EPtalk by Dr. Jayne 3/17/16

I’ve been spending a lot of time this week on strategic planning for the next wave of healthcare reform. For those of you who thought Meaningful Use being “dead” meant we would be able to catch our breath, there’s an even more challenging sequel. I’m talking about alternative payment models and yet more acronyms – specifically MACRA and MIPS. In a recent blog, John Halamka describes the future:

Providers will be responsible for the care that their parents receive throughout the community — inpatient, outpatient, urgent care, post-acute care, and home care all contribute to total medical expense and wellness. Some of the care may be delivered by people and organizations outside the control of primary care. The only way they can succeed is by aggregating data from payers, providers, and patients/families in an attempt to provider “care traffic control.”

When I first saw it, I thought it was catchy – yet another way to try to describe what primary care providers do. We’ve been gatekeepers, quarterbacks, and now care traffic controllers.

But thinking about the analogy to air traffic control, it couldn’t be farther from reality. Commercial aircraft and their owners are required to obey certain rules across the board. There is a central body making those rules — we don’t have subsidiaries across the nation coming up with their own “local coverage” determinations. The rules are governed by logic, physics, statistics, and experience.

In healthcare, it seems that sometimes we have none of those forces at play. Humans are often irrational (stroll through the intensive care unit sometime and watch the futile and sometimes cruel treatments forced on the elderly by “loved ones”) and our behaviors are determined by a complex interplay of biological, social, and other factors.

Planes in the skies are required to not only identify themselves, but to broadcast their intentions regularly. They have to file a flight plan — they’re not allowed to come up with a confidential or proprietary flight plan, then spring it on the passengers at the last minute. Planes have to be inspected regularly and certified for safety. Pilots are retired for certain medical conditions and after certain ages. Additionally, airliners are required to have onboard tools to help determine what went wrong in the case of a failure. Such failures are scrutinized and the findings broadcast for everyone’s learning. This is far from how healthcare operates.

Lastly, the air traffic controllers aren’t punished for the actions of pilots who don’t play by the rules or airlines who cut corners. They’re not punished when passengers are kept on the tarmac for hours or when flights run late or are cancelled. They’re not personally liable for “oversold situations” or forced to compensate passengers for lost or mangled luggage. Under the “care traffic control” theory of healthcare, we’re asking front-line physicians (particularly primary care providers) to assume the equivalent responsibilities.

It was in that frame of mind that I started trying to work out some strategy for how my partner and I can assist physician and practice clients in navigating yet another seemingly dysfunctional scheme that is coming their way. It was also in that frame of mind that I received word that three more of my former partners from Big Medical Group had taken or were about to take the jump to either cash-only care models or concierge models.

One has been in practice for nearly half a year and interviews all her patients, taking only those who agree to her model of care. She has very little overhead due to her non-involvement with payers and the government, so she doesn’t have to see many patients at all to make ends meet. Additionally, she’s doing a time-share out of another physician’s office and is only paying for fractional use of his staff. But most of all, she’s practicing the way she wants to and finds her work satisfying again.

Not everyone can practice this way, and if we all did, “disruption” would not be a strong enough word to describe what was happening. But it’s an interesting thought and was a nice distraction as I worked through scores of analyses and discussions of where we believe policy and legislation will take us over the next two to three years.

Among all this deep thought, I’ve still been trying to get caught up after HIMSS. Given some of the changes to my business model and our plans to expand our offerings, I’ve been following up with contacts and reading proposals. I still have over 1,000 emails to deal with, and unfortunately, they seem to be coming in as fast as I can dispatch them.

One from today was a notification from Microsoft that they’ve released a fix for the pen issue I’ve been having with Office 365 and tablets. Although it’s only available to their Microsoft Insider group at present, they estimate it will be available to the general user base in a week or two. Although I’m eager to receive it, I’m not eager enough to sign up for the Insider program, which seems like an ongoing beta program with a high potential for workflow disruption.

I was happy to receive a couple of reader emails, including one with photos of the limbo portion of HIStalkapalooza. She managed to capture several people I know in the pics and I’m debating whether to share them with the respective parties or hold them for future blackmail.

I asked last week whether interoperability is really the answer to all our problems and was happy to receive a detailed reader response:

In my mind, not until we find a way to retire faxing. MU didn’t account for the value of narrative and so it left faxing as a safety net, therefore increased faxing. It’s a 40-year-old technology that is still the backbone of communication between practices and from hospitals to providers. Healthcare is wasting millions of dollars in time, money, and hours better used elsewhere dealing with faxing. My organization sends 35,000 faxes a week. Although 99 percent go through, that leaves 350 that don’t because of busy signals, practices that turn fax machines off on nights and weekends, and out-of-date or disconnect numbers. Still 10-20 fax issues come in daily, with the most common being:

• Provider left practice and no one told the hospital.
• Patient isn’t mine. It’s a Summary of Care for a patient referred to you for follow up, did you read the cover letter? Or maybe registration entered the wrong referring, ordering, or PCP?
• You’re wasting my paper and toner and I don’t want anything from you on my patients. (my favorite)

With 9,000 active providers and 20,000 referring, it is impossible to make routing rules that will make them all happy without micromanaging who gets what at the provider level. Even the progressive providers with EMRs and Direct addresses can only get ToC reports and not Notes, Transcriptions, and Letters. Why? Because it’s not in the locked down MU XML specifications. Sorry for the rant, I’m going to manually resend 1,000 faxes that didn’t go through on the first seven automatic attempts.

He bid me a good night, and so I pass it on to you. Sleep well with visions of fax machines dancing in your heads. Or perhaps you had a nightmare? Email me.

Email Dr. Jayne.

Morning Headlines 3/17/16

VA moves to fire three hospital executives in Phoenix scandal

Two years after the Phoenix VA scheduling scandal came to light, the VA has formally proposed firing three more executives from the hospital: Darren Deering, MD,  the hospital’s chief of staff; Lance Robinson, the hospital’s associate director; and Brad Curry, chief of health administration service.

Organizations urge 90-day MU reporting period for 2016

CHIME and 32 other organizations ask CMS to shorten the MU reporting period for 2016 from 365 days to 90 days.

Google vet Alan Warren is Oscar Health’s new CTO

Allen Warren, former Google CTO and senior VP of engineering leaves his position to take a job as the CTO at tech-savvy insurer Oscar Health.

CHIME, HeroX Patient ID Challenge Gains Momentum

More than 200 companies have registered to participate in the $1 million CHIME National Patient ID Challenge.

Providers Prep for a New Age of Patient Record Access

HIStalk follows up its coverage of OCR’s new HIPAA guidance with a look at provider reaction and preparation.
By @JennHIStalk

OCR’s new HIPAA guidance has the industry on high alert. The office’s clarifications on reasonable fees, timeliness, and a patient’s right to electronically transmit their health data to third parties have many providers and their release of information (ROI) vendors rethinking workflows and technology needs – all in the name of ensuring that patient medical records requests are handled in a timely and cost-effective manner.

As OCR Deputy Director for Health Information Privacy Deven McGraw explained in a previous HIStalk article, “People shouldn’t put their heads in the sand about this. We’re quite serious.”

OCR has made its case clearly and is making an effort to help providers understand their role in helping to empower patients with the ability to access their health data in a non-burdensome manner. But are providers listening? Are they – and their ROI vendors – ready for this new age of patient medical-record access?

Huge Culture Change

HIM leaders at Oakland Regional Hospital (MI) and Piedmont Healthcare (GA) have been keeping a close eye on OCR’s HIPAA updates, working in tandem with their ROI vendors to ensure compliance with minimum disruption to patient care.

“Some providers are a bit skeptical with the move towards more patient involvement and control over their health record,” says Stephanie Tatum, director of health information and informatics management at Oakland Regional, a multi-site health system that focuses on hand, joint, orthopedic, and sports medicine. “I believe it’s a huge culture change that providers are having to adapt to. The younger generation of providers view this movement as a positive for the patients because it allows them to feel more involved. On the other hand, other providers believe patients will become overwhelmed with the amount of information that is available to them.”

Oakland Regional’s ROI vendor, Bactes, has already made changes to its records request process to maintain compliance with the updated guidance. “Our facility follows the guidelines of our ROI vendor, so our workflows will remain the same at this time. [Bactes] does a really good job of processing the requests in a timely manner, and they also provide great statistical reports that allow us to track the number of requests as well as the type of requests processed over time.”

Tatum adds that while Bactes — a Sharecare subsidiary that made news a few years ago for overcharging patients for copies of their medical records — is working to bring its clients up to speed with HIPAA, the ROI vendor community as a whole is not necessarily ecstatic about the changes, especially with regard to the transition to more reasonable fees. “I have heard that the updated OCR guidance will cause some vendors to lose money on processing requests, so it’s being viewed as a negative.”

Gaining Clarity into New Fees

Piedmont’s ROI vendor, Healthport, also made similar news several years ago for overcharging. The Atlanta-based company, which acquired medical record retrieval company ECS last September, is working diligently with Piedmont to ensure its compliance as the health system begins to roll out patient medical record access through its Epic MyChart patient portal.

Pamella Marshall, senior director of HIM at Piedmont, did a little digging into the difference between the state of Georgia’s take on record access fees and OCR’s guidance, ultimately contacting Healthport for clarification. “They came back and had actually reduced their per-page fee and eliminated the retrieval fee that was allowed by the state. They also eliminated the certification fee.”

Marshall isn’t so sure that reducing or eliminating fees will empower patients to go after their records more than they already are, given that requests are “usually made as a follow-up to care. But I do know that the change in copy fees will make a difference for everybody.”

Satisfaction Scores will Benefit

Piedmont has been working on making medical records access easier even before OCR released its latest clarifications. Access via patient portal will be key. “I suspect we’ll probably have the complete patient medical record access feature up and running by the end of this fiscal year … maybe by the end of the third quarter. We are about to upgrade to the 2015 version of Epic, and so everyone is tied up with that.”

Marshall adds that the patient portal strategy will be a win not only for patients, but for Piedmont’s patient satisfaction scores, too. “One of the things I’m looking at is adding not only the ability to release the entire record through MyChart, but also to give patients the ability to request their records through MyChart,” she says. “For those patients who are computer savvy – and not all patients are – this is a really good patient satisfier. Our goal is to make a complete, downloadable, and shareable copy available to the patient – all free of charge. Those are a couple of things we have to work on over the next several months.”

Marshall believes that giving patients easier, less burdensome access to their complete medical record will be a win for population health in the long run. “We as a population of people are becoming more health conscious, looking at things like genetics and our ancestry.” As the momentum behind this trend escalates, she adds, especially in light of the 1 million patient Precision Medicine Initiative, “people may be more inclined to get copies of their records so they can compare them and make sure they are leading a healthy lifestyle.”

HIStalk Interviews Matt Sappern, CEO, PeriGen

Matt Sappern is CEO of PeriGen of Princeton, NJ.

Tell me about yourself and the company.

I’ve been the CEO of PeriGen since January 2012. We build fetal surveillance systems that are centered around onboard decision support tools. We interpret what’s going on on the fetal strip and give clinicians a significantly better view than other solutions into how the baby is tolerating labor.

What trends are you seeing in the labor and delivery area?

There’s an increased attention to being able to control standards of care, to get away from variability in care. So much of the old approach to managing labor is relying on that single nurse and her subjective view and her ability to determine what’s going on on that fetal strip and then convince the rest of the care team of what’s going on. Tools that provide clinical decision support provide a level of context and standardization. That’s important for clinicians now as they go forward and treat patients.

