiple stakeholders, but at the end of the day, the provider has all of the information needed, including the impact of the provider’s financial assistance policies, to communicate effectively with the patient about the financial responsibility involved.”

“Rather than ignore this challenge from HHS,” she adds, “providers should realize that this medical billing challenge is simply another step in the transparency journey. HFMA has publicized industry guidance and best practices around price transparency and patient financial communications, and sees this HHS initiative as another component in developing a high-quality, comprehensive financial care approach for patients to compliment the high-quality clinical care already being provided.”

Billing’s Bottom Line

While steps in the right direction and forward momentum on the transparency journey are positives for patients, the challenge and its results may be more of a marketing exercise than a truly game-changing attempt to create an industry standard.

“I think the challenge is a great exercise, but there are ultimately too many competing interests,” explains Patientco founder and CEO Bird Blitch, adding that there will be technological challenges for those providers who use different inpatient and outpatient billing systems. “I think everyone is passionate. People have to think objectively about the payment piece and not just about sending the bill. Payment is what we need to be thinking about, not billing. If we focus on that, then we’ll be answering the right question of how to bill better.”

Blitch brings up a good point. While many providers are beginning to think about patient bill design from a marketing and patient satisfaction perspective, the bottom line of patient billing is still payments received. Patient satisfaction scores could improve in tandem with bill design, but the success of any design standards adopted as a result of the challenge will ultimately be measured in lower provider billing costs related to more timely patient payments.

Better Bills Start with Consumer Friendliness

“If you’re building it to increase patient satisfaction, great,” Blitch says. “Then, you’ve got to understand patient dissatisfaction. I think the biggest thing I might look at from a billing perspective is that it’s written from the standpoint of an accountant. If you look at a lot of these bills, they’re columns, debits, and credits. Most consumers don’t have accounting majors, and so when we look at designing the bill, we look at how consumers are understanding and consuming Web content. We look at not only color psychology, but iconography, even the actual user experience. How do their eyes track? Eye motion up, down, and around the bill happens within split seconds of opening the letter, and that matters. I don’t think providers are looking at it that way yet. They’re still looking at it from the accountant’s viewpoint. The challenge’s stance is that you’ve got to tear your current design down and start over.”

“We all need to be thinking about this from the consumer’s standpoint, but I think we also need to ask, ‘Why are we doing this?’ This is not a bunch of snake oil,” he emphasizes. “We’ve all had terrible billing experiences. Change will happen when it is driven by consumers, or when it is driven from the bottom up. No one thought that the banking industry could be disrupted, but online bill pay did. No one thought that Walmart could be disrupted, but Amazon has done it. No one thought that Blockbuster could be disrupted, but Netflix did it. When you empower the consumer, when industry gets out of the way and lets them choose and gives them freedom to understand, they will respond accordingly.”

(Dis)Satisfaction will Lead to Savvy Shopping

As Blitch mentioned, healthcare’s many stakeholders are passionate about this topic. Whether it’s patient satisfaction or payments received (and it’s becoming increasingly difficult to separate the two), the medical bill of the future will be a key component of a patient’s healthcare journey – perhaps even the deciding factor when the question of follow-up care arises.

The HHS design challenge has at the very least placed a spotlight on the need for more patient-friendly billing, and that’s no small thing given that 47 percent of consumers are paying more attention to their healthcare bills than they did a year ago. That figure will likely increase as premiums and deductibles continue to soar, hopefully making savvier healthcare shoppers of us all.

Morning Headlines 6/22/16

McKesson considers IT unit merger with Change Healthcare

Reuters reports that McKesson is considering merging its health IT business unit with Change Healthcare, the former Emdeon.

Healthcare RCM: Trends in Alternative Payment Model Adoption

A Peer60 report explores adoption of alternative payment models, finding that hospitals under 500 beds are far less likely to transition to new payment models than larger organizations.

VA Won’t Use Law That Allows Expedited Firing of Executives

The VA will no longer use its authority to expedite the firing senior executives after the Justice Department ruled the provision unconstitutional because it denies employees the right to appeal their firing.

CancerLinQ—ASCO’s Rapid Learning System to Improve Quality and Personalize Insights

Robert Miller, MD director of the American Society of Clinical Oncology’s CancerLinQ big data project, describes how the platform works and the value it offers front line oncologists.

News 6/22/16

Top News

Reuters reports that McKesson is discussing a merger of its Technology Solutions IT business with Change Healthcare (the former Emdeon) as MCK sheds its non-pharmaceutical business lines in trying to prop up its share price, which has dropped 24 percent in the past year.

It’s not likely MCK will get anywhere near the $14.5 billion it massively overpaid for book-cooking HBOC in 1998 since most of HBOC’s original product lines are dead or dying, customers were alienated by the poorly devised and executed Better Health 2020 program in 2011, and there’s not much new to crow about other than RelayHealth. But getting out of the IT business should at least temporarily buy time of the “unlock shareholder value” type.

The industry will once again relearn the oft-told lesson that health IT toe-dippers who earn most of their money in unrelated sectors will always bail out for greener pastures while shafting the customers who believed the lofty predictions and promises made by executives who have long since left for greener pastures themselves. I’ll wait patiently while you ponder your answer to, “Name something amazing McKesson has done in its 18 years in health IT.”

Reader Comments

From Lou: “Re: LinkedIn recommendation. I left this for you." That made my day – thanks.

From Able Bodied: “Re: Presence Health (the merger of Resurrection Health and Provena Health). Has decided to go all Epic. Provena uses Meditech. Interesting considering the cost of Epic and that Presence Health bonds have been downgraded by Moody’s to nearly junk status because of poor financial performance and a questionable outlook for the next 18 months. Can you say a merger with a larger system? Word on the street is that they are talking to Ascension.” Unverified. New management at Presence has taken a lot of write-downs, laid off hundreds of people, and had to borrow more than $500 million at the end of May after losing $186 million last year. Resurrection moved from McKesson Horizon to Epic in 2011.

HIStalk Announcements and Requests

I spent quite a bit of time Monday resolving a hack on my AT&T cell phone account. I called the company immediately after receiving $2,300 in emailed payment updates. A hacker had somehow added himself as an authorized user of my account, bought two iPhones on contract, then paid the contracts off in a Washington Apple store.  AT&T telephone support backed out the charges, but I had to go to the AT&T store to have the SIM card replaced. I also changed my password to a stronger one (I admit that my years-old one was weak) and added a second-level security challenge of a four-digit PIN. It’s interesting that my credit card wasn’t compromised since nobody – including AT&T employees – can see the actual credit card number, only the last four digits, but once you’re in the account you can make purchases using it. I was thankful yet again that I use the magnificent LastPass to manage all my passwords for a princely $12 per year, meaning I log on seamlessly to all sites despite having created strong passwords like my new AT&T one.

My overused word of the week: “seasoned,” a meaningless adjective peppered (pun intended) throughout LinkedIn by executives who describe themselves as such instead of allowing the reader to simply peruse their past experience and decide for themselves. I’m also occasionally annoyed by LinkedIn profiles written in the third person or that don’t contain complete sentences and thus give the appearance of being written by a Godcam-like observer instead of the profile holder, such as, “Proven track record of consistently increasing business performance.” If you want to stand out on LinkedIn, be yourself instead of spitting out inflated, boring bullet lists extolling personal greatness. Also, invest in a professional headshot instead of cropping the grainy image of your head from a family photo (or inexcusably not including a photo at all, suggesting body image issues).

I received an email link to the HIMSS member survey today and, as happens every year, bailed out after wading through three dense pages of questions with no end in sight. They just can’t seem to understand that (a) the time requirement should be reduced and clearly stated in the email; (b) the survey should show a progress meter; and (c) making every answer required instead of just assuming the don’t know/not applicable choice as the default is annoying. It looks like a survey designed by a committee of people who don’t know much about surveys.