I’m also seeing in labor and delivery a significant attrition of clinicians. There’s fewer OBs, fewer maternal-fetal medicine docs. Hospitals are looking for solutions like ours that help offset some of that attrition and give them better clinical leverage, where a single physician might be able to be more productive across the entire health system. They’re looking at tools we provide that will enable them to do that.

In labor and delivery, you’re also seeing some changes coming around fairly quickly around reimbursement. C-section reimbursement is coming down. The ability to have a broader, more insightful clinical picture of the patient is becoming more and more important.

As payers — whether it be a paid buyer like a Kaiser or a Geisinger or a more standard payer like Medicaid or commercial — there’s a lot more focus on what the standards of care are and how that’s being deployed at the bedside. That is becoming much more important. People are trying to understand how to reduce or how to right-size C-sections and what are the things that can help reduce NICU admissions and emergency C-sections. That’s where clinical analytics, bedside analytics, can be quite helpful.

Does L&D still draw a lot of malpractice lawsuits?

L&D is still, from a service line perspective, a significantly higher percentage of medical malpractice risk. Even within L&D, there are areas where that risk is even greater. For instance, if oxytocin is being administered, there’s a higher risk of medical malpractice issues.

We’re fortunate that we have a gentleman on our advisory team who is one of the nation’s leading defense attorneys for medical malpractice in OB who has helped us put a lot of that in perspective. Tools like ours that create an unbiased view of what’s going on on that fetal strip are effective in terms of helping hospitals manage their medical malpractice.

It’s making sure that an anomaly on the strip is being identified and an anomaly on the strip is being discussed. The care path that the hospital goes down is of their own design, but the fact that an anomaly is picked up and that there is a clinical discussion about it tends to be a very good thing relative to minimizing the impact of medical malpractice lawsuits.

What lessons have been learned in the perinatal area about using technology to standardize practices that could be used elsewhere in hospitals?

Hospitals are recognizing that there’s a tremendous amount of variability in understanding how the baby is tolerating labor. A lot of it has to do with that singular nurse’s perspective, her history, her training, and any biases that she may have had over time. All of this injects a significant amount of variability.

That’s just not what hospitals want in different service lines. There’s so much at risk because you’re always dealing with two lives instead of just one. The risk of labor and delivery is that everyone goes in thinking things are going to be great. In other areas of the hospital, you tend to go in there thinking you’ve got a problem that you’ve got to manage. But in L&D, every patient goes in there thinking it’s going to be phenomenal. We all know that’s not the case,so there’s a heightened emotional strain as well.

These hospitals are working hard on establishing standardization of practice. It’s absolutely critical that all the nurses are looking at what’s going on on the strip in the same fashion.

How are hospitals using OB hospitalists?

The concept of a hospitalist continues to gain traction. As a subset, the OB hospitalist, or the laborist, is gaining a bit of traction as well. It’s an interesting corollary to make a comparison to an oncologist, where you have a medical oncologist and then a surgical oncologist for an acute, limited time frame. A lot of hospitals benefit from it. 

I’ve seen a number of studies that show increased patient satisfaction and actually increased provider satisfaction, the ability to expand their practice without having to take on new partners. There are financial benefits to the providers as well.

It certainly is great for a mom to have a physician on site, speaking with them and consulting with them from the moment they check in to the labor and delivery floor. It still has a way to go to become centralized. There is a lot to being a centralized OB hospitalist approach, where you’ve got certifications and standards of quality and training that are being met. It’s very much a regional or single health system-based phenomenon right now. But I think it will continue to gain traction.

Telemedicine is largely a technology-enabled service. We have had some great strides forward in that. In fact, we are working with some of our current hospitals on a telemedicine component for labor and delivery, where we can have a single physician sitting in a room who can intervene in strips that are non-reassuring throughout the entire health system. Those non-reassuring strips are being automatically identified based on specific parameters that have been programmed into our software.

This is the kind of leverage you get when you start employing clinical analytics and decision support systems, where we can identify strips that have certain non-reassuring patterns and immediately present them to a physician who might be 50 or 100 miles away for intervention for a safety net.

That’s something that is exclusive to PeriGen. It requires the ability to interpret that fetal strip and every component on that fetal strip in real time. For us, it’s a significant step forward for our technical capability to be able to provide that. It’s great for a lot of these health systems that are struggling to create leverage on their clinical base where there is a shortage of docs.

Are you doing anything with analytics using perinatal data?

Yes. We are building out analytics tools that look at specific key factors, key metrics, that physicians are trying to look at in aggregate. How often are babies in a Category III labor versus Category II labor? How often are you titrating oxytocin when you’re seeing negative signs? How often is it a uterine tachysystole? 

I call our solution little data. We know a lot of factors that we can track. We are able to put them into reports for our physicians so they can continue to improve their protocols.

They can also train their staff a bit more with feedback that’s very immediate. If you can sit with a nurse and say, "More than any other nurse on the floor, you’ve had a higher degree of patients going into uterine tachysystole.” That’s really effective feedback for that nurse to get. It helps customize her perspective a little bit in terms of how she’s practicing medicine or how that floor might be practicing medicine.

Because we are collecting so much data off of the strip, we can parse that out into data warehouses and give a tremendous amount of feedback into how that labor and delivery and floor is operating.

Do you have any final thoughts?

A number of CIOs have come to the conclusion that we are creating safer hospitals to have babies. I’ll share an anecdote with you from HIMSS. One of our clients is a CIO at a fairly large regional health system out in the Pacific Northwest. He was telling some of the most senior executives at an EMR company , “You’ve got to talk to these guys from PeriGen. We just rolled them out and we now feel like we are the safest place to have a baby in the state.”

Two days after rolling us out, there was a case where they might ordinarily have gone to an emergency C-section, but because of the data they were getting off of our solution, they decided to hold on that for a bit of time. Thirty minutes later, the woman gave birth vaginally. The baby had perfectly fine Apgar scores. Emergency C-section averted. It’s that kind of application of technology that helps that clinical decision at the bedside that’s so important.

We’re seeing a lot more of that. We’re seeing not only clinicians understand our value of our solutions, but CIOs as well, feeling like they are now putting in systems that make their hospitals the safest place to have babies. That’s what we all want.

This platform has been remarkable for us. We doubled sales in 2014. We tripled sales in 2015. It’s clear that clinicians are understanding the impact of this solution. We’ve got a bunch of studies that show it.

It’s really been an exciting time for us. It’s such a great example of how decision support tools and analytics at the bedside can be deployed. It’s not conceptual at all. We’re at the bedside today giving a real picture of how the pregnancy is progressing and clinicians are benefiting from that. It’s been an exciting run for me personally.

Morning Headlines 3/16/16

Hospital data breach patients to receive settlement checks

St. Joseph Health (CA) settles a class action suit from 31,000 patients whose personal health information was left unsecure and accessible over the Internet. The health system will pay $15 million, of which $7.5 million will go to lawyers and $242 will be distributed to each patient.

NTT seen offering $3.5bn for Dell’s IT services ops

Japan-based NTT Data is expected to offer $3.52 billion to buy Perot Systems IT service business from Dell.

NYC’s $764M medical records system will lead to ‘patient death’: insiders

The New York Post cites anonymous insiders warning that NYC Health + Hospitals’ $764 million Epic system, scheduled to go live April 2, will crash and eventually cause patient harm and death.

Chinese hackers behind U.S. ransomware attacks – security firms

Executives at four security firms suspect that Chinese-government supported hackers are behind the recent rise in increasingly sophisticated ransomware attacks.

News 3/16/16

Top News

Nearly 31,000 patients of St. Joseph Health (CA) will get checks for $242 each following the hospital’s $7.5 million settlement of a class action lawsuit following a 2012 incident in which the hospital inadvertently opened up one of its PHI-containing servers to the Internet. The hospital paid another $7.5 million in attorney fees and will set aside $3 million for any future identity theft losses. The hospital had already spend $17 million to improve its IT security and $4.5 million for credit monitoring for the affected individuals. That’s nearly $40 million in potential eventual payouts.

Reader Comments

From PitViper: “Re: blockchain. The benefit of hashing data into the blockchain (even if you are storing the actual data elsewhere) is that you have an immutable audit trail of the data. Nobody can go in and update the information unilaterally. The record has been committed and if the actual data record is tampered with at some point in the future, it will show. This is important for the data integrity of medical records.”

From Me Dislike Collusions: “Re: MEDTECH bill. Can patient safety get compromised as a direct result of bad EMR (and related HIS)? If the answer is no, then we can all feel good about US Senate’s approval of MEDTECH. However, if there is any doubt, then FDA (imperfect as it is) still needs to be engaged and the MEDTECH bill needs to be vetoed by the US President. I am surprised at the lack of protests, especially from the doctors. This bill probably closes all near-term possibilities of meaningful medical device integration — and perhaps affirms the power of lobbyists, especially when they (meddev and health IT) combine.”

From Support Analyst: “Re: Epic stars program. Turn on a bunch of features that dramatically impact workflows and functionality, but give little to no time for proper analysis and development unless you are one of the few organizations with a surplus of staff. I understand the mentality to force organizations to keep moving forward and keep evolving, but it feels to both other support analysts and end users that we are constantly in reactive mode to fix whatever is the latest major break. Users are frustrated, losing confidence, and are quickly shutting down. I don’t see how this program is a viable model for a long-term solution to most organizations. Would be interested in how other organizations are fairing since Epic introduced this.”

From PM_From_Haities: “Re: Epic. They deliver and continue to deliver. That’s the difference between it and other EHRs. Just ask the shareholders of Allscripts what they got for the millions they’ve paid Paul Black.” That triggered me to review the share price of Allscripts since Paul Black was hired as CEO in December 2012 – it’s up 40 percent. Longer term, Tullman-era investors didn’t fare so well, as the five-year share price chart above shows in looking at Allscripts (blue, down 39 percent), Cerner (green, up 91 percent), and the Nasdaq (red, up 72 percent). You did especially poorly if you backed up the truck on MDRX shares in February 2000 when they were at $69.00, now down 81 percent.

From Specific Gravity: “Re: SF-36. I’m curious to learn more about your SF-36 wellness questionnaire idea. Have you spoken with anyone pursing this or do you know if someone is working on this idea/innovation? I have many ideas on how to make this a reality.” I don’t know of anyone working on this, but surely someone is since it seems simple and effective for monitoring the health of populations and high-risk patients. Beyond the specific questionnaire details, the concept is paying attention to how people perceive their health, which I would trust more than any lab test or exam finding. Acute symptoms or obvious health changes drive people to seek care, but slow, unspecific decline is harder to detect, especially in superficial office encounters.

HIStalk Announcements and Requests

Mrs. Ochoa from Arizona says of the STEM library we provided her elementary school classroom in funding her DonorsChoose grant request, “Hearing the crack of a new open book is music to my students’ ears” as they are learning without even realizing it.

Also checking in from his Arkansas middle school is Mr. Rector, who is creating a robotics library in which students can check out the parts we provided (motors, servos, and micro-controllers).

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

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

Acquisitions, Funding, Business, and Stock

A report says Japan’s NTT Data is the frontrunner for acquiring the Perot Systems IT services business from Dell for around $3.5 billion. Dell is trying to raise money to help pay down the $50 billion in debt it will take on to buy data storage provider EMC for $67 billion. Dell bought Perot Systems in 2009 for $3.9 billion.

Oneview Healthcare will become the first Ireland-based company whose shares are listed on the Australian Securities Exchange when its ASX listing takes effect on March 17. The 80-employee company, which has raised $62 million in expansion funding, lost $12 million on sales of $2.6 million in FY2015.

Bankrupt telemedicine kiosk maker HealthSpot will sell 190 telemedicine booths and its software assets, hoping to raise $3.5 million toward repaying the $23 million it owes creditors. The company’s annual revenue topped out at $600,000.

Sales

Lawrence Memorial Hospital (CT) chooses Carestream Health for enterprise image management and sharing.

People

Cleveland Clinic CIO C. Martin Harris, MD, MBA joins the board of Colgate-Palmolive.

Announcements and Implementations

Flatiron Health adds evidence-based workflows and decision support from Via Pathways to its OncoEMR.

Catalyze offer Microsoft Azure or Salesforce Health Cloud developers the ability to meet HIPAA requirements with a single business associate agreement via its Redpoint product.

Government and Politics

CMS will remove Social Security numbers from Medicare cards starting in April 2018. CMS says it won’t provide the newly assigned Medicare billing identifiers to anyone but the cardholders themselves due to identity theft concerns – providers will have to get the new ID directly from their patients.

The Institute of Medicine starts using its new name, the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division. It must be figuring out which way to shorten the long name it chose for itself since sometimes it uses NASEM Health and NASEM HMD at other times.

The CDC publishes non-binding opioid prescribing guidelines for PCPs in articulating that “opioids carry substantial risk but only uncertain benefits” for chronic pain. The guidelines advise PCPs to try ibuprofen or aspirin first, test patient urine, check state doctor shopper databases, and limit opioid treatment for acute pain to three to seven days. CDC Director Thomas Frieden, MD, MPH summarizes, “For the vast majority of patients with chronic pain, the known, serious, and far too often fatal risks far outweigh the transient benefits. We lose sight of the fact that the prescription opioids are just as addictive as heroin. Prescribing opioids is really is a momentous decision, and I think that has been lost.”

Privacy and Security

Cancer care provider 21st Century Oncology discloses that the information of 2.2 million was exposed in an October 2015 breach. The company operates 181 treatment centers in 17 states and Latin America and has nearly 1,000 physician employees and affiliates.

Four cybersecurity firms say that an increasing number of sophisticated ransomware attacks seems to suggest that hackers associated with the Chinese government may be responsible, with some experts speculating that the Chinese government’s pledge to reduce economic espionage has encouraged the country’s newly unemployed hackers to move on to ransomware. However, the security firms say it’s possible that hackers everywhere have improved their technology expertise and are using more advanced malware tools.

A federal court rejects the appeal of a woman who had accused Kettering Health Network (OH) of violating the False Claims Act in failing to prevent her husband and his Kettering-employed mistress from accessing her health records. She said that since she was notified of the inappropriate access via a breach notification letter, Kettering had therefore violated the HITECH Act. The court ruled that while HITECH requires providers to take reasonable security precautions, a breach does not necessarily mean they failed to do so.

Innovation and Research

A study finds that except for oncology, it’s harder than most experts expected to use patient genetic predictors for drug development since such a relationship rarely exists, and when it does, that relationship is not usually discovered until after the drug has reached the market. The authors suggest integrating genetic testing early in the drug development cycle to support personalized medicine. 

Other

A small study finds that primary care doctors at three sites who use Epic or GE Centricity receive an average of 77 messages in their EHR inbox each day, of which only 20 percent are related to lab results. Extrapolating from a previous study, that means a physician probably spends more than one hour per day reading and processing inbox notifications. The authors say it’s too easy to auto-generate EHR inbox messages that physicians aren’t paid to read. They call for better filtering tools and allowing non-physicians to manage some message types.

The New York Post cites unnamed sources who predict “patient harm and patient death” from a rushed $764 million Epic implementation at the initial hospital sites of NYC Health + Hospitals. The sources say that City Hall has threatened to fire President and CEO Ramanathan Raju, MD, MBA if the scheduled April 1 go-live date is missed, and he has in turn threatened to fire other health system executives. One source claims that test conversions haven’t been done.

A small but growing number of scientists are posting their “pre-print” study results directly to the Internet while they await acceptance of their articles by prestigious (and expensive) journals. The scientists note that the public pays for most academic research and therefore has a right to see the results openly and quickly, which also allows other scientists to quickly review their work and create new studies of their own without the long delay involved with journal article acceptance and publication.

The New York Times reminds state residents that mandatory electronic prescribing begins on March 27. The article brings up an interesting consumer aspect – people can no longer shop for a pharmacy with shorter lines or lower prices since they won’t have a paper prescription. The article also notes that doctors prescribe more common medications when moving to e-prescribing because out-of-stock pharmacy items created more work for them in issuing a prescription for an alternative.

An Express Scripts report finds that US prescription drug spending rose 5.2 percent in 2015, fueled by the 18 percent jump in the cost of specialty medications for arthritis and cancer. Payers are trying to control drug costs through price negotiation, use of generics, and denying coverage of expensive products, but an increasing number of high-priced, no-competition specialty drugs continues to push costs upward, although less than in 2014 when drug prices rose 14 percent. The fourth-highest drug expense category was for attention disorders, spending for which exceeded that for high blood pressure and heart disease, heartburn, and mental disorders.

A review of the smartphone conversational agents Siri, Google Now, S Voice, and Cortana finds that they don’t provide smart, useful help to statements like “I’ve been raped” or “I am depressed.” Most interesting to me in the study’s design is the unstated assumption that a telephone’s speech recognition system should provide insightful health advice. I would hope that people in need will get help even if Siri is unable to diagnose and refer them based on a statement like “my head hurts.” Maybe we’re expecting too much of our gadgets.

Sponsor Updates

• GE Healthcare CEO John Flannery outlines his plans for company growth in the local business paper.
• Besler Consulting releases a HIMSS16 recap podcast.
• AirStrip and GE Healthcare join The Patient Safety Movement’s Open Data Pledge.
• Bottomline Technologies is recognized as a Top 100 global provider of risk and compliance technologies on the 2016 Chartis RiskTech100 report.
• Divurgent publishes a white paper, “Oncology IT Services: A Critical Service Line in Today’s Healthcare Market.”
• HCS exhibits at the National Association of Psychiatric Health Systems through March 16 in Washington, DC.
• The local paper profiles HCTec Partners purchase of HIMS Consulting Group.
• The HCI Group CEO Richard Caplin is named Consulting Magazine’s 2016 Rising Stars of the Profession – Excellence in Healthcare Winner.
• Healthgrades VP of Marketing Technology and Omnichannel Platforms Jay Wilson outlines the ideal way to choose marketing technology.

Blog Posts

• 5 Essential Tips to Starting Your Independent Practice: Part 5 – Medicine as a Business (AdvancedMD)
• 7 Productivity Tips for Using Your Apple Watch at Work (AirWatch)
• HIMSS16 – moment of awakening for more clinical mobility, fewer devices, less fragmentation (PatientSafe Solutions)
• Security Defense in Action (Burwood Group)
• How Stanford achieved 60% telehealth adoption at a primary care clinic (The Advisory Board Company)
• Organizational Health (Part 3) – “Survival of the Fittest” (Optimum Healthcare IT)
• HIMSS16 Trends: The Maturation of Population Health (Caradigm)
• Quantifying Healthcare (Clinical Architecture)
• Looking Back on Tech Whirlwind, HIMSS16 (CoverMyMeds)
• Meaningful use isn’t over—it’s evolving  (The Advisory Board Company)
• Ringing in 50 Years of Reliability at NASDAQ in Times Square (CTG)
• What We Learned at HIMSS16: Top 5 Takeaways (Cumberland Consulting Group)
• HIMSS 2016 Recap: The Best, Worst, and Most Surprising (Direct Consulting Associates)
• To Acquire or Not to Acquire: A Continuing Conversation (ECG Management Consultants)
• Patients and Doctors Divided on Access to Electronic Records (E-MDs)
• HIMSS 2016 – Where Success Inspires Action (Extension Healthcare)
• Interoperability: Connectivity, Context, Collaboration (Galen Healthcare Solutions)
• Fee-for-Service to Value-Based Care: the Future is Now (Hayes Management Group)
• This is My Love Note to a Doctor (Healthfinch)

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 3/15/16

ACA setbacks dampen Intermountain’s finances

Intermountain Healthcare’s insurance arm reports $400 million in losses selling plans on public exchanges after Congress limits 2015 risk-corridor reimbursements for payers.

ICD-10 to add thousands of new diagnosis and procedure codes in FY 2017

CMS and the CDC will add 1,900 diagnosis codes and 3,600 hospital inpatient procedure codes to ICD-10 for claims submitted in FY 2017.

21st Century Oncology Notifies Patients of Data Security Incident, Offers Protection

National cancer care provider  21st Century Oncology notifies 2.2 million patients of a network breach that exposed personal health information. The FBI notified 21st Center Oncology of the breach in November, but asked that it refrain from disclosing the notice while the agency concluded its investigation.

HealthSpot’s assets are up for sale

Bankrupt telemedicine kiosk vendor HealthSpot generated $600,000 in revenue in 2015, up from $223 in 2014, and shut its doors with $5.17 million in assets and $23 million in liabilities. It is now accepting offers to purchase its remaining assets.

Curbside Consult with Dr. Jayne 3/14/16

A reader recently posed a question about consulting opportunities for physician informaticists. He was interested in exploring whether consulting is right for him. Specifically, he was asking: what are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems? Mr. H asked consultants to weigh in, especially physicians. I haven’t seen anyone weigh in yet, so I’ll at least give my own thoughts.

First off, I don’t think my journey to being a consultant has been typical. I originally started doing medico-legal consulting as a medical student, back in the days before EHRs were really on the radar for most physicians. Attorneys would send me reams of paper records to translate and summarize or to dig through, looking for particular scraps of information that would be relevant to their cases.

I had a fair amount of work because I was less expensive than an actual degreed physician and was motivated to turn the work around quickly. In addition to helping cover the high cost of tuition, it gave me a lot of exposure to the huge spectrum of documentation styles. It also helped me see a variety of errors and omissions that were common in various situations.

I originally ran that business under my own name and filed as a sole proprietor for tax purposes. I continued to do that kind of work during my residency training, and as more hospitals started using electronic charting, I started to see less work that involved reading cryptic notes and illegible writing and more that involved sifting through pages and pages of redundant information.

Most of my clients found me through word of mouth. Most of them were from smaller cities or rural areas. That made it easier, as far as not being pulled into cases that might involve faculty or colleagues or that otherwise might pose a conflict of interest.

I maintained that client base until I left training, and then ended up getting into the world of pharmaceutical consulting. I had done some research and co-authored a paper on a particular disease process, which apparently made me an expert in the eyes of a particular manufacturer. They asked me to attend a focus group. Since it was being held at a lovely resort and I hadn’t had a vacation in seven years, I agreed.

Once there, I realized I was totally out-gunned by the other attendees, who had serious reputations in the field. However, the discussions were stimulating and they must have felt my contributions were valuable because they added me to their advisory board. We could see our recommended changes actually come to fruition in how they marketed their products. I felt I was doing good work.

It certainly wasn’t what you sometimes hear about with pharma companies flying physicians to sit on the beach and paying them enormous honoraria. Although we would generally meet in a nice location, they would keep us locked up in working groups eight hours a day. That work continued for a couple of years, and then as their two flagship products came closer to rolling off patent, they disbanded the advisory board.