Mr. Weber (who is a Teach for America teacher) reports that his Hawaii middle schoolers are using the two Chromebooks and assorted supplies we provided in funding his DonorsChoose grant request to dig deeper into math and to perform college readiness work during his advisory time. He adds, “My students were thankful for everything. They wondered who could donate so much to our school without even knowing them. They sincerely appreciated the generosity of strangers, and I think it made them think about ways that they could contribute to society in the future.”

Webinars

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

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Lorre’s getting bored because of the industry slowdown that kicks in every year right about now, so ask her nicely for her “Summer Doldrums Special” that we always run through Labor Day and you’ll get a great deal.

Acquisitions, Funding, Business, and Stock

Pharmacy restocking software vendor Kit Check raises $15 million in a Series C round, increasing its total to $37 million.

The New York Times profiles the struggling Oscar Health, a self-proclaimed insurance disruptor that uses technology to offer consumer-friendly policies. The company, which has raised $728 million and is starting a New York health center to deliver care itself, is losing money because:

• It sells policies only on insurance exchanges, which have enrolled fewer people than expected.
• It’s getting stuck with sicker patients with expensive pre-existing conditions whose coverage is guaranteed by ACA.
• All insurers are realizing that they priced their exchange policies too low to break even, although Oscar’s competitors have the advantage of being able to make up their losses elsewhere.

Philips acquires Northern Ireland-based digital pathology software vendor PathXL.

Sales

The Koble-MN HIE, health data intermediary, and health information organization chooses Orion Health’s Amadeus precision medicine platform.

People

Release-of-information systems vendor Verisma names Marty McKenna (Allscripts Analytics) as president and CEO.

Paul Boemer (FIS Healthcare Solutions) joins PatientPay as EVP.

Announcements and Implementations

Denver Health (CO) goes live on Bernoulli’s Nuvon VEGA medical device integration.

A new Peer60 revenue cycle report finds that about two-thirds of hospitals don’t plan to participate in value-based payment programs, with those under 500 beds being more hesitant to change. They worry about getting stuck with non-compliant patients as competitors cherry-pick the patients that show higher levels of value and thus generate more revenue. Interestingly, the second-most reported expected impact of value-based payment is eliminating IT vendors who can’t demonstrate solid return on investment, with hospitals apparently happy to give them a pass until money gets tight.

The US Patient and Trademark Office issues Aventura its eighth patent, this one covering how the company’s Sympatica situational awareness platform updates virtual resources and applications based on user location in managing roaming computing sessions.

Quintiles opens a healthcare technology and apps accelerator in Research Triangle Park, NC, staffing it with simulation analysts, wearables experts, and user interface designers.

C.L. Brumback Primary Care Clinics (FL) goes live with Forward Health Group’s PopulationManager and The Guideline Advantage.

Scottsdale Institute publishes a report describing the IT challenges involved in creating clinically integrated networks.

Government and Politics

California auditors find that CalVet, the state’s VA operation, has wasted $28 million since 2007 on a since-cancelled EHR contract for veterans homes. The auditors blame CalVet for poor project oversight. CalVet had decided to replace Meditech because veteran histories could not be viewed across facilities, choosing SolutionsWest Consulting (later Brekken Technology) as a replacement even though it was not Meaningful Use certified.

Medicare finally realizes that its fraud-incenting “pay and chase” practice of paying providers first then asking questions later doesn’t make sense as it tests a program in five fraud-famous states (IL, FL, MI, MA, and TX) in which home care providers will have their claims reviewed in advance before CMS pays for those services. CMS previously found that 60 percent of the home care claims it paid were “improper.”

The VA won’t fast-track executive firings now that the Justice Department has ruled that VA employees have the right to appeal their termination to the Merit Systems Protection Board. Rep. Jeff Miller (R-FL), chair of the House veterans panel, said of the VA’s decision not to use the authority given it by Congress in response to the wait times scandal, “Everyone knows VA isn’t very good at disciplining employees, but this decision calls into question whether department leaders are even interested in doing so."

Other

Oncologist and informaticist Robert Miller, MD, medical director of the American Society of Clinical Oncology’s CancerLinQ cancer big data project, describes how the “learning system for oncology” works. CancerLinQ, built on SAP’s HANA platform, extracts data from oncologist EHRs via several methods and standardizes the information with a terminology rules engine and natural language processing. Doctors can query the identifiable information of their own practice’s patients, while de-identified analytics reports are provided by the CancerLinQ team. CancerLinQ provides real-time practice performance analysis against standard quality measures and gives oncologists observational data to support clinical decisions. The article concludes with an excerpt from a journal editorial:

However, how is an individual clinician to proceed when faced with a patient in the exam room with a rare tumor for which evidence-based clinical practice guidelines do not exist, and the patient is not a candidate for a trial? Or a patient with a common malignancy like breast cancer coexisting with a myelodysplastic syndrome with del[5q]? Or the much more common scenario of a patient with compromised renal function faced with the decision as to the advisability of potentially nephrotoxic, but curative adjuvant chemotherapy? The availability of a powerful tool like, CancerLinQ, that can provide insights into the real world outcomes of similar patients, when combined with existing trial-generated evidence and full patient consent, may be transformative to the practice of the art of medicine in these difficult situations.

UCSD Health CIO Chris Longhurst, MD, MS tweeted out this photo from the CHIME/AMDIS CMIO Boot Camp, held this past Sunday through Tuesday in Ojai, CA.

A study finds that doctors who accept inexpensive drug company-paid lunches prescribe more of the brand-name drugs the company sells to their Medicare patients. Perhaps the AMA could look into this instead of chasing imaginary “digital snake oil” or maybe CMS should just buy every doctor a fast food lunch to get on their good side about MACRA. My experience with doctors is this: while maybe a fourth of them apply quid pro quo in intentionally returning the drug company favor by altering their prescribing habits, most of them instead simply overestimate their own objectivity and intelligence in being able to distinguish drug company propaganda from rigorous scientific review. In other words, they actually think they were educated rather than sold to. Drug reps love playing to a doctor’s inflated ego in getting them to do their bidding.

CNBC profiles a former Microsoft designer who was paralyzed by a medical mistake at Overlake Hospital Medical Center (WA). He received a $20 million settlement and a seat at the table as Overlake reviews what went wrong in his case and how systems design work might prevent other errors.

The 66-year-old bass player of Foghat (“Slow Ride”) is left unable to play music due to the side effects of lung cancer chemotherapy. A 2012 CT scan revealed a lung mass and the suggestion “to exclude the possibility of a primary lung neoplasm,” but he wasn’t notified of the finding and nobody followed up. The tiny growth has since spread, is inoperable, and carries just a 4 percent survival likelihood. He’s suing.

Sponsor Updates

• AirStrip is featured in an Ultera Digital podcast on health IT marketing.
• GetWellNetwork Founder and CEO Michael O’Neil is named EY Entrepreneur of the Year for 2016 in the health category in the Mid-Atlantic region.
• Besler Consulting releases a new podcast, “Healthcare Retrospect Part 1: All Americans Were Uninsured.”
• Strata Decision Technology receives “Peer Reviewed by HFMA” designation for the second time.
• Boston Software Systems releases a new podcast, “Migrating Legacy Systems to Epic.”
• Optimum Healthcare IT hires Larry Kaiser as director of marketing.
• Impact Advisors publishes a white paper, “Cutover Plan: The Missing Link to a Successful Go-Live.” 
• Divurgent will exhibit at HFMA’s ANI Conference June 26-29 in Las Vegas.
• E-MDs will host its annual User Conference & Symposium June 23-25 in Austin, TX.
• HealthGrid will deliver patient education content from Healthwise via its patient engagement solution.
• EClinicalWorks will exhibit at 2016 Optometry’s Meeting June 30-July 2 in Boston.
• Glytec’s Glucommander and EGlycemic Management System are featured in five studies presented at the American Diabetes Association scientific sessions.
• Greencastle Associate Consulting’s Jim Blanchet earns PMP certification from The Product Management Institute.
• HCS will exhibit at the Texas Hospital Association Behavioral Health Conference June 23-24 in Austin, TX.