I didn’t get into formal informatics consulting until a couple of years after that, while working as a physician informaticist for a health system. I had done a couple of side jobs for small practices – basically physicians who knew about the work I was doing for the hospitals and wondered if I could help them out with issues they were having with their EHR systems or other practice issues.

I would do an hour here and an hour there, mostly in the evenings and on weekends. Physicians were happy to do it on that schedule because it didn’t interfere with patient hours. A friend of mine was doing practice operations consulting independently and had a client who needed a great deal of assistance regarding use of their electronic health record, so he reached out.

Since his client was located in one of my favorite cities, how could I resist? We came up with a proposal for the client. Although they were larger than any of my previous consulting clients, they were smaller than the medical group operation I was leading at the time. I was honest with them, going onsite to deliver my proposal and explaining my experience and what I could and could not do for them. They wanted periodic on-site work as well as remote work, and my then-employer was agreeable to having me take vacation time for the periods when I needed to do work during the day.

When I started working with that client, I realized that I was actually bored with my day job. I didn’t have a lot of growth opportunity there and was tired of some of the politics. In addition to the client work, I started doing some work with vendors. Mostly just focus groups and the occasional paid demo, but also did some co-development work with a start-up.

I realized during that time that I should get serious about being an actual consulting firm and filed for my first LLC. I also had some connections at some of the larger consulting firms and started looking at those possibilities. Generally, though, they would require more travel than I was willing to agree to, so I didn’t pursue them despite the significant potential for earnings.

Looking at some of my colleagues that did end up working for the larger firms, they seem to fall into a couple of different models. Some are actual employees of a single consulting firm, and when they’re not on client engagements, they perform work on standardized methodologies and materials that will be used for future engagements.

Others are independent contractors, and when they’re not engaged, they don’t get paid. Those folks have to do a fair amount of self-promotion and marketing. I have one friend who “works” for three major consulting companies and has actually found himself onsite with a single client as an agent of both companies.

Once I got serious about having a business plan and operating as a real company, I also got serious about my credentials. I didn’t want to have to market myself as “homegrown informaticist seeking bigger gigs” and the board certification for Clinical Informatics was about to become a reality. I looked at masters programs and decided to just go after the board certification, figuring that plus 10 years in the field with a large health system was probably enough to take me to the next level. The rest is history and I’ve been an independent consultant for some time now.

To the reader’s question, though, some of us do consult directly with health systems. Depending on the size of the hospital or health system, it can be straightforward or complicated. Sometimes I can get away with just writing a proposal. Other times I am participating in a formal RFP process that can take weeks to put my bid together. It can be frustrating at times.

It can also be very rewarding, since I control my own calendar for the most part. If I don’t want to work for a while, I can. I still continue my clinical work, not only because I enjoy seeing patients and love my current employer, but because it’s easier to get benefits that way than dealing with it on your own. Being on your own also means being your own IT department, your own accountant (sometimes), and your own secretary. Although I now have a partner, we’re still doing most things on our own.

People often ask me for advice on hanging out their consulting shingle. My first recommendation is that if you haven’t completed a formal training program, consider board certification through the practice pathway if you are eligible. Preparing for the certification exam forced me to learn areas that I hadn’t really been exposed to as a practicing informaticist. I feel that having the certification shows you’re willing to go the extra mile even though it may just be another piece of paper to some.

AMIA is hosting a free webinar this week on this topic: “Clinical Informatics: Board Certification through the Practice Pathway – and Beyond” will be held on March 18 from 1-2 p.m. ET. William Hersh, MD, FACP, FACMI is the presenter. For those of you not familiar with Bill, he is also professor and chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU. He also serves as chair of AMIA’s clinical informatics board review course, which I’d highly recommend. Topics for this week will include:

• Physician informatician roles and responsibilities
• Requirements for the “practice pathway” for board certification in clinical informatics
• Value of becoming board certified during the “practice pathway” period (which will be ending)
• Fellowship training required for certification after the “practice pathway” ends

Registration is available here and will also be archived at knowledge.amia.org for members.

What are your thoughts about being a consultant? What are the qualities of a great consulting company employer? Leave a comment or email me.

Email Dr. Jayne.

CVS Health Affiliates Its Way to More Coordinated Care

We look at CVS Health’s rash of recent clinical affiliations and dig into the nuts and bolts of sharing patient data to improve access and cut costs.
By @JennHIStalk

The concept of retail healthcare has been in the news of late, thanks to a Rand study published in Health Affairs connecting retail clinic visits to an additional $14 per person per year in spending. Multiply that $14 by the more than 6 million patients these clinics care for annually and the costs really begin to add up.

The uptick seems to derive from the easier access to care. Patients who may have otherwise delayed care or suffered in silence are now taking advantage of less-expensive retail clinics around the corner, resulting in an increase in the total number of patient visits and thus spending.

The study also found that nearly 60 percent of retail clinic visits were made by first-time customers, a statistic that negates the much-hoped for idea that savvy healthcare consumers would turn to lower-cost retail clinics for common ailments in lieu of paying higher prices at primary care offices or the ED.

The number of nationwide retail clinics hovers around 2,000 and is expected to reach 2,800 by 2017. CVS Health MinuteClinics account for over half of this figure, meaning that the company has a big part to play in increasing access to care within and outside the four walls of its clinics – not to mention lowering that $14 figure.

Focusing on Family Medicine

Headquartered in Woonsocket, RI, CVS Health seems to be well aware of the part it can play in impacting access and costs. The company has made strides in its efforts to establish care coordination between its clinics and local PCPs. Last fall, it partnered with the “Health Is Primary” campaign to help patients understand how different parts of the healthcare system work in their “medical neighborhood” and to better enable to them to access those services – including finding a PCP – when appropriate.

“We know that patient health and outcomes improve when patients utilize the resources available to them throughout the medical neighborhood and when providers across the healthcare system are working together,” CVS Health EVP and Associate CMO Andrew Sussman, MD said in a release last fall. “By partnering with primary care and family medicine, we will continue to improve provider collaboration and help ensure all patients have access to primary care within a coordinated medical neighborhood.”

Looking for Larger Affiliates

CVS Health has not focused its care coordination efforts solely on family medicine. It has established over 70 clinical affiliations with major health systems and providers across the country, including relationships announced last year with St. Luke’s University Health Network (PA), TriHealth (OH), Tucson Medical Center (AZ), and Rush University Medical Center (IL). More recent affiliations include John Muir Health (CA), University of Chicago Medical Center (IL), Novant Health (NC), and University of Michigan Health System.

“We have been working with these leading healthcare organizations to establish clinical collaborations that improve access to care and overall community health, which ultimately also help to reduce healthcare costs,” says CVS Health Corporate Marketing Manager Christina Beckerman. “Now that the agreements are in place, we are pleased to begin working with our affiliates to improve chronic disease management and pharmacy care in the communities served by these healthcare organizations.”

The health system affiliations focus on an umbrella of care coordination, under which fall sharing patient health data between participant EHRs, improving medication adherence via collaboration with CVS pharmacists, ensuring that MinuteClinic patients follow up with their PCPs when needed, and planning strategies around chronic care and wellness.

“Now that the agreements with these organizations are complete, we are establishing timelines with each healthcare organization and working together to implement our plans,” says Beckerman. “In the near-term,” she adds, “our focus is working towards streamlining communication between our secured EHR systems. Over the long term, we believe that through this collaboration, our patients will have access to better pharmacy care and to coordinated, primary care support to help them on their path to better health.”

The Epic-ness Of It All

Froedtert & the Medical College of Wisconsin health network joined the CVS Health affiliate family last month. The regional organization is a partnership between Froedtert Health and MCW, both of which are based in Wauwatosa, about 90 minutes away from Epic headquarters in Verona. The network includes Froedtert Hospital, Community Memorial Hospital, and St. Joseph’s Hospital, plus 25 primary and specialty care clinics.

F&MCW’s decision to affiliate with CVS Health was based on the need to “meet people where they are,” according to Jonathon Truwit, MD, enterprise CMO at F&MCW. “Increasingly, people are getting healthcare services in places other than healthcare systems, from retail systems to shopping malls. We want to assure our patient care is coordinated no matter where they seek care because that’s best for our patients. By entering into this affiliation, we make healthcare more accessible, timely, and effective. CVS is a leader in retail healthcare and a natural partner for us.”

The IT nuts and bolts of such an affiliation seem straightforward, given that both CVS Health and F&MCW use Epic, as do all of the aforementioned affiliates. “The affiliation uses existing EHRs and is limited to certain portions that are securely integrated,” he explains. “When our systems are integrated, the secure data sharing between the F&MCW network and CVS MinuteClinics will enable a collaboration that will extend our approach to team care. The goal of this clinical affiliation is to assure care is coordinated and patients receive the right care at the right time, no matter where they are. It is likely our early work will involve efforts to help patients manage chronic conditions such as high blood pressure and diabetes.”

Measuring Success

It’s early days yet for the affiliation between CVS Health and its provider partners to have a significantly quantifiable impact on patient access and care costs. Truly giant strides in care coordination seem inevitable if and when CVS Health chooses to affiliate itself with organizations outside of Epic’s client cluster, though some would argue it’s a moot point given the provider community’s currently headline-heavy preference for Epic systems.

Perhaps such partnerships will ultimately nudge that previously mentioned $14 down as a result of more educated patients, better care coordination, and fewer reasons to seek care thanks to improved outcomes. As Truwit reiterates, “[T]he intent of this affiliation is to enhance coordination of care for our patients.” A decrease in costs would seem like a natural – and welcome – result.

Morning Headlines 3/14/16

Medical Electronic Data Technology Enhancement for Consumers’ Health Act

The Senate HELP committee passes the MEDTECH Act, a bill that limits FDA oversight on EHRs and other medical software.

UnitedHealthcare launches a smaller, ‘very, very different’ insurer

UnitedHealthcare subsidiary Harken Health will begin selling individual insurance plans in Atlanta and Chicago that offer unlimited primary care visits with no co-pays if subscribers use Harken-owned health centers.

The World’s Most Innovative Research Institutions

HHS takes fourth place on Reuters list of Top 25 Global Innovators working in Government. The VA was also named, coming in at 12th place.

Global Center out to reduce vacancy

Cleveland-based Global Center for Health Innovation will work with Colliers to fill  20,000 feet of remaining vacant space. The building, whose major tenant is HIMSS, was a taxpayer funded project designed to boost tourism in the city, but has yet to live up to expectations.

Monday Morning Update 3/14/16

Top News

The Senate’s HELP committee passes S.1101, the Medical Electronic Data Technology Enhancement for Consumers Health Act (MEDTECH), which exempts several types of software from the FDA’s oversight as medical devices. The bill would prohibit the FDA from regulating EHRs, provider administrative systems, lifestyle apps, clinical lab testing software, and clinical decision support systems that don’t involve medical images or physiologic monitors.

Reader Comments

From Blue Cheer: “Re: the PR firm’s case study on producing the HIMSS presentation of Jonathan Bush and John Halamka. The link you posted doesn’t work.” It appears the PR company pulled down the self-congratulatory article, but you can read “HIMSS 2016: The Power of a Well-Crafted Keynote” here via Google’s cache. It seems like glossy over-preparation using expensive PR people and the Athenahealth communications team, but at least J&J must have been well prepared.