Blog Posts

• Advanced Practice Training: AdvancedInsight Visit Coding Graphs (AdvancedMD)
• New BYOD Adoption Kit: The Missing Piece to BYOD Success (AirWatch)
• A successful approach to making time for optimization (Nordic)
• The Advantages and Measures of Outsourcing in Healthcare (Catalyze)
• Filling the Care Management Tool Box (Caradigm)
• Dental Emergencies: Using ED Visits for Dental Problems (Wolters Kluwer Clinical Drug Information)
• My Doctor Believed Me! (CareSync)
• What’s new with the CHPL (Certified Health IT Product List) and Certification Surveillance? (Iatric)
• Ohio Passes Prior Authorization Reform Act; Mandates Acceptance of EPA Solution (CoverMyMeds)
• The Population Health Jungle (CTG)
• The CIO of the Future – Long Live the CIO (Culbert Healthcare Solutions)
• Building Your Personal Brand (Direct Consulting Associates)
• Three Steps for Aligning Cost and Compensation (ECG Management Consultants)
• Unified Communications and Advanced Clinical Presence (Part 4) (Extension Healthcare)
• Galen’s Top 10 Reasons to Migrate Your Data (Galen Healthcare Solutions)
• The Top 10 Reasons Transformation is the New Normal for Healthcare – Reason 2 (GE Healthcare)
• 8 Things That May Surprise You About Healthcare Analytics – Part 1 of 2 (Hayes Management Consulting)
• Changing the Culture – Small Changes Matter in Innovation (HCTec)

Contacts

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

Morning Headlines 6/21/16

Should digital health be regulated like air travel?

AMA CEO James Madara, MD doubles down on his “snake oil” analogy, reiterating that “That bluntness was by design” and citing a recent Commonwealth Fund study that looked at 1,000 healthcare apps for patients and concluded that only a minority were likely to be useful to patients.

First Human Test of CRISPR Proposed

Doctors at the University of Pennsylvania are seeking approval to use CRISPR gene editing technology on humans for the first time. The researchers seeking approval are working on a therapy in which immune cells are removed from the patient, edited to target myeloma, melanoma, and sarcomas, and then re-infused into the bloodstream.

Health Insurer Hoped to Disrupt the Industry, but Struggles in State Marketplaces

The New York Times profiles Oscar Health, a tech-focused health insurance startup that has raised $727 million in funding, but has yet to establish a profitable business model in the hyper-competitive ACA marketplaces.

Supercomputers Join the Fight Against Cancer

In an article published by Medium, US Secretary of Energy Ernest Moniz pledges to support the Cancer Moonshot project with supercomputers owned by the Department of Energy’s 17 national laboratories.

Curbside Consult with Dr. Jayne 6/20/16

CMS sent an email notifying people that it will be making updates to the portion of the CMS website covering HIPAA administrative simplification. Although users might be looking forward to “streamlined content and easier navigation,” nothing says “administrative simplification” quite like creating a new URL and making tens of thousands of users across the country update their bookmarks.

Unfortunately, this is just the tip of the iceberg with CMS and all the other federal bodies that have a say in regulating how we practice medicine and how our EHR vendors should support us.

A physician friend of mine works for a vendor. We had the opportunity to get together over the weekend and commiserate about what medicine has become and what MIPS/MACRA is going to do to our respective customers. He’s completely frustrated by some of the clinical quality measures that he is expected to bake into his application. Some of them aren’t really ambulatory measures and would require a lot of manual abstracting of hospital data into the ambulatory chart. There are another group of measures that impact few patients unless you’re in a narrow subspecialty, which makes it difficult for EHR vendors that are trying to support all possible specialties.

Others require use of screening tools that his company doesn’t already have rights to use. This process can take months (plus a fair amount of cash) to get legal agreements in place allowing software vendors to use proprietary screening tools. In the spirit of interoperability, shouldn’t our federal and regulatory “partners” be selecting the open-source equivalent for the content they are specifying? I know there may not always be a non-proprietary option, but if there isn’t, maybe they can use their development dollars to create initiatives and competitions to create that content so everyone can use it.

Every time we get into a regulatory update cycle, vendors’ attention is diverted from providing the content that their users want and need to providing what they are required to provide, regardless of whether their users plan to use it or not. My consulting firm is involved in a fairly deep way with three vendors, all of which are in the same pinch whether they’re privately owned or publicly traded. Of course some vendors are more nimble than others and they have it a bit easier as far as creating content and distributing it to their respective client bases. Like physicians, though, they’re all having to focus on checking the box. This means that they’re not necessarily as focused on innovation as they otherwise could be.

Vendors are not entirely without blame in this game, though. One that I work with frequently recently made a decision that defied logic: they changed the provider home page to remove the instant messaging portion that had previously been embedded at the top of the screen. Now, physicians have to go to a separate screen to address their messages, which not only adds clicks, but increases the possibility that something will be missed.

Since they didn’t use the real estate for anything else, it boggles the mind why they would have thought this was a good idea. I can’t imagine they did usability testing on this before releasing it to the client base, and if they did, I’d be interested to talk to the people who thought it was a good idea so they can explain it to me because I’m missing it.

As with so many things in healthcare today, it feels like we’re focusing on the wrong things. Case in point: precision medicine. Don’t get me wrong, I think technology is sexy. The idea of being able to look at someone’s genetic makeup and use that information to diagnose disease before it happens is extremely sexy. But it’s expensive. Given the need for research, development, etc. it has a long lead time, so that makes it feel a bit like we’re pouring money into something that’s not going to provide benefit to everyone, and not for a long time. That’s my perception from the trenches and I’m sure the perception from academia or industry is likely to be different.

It might feel different it we were also pouring money into proven but un-sexy solutions like public health. Obesity prevention, anyone? Getting the number of obese people in our country down under 20 percent again is going to save more lives and provide more quality of life in the intermediate to short term than precision medicine will. But it’s not sexy.

I was on a webinar the other day for family physicians where the speaker was telling us we’re supposed to be referring our patients to community gardens and organic food pantries as ways to combat obesity and food insecurity. Yet another thing for primary care physicians to do while they’re trying to keep all the plates spinning and coordinate care in an increasingly fragmented environment.

Where’s the funding to promote these solutions? Can I get an embedded care coordinator to reach out to those patients and have the conversation about community gardens? Can I get someone to pay for the custom reporting I’ll need to identify eligible patients by diagnosis and ZIP code? Guess what, there’s no funding for that. And even if you have an EHR that can do it and a population health system that can do the outreach, there’s no recognition of the fact that it’s additional work on the practice.

Of course if the dreams of advanced payment models and whatnot come true and we start to see additional reimbursement for this additional work, it might all balance out. But that’s not the reality that most of my primary care clients are living in today. I’m watching my colleagues retire or move to non-continuity practices like urgent care or cosmetic medicine in droves.

Although I find issues like this to be exasperating, it’s a good reminder of why I’m in consulting. Many of my clients are small practices that can’t navigate this world on their own and rely on my partner and me to get it done. We’re their first line of education and sometimes the last line of defense at keeping their practices afloat. They trust us to help them, and by extension, their patients. When it all works out, it can be very satisfying. But most days it just feels like a grind.

What do you think about the tension between high-tech and public health fieldwork? Email me.