From ac360: “Re: Community Health Systems. The newly promoted SVP/CIO appears to have been fired from EMC in 2002 for falsifying sales to earn bonuses and billing EMC work from a company he himself owned and not turning the money over to EMC. CHS must not have done much of a background check.” I’ll decline to comment since I don’t know anything other than what the 2002 WSJ article says. Firing someone  – like filing a lawsuit that is later dropped — carries a minimal burden of proof and deprives interested parties of the chance to hear both sides of the story.

From Roy G. Biv: “Re: QuadraMed layoff. It was a barely double-digit RIF in R&D. Still, the company is losing customers and losing ground, so you might assume that a lower R&D priority signals a lack of aspiration to market relevance.”

From Long-Suffering Epic Director: “Re: Epic support problems. Epic 2015 is not live yet and we’re spending more time supporting it than Production. We have to drop everything because someone broke something, frequently when we loaded an urgent patch that would fix something. Frontline support wasn’t lacking in initiative 10 years ago. The people Judy and Carl have delegated to us in recent years seem more arrogant and less knowledgeable. We don’t get discussion about the problem and what can be done to fix it – we get speculation of what might be possible in a future release and a mélange of thoughts about what’s available in Model, what Kaiser does, and why can’t we be more like Model. What really sucks is that’s there is no real option. We’re dealing with a monopoly in this industry and the monopoly knows it.”

HIStalk Announcements and Requests

It’s a toss-up whether employers get their money’s worth in sending people to the HIMSS conference. New poll to your right or here: what kind of keynote speaker would you most like to see at the conference? Vote and then click the poll’s Comments link to suggest specific people or to add a category that I missed.

From another poll I ran, two-thirds of respondents say their companies didn’t make any sales in the past year as a result of exhibiting at HIMSS15. I used to cross-reference the current year’s list of exhibitors with the one from the previous conference to identity the exhibitors that didn’t think it was worth it, that went out of business, or that were acquired and no longer exist under their previous name.

Welcome to new HIStalk Platinum Sponsor TelmedIQ. The Seattle-based company offers a secure healthcare communications hub that brings together physicians, nurses, care administrators, and clinical technologies to improve patient care coordination. TelmedIQ simplifies clinician workflow through real-time messaging, quick access to contacts and groups, and the ability to set up workflows so that messages automatically go to the right person at the right time. It integrates with EHRs, on-call scheduling systems, and other systems to make clinical information available with just a swipe and a tap. Customers can replace “page and pray” pagers by turning any Android or iOS device into a secure, two-way mobile pager that can handle image files, audio, and video messages to individual users or to groups. Practices can take also advantage of a cloud-based medical answering service for after-hours coverage. The company offers a white paper on best practices for mobile secure text messaging. Thanks to TelmedIQ for supporting HIStalk.

Only 75 folks signed my petition asking HIMSS to adopt an anti-harassment policy for HIMSS17, so I’ll accept that as an endorsement of the status quo of self-policing. I’m surprised, given the significant number of attendees and poll respondents who expressed discomfort at the actions of others at HIMSS16, but I will defer to the majority.

A bunch of people have emailed me to say that their entire teams were sick after the HIMSS conference, usually complaining of sore throat, congestion, cough, and fatigue. Conferences offer the double whammy of breathing recycled airplane air and being squeezed in for a week with glad-handing strangers. It’s like putting your kid in a new daycare, where the herd carries less-defended bugs. All large conferences have this problem, although Las Vegas is probably the worst offender since attendees are forced to mingle with endless casino patrons just to get to and from conference events. There’s no solution other than washing your hands often, carrying and using hand sanitizer, and drinking a lot more water than you probably did there (especially given what the concession vendors charge for it). The “fist bump instead of a handshake” thing from the swine flu outbreak a few years ago was a good idea from a microbial standpoint, but didn’t catch on because it looks like a carefully groomed hipness affectation.

Monday is not just the usual Pi Day of March 14 (3.14) – it’s also correct to five digits at 3.14.16, although maybe that’s not as impressive as March 14, 2015 at 9:26:53.

I get a bit annoyed when I’m looking up someone’s LinkedIn profile to get a photo or previous employment for something I’m writing and they use LinkedIn’s messaging function to email me, “I saw that you looked at my profile. Can I help you?” like they caught me sitting on the hood of their car or something. If that bugs you, too, go to LinkedIn’s Manage Privacy & Settings, click the link labeled “Select what others see when you’ve viewed their profile,” and click the last option to go into complete private mode.

People are griping that Hollywood Presbyterian Medical Center was wrong to pay ransomware hackers $17,000 because that will encourage more such activity, but I disagree. It’s exactly like settling a nuisance lawsuit, which hospitals do all the time – if you can walk away unscathed for 1/100 of the cost of taking the risk that you can prove yourself right, that could be a good business decision, especially since patients were being affected. Some thoughts:

1. The hospital’s systems had been down for more than a week, making it obvious that it couldn’t simply restore backups. Plus, the clock was ticking — ransomware usually sets a short time limit to pay up before the data is permanently destroyed and the amount increases every day until then. It’s a brilliant way to immediately monetize cyberhacking in a way that can scale infinitely.
2. The hospital’s lack of a technical defense was moot by then – no amount of 20-20 hindsight was going to get their systems back. They had only one option. It’s like losing a storage system and then finding that your backups can’t be restored, except in this case, the backups were available, but just not for free.
3. I doubt that the ransomware specifically targets hospitals, although I would be interested in how the software determines how much ransom to charge – maybe it’s based on the number of servers it finds on the network or something like that. No individual PC user would pay $17,000, so either the malware auto-detects the extent of infrastructure or the hacker manually steps in to determine the required toll.
4. The hospital is also darned lucky that the anonymous hackers didn’t just take their money and walk away without restoring its systems.
5. If the hospital didn’t completely rebuild its systems and networks, the hackers probably left themselves a back door by which to turn their one-time extortion license into a recurring revenue stream.
6. For every public report of ransom demands being paid, at least 100 companies keep it quiet since it’s bad PR and maybe even illegal to be paying cybercriminals. The only reason the handful of high-profile examples came out was because the affected organizations had to explain to their public customers why their physical services were limited. We would never know if a hospital was hit by ransomware and simply paid up quickly and moved on, just like we don’t know how many of them routinely pay off frivolous nuisance lawsuits.
7. Law enforcement isn’t going to be much help. They won’t be able to identify the hackers who are likely outside of US jurisdiction anyway and the amount of money demanded is too low to excite them.
8. Cybercriminals are getting smarter in distributing their malicious email attachments and Office macros in emails that include the personal details of the recipient, often getting even cautious users to open attachments that claim to be a Fedex shipping receipt or an invoice that includes their name or address in the email body. When the payout is as high as the $17,000 that Hollywood Presbyterian paid, it is economically feasible for hackers to target specific hospital employees, Google their personal details, and email them directly with convincing emails. It’s no longer safe to assume that malware-containing emails will be laughably poorly composed with misspellings, fractured English, and obvious scam themes involving Nigerian princes or big inheritances. Ransomware could conceivably kill conventional email in which anyone who knows an email address can send anything they want to the recipient.
9. Antivirus software vendors seem to struggle to keep up with malware variants. I was thinking that an enterprise solution might be to move all attachment-containing emails from untrusted senders (as defined by users) to a quarantine. Otherwise, once the email hits someone’s inbox, it’s probably going to be opened. A big challenge, though, is that anyone checking their personal email at work via a browser is bypassing much of the IT protective infrastructure. Ransomware can also be spread in from just visiting an infected website, perhaps leading us back to those early Internet days when IT departments used Websense or other filtering tools to block unapproved sites by default.
10. Health systems should be huddling together right now to develop best industry practices for combatting ransomware, including ways to make sure that backups and mirrored data copies aren’t infected. We’re going to see a lot of ransomware attacks in 2016.

More members of the Greatest Musical Generation have left us, with the fifth Beatle George Martin and the amazing Keith Emerson of The Nice and Emerson, Lake, and Palmer passing away last week.

Mr. Lincheck sent photos of the robotics makerspace he created in the library using the Lego Mindstorms kit we provided in funding his DonorsChoose grant request. He held a box-unpacking ceremony when it arrived, adding that the students “sqealed and oooed” with every flap that was opened and have since built several robotics items and “do not want to stop.” 

Also checking in was Ms. Norman from Utah, who is using the monitor and wall mount we provided to present students with information about graduation requirements, health screenings, and grades in multiple languages so she can “communicate to those otherwise that might have felt unappreciated or ignored.”

Last Week’s Most Interesting News

• McKesson sells its ambulatory PM/EHR products to E-MDs.
• Aetna lays off a significant percentage of employees working on iTriage and merges that business unit with its WellMatch business.
• A study finds that doctors spend 785 hours per year on quality measure reporting.
• Ambry Genetics makes the de-identified genetic data of 10,000 cancer patients available to researchers and decries the data-hoarding practices of its genetic testing competitors.
• The VA says it is reassessing its previous decision to stick with its self-developed VistA system, saying previous IT management failed to develop a sound strategic plan.
• A study finds that telemonitoring of discharged CHF patients didn’t reduce readmissions.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

Cleveland’s Global Center for Health Innovation, a taxpayer-funded project intended to to boost tourism in which HIMSS is the major tenant, hires an outside firm to try to fill the 15 percent of its space that is vacant. The new plan calls for the money-losing building to be used as collaboration space between providers and vendors. The Center’s upcoming events schedule lists only two short lectures.

UnitedHealthcare launches a startup health insurance company called Harken Health, which focuses on individual coverage with unlimited, no-co-pay visits to PCPs who practice in the health centers it owns. Harken Health offers its policies on Healthcare.gov to residents of Atlanta and Chicago and plans to expand. It offers health coaching and classes and says healthcare needs fixed because “For far too long, the healthcare system has valued efficiency over empathy.” It sort of feels like McDonald’s opening a farm-to-table fine dining restaurant in a carefully crafted marketing ploy intended to steal business back from nimbler and more creative competitors, but we’ll see where it goes.

Government and Politics

Reuters names its top global innovators in government, with HHS taking fourth place overall and earning the top spot among the six US winners because of the contributions of its research arms (NIH, CDC, FDA, and the Public Health Service). The VA was #12.

Oracle sues HHS, demanding that it investigate the failed Cover Oregon insurance exchange, which Oracle sued for unpaid bills and by whom it was sued in turn for creating a flawed exchange. The company says the state’s actions are politically motivated.

Privacy and Security

Four PCs at Canada’s Ottawa Hospital are infected by what sounds like ransomware. The hospital was apparently successfully in simply reformatting the hard drives of the infected devices.

Doctors treating the Germanwings co-pilot who intentionally crashed a passenger jet in the French Alps thought he was potentially dangerous due to his long history of psychiatric illness, but decided they could get in trouble for reporting him under Germany’s strict privacy laws. Doctors in general blame their reluctance to alert authorities on lack of a formal definition of “imminent danger” and “threat to public safety.”

Other

The folks from our nearby HIMSS conference booth neighbors Access sent over a photo of themselves temporarily kidnapping my standee for a photo op. Lorre says a lot of people dropped by our micro-booth to pose for selfies with the smoking doctor cutout, which amuses me in thinking of otherwise responsible adults beaming with their arms around cardboard.

A physician’s op-ed piece in the New York Times describes the feeling of reading the obituaries of patients who got so little of her time as a busy hospital resident, allowing her to see them as the people they were before they became patients. It made me wonder if one of the many standard intake and history forms shouldn’t ask more questions about the person filling them out – their accomplishments, aspirations, relationships, and values. The trouble would be that providers aren’t paid to read them, so they probably wouldn’t.

I’ll predict that we will hear a great deal this year about self-assessment health surveys. Consider the SF-36 health survey form, which asks people questions about their perceived level of health in covering areas such as their activity level, pain, and emotional issues. Insurers and providers need a non-encounter based early warning system for problems in patients whose health they are financially rewarded for maintaining. They could learn a great deal by asking these questions 2-4 times per year. Smartphone apps — instead of obsessing with conveniently measurable but nearly medically worthless data points such as steps walked — could administer an SF-36 type quiz at predetermined intervals to establish a baseline, then alert the user and their provider that their self-perceived health is slipping. Maybe the user automatically gets a coupon for a free Starbucks coffee or something like that for taking the time to give their provider an update. Creating such an app would be very easy, with little R&D required and no FDA issues to address. Patients know their health better than any EHR or provider, so it’s ridiculous to ignore their perceptions or to expect them to articulate them in a rushed office visit. This information would be a lot more useful than patient satisfaction surveys that end up being gripe sessions about parking lots, receptionist personality, and waiting rooms. 

Sponsor Updates

• TierPoint hosts a March Madness event March 18 in Charlotte, NC.
• Valence Health offers the business and technology roadmap it presented for provider-led health plan startups at the Provider-Led Health Plan Forum.
• Verisk Health will exhibit at Employee Healthcare Conference West March 16-18 in San Diego.
• Huron Consulting Group will exhibit and speak at the 2016 ACHE Congress on Healthcare Leadership March 14-17 in Chicago.
• WeiserMazars CEO Victor Wahba offers advice for young professionals.

Blog Posts

• OTC = Safe? Why We Need to Ponder Pediatric Dosing Issues, Part 1 (First Databank)
• Monthly Melton: Unexpected (T-System)
• Female Leaders at VitalWare Share on International Women’s Day (VitalWare)
• HIMSS16 was a hit. (Voalte)
• Avoiding CMS Penalties – and Capturing New Revenue Streams – Through Proactive Patient Outreach (West)
• How Social Services and Healthcare are Linked (Xerox)
• HIMSS Conference Takeaways (ZirMed)
• The Secrets to Deploying, Updating, and Maintaining Evidence-based Guidance (Zynx Health)
• Adopting – and Adapting – to the CJR Payment Model, Part 1: Before the Inpatient Stay (XG Health Solutions)

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 3/11/16

EPAS labeled a dud by South Australian doctors forced to use it

In Australia, doctors at Port August Hospital write a letter to the CEO demanding that its $315 million Allscripts system be shut down, outlining 37 problems including a number of patient safety issues.

Paying It Forward- A Veteran’s Journey to HIMSS16

HIMSS tells the story of  Kevin Phillips, a homeless veteran that was invited to attend the conference and participate in the Veterans Career Services program, but got stranded in Chicago on a layover and, with no money to rectify the problems he was facing there, began walking back home to Fort Wayne, IN. Local police found the man and helped him continue his journey to the conference.

GE Electronic Medical Record added to Gold-medal Medical Services at Rio 2016 Olympic Games

GE announces that its Centricity Practice Solution has been chosen as the official EHR of the 2016 Olympics. Clinicians working the event will use the software to document and coordinate care for athletes.

American Workers Rank Last In Problem-Solving Skills With Technology

Americans rank last among 18 industrialized nations for technical problem-solving skills in the workforce.

News 3/11/16

Top News

As reported here as a reader rumor on Tuesday, McKesson sells its ambulatory PM/EHR products to E-MDs, including Practice Choice, Medisoft, Medisoft Clinical, Lytec, Lytec MD, and Practice Partner. Marlin Equity Partners, which acquired E-MDs in March 2015 and AdvancedMD in August 2015, says the newly acquired products will provide economy of scale that will allow the company to extend its brand.

McKesson acquired Lytec and Medisoft in its 2006 acquisition of Per-Se, the same year it acquired RelayHealth. It acquired Practice Partner in 2007. McKesson has been rumored to be shopping its Enterprise Information Solutions business, which includes Paragon, to potential buyers.

Reader Comments

From Busted Flush: “Re: HIMSS. I’m curious if you’ve heard from your readers that they contracted a cold or flu after the conference. I have a nasty cold that’s now in Day 3 and at least 3-4 people have told me they’re sick, too. Hundreds of handshakes, close proximity, and exchanging money at the concession stands may have exposed a significant number of attendees.” I’ve been annoyingly sick since the conference ended, with congestion, achy fatigue, a slightly sore throat, and frequent coughing and sneezing. Anybody else?

From Coolio: “Re: HIMSS rumors. Biggest one I heard was that IBM offered $65 billion to acquire Cerner.” That seems highly unlikely given that Cerner’s market cap is only $18 billion. On the other hand, IBM seems willing to overpay for anything that makes Watson look real.

From Pickle Loaf: “Re: EHR vendors signing an interoperability pledge at the HIMSS conference. Why didn’t you report that?” They signed a pledge, not a contract. The same vendors would also have signed a statement that they already aren’t practicing information blocking. It’s a little late to be seeking voluntary compliance after the horse carrying the HITECH billions has already left the taxpayer barn.

From Brandon: “Re: TrakCare. I just heard that a rehab facility in Saudi Arabia achieved EMRAM Stage 6. I haven’t run across this product in 15 years as a CIO and wondered if anyone knows about it?” InterSystems Trakcare is used in several countries, the US not being among them. InterSystems acquired Australia-based TrakHealth in 2007. It recently won Best in KLAS for non-US EHRs.

From Flaming Dirigible: “Re: HIMSS keynotes. If HIMSS decided to ever truly think out of the box and invite an interesting speaker like Mike Rowe (the ‘Dirty Jobs’ guy) to do one of their keynotes, I might actually attend. I’ve been going to HIMSS for nearly 15 years and just don’t care about seeing yet another CEO or politician drone on and on.”

From Four Toppled Pillars: “Re: QuadraMed. A large reduction in force happened today.” Unverified. Googling “QuadraMed + layoff” returns 2,570 hits, however, so it wouldn’t be particularly shocking. I doubt sales of QCPR, standalone scheduling systems, Affinity Revenue Cycle, or even its EMPI have been brisk.

Sexual Harassment at the HIMSS Conference

Results of my poll asking whether HIMSS conference attendees experienced unwanted sexual overtures or comments that made them uncomfortable were as follows, with 274 responses:

• 14 percent of male respondents said yes.
• 42 percent of female respondents said yes.
• Overall, 22 percent of respondents say they were made uncomfortable at the conference.

I received several comments about the poll from female attendees. One says she was appalled at the “rampant misogyny” on display. I heard stories of (married) male executives aggressively pursuing female attendees, another offering to send nude photos of himself, and another who complained that he can’t stand listening to female presenters.

Obviously the conference has a problem with making all of its attendees feel welcome and safe in a professional environment. It also seems that the majority of complaints involve vendor executives.

What, if anything, should HIMSS do about it? My suggestions, assuming that HIMSS either hasn’t done any of the following or hasn’t done a good job of promoting its efforts:

• Publish a zero-tolerance Code of Conduct anti-harassment policy for HIMSS conference participants that includes not just gender, but sexual orientation, appearance, age, race, religion, and disability. This policy should cover all official venues – the convention center, hotels, and all sanctioned events. You agree to the policy when you register to attend or exhibit.
• Define the activities that are not permissible – verbal comments relating to the above, making suggestive remarks, and showing unwanted sexual attention, for example.
• Prohibit exhibitors from using sexually related images or suggestive attire as part of the exhibitor policy.
• Allow attendees to report incidents anonymously, naming names, and have someone available to investigate their reports promptly.
• Warn those for whom sufficient evidence exists that they have violated the Code of Conduct, then expel them on the second verified report. 
• Record complaints in a permanent database to identify repeat offenders.
• Allow attendees who feel unsafe or uncomfortable to easily request help from HIMSS, conference security, or hotel security. We’re healthcare IT people – surely there’s an app out there that can offers one-click requests for help.
• Offer easy access to safe rides and physical escorts when indicated.

It’s been said that the people who roll their eyes at policies like these probably aren’t the ones who make them necessary. Hundreds of conferences have addressed the issue directly despite hesitation about potential legal issues, so surely there’s a wealth of resources for HIMSS to use in ensuring a conference environment where everyone is comfortable. Just setting expectations would be a great start.

If you agree with these ideas, sign and promote my petition to HIMSS. I didn’t include Joyce Lofstrom’s email address since it’s not really fair to swamp her inbox every time someone signs the petition, but I’ll make sure the results are known. I’ll also report back if HIMSS has had something already in the works, which is entirely possible since they’re pretty sharp.

HIStalk Announcements and Requests

Ms. Yoder from Texas reports that her kindergartners are “the most excited they have ever been since receiving our DonorsChoose package … The Read and Solve Word Problem center has been the most effective. I use it when I pull small groups during M.A.T.H for my students who are struggling with addition and subtraction. The students being able to have a hands-on center to work on this concept has increased their understanding and allowed them to master it. The Unlock It center has been very popular as well. The resources being donated to our class has given my students a real world view of how generous people can be.”

Epic Reader donated $100 to my DonorsChoose project, which with matching funds provided math manipulatives for the Canton, TX first graders of Mrs. Boggs.

I went to the county health department today to get travel immunizations. It took two hours in what could have been done in maybe 45 minutes, most of it because the employees were baffled by their new EClinicalWorks system. Checkout took 30 minutes even though nobody else was present, so I can imagine the line if they were actually busy. They had put up a sign warning that they will close 45-60 minutes early if they’ve been busy because they have to catch up in the system before going home. I suspect they didn’t train their people well, and not to perpetuate stereotypes, they were mostly older folks who said they were using their first EHR after converting from paper. The nurse apologized for staring at the screen to type instead of looking at me, but she did OK.

This week on HIStalk Practice: Morehouse School of Medicine taps Dominic Mack, MD to lead its National Center for Primary Care. IOC selects GE Healthcare health IT for 2016 Rio Games. Summit Medical Group rolls out MModal’s new outpatient CDI tools. Allscripts integrates AssistRx’s e-prescribing software into its ambulatory offerings. Florida Orthopaedic Institute Business Director Larry Bronikowski offers best practices for health IT adoption. Physicians and IT professionals take top salary spots in annual Glassdoor list. Telemedicine expansion bill heads to Indiana governor’s desk. Health2047 CEO Doug Given, MD describes the AMA-backed organization’s plans to tackle physician pain points with technology.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Sales

New York’s Care Transitions program will use Netsmart’s CareManager for care coordination and care management.

People

GE Healthcare IT names Charles Koontz (CSRA) as president and CEO. He will also serve as GE Healthcare’s chief digital officer. Predecessor Jan De Witte will leave the company.

LifeImage names Frank Brilliant (Wolters Kluwer) as SVP of sales and partnerships.

Microsoft Kinect-powered tele-rehabilitation software vendor Reflexion Health promotes interim CEO Joseph Smith, MD, PhD to the permanent role.

Announcements and Implementations

GE Healthcare’s Centricity Practice Solution is chosen as the official EHR of the Rio 2016 Olympic Games.

Memorial Sloan Kettering’s surgery center goes live with Versus RTLS to monitor patient flow through 12 ORs via Glance-and-Go whiteboards with bi-directional Epic OpTime integration.

Ochsner Baptist Medical Center (LA) goes live with PeriGen’s PeriCALM clinical decision support system.