Email Dr. Jayne.

Readers Write: Patient Privacy — A New Way Forward

Patient Privacy — A New Way Forward
By Robert Lord

Health data security and patient privacy are in a state of crisis. Electronic health records (EHRs) are in the process of being ubiquitously rolled out, providing access to as much patient data as possible, to as many users as possible, in as little time as possible. As a consequence, hundreds of millions of patient records have been made easily accessible to millions of health system employees and affiliates, with essentially no oversight of who is viewing what patient data in the EHR and if that access is appropriate.

However, this isn’t because of health system negligence – it’s about a collective lack of accountability among several key stakeholders. Due to the sheer volume and complexity of patient records accessed each day, it is impossible for privacy and security officers to efficiently detect breaches without new and practical solutions and standards.

Something needs to change. Despite promises of role-based access controls, training programs, and security templates, the problem just isn’t being solved, and HIPAA violations continue to affect hospitals on a daily basis. That critical human layer of access is the root of these problems, and that doesn’t have an easy solution.

A new report from the Brookings Institution details that the majority of recent healthcare data breaches are caused by theft or unauthorized access. Research also shows it takes more than 200 days to detect an insider threat, if it is detected at all. And the in-depth report from ProPublica last December helped bring into focus that small-scale violations of medical privacy — like the Walgreens pharmacist who snooped in the prescription records of her boyfriend’s ex — often cause the most harm.

We are now at an inflection point that will decide the future of patient privacy. The actions and decisions of four key stakeholders and their collective will to collaborate through an independent fifth apparatus will significantly advance or stall patient privacy protection and next-generation health data security.

Patient privacy technology vendors need to invest in their teams and products to take advantage of the significant advances made in big data analytics, clinical informatics, and cybersecurity. These advances have changed many other fields, but cybersecurity and compliance solutions built for non-healthcare industries are rarely effective in the complex and idiosyncratic healthcare environment.

Furthermore, the big data environments that define many modern hospitals also require big data solutions that are at the cutting-edge of technological possibility. Critically, vendors need to better listen to their customers to create clinically-aware, healthcare-first solutions that address patient privacy. Health systems cannot purchase what does not exist and rarely have the in-house bandwidth to create production-ready systems.

Hospitals and health systems are working hard to protect patient privacy, but their security and privacy teams are stuck in a reactive mode, having to put out fires with limited resources. It’s clear that CISOs and chief privacy officers need a seat at the boardroom table and their roles need to give them the breathing room to see into the future rather than just to react to challenges as they occur.

Furthermore, compliance and bare-minimum standards are no longer enough. To truly protect patient data, a close relationship between hospital security and privacy groups must be formed. This partnership must be augmented by the technology necessary to detect and remediate threats and their collective mission must be aligned with the board. Fundamentally, resources and C-suite support must be allocated to tackle the next generation of privacy and security challenges, as current efforts aren’t on the right trajectory.

The federal government, with privacy protection authorities like the Office of Civil Rights and standard-setting bodies like ONC, want very earnestly to protect vulnerable populations and help hospitals protect patient data, and I have always been impressed by my interactions with them. However, there is no denying that they are under-resourced and limited in the amount of time they can spend looking into better solutions that could serve as next-generation patient privacy platforms. As a result, they are not able to offer much substantive guidance on what hospitals should and shouldn’t do to keep patient data secure. While distance must be maintained between vendors and regulators, greater public-private partnerships, like those in national security, are critical.

All of us as patients are an important but (amazingly) often overlooked constituency when it comes to advancing the protection of health data. Just as we wouldn’t keep our money in a bank that didn’t use passwords for online accounts or locks on their vaults, patients should expect and ask for more details about a hospital’s security posture. When hospitals ask you to sign forms that let them use your data, we should request that our providers detail how they’re protecting our information. A basic set of criteria about data encryption, proactive patient privacy monitoring, dual-factor authentication, network security, and whether or not a CISO/CPO are part of the team can tell you a huge amount about a hospital’s stewardship of patient data. We are all patients and I’m just as guilty of signing a HIPAA release form without thinking as anyone else. But if we’re to drive change, we have to think hard about what’s truly important to us and take a stand.

Ultimately, each of the above stakeholders has its own incentives, and I would contend, its own set of responsibilities and roles with respect to bringing about a new standard of patient privacy. In addition, while industry partnerships and bodies like the NH-ISAC are steps in the right direction in unifying these stakeholders, we need collective accountability and transparency regarding insider threats and HIPAA breaches beyond HHS’s “wall of shame.” Only through creating central, practical, collaborative bodies that bring all of these stakeholders to the table will we be able to move patient privacy forward and set a new standard for protecting our patients’ data.

Robert Lord is co-founder and CEO of Protenus in Baltimore, MD.

Readers Write: Mapping Out a Big-Picture Strategy to Drive Smarter Healthcare Decisions

Mapping Out a Big-Picture Strategy to Drive Smarter Healthcare Decisions
By Nancy Ham

Analytics are like a GPS navigation system for healthcare. With a full view of your route, they give you step-by-step directions for exactly where you need to go. By aggregating data from electronic medical records (EMRs), claims, health risk assessments, admission / discharge / transfer (ADT) systems, and other sources, analytics can create 360-degree views of individual patients and entire populations. This holistic approach drives smarter decisions and better outcomes.

When providers can see which patients are not following treatment guidelines, visiting out-of-network specialists, or are at risk for readmission, they can deliver more impactful interventions, close gaps in care, and improve quality. In a recent survey, 82 percent of healthcare decision makers say analytics have helped to improve patient care at their hospital or health system and 63 percent say analytics helped to reduce readmission rates.

With the right technology and strategies in place, health systems can drive change and shift value-based care initiatives into high gear.

Strategy #1: Keep patients in-network

When patient care falls outside of a health system’s network, it can lead to gaps in care, administrative referral headaches, and lost revenue opportunities. However, keeping patients in-network is a challenge, especially in today’s competitive healthcare market. Having the right data to even know who is going out of network and why compounds the problem.

Yet studies estimate that only 35-45 percent of adult inpatient care stays in network. For one accountable care organization with 27,000 lives, out-of-network services resulted in lost data, missed care coordination opportunities, and increased costs. Patients seeking treatment for hip/knee replacements saw a:

• 10 percent increase in radiology services
• 32 percent increase in emergency and medical visits
• 25 percent increase in physical therapy sessions

Advanced analytics with drill-down capabilities can help. It allows users to tap into claims and clinical data so they can identify out-of-network drivers by service line and provider. These systems even allow users to see how much they are losing by diagnosis code.

From there, health systems can find ways to close gaps in services and create a strategy to keep patients in-network. For example, health systems may find opportunities to improve retention by expanding their cancer service line or adding a new service such as electrophysiology. As a result, out-of-network referrals are reduced, in-network retention improves, and the health system finds new revenue opportunities.

With this detailed level of insight, it’s also possible for health systems to pinpoint network leakage down to the provider level and use this information to educate providers about their referral patterns. When doctors and other caregivers see the impact of their referral processes on overall network performance, it’s easier to have collaborative conversations and work towards improving retention.

Strategy #2: Coordinate care to reduce readmissions

Patient data resides in a number of different sources across the continuum of care, including ambulatory EMRs, community health records, and hospital information systems. By aggregating and analyzing this data and applying predictive algorithms, it’s possible to create readmission risk scores for admitted patients so they can be proactively flagged for intervention or special consideration upon discharge.

Capabilities like these are critical for improving outcomes, particularly when it comes to managing the five percent of patients who drive more than 40 percent of our healthcare costs. When this type of information is presented as part of the clinical workflow, providers can review discharge data, anticipate potential roadblocks, take action quickly and efficiently, and reduce readmission rates.