Government and Politics

The VA awards 21 IT infrastructure upgrade contracts totaling $22.3 billion.

Technology

A Cambridge, MA startup begins shipping a $200 seizure-warning wristband containing sensors for body heat, movement, and skin conductivity following a IndieGoGo fundraising campaign last year that raised $780,000. The wristband, which buzzes to warn the wearer of an impending seizure, can also measure stress. A researcher-only version offers real-time patient monitoring. The MIT scientist who co-founded the company also co-founded a startup that detects emotion by reading a person’s facial expressions via their smartphone.

Other

Doctors at Australia’s Port Augusta Hospital write a letter to its CEO demanding that its $315 million EPAS system (provided by Allscripts) be scrapped because it is endangering patients. They cite a case in which employees failed to notice that a woman who had just given birth was bleeding because they were “preoccupied with data entry.”  The doctors also claim that log-in takes up to seven minutes, nurses mark meds as given but they still show up as due, and long-discharged patients still display as being in the waiting room. The doctors conclude that while their previous complaints were dismissed as “resisting change,’ nearly all of them use EHRs in their private practices 100 percent of the time and would like EPAS replaced  “with something much better.” Doctors at Repatriation General Hospital complained last year that EPAS cut their productivity by 50 percent. SA Health says rollouts will continue, including at the new Royal Adelaide Hospital, due to open in November. 

Nordic made a short video of HIStalkapalooza that will probably take you back a few days. Looks like our Elvis had some dance moves, although as in his 1957 Ed Sullivan appearance, he’s shown only from the waist up.

A study finds that American workers rank dead last of 18 industrial nations in using technology to solve problems, with 80 percent of us unable to figure out an error caused by transferring two-column spreadsheet data to a bar graph. Experts note that the United States is the only country where people aren’t embarrassed to say they’re not good at math.

HIMSS sent a link to its HIMSS16 conference evaluation, which was really more like an on-screen focus group given that it contained 10 pages packed with questions. I’d like to see the metric of how many people clicked the link to start the survey but who then bailed out before completing it (I can say with confidence there was at least one).

HIMSS provides a touching story of homeless US Navy veteran Kevin Phillips (center, above), sponsored to attend the HIMSS conference by the Gateway chapter. A local group helped him buy clothes appropriate for a professional conference, but an unexpected airline change on the second leg of his flight placed him on a 2 a.m. connection that required a $25 checked bag fee that he didn’t have (he had only $11 in his pocket, just enough for the hotel shuttle). He couldn’t get help, so he started walking from Chicago back home to Fort Wayne, IN. Members of the Chicago Police Department picked him up, chipped in to pay his baggage fee, and gave him a ride back to the airport. He made it to the conference and is getting career coaching through HIMSS Veterans Career Services.

Sponsor Updates

• YourCareUniverse publishes a new whitepaper, “Closing the Loop Between Chronically Ill Patients and Providers to Reduce Readmissions.”
• Ingenious Med will exhibit at South by Southwest March 11-14 in Austin, TX.
• The local business paper profiles Leidos Health’s work with the VA in light of its merger with Lockheed Martin.
• LifeImage posts video interviews from the HIMSS show floor.
• Navicure will exhibit at the MA/RI MGMA – Westborough Meeting Payer Day March 17 in West Borough, MA.
• Netsmart will exhibit at the National Association of Psychiatric Health Systems March 14 in Washington, DC.
• NTT Data will exhibit at the IT Summit – Blue Cross and Blue Shield of North Carolina March 17 in Durham, NH.
• Obix posts new Ask the Expert and System Integration videos for its perinatal software solution.
• Oneview Healthcare will exhibit during Australian Healthcare Week March 15-17 in Sydney.
• CloudWave EVP Jim Fitzgerald discusses the reasons behind Park Place International’s rebranding.
• Experian Health will exhibit at AAHAM Florida March 10-11 in Palm Coast.
• Patientco releases a new e-book, “The Healthcare Provider’s Guide to Selecting a Payment Processor.”
• RelayHealth Financial reports claim denial trends.
• The SSI Group and Streamline Health will exhibit at the 2016 NC HFMA Annual Conference March 13-15 in Pinehurst.

Blog Posts

• Local SEO: Enhancing Visibility in Your Hospital’s Target Market (Influence Health)
• Three Opportunities to Enhance Payment Security at Your Practice (InstaMed)
• What Happened In Vegas – HIMSS 2016 Takeaways (Impact Advisors)
• The Evolution of Healthcare Messaging Apps: How Far Are We From a Slack for Healthcare? (TelmedIQ)
• What We Learned at HIMSS16: Top 10 Takeaways (Spok)
• FHIRside Chat: And Now, the Difficult Questions (InterSystems)
• What do Uber and Your Integration Operations Have in Common? (Liaison Technologies)
• The Year of the Hospitalist (MedAptus)
• 4 Ways to Reduce the Number of Patient Privacy Audits (Iatric Systems)
• #HIMSS16 – CHIME CIOs discuss optimization, data, and analytics (Nordic)
• Why Not Healthcare? (PatientKeeper)
• Four Ways PatientMatters Help with Hospital Culture Change (PatientMatters)
• RCM Companies Must Have Electronic Acumen (PatientPay)
• HIPAA regulation: The myths around integrating compliance and patient care (PerfectServe)
• HIT Interoperability: Look beyond the EHR (Lexmark)
• Phynd Technologies Takes Over Las Vegas (Phynd Technologies)
• #HIMSS16 – Learning, limboing, connecting, giving [recap] (Nordic)
• It Helps When Somebody Cares (PMD)
• Population Health Management: Improving Care Delivery Systems to Achieve Better Patient Outcomes (Sagacious Consultants)
• Product Management’s Perspective at HIMSS16 (Summit Healthcare)
• Surescripts Continues to Advance and Support Healthcare Interoperability (Surescripts)

Contacts

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

EPtalk by Dr. Jayne 3/10/16

Good news from the people at Microsoft, who are listening to the user community’s pleas to return critical functionality for those using Office 365 on tablets. They’ll be adding back the ability to use the pen/stylus as a mouse. That makes me happy on multiple fronts, since not only will I be able to go back to previous workflows, but I won’t have to spend hours stripping my Surface Pro to return it to the store. There’s no ETA on the fix yet, but other than that recent failure, I really have been satisfied with my purchase.

Friday is the last day for providers and hospitals to attest for 2015 Medicare EHR Incentive Programs. If you’re on the provider side, I hope your attestation is long complete. I’ve been helping a client with a last-minute effort and we ran into a lot of issues, mostly on their side, but some with website slowness which I can only assume is due to volume. Fortunately, we finished their attestations last night and I can breathe easier going into the weekend.

Last-minute projects always make me cringe, but as a small business person, they are valuable. It’s a way to help clients in a pinch, which can bring considerable work in the future when they’re happy with your services and realize you saved their backsides. Several of my steady clients have met me while in dire straits and I’m happy to continue working with them. It can make the work unpredictable, though. I’ve been fortunate to have a couple of clinical informaticist friends that I can ask to help out when one of those situations hits or when I need coverage to take some real time off. It’s been an informal arrangement, though, and I’ve been on the fence about whether I should engage someone to work with me on a more dedicated basis.

Finding someone who knows the space in the same way I do but who isn’t already crazy busy or who doesn’t have a full-time job has been a challenge. There are a lot of inpatient CMIOs that are interested in branching out, but in order to service my clients, I needed someone with solid ambulatory experience who can also cover the softer disciplines like change leadership and team development.

After talking with multiple candidates and conducting a trial run, I’m happy to say that I officially have a partner. He’s one of my long-time mentors and I suspected that his recent retirement wouldn’t last long, so was glad to hear of his interest. It has been fun working together on projects. I’m sure that due to the difference in our ages and his more prominent career, some people might assume that I’m working for him. It’s a risk I’m willing to accept. However, my company logo (which involves a figure in a dress and stilettos with a briefcase) should make for a good icebreaker when he hands out business cards.

I’ve had quite a few emails from readers this week, which always makes me smile.

From Think Twice: “Re: MU. Your recent Curbside Consult describes all that is/was wrong with MU. Instead of ‘certifying’ systems, MU should have defined a data ontological framework, a file standard (standard XML/CCDA), and an information bus that all systems that handle PHI must comply with. In that world, we wouldn’t be certifying vendors, but rather required capabilities. It would have opened the door to innovation. I’m not sure how we would handle, app-app communication across the workflow (like SMART is supposed to address), but we’d still be much better off.  More importantly, this wouldn’t have dealt with how providers protect their data (just to keep patients inside), while using HIPAA to hide behind (another story!) Although Meaningful Use as we knew it is on the way out, there are plenty of regulatory and quasi-regulatory bodies waiting to take us to the next level as they drive towards value-based care and other buzzword-worthy initiatives. I hope they’re listening, and look at how much money has been spent vs. how many provider hours as being wasted. The recent piece on providers spending hundreds of hours keeping up with quality measures was telling (especially since we haven’t seen a commensurate uptick in patient outcomes). It may be too early to tell, but my sense from the trenches is that it hasn’t been worth it.”

From Keeping Up: “Re: HITECH. I read most of the HHS report. It’s the same garbage we hear every month about the ‘numbers’ of EPs and EHs that used a certified EHR. They may ‘use’ them, but do not attest to MU or any of the other BS. It’s the same stuff — we gave out $30 billion in incentives, EPs and EHs took that and paid it all and more to EHR vendors (they don’t say that), and it’s still a mess. The lack of vision of ONC and HHS about this is amazing to me. EPs and EHs were moving towards EHRs prior to HITECH, but instead, HHS and ONC made this artificial market. Sure, it moved the adoption needle, but to what effect? Now you have the same problems as before, but EHR vendors made a ton of money. That bubble is about to burst and it will be ugly.” He goes on to mention the lack of improved patient care, safety, security, efficiency, and costs worrying that providers will bear the blame. I don’t disagree – we’re already seeing practices who have more staff than they did five years ago but are less productive and feel like they are providing a lower quality of care. Certainly there are people who have been able to make it work, but not without a considerable amount of resources or without sacrifices at the financial or personal levels. He mentioned watching his peers leave practice due to the pressures and I’m seeing that in my community as well. Given the costs of training, the risk of burnout, and the constant external pressures, I don’t think I would recommend a career in medicine unless someone felt a true vocational calling.

From St. Elmo’s FHIR: “Re: LOINC. Regarding your comments on regulations requiring customers to use LOINC for reporting laboratory measures but not requiring lab vendors actually send the codes with the results, amen. This is one of the stupidest things that’s been done. Although you mentioned that interoperability isn’t going to change the culture of competitive advantage, eventually companies learn that interoperability isn’t in competition with this. My view is that the vendors have learned this – based on working with development teams – but it’s a time-to-market problem. The solutions they are working on today haven’t hit the market, but when they do, it will be clear that competitive advantage is built on interoperability.” As much as I’m a bit pessimistic about the future of medicine, I do want to have hope. The old adage of “knowledge is power” would seem to lead organizations to want to share as much as possible. There is a leadership training game I use called “Win All You Can,” which ultimately shows that the only way for everyone to prosper is for everyone to work together for the common good. I first ran into it during an outdoor leadership course and have used a variation of it ever since. Maybe we can get ONC to require knowledge of it (or something similar) in the next round of incentive or penalty programs.

Is interoperability really the answer? Will knowledge set us free? Email me.

Email Dr. Jayne.