Strategy #3: Leverage actionable intelligence and analytics

Data and analytics can help providers to gain a clearer picture of all of the populations they serve. With data from multiple sources in one central location, it’s possible to layer and visualize this information in new ways. Much like how a GPS presents directions differently based on whether you are walking, driving, or taking public transit, these tools offer users flexibility on how to view and analyze data.

By looking at clinical and claims data in a new light, providers can better understand a patient’s complete profile, including lab tests, self-reported data, health conditions, co-morbidities, lifestyle risk factors, and gaps in care. As a result, it’s possible to better stratify risk, match patients to the right interventions, and address high-risk conditions before they lead to costly treatment. Providers can then prioritize the appropriate interventions and determine a complete care plan that includes support, such as personalized patient education and coaching.

Having a comprehensive, 360-degree view of a patient or population—much like the one a GPS navigational system would provide—can ensure your journey is a successful one. With this perspective, you can reach your destination of high-quality, cost-effective care by following these key takeaways:

• Concentrate on keeping patients in-network to improve quality care, capture vital performance metrics, and retain service revenue
• Strengthen care coordination to reduce readmissions
• Visualize data in new and different ways through enhanced analytic capabilities to promote better clinical and financial performance

Providers need a full picture of their patients and populations to deliver high-quality, impactful care. By harnessing a wide range of data and actionable insights, healthcare organizations can make smarter decisions that better engage patients and clinicians, reduce duplicative services, mitigate risk, and improve quality.

Nancy Ham is CEO of Medicity and VP of Healthagen Population Health Solutions, an Aetna company.

Morning Headlines 6/20/16

Up to 20 Percent of U.S. Trauma Deaths Could Be Prevented With Better Care

A report by the National Academies of Sciences, Engineering, and Medicine on trauma-based mortality rates in the US finds that quality of care for trauma patients varies greatly depending on when and where a patient is injured, resulting in 30,000 preventable deaths per year. The report calls for a national trauma care network to establish best practices and integrate civilian and military trauma care practices.

Online Trust Audit Briefing

An independent investigation recognizes Healthcare.gov as the second-most secure consumer website, while Twitter took top honors.

Doctors’ Hand Hygiene Plummets Unless They Know They’re Being Watched, Study Finds

A new study from Santa Clara Valley Medical Center (CA) finds that hand washing compliance rates improve dramatically when health professionals know they are being watched.

LeadingAge CAST Releases New Electronic Health Record Adoption Model

LeadingAge introduces an EHR adoption model for long-term and post-acute care organizations.

Monday Morning Update 6/20/16

Top News

A government report estimates that 30,000 US patients die unnecessarily from trauma each year since trauma center death rates vary widely such that “where you are injured my determine whether you survive.” It urges creation of a national trauma system driven by best practices that includes both military and civilian systems and pre-hospital providers such as ambulance services.

The leading cause of death among people under 46 years old is trauma (motor vehicle accidents, gunshots, and falls).

The report from the National Academies of Sciences, Engineering, and Medicine recommends that trauma centers create real-time access to patient-level data that would also be used in a national quality improvement program.

Reader Comments

From Former Westminster, CO Employee: “Re: McKesson. I worked on Horizon for 15 years. Upper management refused to listen to QA, support, implementation, and development and would demand that change requests be closed with known software bugs shipped to clients to meet project deadlines. Hospitals would then report the bug, which would be re-opened as a Hot Fix Solution as the cycle repeated. Management was more concerned about running a tight ship and laid off many critical people. Paragon will suffer the same because the management culture has not changed.” Unverified.

HIStalk Announcements and Requests

Most poll respondents would struggle to pay an unexpected medical bill of $5,000 to $25,000, which is a lot better than the 47 percent of Americans that a federal study found would struggle to pay a $400 emergency bill. New poll to your right or here: do digital tools reduce the efficiency of care delivery as the AMA contends?

Here’s a fun enhancement idea for the new iPhone patient data EHR query: let the app automatically file an HHS data-blocking complaint for unsuccessful requests.

Mr. Martinez is using the document camera we provided in funding his DonorsChoose grant request to record his live presentations so that students in his California high school classroom can review portions they missed or to keep up when they’re absent. He’s recording additional examples and placing them on his website so that students can follow along on their own time.

Also checking in is Mrs. Evans from Florida, who says many of her elementary school’s students had never used a tablet until we provided six of them for her gifted class.

Listening: new from Radiohead, slower and more melodic (some might say “wimpier”) than previous masterworks like “OK Computer,” but sometimes you have to let good bands evolve and give their new stuff a multiple-play chance to grow on you.

Last Week’s Most Interesting News

• Apple adds C-CDA records import capability to iOS 10, giving iPhone-using consumers the theoretical ability to request and capture their basic medical information from provider EHRs.
• AMA passes a resolution supporting creation of an ONC-administered health IT safety center.
• Doctors in Australia demand that patient update access to their own medical records be revoked, saying they can’t trust the information.
• The AMA’s EVP/CEO lashes out at “digital snake oil,” broadly panning the health-related software that is available to doctors and consumers.

Webinars

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

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Lorre’s getting bored because of the industry slowdown that kicks in every year right about now, so ask her nicely for her “Summer Doldrums Special” that we always run through Labor Day and you’ll get a great deal.

Acquisitions, Funding, Business, and Stock

TransUnion acquires Auditz, which offers point-of-service patient revenue products.

Cerner shares continue their recent slide, closing at prices not seen since July 2014. Above is the one-year price chart of CERN (blue, down 22 percent) vs. the Nasdaq (red, down 6 percent).

Announcements and Implementations

LeadingAge Center for Aging Services Technologies creates an EHR adoption model for long-term and post-acute care providers.

Government and Politics

The government of South Australia continues its years-long legal pleading to software vendor Work Systems, whose 1990s-era, DOS-based patient records system is still being used by 64 of South Australia’s health sites. The vendor demands that state government stop using its software since its license for a retired version has expired, but the government argues that forcing it to stop using the system would endanger patients. South Australia is in a bind because its Allscripts-powered EPAS project is behind schedule and over budget with only three sites live amidst widespread doctor protests that the system endangers patients.

Karen DeSalvo, MD, MPH and her HHS team wore blue to support Men’s Health Week last week.

An independent analysis finds Healthcare.gov to be the second-most secure consumer website.

The VA engages Underwriters Laboratories to help improve the cybersecurity of its medical devices.

Other

It’s been said that “a true test of a man’s character is what he does when no one is watching,” which is an apt summary of a new study that finds increased rates of hospital hand-washing when clinicians know they are being observed. Easy-to-spot infection prevention nurses saw a 57 percent rate of hand-washing compliance, while less-recognized volunteers saw staff washing their hands when they should only 22 percent of the time.

An excellent analysis by Arcadia Healthcare Solutions that I hadn’t previously noticed until NPR ran a story on it finds that the cost of care provided to dying patients in their final 30 days varies widely by where they die. Patients who expire in a hospital consume $32,000 worth of services, while those who pass away in nursing homes, hospices, and at home cost $21,000, $18,000, and $5,000 respectively. Saddest of all is that 40 percent of patients died in a hospital, something that few people want. The company offers several interesting dataset visualizations on its site.

I also missed this New York Times op-ed piece from a few weeks back in which a University of Oslo professor pans the idea of a “cancer moonshot,” saying the Catch-22 of cancer is that it can’t be cured and thus keeping people alive longer means they’re more likely to get cancer again. He recalls that President Nixon called for a cancer moonshot of his own in 1971 and the National Cancer Institute has spent $90 billion since then even as cancer rates increased. He concludes that the effort wasn’t wasted, however: “We’re a lot better at fighting cancer. We just can’t cure it,” but warns of “the rhetorical spin that drives the cancer enterprise.” He urges that doctors save lives via the “boring stuff” of getting patients to stop smoking, use sunscreen, eat better, and exercise, saying that will do more good than “promising the moon.”

Sponsor Updates

• Vital Images will exhibit at SCCT 2016 June 23-26 in Orlando.
• Zynx Health will exhibit at AMDIS 2016 June 21-24 in Ojai, CA, as will LogicStream.
• Integris and The Chartis Group will present “Centralized Scheduling for a Physician Enteprise” at the HFMA National Institute June 26-29 in Las Vegas.

Blog Posts

• Access to Care – a Cornerstone of Healthcare (TeleTracking)
• How to Fine Tune Your Investigation Approach (Verisk Health)
• Fall in Love with ICD-10-PCS Cardiovascular Coding (VitalWare)
• Hand-in-hand. (Voalte)
• Crawl, Walk, Run: Know Where You Are in Your Modernization Journey (West Corp.)
• What’s in a Name? (Xerox)
• Automating manual revenue cycle processes and reducing hands-on tasks. (ZirMed)

Contacts

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

Morning Headlines 6/17/16

Hands-on: Apple brings HL7 CCD health records to HealthKit in iOS 10

iOS 10 includes an enhancement that will let iPhone users to download and store their health records from providers capable of transmitting a CCD.

Navicure Partners with Bain Capital Private Equity to Continue Growth and Expand Healthcare Technology Platform

Navicure receives a strategic investment from Bain Capital Private Equity. Financial terms were not disclosed.

AMA Throws Support Behind Development of a National Health IT Safety Center

AMA house delegates approve a proposal formally supporting the creation of a National Health IT Safety Center.

Doctors want patient control over e-health records revoked

The Australian Medical Association argues that patients should not be able to control what is entered into their personal health records. AMA president Michael Gannon, MD explains, “If patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.”

News 6/17/16

Top News

Apple’s iOS 10 will allow users to request copies of their medical records from their smartphones, provided their provider’s EHR can export a Continuity of Care Document. Users can also import records from Safari and Mail. The translated medical summary can be stored directly in Health.

Reader Comments

From Meltoots: “Re: CMS and EHR vendor snake oil. MU was an unmitigated disaster for safety, security, usability, efficiency, and physician burden, yet it continues with a new name. Everyone wants to move away from fee-for-service, yet we have no idea how to attribute quality care from multiple doctors to a single patient. This is a not-so-secret CMS push to put providers into large practices so they can crank down on payments. Providers have had enough.” The other concept at work is that hospitals, which have performed so pitifully and indifferently in coordinating patient care and managing populations, are figuring out how to reap the lion’s share of the money that will be spent to improve it. It’s also interest that just as it’s hard to detect Medicare fraud because providers work under the NPI of other providers in group settings, it’s equally hard to determine using billing data which of them is individually responsible for wise or unwise care decisions.

From Gray Sky: “Re: Medhost. Has had outages for the past two weeks for all hosted applications. Inside information points to a storage information where customer data has been erased. The company continues to investigate options to restore the data to a reasonable point in time.” I ran this rumor Tuesday with the vendor name omitted pending the company’s response, which Medhost has provided:

Medhost supports software applications in over 1,100 facilities across the United States, Canada, and Puerto Rico. Over the past several weeks we have experienced system outages impacting a total of three hosted facilities. In one instance, the outage was extended for several days. Medhost utilized both system vendors and consultants as well as its internal resources to determine the cause of these outages and to act to prevent any future outages. The extended outage was due to failure of the operating system. Medhost applications were not a contributing factor to this system outage and no customer data was lost. All customer systems have been restored and are working as designed. While we view any outage as unacceptable, we will use this as an opportunity to improve availability and resiliency of the Medhost systems. Medhost Direct historical uptime availability exceeds 99.99 percent, and no hosted facility has experienced an outage of more than 14 hours in over two years.

From  Credenza Cowboy: “Re: Martha Jefferson’s errant EHR click that mistakenly labeled the patient as deceased. They aren’t live on Epic yet.” I didn’t realize that, although I attended a years-ago Cerner user meeting at which their IT director was present, so maybe they are on Cerner. Either way, it’s an interesting tip-of-the-iceberg type user error that fortunately, in this case anyway, had no clinical impact. Sentara bought the Charlottesville, VA hospital in 2010.

From Pensive Moment: “Re: digital snake oil. Do  you agree with the AMA?” Mostly no. The AMA’s solution to all problems is to put doctors in charge of everything despite their poor track record of following evidence-based guidelines, delivering whole-person health, and serving as patient advocates without bias toward their personal incomes. They have also demonstrated their own snake-oil gullibility in letting drug and medical device companies dictate their clinical behavior via shady but effective sales tactics that sometimes result in sub-optimal or even dangerous medical decisions. You will notice minimal reference to care teams in the AMA’s impassioned stand that, as usual, assumes the “Doctor as God” position in excluding all other clinicians and in pushing AMA’s commercial interests. The AMA is right that many apps (especially the consumer-facing ones) are of questionable value and that doctors have been shafted in being expected to document everything for the benefit of bureaucrats. They’re also correct that much of what doctors don’t like was handed down to them from insurance companies and the government (whose checks they don’t mind cashing, however, as evidenced by their continued participation). The AMA’s bloviating is what you get when each clinical profession has its own membership organization looking out for the interests of its dues payers while claiming to represent patients who are – along with the 80 percent or so of US doctors who aren’t AMA members, including a bunch who quit after AMA endorsed passage of the Affordable Care Act — invariably absent from its proceedings. All of the solutions offered by the AMA for “digital dystophia” involve AMA-led products and services, so from now on, let’s blame them.

From Limelight Seeker: “Re: our event. Please promote the upcoming tweetchat, webinar, or video I’m involved with.” I will say only this: quite a few overexposed pontificators — especially social media self-gratifiers and cheap-seats observers — are short on credentials to be educating the rest of us. My accomplishment-driven twit filter is powered by LinkedIn.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Catalyst Healthcare Advisors. The eight-year-old company offers consulting services in strategy, finance, operations, and technology (IT strategy, system selection, contract negotiation, and system implementation, optimization, and integration). The company led Yale-New Haven’s expense reduction project in helping the health system save $350 million annually. Among its other 200 clients are Baylor, Indiana University Health, Community Health Network, and Good Samaritan Hospital. You may know founder and CEO Steve Furry, who has been in healthcare consulting for 35 years, and senior advisor Parker Hinshaw, who founded maxIT. The company just announced the hiring of two new sales executives covering the West and Midwest. Thanks to Catalyst Healthcare Advisors for supporting HIStalk.

Ms. Marlowe says her North Carolina kindergarten class is benefitting greatly from the Chromebook we provided in funding her DonorsChoose grant request, with the students specifically enjoying listening to stories online.

Listening: reader-recommended Richmond-based singer-songwriter Lucy Dacus, an up-and-comer who sings thoughtful and warm indie folk music that reminders the reader of the magnificent Cowboy Junkies and me of Kristin Hersh of Throwing Muses. 

This week on HIStalk Practice: CMS announces $10 million in grants to help practices transition to new payment models. Midwest Orthopaedic Consultants goes with care coordination tech from PinpointCare. AMA adopts long-awaited ethical guidelines for telemedicine practice. CureMD adds Izenda business intelligence tool to its PM software. Emergency Care Specialists launches joint venture with Answer Health Telemedicine. Facebook develops suicide prevention tools and protocols. Culbert Healthcare Solutions VP Randy Jones equates revenue cycle KPIs to “the ritual of the snipe hunt.”