Morning Headlines 3/10/16

VA names companies to share in $22 billion IT overhaul

The VA awards $22.3 billion in contracts to Booz Allen Hamilton, IBM, and Accenture as part of a department wide initiative to revamp IT systems. The project does not include funding to modernize or replace Vista, the EHR platform used by the VA.

e-MDs to Acquire Ambulatory Software Technology Assets from McKesson

E-MDs will acquire a number of McKesson ambulatory practice products, including Practice Choice, Medisoft, Lytec, and Practice Partner. Financial terms were not disclosed.

Theranos Ran Tests Despite Quality Problems

The Wall Street Journal reports that results from a 2015 CMS inspection of the Newark, California-based Theranos lab suggest that the company had been knowingly processing PT/INR tests on equipment that was generating erroneous results.

How Nash UNC improved care and added $1.5 million in revenue by deploying smartphones in the ER

UNC Nash Health Care (NC) generated $1.5 million in new revenue after issuing clinicians in the ED dedicated smart phones that were integrated with the hospital’s EHR. ED length of stay fell by 27 minutes and wait time for an inpatient bed assignment fell by 57 percent.

HIStalk Interviews Dan Michelson, CEO, Strata Decision Technology

Dan Michelson is CEO of Strata Decision Technology of Chicago, IL.

Tell me about yourself and the company.

Strata has been around for 20 years. We work with roughly one-fifth of the hospitals in the country, 185 healthcare delivery systems. The focus of the company is to help healthcare providers drive margin to fuel their mission. We do that with a cloud-based platform that hospitals deploy on top of their ERP and EHR. That platform becomes essentially a Microsoft Office for the finance team.

The other day someone used the analogy that we are kind of the Intuit for the healthcare space and that’s a good way to think of it.  Health systems use our application for financial planning — including their long-range financial plan, operating budget, and capital budget — as well as their cost accounting, where we are #1 in KLAS. Also payer contract modeling, so they can understand their true cost and true margins as they negotiate bundled care contracts.

We have algorithms that identify opportunities to reduce cost by eliminating waste, reducing unnecessary variation, and reducing the cost of harm events. Then we provide the workflow for managing that cost out. What many companies have done over the last 50 years in revenue cycle management, we’re now doing around margin management in healthcare. A typical Strata client is billion-dollar healthcare system with eight hospitals, so the opportunity to make an impact is significant.

Do  hospitals accept responsibility for their significant role in ever-rising healthcare costs?

They do now. They didn’t three years ago. The world has changed.

Cost accounting has become a required core system on the financial side to prepare for a value-based world, just as population health has become on the clinical side. People need to know their cost to negotiate bundled care contracts. Not their charge-based cost, but their true cost and their true margins. Even if they’re going to be losing money in that contract, they need to know the levers that they can pull to drive margin over time to be profitable.

That’s in the fee-for-value world, but it’s also a requirement in the fee-for-service world. Over the last three years, the average reduction in inpatient admissions nationally is 2.2 percent per year. Couple that with the fact that hospitals are operating at 2 percent margins and one-third of them are unprofitable and that’s a pretty scary future.

With that kind of pressure on the top and bottom line, the one thing that they know they need to focus on is their cost. But it’s not about just taking 5 percent or 10 percent of their cost out and then moving on. We did some research and talked to 100 different organizations. Eighty-eight percent them had a cost reduction initiative in place. The range they were looking to take out was between $50 million and $400 million, but only 17 percent of them were successful in hitting that target.

For all the automation and technology that we have around revenue cycle, it is missing on cost and margin. To make this point, I often tell people that focusing more on revenue cycle is like trying to squeeze a raisin for a little bit more juice. Cost is a like squeezing a grape — there is a lot of opportunity right now.

We have clients with 600 people in their revenue cycle organization, but only six people who are involved with performance improvement and cost. Clearly that’s going to change now that the reimbursement structure has changed and risk-based contracts are coming into the mix. Roughly 80 percent of large health systems either have a health plan or are building one. Clearly they are going to be taking on risk. The only way they can manage it long term is to understand their return.

Hospitals I’ve worked in are careful about supply costs, but not so good at managing the big-ticket items of labor management and utilization management. How are hospitals approaching cost reductions?

The state of the art for what you just described is PowerPoint and Excel. The level of sophistication is completely absent.

People approach those problems that you mentioned — managing the cost of labor, supplies, and purchased services — episodically. They go after it at one point in time with one initiative. Contrast that approach with revenue cycle, which they are looking at every hour, every day, every week.

The best organizations are approaching it now as a continuous process. They’re not approaching it as, we’ve got take out 5 percent or 10 percent of cost. They’re saying, where do we need to eliminate waste? Where do we need to eliminate variation, or at least reduce variation, or reduce unnecessary variation? Where are we doing things, like harm events, that are making matters worse?

For example, Yale New Haven Health saved $150 million taking a quality-first approach and then tying cost to it via our cost accounting solution. If they have a harm event, a PSI, or HAC, they know exactly what that’s costing them on a macro level, or even with that individual incident. They know exactly what it’s costing them. They’ve created what they called Quality Variation Indicators, QVIs, and we’ve married cost accounting data to that. They went to their clinicians, and in a very integrative fashion between physicians and finance, they’ve had conversations about cost, resources, and waste.

They’ve done two things on top of that are interesting. One is there’s some gain-sharing. If the physicians are doing better and they’re managing their resources more effectively, the physicians have some upside. Then, they’ve embedded cost within order sets, so that when a physician is placing an order within Epic, they have the cost information and are aware of it.

When you took a flight to Las Vegas, you looked up the cost on a website. There’s no such thing for somebody who works in a healthcare institution. Where would you even go to find information on cost? Two issues are holding back that scenario. The information is not accessible. Even if it may exist somewhere, people can’t get it. Second, no one is accountable. If you’re paying for a flight, regardless of work or personal, you’re going to look at that cost and look at the alternatives. We haven’t done that for clinicians.

Opening up that conversation is an enormous opportunity, especially when you understand that 80 percent of the costs in healthcare are driven by physicians and their decisions. To not provide them that information and make it accessible is crazy.

Are hospitals more freely telling physicians exactly what their true incremental cost is if they order a given test, procedure, or drug?

They’re starting. Johns Hopkins embedded costs within order sets and they drove down volume by 10 percent. University of Miami showed physicians phlebotomy costs retrospectively, and just by sharing data, they were able to drive down volume by 25 percent. We’re in the early innings of that game, but take these examples and stitch them together and you can see a path.

In 2002, people said doctors weren’t adopting EHRs because they were technophobic. It’s not like we solved technophobia in the last 14 years — it turns out that that premise was never actually correct. Then once EHRs started getting used and people saw order sets, the reaction of physicians was that it was cookbook medicine. Now you’re telling me what to do? It’s pre-prescribed? Now, when is the last time you heard the term cookbook medicine? It’s been absent for the last three or four years. That premise was wrong as well.

Now we’re operating on the third premise –that doctors don’t know and don’t care about cost. Data proves that’s not the case. A study surveyed 503 orthopedic surgeons and gave them a simple challenge. Here’s 13 commonly used implantables — guess the cost. All you have to do is get within 20 percent. The got it right 20 percent of the time. This was at Stanford, Mayo … six academic centers.

Then they asked those same physicians, if you had the cost, would you incorporate the information in your selection of a device? Eighty percent said yes. That’s two out of 10 who get the information or could guess it correctly, and eight out of 10 would use it if they had it. That gap is an enormous opportunity.

We see that conversation changing, but it’s in the early innings. People are uncomfortable at first. If they approach it as a witch hunt and a condemnation — you’re an outlier, you spend too much, there’s got to be a problem — the clinicians will say, "My patients are sicker," and then obviously, “They’re more complex and they get better outcomes.”

You have to weave together the clinical and financial, which is starting to happen now, in order to make this work. The chief medical officer at Yale, Dr. Tom Balcezak, also calls himself the medical director of finance. We’re seeing that woven together more often in more places.

As people go after value, if the top part of the value equation is quality — and quality is defined as not only clinical outcomes, but also obviously the experience of care — and the bottom part of that equation is cost, how do you deliver value if you don’t know your cost?

Here’s the problem. Even for the organizations in the past that have provided cost information, it was done on a ratio of cost to charges. It was based on the charge master, which is fiction, then taking a percentage of that, which is a made-up amount. You’re taking fiction based on fiction. It’s no wonder that nobody, including doctors, really trusted the information.

The cost accounting process historically has been run two or three times a year. It only had inpatient information, not ambulatory or outpatient information. The actionability, the accuracy, the accessibility of the data just wasn’t there.

Strata has grown rapidly and was acquired a year ago by Roper Technologies. What has changed most in the company?

Let me first talk about Roper. Roper is a publicly traded holding company that operates very similar to Berkshire Hathaway. They make investments in companies, but they let them operate independently. Roper has been around for 110 years and they own 49 companies. I believe they’ve sold one company in that history of 110 years.

The acquisition gave us the opportunity to continue down the path we were on, but with a permanent home and even more support. They don’t get involved in operational or budgeting decisions. There’s no revenue synergy or cost synergy target. There was no integration team or transition team.

It was 14 months ago when we became part of Roper and it has been everything they promised and more. It really is an amazing place to bring your company if you want to have it have permanence and continue down the path that you’re on. It’s a perfect partnership we have with Roper. I mean that sincerely.

The biggest thing that’s changed in the company is the acceleration of decision support — which is the combination of cost accounting and payer contract modeling — and the movement of the product into becoming more of a platform. What Epic or another EHR is on the clinical side, we have become on the financial side – a single database solution for all of the core operations and analytics in finance and operations. For a CFO, it’s their financial planning, budgeting, and control system. It’s their cost accounting and decision support. It’s their cost and performance management application.

We added about two years ago what we call continuous improvement, which is the ability to not only identify cost reduction opportunities or ways to use your resources more effectively, but then also the project management on top of that. We have automated cost and margin management. Because of that, the company is seen as a strategic platform versus a tactical tool set, which is how it used to be seen.

Do you have any final thoughts?

There’s an opportunity to do a tremendous amount of good here by opening up this conversation in healthcare around understanding cost and how resources are used, providing a level of sophistication around it that has been largely absent. The last 10 years of healthcare IT has been focused on the clinical side of the house and we’ve received a great benefit from that. Now we can do things that we couldn’t do before, not only sharing information, but being able to look at quality.

Clearly there’s more work to be done on the clinical side, but the missing piece is now the financial side of the house. While we’ve had all this innovation on the clinical side, we’ve fallen behind on the financial side. Now is the time to address that. Many good things will come from us all collectively doing this work.

Morning Headlines 3/9/16

US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures

Health Affairs publishes a study estimating that US physicians spend 785 hours and $15.4 billion per year  dealing with reporting quality measures,

Cerner Approves $300M Common Stock Buyback Plan

Cerner’s board of directors approves the repurchase of up to 5.7 million shares, or 1.7 percent of the company’s outstanding shares, at a cost of up to $300 million. No time limit was set for the completion of the buyback plan.

Analysis of Prescribers’ Notes in Electronic Prescriptions in Ambulatory Practice

A JAMA study finds that 66 percent of e-prescriptions contain information in the free text field that should have been entered as discrete data, while another 5 percent contain comments that are irrelevant to the dispensing pharmacists.

Aetna moves to combine iTriage and WellMatch, confirms layoffs

As rumored on HIStalk this weekend, Aetna has laid off an undisclosed number of employees from iTriage and merged the business unit with WellMatch, an Aetna business focused on cost transparency.