Webinars

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

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

Acquisitions, Funding, Business, and Stock

As I mentioned in an update to Monday night’s post following a response to my inquiry to Navicure, Bain Capital Private Equity makes an unstated strategic investment (presumably taking a majority interest that meets the definition of an acquisition) in the company. Among the sellers is JMI Equity, which took a minority position in Navicure in 2009. JMI bears the initials of John Moores Inc., whose other accomplishments (beyond being an IBM programmer) include founding BMC Software, serving as lead financier of Peregrine Systems and ServiceNow, and formerly owning of the San Diego Padres.

Sales

The soon-to-open Sacred Oak Medical Center (TX) chooses Medsphere’s OpenVista EHR.

In Scotland, NHS Fife chooses InterSystems TrakCare, the twelfth Scottish Health Board to do so. 

People

Clinical rules modeling vendor Applied Pathways hires Steve Lefar (Sg2) as CEO. Founder and CEO John Feldman will continue as board chair.

Madhu Sasidhar, MD (Cleveland Clinic) joins consumer engagement platform vendor Envera Health as CMIO.

Announcements and Implementations

Congratulations to the HIStalk sponsors who took 40 spots in the 2016 HCI 100:

• Xerox (#7)
• GE Healthcare (#9)
• Allscripts (#13)
• Nuance (#14)
• The Advisory Board Company (#17)
• Leidos (#21)
• Roper Technologies (#23)
• Wolters Kluwer (#26)
• Quality Systems/NextGen Healthcare (#27)
• Meditech (#29)
• InterSystems (#31)
• EClinicalWorks (#33)
• MModal (#39)
• Verisk Health (#41)
• West Corporation (#42)
• Premier (#44)
• Experian Health (#45)
• Merge Healthcare, An IBM Company (#46)
• NTT Data (#47)
• Netsmart (#50)
• Spok (#52)
• Lexmark Healthcare (#57)
• Medhost (#58)
• Evolent Health (#59)
• Elsevier (#63)
• ZirMed (#66)
• Nordic (#67)
• Orion Health (#74)
• Imprivata (#75)
• Burwood Group (#79)
• TeleTracking Technologies (#81)
• Medecision (#82)
• The HCI Group (#83)
• T-System (#91)
• CTG (#92)
• Capsule (#93)
• Cumberland Consulting Group (#95)
• Caradigm (#97)
• Surgical Information Systems (#98)
• Zynx Health (#100)

The local paper notes that FHN Memorial Hospital (IL) is testing Meditech 6.1 in its $8 million OurFHN project, expecting an October go-live.

Government and Politics

The American Medical Association approves a policy supporting the creating of an ONC-administered National Health IT Safety Center. The policy proposal was submitted by Matt Murray, MD, chair of the Texas Medical Association’s IT committee, driven in part by work done by Texas-based health IT researchers Dean Sittig, PhD and Hardeep Singh, MD, MPH.

The US Supreme Court rules that the VA must always give exclusive preference to veteran-owned small businesses when issuing contracts, overriding the VA’s argument that it is only required to meet specific annual contracting goals. The court says the VA must show preference to veteran-owned bidders as long as the competition meets the Rule of Two (at least two bidders are expected to submit offers and the amount of those bids is expected to be reasonable).

New York’s attorney general forces legal website Law360 to stop requiring employees to sign non-compete agreements unless the employee has insider knowledge of trade secrets. Law360’s terms required all employees, even those fresh out of college, to sit out a year before taking another job in the same industry. The attorney general of Illinois is also upset that the non-compete clause in the employment agreement of sandwich chain Jimmy John’s prohibits employees from taking a job with another sub sandwich company for two years after quitting.

Privacy and Security

A former IT employee sues Aspen Valley Hospital (CO) and its privacy officer, claiming that the hospital’s HR director/privacy officer disclosed the employee’s HIV status over cocktails with the hospital’s HR recruiter at a conference after noting a large medical claim for his antiviral medications. The employee filed a complaint with the hospital and then HHS as a HIPAA violation, after which he says he was disciplined, demoted, and then fired after 11 years at the hospital.

Other

The Australian Medical Association calls for the capability of patients to manage their own medical records to be removed, saying that doctors don’t participate in the national My Health Record data-sharing program because they can’t rely on patient-provided information. The AMA wants patients locked out of making changes to core set of database elements that includes the meds list, allergies, discharge summaries, pathology and imaging results, weight, height, blood pressure, and advance directives. They also want eventual restriction of patient changes to ECG results, blood type, vaccination history, infectious disease status, surgery history, and even the patient’s chosen emergency contact. The AMA says the changes will increase trust and therefore physician usage of the system, which is nearly non-existent.

A Nielsen survey finds that 89 percent of PCPs claim they often remind patients about preventive screenings, but only 14 percent of patients say they receive them. Only 5 percent of the two-thirds of Americans who are overweight say their doctors suggested a weight loss program. Half of patients aren’t seeing doctors who can view their history via an EHR. Only one in four patients can contact their doctor by email or patient portal question submission, with older people more likely to avoid use of available technology.

This has a small amount of health IT relevance: the mold-breaking YouTube teen vlog series “lonelygirl15” is being re-launched after 10 years by its creators, which include Miles Beckett, MD, CEO of electronic credentialing vendor Silversheet. I interviewed him in April 2016.

Theranos CEO Elizabeth Holmes will present at the American Association for Clinical Chemistry’s annual conference in August, with her submitted abstract suggesting that her talk will be long on defensive self-promotion and short on offering the definitive clinical validation data that scientists long to see. I’m not clear about why a college dropout should be presenting at a clinical conference or why the education committee would accept a presentation titled “Theranos Science & Technology: the miniaturization of lab testing,” but it will probably be an overflow session. I will be disappointed if the attendees don’t boo her off the stage.

In China, a hospital janitor is arrested hiring friends to direct out-of-towners looking for the hospital to a specific room he had rented inside it, where he delivered ineffective but expensive treatments. The health department has closed the hospital as a result. That type of scam is common in China, where hospitals routinely rent out rooms to anyone willing to pay.

Sponsor Updates

• InstaMed releases its annual report on trends in healthcare payments.
• InterSystems, Intelligent Medical Objects, and Meditech will exhibit at AMDIS 2016 June 21-24 in Ojai, CA.
• Liaison Technologies wins a Stevie Award for Favorite New Product from the American Business Awards.
• Visage Imaging validates the interoperability capabilities of its Visage 7 Enterprise Imaging Platform at the IHE Connectathon 2016 held in Bochum, Germany.
• MedData will host a job fair June 22 in Grand Rapids, MI.
• The HIMSS SIIM Enterprise Imagine Workgroup publishes its second white paper.
• Validic and Omnicom Health Group will partner to counsel healthcare companies on connected health.
• Netsmart will exhibit at the Washington Behavioral Health Conference June 22 in Yakima, WA.
• Nordic receives RightSourcing’s Gold Supplier Award.
• Qpid Health and Streamline Health will exhibit at AMDIS 2016 June 21-24 in Ojai, CA.
• The latest KLAS report ranks Sagacious Consultants as the highest-rated firm for revenue-cycle optimization.

Blog Posts

• Mobile Devices Expanding Threats to Healthcare Data (ID Experts)
• Is MIPS “Stacking the Deck” Against Solo Providers? (Impact Providers)
• Do You Have the Right Marketing Mix? (Influence Health)
• The Rise of Apple in Healthcare IT (Spok)
• Why Mammosphere? (LifeImage)
• Patient Payments: How to Make the Right Statement to Get Paid (Navicure)
• How the Internet of Things will lead us to Healthcare Utopia (Orion Healthcare)
• Is MIPS “Stacking the Deck” against Solo Providers? (Impact Advisors)
• Connecting Providers and Patients through their Healthcare Journey with Mobile (PatientSafe Solutions)
• Healthcare Providers: Watch Out for Hidden Payment Processing Charges (Patientco)
• Making a Difference (PatientKeeper)
• We’re on FHIR! Why Health IT Software Developers Should Care About Open APIs (First Databank)
• Those Sticky Fingers can be Cut Off (PatientPay)
• Nurses need innovative care team collaboration technology (PerfectServe)
• How some nurses can leave earlier than others (PeriGen)
• Unifying Provider Data Solves Many Healthcare Challenges (Phynd Technologies)
• Eating Your Own Dog Food – and Why That’s a Good Thing (PMD)
• MUSE 2016 Insights: Forward Thinking for New Opportunities and Solutions (Summit Healthcare)

Contacts

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

EPtalk by Dr. Jayne 6/16/16

It’s weeks like this that make me want to hang up my consulting shoes for sure. Storms have intermittently snarled air traffic in the Midwest, making it hard for my partner and me to get to clients. Fortunately, since we work for ourselves, we have the ultimate authority as far as rebooking and rerouting and can decide whether we want to absorb the cost of a new ticket or stick it out.

On Monday, I was surrounded by business travelers who weren’t as lucky as I overheard several frantically calling travel agencies or seeking management approval to reroute their flights. As the week progressed, I did my fair share of sitting on the tarmac and also had one round of going back to the gate. Early summer travel is always dicey (especially if you have to go through Chicago) and my plans to avoid it never seem to actually happen.

I was optimistic yesterday morning, as I found a seat on an evening flight that would allow me to avoid leaving my hotel at 4 a.m. to catch a 6 a.m. flight to the next client. The only wrinkle was that I had to arrive at a different airport than originally planned, but that seemed OK since the client is halfway between two major airports and the drive time from each is about the same. I could arrive at my destination airport at 10 p.m., hop in my rental, drive for an hour and a half, and still get a good night’s sleep. My friends at my favorite hotel chain were happy to waive any early check-out penalty because I was booking the night at another hotel in the chain.

Little did I know that the travel gods were going to make up for my seemingly good decision in a multitude of ways. I arrived at the rental car vendor to find that there were no cars. Seriously, none. The staff was kind and offered bottled water while we waited for vehicles to be brought around. There were six of us who had come off the shuttle bus from my flight, all of us had reservations, and our flight was on time, so I’m not sure why it was a problem. Since I wanted to get to my hotel to crash, I took the first car available and headed for the exit.

All was smooth until exited the airport proper and immediately got nabbed running a red light. It was a large intersection and the light turned yellow right as I entered it, but it went red while I was in the middle of it. I’d chalk it up to bad luck, but there were three other cars that also got caught so I think it’s a timing issue on the lights. Regardless, I’ll be looking forward to a ticket in the mail in a couple of weeks and really didn’t need to add that to my to-do list.

I finally made it to the highway and settled in. I knew that I was going to have to be on toll roads, so I came prepared with cash. What I didn’t know is that the toll roads were coin-only, unattended. At the first one, I didn’t have the right change but made note of the website where I can supposedly go online and pay later. At the second booth, there was an attendant, but I was so flustered by the previous incidents that I forgot to get a receipt. Depending on who you work for, there’s no reimbursement without a receipt. I’m not going to quibble about a couple of dollars, but was just annoyed at forgetting it. At the third booth, I remembered to get a receipt, so thought victory was just around the corner. Sure enough, a fourth booth (again, unattended and coin-only) loomed.

I had planned ahead at the previous attended toll booths by making sure I got my change in quarters, so I was ready. There was a car in front of me whose driver was clearly digging through the console for change. He’d come up with a coin, throw it in the basket, and start digging again. I had my window down ready to throw my quarters in when it was my turn and could hear when he started cursing and yelling. Apparently he had thrown in enough change and it still wasn’t changing his status from “Stop!” to “Thank You” and he was getting agitated. He was reaching out and punching the toll basket. The yelling was getting louder and at one point half his body was out the window. His car was shaking from side to side because he was a big guy and he was getting really, really agitated. Needless to say I put my window up – there’s nothing quite like being trapped in a line of cars with someone acting strangely near you and you know you can’t get away. Given our current times, I wasn’t sure if he was going to end up shooting the toll station or what. He finally drove through.

I confidently tossed my coins in the basket and waited for my “Thank You” and never got it either. By now it was well past midnight, I was tired and agitated, and I just drove through, thinking I’ll sort it out on the website later. Clearly the booth wasn’t functioning correctly, but what can you do at that point? I thought back to my exit from the rental car lot –  they didn’t even offer the magic toll pass option, but I promise if I ever have to rent a car in this city again, I’m definitely asking for one.

I arrived at my hotel well after midnight, but luckily check-in was uneventful. The travel gods did finally reward me, though, with the best hotel water pressure I’ve had in a long time. People without long hair don’t always appreciate the value of ridiculously high shower water pressure, and people who aren’t on the road day in and day out may not understand the value of the little things when you’re away from home. When I got to my room, I found dozens of emails waiting for me and am now addressing them intermittently while I eat breakfast and get dressed.

For those organizations who work with consultants, it’s good to understand what your hired help might have been through to get there. If they look less than rested, there’s a reasonable likelihood that they had a hard day of travel rather than staying up watching Netflix and surfing the net. (Of course I’ve had the latter kind of days too, but they’re extremely rare.) So offer them a cup of coffee and a comfortable chair (my current one at the hotel doesn’t adjust up enough to reach the desk correctly, so I’m getting tingly nerves as I type this) and let them get to work. Don’t assume their travel has been glamorous and ask them to tell you about it. You might just get more than you bargained for.

What’s your worst travel day story? Email me.

Email Dr. Jayne.

Morning Headlines 6/16/16

Cerner chips away at building $4.5B campus

A local Kansas City newspaper reports on the progress Cerner has made on its 10-year, $4.5 billion Trails Campus construction.

Florida Blues collected $471 million profit on ACA plans in 2015

Florida Blue Cross and Blue Shield reports $471 million in profits from its insurance exchange business, unlike the massive losses reported by other major insurers like Highmark, Humana, and UnitedHealth Group.

Consumerism in focus at AHIP 2016 this week, organizers say

Former CMS Administrator and current AHIP President and CEO Marilyn Tavenner presents the keynote speech at this year’s AHIP annual conference, calling for an increase in technology as healthcare reimbursement moves away from fee-for-service payment models.

New Methodology To Examine Spending Patterns For End-Of-Life Care

According to a Health Affairs study analyzing end-of-life spending data for Medicare patients finds that costs run five times higher for patients with multiple chronic diseases during the last year of life.

Morning Headlines 6/15/16

Why I Disagree with the Snake Oil Analogy

BIDMC CIO John Halamka, MD takes issue with the “snake oil” analogy AMA CEO James Madara, MD used to describe EHRs during a speech at the AMA Annual Meeting. Halamka acknowledges that current EHRs do not share data, engage patients, or enable population health effectively, but says “There is no snake oil.   We created the digital foundation that is a prerequisite for the next generation of tools.”

Sonoma West Medical Center chief nursing officer sues hospital, Dan Smith, after dismissal

The former CNO at Sonoma West Medical Center (CA) files a wrongful termination suit after being fired for voicing concerns that the home-grown EHR designed and implemented by a hospital board members’ startup company was unsafe.

Teladoc Secures Major Victory in Patent Dispute with American Well

A Massachusetts federal court judge dismisses a patent infringement suit filed by American Well against telehealth competitor Teladoc, concluding that American Well’s patent is invalid because major elements are “too abstract” to be patentable.

Patient wishes are tough to see in electronic health records

A Minneapolis newspaper discusses the difficulty providers have finding advance directives within EHRs, citing a recent study that found “less than one-third of ER doctors feel very confident they could locate information in the electronic record.”